Malaria Is Chief Concern for Vietnam Visitors : Immunizations are urged now that U.S. travel restrictions have been eased.

Vietnam War veteran Gregory Kleven has gone back to visit “Nam” seven times since his one-year tour of duty ended. Fredy Champagne, a former combat infantryman, has returned nine times.

“I enjoy the country and its beauty,” said Kleven, a Concord, Calif., veteran who publishes a newsletter on Vietnam. Champagne, of Garberville, Calif., has been building medical clinics and is organizing the first Ride Nam, a Hanoi-to-Saigon motorcycle ride, in October.

Increasing numbers of tourists with no connection to the country, as well as veterans like Kleven and Champagne, are expected to return to Vietnam this year, spurred by several factors. The U.S. State Department has eased its long-held trade embargo with Vietnam, making it possible for U.S. travel agents to book hotels, local tours and ground transportation. Growing numbers of tours tailored to veterans are being offered.

“We get them back as close as possible to the site (where) they were stationed,” said Diana Wilson of the Summit County (Ohio) Chapter of the Vietnam Veterans of America, which books tours. “One guy went back to the hill where he got shot. He wanted to see the place that caused such a traumatic difference to his life. Many tell us it is psychologically healing.”

To ensure a physically healthy trip, veterans and others visiting Vietnam are urged to take a number of precautions, from pre-trip immunizations to everyday measures, such as avoiding contaminated food while there.

Travelers should worry most about malaria, a serious parasitic disease spread by mosquitoes, according to the federal Centers for Disease Control in Atlanta. Experts recommend taking antimalarial drugs before departure.

For travelers to Vietnam, the best choices are Lariam (mefloquine) and Vibramycin (doxycycline), according to Dr. Gerald Wagner, medical director of the immunization program for the Orange County Health Care Agency, Public Health, since some malaria strains in Vietnam are resistant to chloroquine, a commonly used anti-malarial drug.

The CDC advises travelers to also consider getting an injection of an immune serum globulin (formerly called gamma globulin) to protect against hepatitis A, an inflammation of the liver caused by a viral infection. It is more common in rural areas and the back country than in cities.

The risk of hepatitis B infection is high in all of southeast Asia and China, according to the CDC. This infection is commonly spread by sexual contact and exposure to infected blood. Although no immunization is required, the CDC recommends hepatitis B vaccine for certain travelers. Health care workers who might be exposed to blood and travelers who might have sexual contact with local residents should consider the vaccine. Any visitors staying six months or more who will live in rural areas or have daily physical contact with local residents should get the vaccine, as well as anyone who might obtain dental or medical care while there.

Long-term visitors might also consider a vaccine against Japanese encephalitis, a mosquito-borne viral disease prevalent in Vietnam’s rural areas. But the vaccine is currently not available in the United States, so travelers need to make arrangements to obtain the vaccine overseas. The vaccine schedule, one shot a week for three weeks, often makes its use impractical for U.S. visitors. Travelers are also advised to take along mosquito repellent and netting.

Precautionary measures against mosquitoes can also minimize the risk of dengue fever, another mosquito-borne disease. There is no vaccine available against dengue fever, but the CDC cautions travelers to be alert for symptoms of flulike illness and rash--especially if the rash occurs three or four days after the fever. If a fever occurs within a month after returning from Vietnam, the CDC advises travelers to alert their doctors.

Typhoid fever, an infectious disease caused by eating food or drinking water contaminated with the bacterium Salmonella typhosa, is most common in small villages and rural areas. CDC recommends immunization if travelers plan to visit rural areas or stay six weeks or more.

Rabies, a viral infection of the central nervous system, is also prevalent in Vietnam. The CDC recommends pre-exposure vaccine if travelers plan to stay longer than 30 days. “It’s given over a month’s time, in a series of three shots,” Wagner said.

The CDC also warns travelers not to swim in freshwater to avoid the risk of trypanosomiasis, a tropical disease contracted when the larva of infected flatworms penetrate the skin. These larvae are released by infected snails in freshwater. Heat bath water to 122 degrees for five minutes, or chemically disinfect before use, the CDC advises. Travelers exposed to the larvae should apply rubbing alcohol or towel-dry themselves briskly, according to the CDC. Seek medical help for screening. Drugs are available to treat the condition.

Travelers should also be sure that routine immunizations, such as tetanus, are up to date, Wagner said.

It’s a good idea to begin your immunizations about a month before departure, Wagner advises. Because the need for specific immunizations varies by individual, experts recommend checking with a doctor about the best schedule. Some immunizations should be taken before others, for instance.

“We have switched to the oral typhoid vaccine,” said Wagner. “If it is taken at the same time as antimalarial drugs, the antimalarial will inactivate the typhoid. So we recommend taking the typhoid two or three weeks before departure, and then the antimalarial.”

“We also recommend that travelers take along an antibiotic, along with over-the-counter eyedrops, to relieve discomfort from bright sunlight, and an antibacterial cream,” said Wilson of Vietnam Veterans of America.

Once in Vietnam, “stay away from milk or milk products. Stay away from leafy green vegetables,” advised Wagner. If you’re not sure of the safety of the water, make sure it is boiled. An alternative is chemical disinfection by adding iodine or chlorine, according to package directions. Kleven’s advice: While the street food may look enticing, one bite could cause illness. His one experience with sickness while in Vietnam occurred after he “ate something that looked like an avocado--it was street food.”

If traveler’s diarrhea strikes despite precautions, consider taking Pepto-Bismol or Imodium, available over the counter, Wagner advised. “But if you have a fever or blood in the bowel movement, don’t take the Imodium,” he said. “See a doctor.”

Staying healthy in Vietnam is not difficult, according to Kleven and Champagne. “In general, the food is good, health services are excellent and antibiotics are readily available,” Champagne said. “I see three big problems. Polio is still prevalent. There are a lot of (land) mines still around. There are many head injuries from crashes between cars and motorcycles.”

Vietnam-bound travelers can call the Centers for Disease Control International Traveler’s Information Hotline, (404) 639-2572), for specific information about immunizations and precautions while traveling. Depending on which choices are made on the telephone menu, listening to the recorded information can take 20 minutes or more. Travelers can also call the Orange County Health Care Agency at (714) 834-8411 to inquire about needed immunizations.