^ I do whenever I go -- and I'm still here.

I don't think the problem with the Chinese tap water is bacterial. Maybe too much chlorine/heavy metals.

Just want to point out that a lot of travelers to Asia who feel they are at no risk of Hep B since they don't do the biggies (needle drugs, wanton sex, planned blood transfusions) seem to have no problem exposing themselves in seemingly innocuous ways such as having manicures/pedicures, some hairdressing/grooming procedures. You think those instruments are sterilized well between patrons?! Emergency dental procedure? An accident that bangs you up with cuts and scrapes and while not needing transfusions, could put you in an at-risk situation from first aid providers especially if not near a major city's facility. All of these scenarios are actually extremely common for travelers to find themselves in, all over developing Asia. And with such a significant part of local populations carrying the Hep B virus in these parts, there is risk.

On the brush teeth with local water issue, I usually don't but in Beijing, Shanghai, and maybe Chengdu I do "cheat" sometimes but always do a final mouth rinse with bottled water. As stated above, purchased in supermarkets, it's just too cheap and accessible to make keeping some around a hardship.

In fairness to China - manicures/pedicures can pose dangers to customers just about anywhere in the world:

http://www.epa.gov/pesticides/factsheets/pedicure.htm

http://www.huffingtonpost.com/2012/0...n_1610265.html

http://www.dailymail.co.uk/health/ar...patitis-C.html

Robyn

Also check the price at the local public health department. We've gotten our travel shots there and cheaper than we could get them anywhere else. Note that insurance normally does not pay for anything you need only for travel.

Those foot massage places in SGV place a white plastic bag inside the wooden soaking
basin. I suppose they change it after each customer.

Probably some health code.

Yes, the risk is everywhere, which is a good reason for frequent travelers who have no contraindications, to go ahead and get the vaccine. FWIW, I've seen plenty of U.S. salons that now assign manicure customers personal kits so their tools are used only on them. However, we were talking about China. "Fairness" is irrelevant. The difference is that the prevalence of Hep B infection in the general population is much higher here and SE Asia than much of the rest of the world except for parts of Africa. There's a reason why labwork for annual physicals in this region include a Hep B screen as standard, right up there with blood count and cholesterol measurement. Chances are good that 1 of every 6 people you see on the street in China is a carrier, most of them infected neonatally or during childhood and relatively fewer from adult fun & games.

Put another way, quoting news articles about risks of Hep B in other countries does not lessen the greater risk of same in China. It just seems like an attempt to trivialize the problem. Take or do not take the vaccine as you wish for your personal circumstances, but don't trivialize.

I didn't mean to trivialize anything (and - if you knew me - you'd know I'm a pretty serious person). FWIW - I do my own manicures/pedicures at home - for precisely some of the reasons you mentioned.

Note that although I have asked - I can't find that Twinrix vaccine you mentioned where I live (except perhaps as a "special order"). Separate Hep A and Hep B - yes - Twinrix - no. Robyn

Not that it will help with your trip, I got mine at Bayley Jackson in Beijing for around Y300 per shot (3 shot series). IIRC, the first shot alone nearly completely defends against A and gets you over the 50% mark wrt B. Shots 2 and 3 simply increase your odds in the battle against B, but still fall short of 100% efficacy in aggregate.

It's not a terribly common vaccine so many doctors and clinics don't stock it, but your GP should be able to get it for you in a day or two if you call and ask.

Oddly, it's the other way round in UK, and many places in China.

I also don't wish to trivialise risk of Hep B. Jiejie has outlined most of the issues, but I would add that for the short-term visitor, likelihood of encountering HBV is low. Most people don't have accidents, etc etc. It's a good jab to have, and extremely safe, so no reason not to, except time (if you want the full course, for maximum efficacy, it's 6 months). I would not consider coming to China/ SE Asia in the long-term without it.

I would recommend Hep A for all travellers, regardless of duration of visit. Hep A is uncommon, but can be extremely nasty if acquired -- from eating -- which we can't really avoid.

Efficacy of the Hep B immunisation is most probably linked to levels of immune response elicited -- which varies by individual, and can be easily measured. If one is a good responder, risk of acquisition is extremely low -- approaching zero. If one has the full course, one should have a booster after 5 years, then one's covered for life -- as far as we know.

Lesson over.

tb

+1. You can boil the tap water, but it's the chemicals I was more worried about.

Our primary care provider is at Mayo JAX - and they don't stock it there. And I'd rather go with a preferred provider under our Medicare Part D policy (because Medicare Part D shots at Mayo can be rather pricey). We usually get our shots at Costco (cheapest local place) - but Costco only has a pharmacist to give shots - not a nurse or doctor or similar - and a pharmacist apparently isn't allowed to administer Hep shots here. So many rules! Anyway - we'll figure out what works best for us. Robyn