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CDC's International Travelers' Health Information Geographic Health Recommendations

CDC's International Travelers' Health Information
Geographic Health Recommendations


Editor's note: The following information is not a complete medical guide for travelers. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. Be sure to read the information about all the regions you are planning to visit. The information presented in this section was condensed from the CDC's website. For complete travel health information view CDC's website on the Internet at http://www.cdc.gov/travel/travel.html, call CDC's toll free voice information system at 888-232-3228, or order a copy of the CDC booklet Health Information for International Travel by calling the Superintendent of Documents, U.S. Government Printing Office, Washington D.C. at 202-512-1800.


CENTRAL AFRICA

Date last revised: January 20, 2006

Countries in this region: Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo (Zaire), Equatorial Guinea, Gabon, Sudan, and Zambia.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Meningococcal Disease

Released: February 15, 2006

Meningococcal disease, caused by the bacterium Neisseria meningitidis occurs worldwide and is a serious, sometimes fatal disease. Serogroup A meningococcal disease transmission regularly peaks in the sub-Saharan African "meningitis belt," which extends from Mali to Ethiopia, during the dry season (December through June). A recent outbreak of meningococcal disease in Sudan, which is in the meningitis belt, serves as a reminder of the potential risk to travelers to these areas. The World Health Organization (WHO) reported over 130 suspected cases (including 15 deaths) of meningococcal disease in six states of Sudan during January 2006. At least one cerebrospinal fluid specimen was positive for N. meningitidis serogroup A. WHO is working with the Federal Ministry of Health to support their outbreak response activities.

WHO has also reported over 300 suspected cases (including 23 deaths) of meningococcal disease in the Nakapiripirit and Moroto districts of northeastern Uganda, a country bordering the meningitis belt, from December 28, 2005, through February 3, 2006. Cerebrospinal fluid specimens from four patients were positive for N. meningitidis serogroup A. WHO is working closely with the Ugandan Ministry of Health in field investigations and surveillance efforts in affected and surrounding districts.

Travelers to the meningitis belt in sub-Saharan Africa during the dry season or to areas currently experiencing outbreaks of meningococcal disease should be advised to receive meningococcal vaccine. Two vaccines (a polysaccharide and a conjugate vaccine) are available in the U.S. that protect against four strains of N. meningitidis (A/C/Y/W-135). The conjugate vaccine was recently approved for use in persons 11-55 years of age. The Advisory Committee on Immunization Practices (ACIP) now recommends its use for routine vaccination of adolescents at 11-12 years of age, adolescents before high school entry (~15years of age), and college freshmen living in dormitories.

Meningococcal disease can include meningitis, an infection of the spinal cord and the fluid that surrounds the brain, as well as bloodstream infections. The bacteria that cause meningococcal disease (N. meningitidis) are spread through close, direct contact with an infected person that leads to exchange of saliva or respiratory and throat secretions (e.g., kissing). Of persons exposed to the bacteria, fewer than 1% become ill. The bacteria are not spread by casual contact.

Risk factors for getting meningococcal disease include immune system problems such as lack of a spleen, respiratory infections such as the flu, smoking or being around people while they smoke, indoor crowding, and close contact with an infected person. People in the same house or day-care center with a patient with meningococcal disease, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) are at increased risk of getting disease. These people should get antibiotics to prevent them from getting the disease.

For more information about meningococcal disease, see Meningococcal Disease in Health Information for International Travel and http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm from the Division of Bacterial and Mycotic Diseases.

For more information about this outbreak, see http://www.who.int/csr/don/2006_02_03/en/index.html and http://www.who.int/csr/don/2006_02_10/en/index.html.

Recommended Vaccinations and Preventive Medications

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

The following vaccines may be recommended for your travel to Central Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: your risk of malaria may be high in all countries in Central Africa, including cities. See your health care provider for a prescription antimalarial drug.
  • Meningococcal (meningitis), if you plan to visit countries in this region that experience epidemics of meningococcal disease during December through June.
  • Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • A certificate of yellow fever vaccination may be required for entry into certain countries in Central Africa. For detailed information, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in all countries in Central Africa, including cities. All travelers to Central Africa, including infants, children, and former residents of Central Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers should take one of the following drugs:

  • atovaquone/proguanil,
  • doxycycline,
  • mefloquine, or
  • primaquine (in special circumstances).

Yellow Fever

A certificate of yellow fever vaccination may be required for entry into certain countries in Central Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Central Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. The risk for contracting African sleeping sickness (trypanosomiasis), which is caused by the bite of an infected tsetse fly, is high in northern Angola, Central African Republic, Cameroon, Chad, Congo, Democratic Republic of the Congo, and southern Sudan and there is significant risk of infection for travelers visiting or working in rural areas. A number of rickettsial infections also occur in this region. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection. Schistosomiasis, a parasitic infection, can be contracted in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, HIV and hepatitis B.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguani or primaquine) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


EAST AFRICA

Date last revised: January 10, 2006

Countries in this region: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mayotte, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Tanzania, and Uganda.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Meningococcal Disease

Released: February 15, 2006

Meningococcal disease, caused by the bacterium Neisseria meningitidis occurs worldwide and is a serious, sometimes fatal disease. Serogroup A meningococcal disease transmission regularly peaks in the sub-Saharan African "meningitis belt," which extends from Mali to Ethiopia, during the dry season (December through June). A recent outbreak of meningococcal disease in Sudan, which is in the meningitis belt, serves as a reminder of the potential risk to travelers to these areas. The World Health Organization (WHO) reported over 130 suspected cases (including 15 deaths) of meningococcal disease in six states of Sudan during January 2006. At least one cerebrospinal fluid specimen was positive for N. meningitidis serogroup A. WHO is working with the Federal Ministry of Health to support their outbreak response activities.

WHO has also reported over 300 suspected cases (including 23 deaths) of meningococcal disease in the Nakapiripirit and Moroto districts of northeastern Uganda, a country bordering the meningitis belt, from December 28, 2005, through February 3, 2006. Cerebrospinal fluid specimens from four patients were positive for N. meningitidis serogroup A. WHO is working closely with the Ugandan Ministry of Health in field investigations and surveillance efforts in affected and surrounding districts.

Travelers to the meningitis belt in sub-Saharan Africa during the dry season or to areas currently experiencing outbreaks of meningococcal disease should be advised to receive meningococcal vaccine. Two vaccines (a polysaccharide and a conjugate vaccine) are available in the U.S. that protect against four strains of N. meningitidis (A/C/Y/W-135). The conjugate vaccine was recently approved for use in persons 11-55 years of age. The Advisory Committee on Immunization Practices (ACIP) now recommends its use for routine vaccination of adolescents at 11-12 years of age, adolescents before high school entry (~15years of age), and college freshmen living in dormitories.

Meningococcal disease can include meningitis, an infection of the spinal cord and the fluid that surrounds the brain, as well as bloodstream infections. The bacteria that cause meningococcal disease (N. meningitidis) are spread through close, direct contact with an infected person that leads to exchange of saliva or respiratory and throat secretions (e.g., kissing). Of persons exposed to the bacteria, fewer than 1% become ill. The bacteria are not spread by casual contact.

Risk factors for getting meningococcal disease include immune system problems such as lack of a spleen, respiratory infections such as the flu, smoking or being around people while they smoke, indoor crowding, and close contact with an infected person. People in the same house or day-care center with a patient with meningococcal disease, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) are at increased risk of getting disease. These people should get antibiotics to prevent them from getting the disease.

For more information about meningococcal disease, see Meningococcal Disease in Health Information for International Travel and http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm from the Division of Bacterial and Mycotic Diseases.

For more information about this outbreak, see http://www.who.int/csr/don/2006_02_03/en/index.html and http://www.who.int/csr/don/2006_02_10/en/index.html.

Chikungunya

Released: February 8, 2006

An outbreak of chikungunya is currently being reported from the territory Réunion (France) and the country of Mauritius, both located in the Indian Ocean. Chikungunya is a viral disease transmitted to humans by the bite of infected mosquitoes (mosquito-borne), usually Aedes aegypti—a day-biting mosquito. Symptoms of chikungunya include sudden onset of fever, chills, headache, nausea, vomiting, joint pain, and rash. It typically is not fatal.

This outbreak highlights that travelers to tropical and subtropical areas of the world may be at risk for contracting diseases that are transmitted through the bites of infected mosquitoes, such as malaria, dengue, Japanese encephalitis, yellow fever, and others. The risk for malaria infection can be greatly reduced through the use of antimalarial drugs and measures to avoid contact with mosquitoes. Vaccines are available to prevent yellow fever and Japanese encephalitis. Other mosquito-borne infections, such as chikungunya and dengue, can also cause serious illness. However, no preventive vaccine or preventive drug exists for either disease.

Dengue, like chikungunya, is a viral disease transmitted by the bite of infected mosquitoes, usually Aedes aegypti. Dengue is presently the most common mosquito-borne viral disease affecting humans worldwide. Symptoms of dengue include severe headache, fever, retro-orbital eye pain (pain behind the eye), and joint and muscle pain. The more severe form of the disease, dengue hemorrhagic fever, can cause death in some cases. Dengue is endemic in many parts of the tropics. Outbreaks have occurred in recent years in several countries in Central and South America, Southeast Asia, the Caribbean, and Africa.

To reduce the risk of contracting malaria, dengue, chikungunya and other mosquito-borne infections, travelers should take measures to reduce their exposure to mosquito bites, including the use of an insect repellent containing up to 50% DEET (N,N-diethyl-m-toluamide). Repellents with lower concentrations of DEET offer short-term protection but are not as long lasting and need more frequent reapplication. An additional repellent, picaridin, is only available in the U.S. in low concentration (7%) formulations, which can also require more frequent reapplication.

For information about dengue, see http://www.cdc.gov/ncidod/dvbid/dengue/index.htm, and "Dengue Fever" in Health Information for International Travel.

For information about malaria, see http://www.cdc.gov/malaria/index.htm, and "Malaria" in Health Information for International Travel.

For information about Chikungunya cases, see http://www.cdc.gov/mmwr/preview/mmwrhtml/00000794.htm.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to East Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: your risk of malaria may be high in all countries in East Africa, including cities. See your health care provider for a prescription antimalarial drug.
  • Meningococcal (meningitis) if you plan to visit countries in this region that experience epidemics of meningococcal disease during December through June.
  • Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • A certificate of yellow fever vaccination may be required for entry into certain countries in East Africa. For detailed information, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in all countries in East Africa, including cities. All travelers to East Africa, including infants, children, and former residents of East Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers should take one of the following drugs:

  • atovaquone/proguanil,
  • doxycycline,
  • mefloquine, or
  • primaquine (in special circumstances).

A certificate of yellow fever vaccination may be required for entry into certain countries in East Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout East Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, filariasis, leishmaniasis, onchocerciasis (river blindness) and Rift Valley fever are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. African sleeping sickness (African trypanosomiasis), which is transmitted through the bite of an infected tsetse fly, can be found in distinct areas of East Africa except Djibouti, Eritrea, Somalia, and the island countries of the Atlantic and Indian Oceans. The number of cases of African sleeping sickness in travelers, primarily to East African game parks, has increased in recent years. A number of rickettsial infections also occur in this region. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection. Schistosomiasis, a parasitic infection, is found in fresh water in the region, including Lake Malawi. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. Polio has also resurfaced in Ethiopia since 2003. Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, HIV and hepatitis B.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell your health care provider your travel history.


NORTH AFRICA

Date last revised: December 16, 2005

Countries in this region: Algeria, Canary Islands (Spain), Egypt, Libyan Arab Jamahiriya, Morocco (including Western Sahara), and Tunisia.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations

The following vaccines may be recommended for your travel to North Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • None.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. A limited risk of malaria exists in parts of Algeria, Egypt, and Morocco. Taking an antimalarial drug is not recommended as the risk for travelers is considered to be extremely low. However, travelers should use insect repellent with DEET (N, N-diethyl-m-toluamide) to prevent mosquito bites.

Yellow Fever

  • There is no risk for yellow fever in North Africa. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated. Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout North Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects that also occur in this region. Protecting yourself against from insect bites will help to prevent these diseases. Schistosomiasis, a parasitic infection, is found in fresh water in the region, including the Nile River. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, hepatitis B, and hepatitis C (prevalence > 15% in Egypt). Polio is also still endemic in Egypt.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

Although the risk of malaria in North Africa is limited, travelers who become ill with fever or flu-like illness while traveling in North Africa and up to 1 year after returning home should seek immediate medical attention and should tell their health care provider their travel history.


SOUTHERN AFRICA

Date last revised: December 16, 2005

Countries in the region of Southern Africa: Botswana, Lesotho, Namibia, South Africa, St. Helena (U.K.), Swaziland, and Zimbabwe.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Southern Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: your risk of malaria may be high in all countries in Southern Africa, including cities. See your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • None.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in all countries in Southern Africa, including cities. All travelers to Southern Africa, including infants, children, and former residents of Southern Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers should take one of the following drugs:

  • atovaquone/proguanil,
  • doxycycline,
  • mefloquine, or
  • primaquine (in special circumstances).

Yellow Fever

There is no risk for yellow fever in Southern Africa. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Southern Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, filariasis, leishmaniasis, onchocerciasis (river blindness), and trypanosomiasis (sleeping sickness) are other diseases carried by insects that also occur in this region, mostly in rural areas. Protecting yourself against (from?) insect bites will help to prevent these diseases (DEET). African tick bite fever, a rickettsial infection, is common in South Africa, Botswana, Swaziland, Lesotho, and Zimbabwe. African sleeping sickness can occur in Botswana and Namibia. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection Schistosomiasis, a parasitic infection, is found in fresh water in this region, particularly in Botswana, Namibia, South Africa, and Swaziland. Do not swim in fresh water (except in well-chlorinated swimming pools) in Southern African countries.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.

Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.

In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.

Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)

To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.

Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

Content Source: National Center for Infectious Diseases, Division of Global Migration and Quarantine


WEST AFRICA

Date last revised: January 10, 2006

Countries in the region of West Africa: contains the countries Benin, Burkina Faso, Cape Verde islands, Côte d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, São Tomé and Principé, Senegal, Sierra Leone, and Togo.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Meningococcal Disease

Released: February 15, 2006

Meningococcal disease, caused by the bacterium Neisseria meningitidis occurs worldwide and is a serious, sometimes fatal disease. Serogroup A meningococcal disease transmission regularly peaks in the sub-Saharan African "meningitis belt," which extends from Mali to Ethiopia, during the dry season (December through June). A recent outbreak of meningococcal disease in Sudan, which is in the meningitis belt, serves as a reminder of the potential risk to travelers to these areas. The World Health Organization (WHO) reported over 130 suspected cases (including 15 deaths) of meningococcal disease in six states of Sudan during January 2006. At least one cerebrospinal fluid specimen was positive for N. meningitidis serogroup A. WHO is working with the Federal Ministry of Health to support their outbreak response activities.

WHO has also reported over 300 suspected cases (including 23 deaths) of meningococcal disease in the Nakapiripirit and Moroto districts of northeastern Uganda, a country bordering the meningitis belt, from December 28, 2005, through February 3, 2006. Cerebrospinal fluid specimens from four patients were positive for N. meningitidis serogroup A. WHO is working closely with the Ugandan Ministry of Health in field investigations and surveillance efforts in affected and surrounding districts.

Travelers to the meningitis belt in sub-Saharan Africa during the dry season or to areas currently experiencing outbreaks of meningococcal disease should be advised to receive meningococcal vaccine. Two vaccines (a polysaccharide and a conjugate vaccine) are available in the U.S. that protect against four strains of N. meningitidis (A/C/Y/W-135). The conjugate vaccine was recently approved for use in persons 11-55 years of age. The Advisory Committee on Immunization Practices (ACIP) now recommends its use for routine vaccination of adolescents at 11-12 years of age, adolescents before high school entry (~15years of age), and college freshmen living in dormitories.

Meningococcal disease can include meningitis, an infection of the spinal cord and the fluid that surrounds the brain, as well as bloodstream infections. The bacteria that cause meningococcal disease (N. meningitidis) are spread through close, direct contact with an infected person that leads to exchange of saliva or respiratory and throat secretions (e.g., kissing). Of persons exposed to the bacteria, fewer than 1% become ill. The bacteria are not spread by casual contact.

Risk factors for getting meningococcal disease include immune system problems such as lack of a spleen, respiratory infections such as the flu, smoking or being around people while they smoke, indoor crowding, and close contact with an infected person. People in the same house or day-care center with a patient with meningococcal disease, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) are at increased risk of getting disease. These people should get antibiotics to prevent them from getting the disease.

For more information about meningococcal disease, see Meningococcal Disease in Health Information for International Travel and http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm from the Division of Bacterial and Mycotic Diseases.

For more information about this outbreak, see http://www.who.int/csr/don/2006_02_03/en/index.html and http://www.who.int/csr/don/2006_02_10/en/index.html.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to West Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: your risk of malaria may be high in all countries in West Africa, including cities. See your health care provider for a prescription antimalarial drug.
  • Meningococcal (meningitis), if you plan to visit countries in this region that experience epidemics of meningococcal disease during December through June.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • A certificate of yellow fever vaccination may be required for entry into certain countries in West Africa. For detailed information, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in all countries in West Africa, including cities. All travelers to West Africa, including infants, children, and former residents of West Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Most travelers to West Africa, including infants, children, and former residents of West Africa, are at risk for malaria. These travelers should take one of the following drugs (listed alphabetically):

  • atovaquone/proguanil,
  • doxycycline,
  • mefloquine,
  • or primaquine (in special circumstances).

Yellow Fever

A certificate of yellow fever vaccination may be required for entry into certain countries in West Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout West Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Other Disease Risks

Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects that also occur in this region. Endemic foci of river blindness exist in all countries listed except in the greater part of The Gambia, Mauritania. Protecting yourself against insect bites will help to prevent these diseases. The risk for contracting African sleeping sickness (trypanosomiasis), which is caused by the bite of an infected tsetse fly, is high in all countries except The Gambia, Niger, and Mauritania. A number of rickettsial infections also occur in this region. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection. Plague occurs sporadically or in outbreaks. Schistosomiasis, a parasitic infection, can be contracted in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. Polio is still endemic in Nigeria. Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, HIV and hepatitis B.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., Malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).

  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC Malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguanil) after leaving the risk area. Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


EAST ASIA

Date last revised: January 13, 2006

Countries in this region: China, Hong Kong S.A.R. (China), Japan, Democratic People's Republic of Korea (North), Republic of Korea (South), Macao S.A.R. (China), Mongolia, and Taiwan.

Human Infection with Avian Influenza A (H5N1) Virus

Updated: February 24, 21, 17, 14, 8 and 3; and January 13, 2006; December 27; November 18 and 3; October 28, 26, 21, 18, and 5, 2005

Released: September 23, 2005

Outbreaks

Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 infection among poultry and other birds and a list of countries reporting laboratory-confirmed human infections with H5N1 viruses, see the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/flu/avian/outbreaks/current.htm.

Situation updates and cumulative reports can also be found on the World Health Organization (WHO) website at http://www.who.int/csr/disease/avian_influenza/en/.

Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry in affected countries. Contact with sick or dead poultry as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Uncooked poultry or poultry products, including blood, should not be consumed.

CDC remains in communication with WHO and continues to closely monitor the H5N1 situation in countries reporting human cases and outbreaks among birds.

The public health threat of a pandemic arising from novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another. Such transmission has not yet been observed. However, a few cases of limited person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one instance of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.

H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. Most of the H5N1 viruses tested have been susceptible to the anti-viral medications oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistance has been reported. The effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see http://www.cdc.gov/flu/professionals/treatment/.

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: Cambodia, China, Indonesia, Thailand, Vietnam, Turkey, Iraq.

Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries: Niger, Nigeria, Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Mongolia, Thailand, Vietnam, Austria, Azerbaijan, Bosnia & Herzegovina, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Romania, Russia, Serbia and Montenegro, Slovak Republic, Slovenia, Switzerland, Turkey, Ukraine, Egypt, Iraq, Iran, India, Kazakhstan.

For additional information about these reports, visit the World Organization for Animal Health Web site.

For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to East Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

The preventive measures you need to take while traveling in East Asia depend on the areas you visit and the length of time you stay. You should observe the precautions listed in this document in most areas of this region. However, in highly developed areas of Japan, Hong Kong, South Korea, and Taiwan, you should observe health precautions similar to those that would apply while traveling in the United States.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Travelers to some areas in China, North Korea, and South Korea may be at risk for malaria. Travelers to malaria-risk areas in China, North Korea, and South Korea should take an antimalarial drug.

There is no risk of malaria in Japan, Taiwan, Hong Kong S.A.R. (China), Macau S.A.R. (China), and Mongolia.

Yellow Fever

There is no risk for yellow fever in East Asia. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout East Asia and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, filariasis, Japanese encephalitis, leishmaniasis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. Avian influenza is also present in China.

Outbreaks of severe acute pulmonary syndrome (SARS) occurred in mainland China, Hong Kong, and Taiwan in 2003. Avian influenza is present in the region.

If you visit the Himalayan Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sunblock rated at least SPF 15, because the risk of sunburn is greater at high altitudes.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas. Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


SOUTH ASIA

Date last revised: January 10, 2006

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to South Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
  • Malaria: your risk of malaria may be high in these countries, including cities. See your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors Vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. There have been recent reports of typhoid drug resistance in India and Nepal.
  • As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults.

Required Vaccinations

  • None.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Your risk of malaria may be high in these countries, including cities. Travelers to malaria-risk areas, including infants, children, and former residents of the Indian Sub-continent, should take an antimalarial drug. NOTE: Chloroquine is NOT an effective antimalarial drug in the Indian Subcontinent and should not be taken to prevent malaria in this region. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.

Yellow Fever

There is no risk for yellow fever in the Indian Subcontinent. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout South Asia and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Other Disease Risks

Filariasis is common in Bangladesh, India, and the southwestern coastal belt of Sri Lanka. A sharp rise in the incidence of visceral leishmaniasis has been observed in Bangladesh, India, and Nepal. In Pakistan, it is mainly reported from the north (Baltisan). Cutaneous leishmaniasis occurs in Afghanistan, India (Rajasthan), and Pakistan. Outbreaks of dengue fever can occur in Bangladesh, India, Pakistan, and Sri Lanka, and the hemorrhagic form has been reported from eastern India and Sri Lanka. Japanese encephalitis occurs widely except in mountainous areas. Protecting yourself against insect bites will help to prevent these diseases.

Polio is still endemic in India and Afghanistan. Rabies is common in the region and poses a risk to travelers, especially to rural areas.

Leptospirosis, a bacterial infection often contracted through recreational water activities in contaminated water is common in tropical areas of this region.

If you visit the Himalayan Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sunblock rated at least 15 SPF, because the risk of sunburn is greater at high altitudes.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets
  • on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (doxycycline or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


SOUTHEAST ASIA

Date last revised: January 13, 2006

Counties in this region: Brunei Darussalam, Burma (Myanmar), Cambodia, East Timor, Indonesia, Lao People's Democratic Republic (Laos), Malaysia, Philippines, Singapore, Thailand, and Vietnam.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Human Infection with Avian Influenza A (H5N1) Virus

Updated: February 24, 21, 17, 14, 8 and 3; and January 13, 2006; December 27; November 18 and 3; October 28, 26, 21, 18, and 5, 2005

Released: September 23, 2005

Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 infection among poultry and other birds and a list of countries reporting laboratory-confirmed human infections with H5N1 viruses, see the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/flu/avian/outbreaks/current.htm.

Situation updates and cumulative reports can also be found on the World Health Organization (WHO) website at http://www.who.int/csr/disease/avian_influenza/en/.

Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry in affected countries. Contact with sick or dead poultry as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Uncooked poultry or poultry products, including blood, should not be consumed.

CDC remains in communication with WHO and continues to closely monitor the H5N1 situation in countries reporting human cases and outbreaks among birds.

The public health threat of a pandemic arising from novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another. Such transmission has not yet been observed. However, a few cases of limited person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one instance of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.

H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. Most of the H5N1 viruses tested have been susceptible to the anti-viral medications oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistance has been reported. The effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see http://www.cdc.gov/flu/professionals/treatment/.

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: Cambodia, China, Indonesia, Thailand, Vietnam, Turkey, Iraq.

Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries: Niger, Nigeria, Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Mongolia, Thailand, Vietnam, Austria, Azerbaijan, Bosnia & Herzegovina, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Romania, Russia, Serbia and Montenegro, Slovak Republic, Slovenia, Switzerland, Turkey, Ukraine, Egypt, Iraq, Iran, India, Kazakhstan.

For additional information about these reports, visit the World Organization for Animal Health Web site.

For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Southeast Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
  • Malaria: your risk of malaria may be high in some of the countries in this region. See your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in some of the countries in this region. Travelers to malaria-risk areas, including infants, children, and former residents of Southeast Asia, should take an antimalarial drug. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.

There is no malaria risk in Singapore and Brunei.

Yellow Fever

There is no risk for yellow fever in Southeast Asia. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Southeast Asia and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Other Disease Risks

Dengue, filariasis, Japanese encephalitis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. Avian influenza is also present throughout this region. Polio has resurfaced in Indonesia. Rabies is common in the region and poses a risk to travelers, especially to rural areas.

Do not swim in fresh water (except in well-chlorinated swimming pools) in certain areas of Cambodia, Indonesia, Laos, Philippines, and Thailand to avoid infection with schistosomiasis. Leptospirosis, a bacterial infection often contracted through recreational water activities in contaminated water, such as kayaking, is common in tropical areas of this region. An outbreak was reported among expedition travelers in 2000.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


AUSTRALIA AND THE SOUTH PACIFIC

Date last revised: August 17, 2005

Countries in this region: Australia and the South Pacific includes the countries Australia, Christmas Island, Cook Island, Federated States of Micronesia, Fiji, French Polynesia (Tahiti), Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands, Palau, Papua New Guinea, Pitcairn, Samoa, American Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Wake Island, Wallis and Futuna.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Australia and the South Pacific. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). (except for Australia and New Zealand). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Japanese encephalitis, Papua New Guinea or the Islands of Torres Strait in Australia. Local transmission documented but rare.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications, see Malaria Information for Travelers to Australia and the South Pacific.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid, (except for Australia and New Zealand), particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

The preventive measures you need to take while traveling in this region depend on the areas you visit and the length of time you stay. You should observe the precautions listed in this document in most areas of this region. However, in highly developed areas of Australia and New Zealand, you should observe health precautions similar to those that would apply while traveling in the United States.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers to malaria-risk areas in Papua New Guinea, the Solomon Islands, and Vanuatu, including infants, children, and former residents of these countries should take an antimalarial drug. Papua New Guinea has risk in all areas under the elevation of 1800 meters (5906 feet). The Solomon Islands has risk in all areas, except for the southern province of Rennell Island and Bellona Island. Vanuatu has risk throughout all its islands.

There is no risk for malaria in Australia, Christmas Island, Cook Island, Federated States of Micronesia, Fiji, French Polynesia (Tahiti), Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands, Palau, Pitcairn, Samoa, American Samoa, Tokelau, Tonga, Tuvalu, Wake Island, Wallis and Futuna.

Yellow Fever

There is no risk for yellow fever in Australia and the South Pacific. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Australia and the South Pacific and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Other Disease Risks

Risk of infection is quite variable within this region. Vaccine rates are high in Australia and New Zealand, but rates of certain infectious diseases are high in travelers to other islands. Dengue, filariasis, Ross River virus, and Murray Valley encephalitis are diseases carried by insects that also occur in this region. Scrub typhus and other rickettsial infections are present in this region. Protecting yourself against insect and tick bites will help to prevent these diseases. Japanese encephalitis is present in Papua New Guinea and the Torres Strait and far northern Australia. Other hazards for travelers include ciguatera poisoning, which occurs frequently on some of the islands. Snake and spider bites are also a risk.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide).
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area in the South Pacific, continue taking your antimalarial drug for 4 weeks (doxycycline or mefloquine) or 7 days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to1 year), you should seek immediate medical attention and should tell the physician your travel history.


CARIBBEAN

Date last revised: January 10, 2006

Countries in this region: Anguilla (U.K.), Antigua & Barbuda, Bahamas, Barbados, Bermuda (U.K.), Cayman Islands (U.K.), Cuba, Dominica, Dominican Republic, Grenada, Guadeloupe including St. Martin Island (France), Haiti, Jamaica, Martinique (France), Montserrat (U.K.), Netherlands Antilles (including Aruba, Bonaire, Curacao, and Sint Maarten islands), Puerto Rico (U.S.), St. Lucia, St. Vincent & the Grenadines, St. Kitts & Nevis, Trinidad & Tobago, Turks and Caicos (U.K.), Virgin Islands (U.S.), and Virgin Islands (U.K.)

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to The Caribbean. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG).Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • Yellow Fever, for travelers to Trinidad and Tobago.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

The preventive measures you need to take while traveling in the Caribbean depend on the areas you visit and the length of time you stay. You should observe the precautions listed in this document in most areas of this region.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers to malaria-risk areas in Haiti and the Dominican Republic, including infants, children, and former residents of these islands, should take an antimalarial drug. All travelers to Haiti are at risk for malaria, except no risk in the cruise port of Labadee (Labadie). Travelers to rural areas of the Dominican Republic are at risk for malaria, with the highest risk in provinces bordering Haiti. In addition, risk in all areas of La Altagracia Province, including resort areas. Travelers to malaria-risk areas in Haiti and the Dominican Republic should take chloroquine to prevent malaria.

There is no risk for malaria in: Anguilla (U.K.), Antigua & Barbuda, Bahamas, Barbados, Bermuda (U.K.), Cayman Islands (U.K.), Cuba, Dominica, Grenada, Guadeloupe, Jamaica, Martinique (France), Montserrat (U.K.), Netherlands Antilles, Puerto Rico (U.S.), St. Kitts & Nevis, St. Lucia, St. Vincent & the Grenadines, Trinidad & Tobago, Turks & Caicos (U.K.), Virgin Islands (U.K., U.S.).

Yellow Fever

Yellow fever is present only in Trinidad & Tobago in this region. A certificate of yellow fever vaccination may be required for entry into certain countries in the region if you have visited Trinidad & Tobago or an endemic area in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the Caribbean and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Illness caused by a parasitic worm (Angiostrongylus cantonensis) can occur in this region. People can get infected by eating raw or under-cooked snails or slugs that are infected with the parasite.

Dengue is transmitted by mosquitoes in this region. Protecting yourself against insect bites will help to prevent this disease.

Cutaneous larval migrans is a risk for travelers with exposures on beaches and leptospirosis is present. Eosinophilic meningitis caused by Angiostongylus cantonensis occurred in travelers to Jamaica. Anthrax occurs in Haiti. Other infections that tend to occur more often in longer-term travelers (or immigrants from this region) include lymphatic filariasis (Dominican Republic and Haiti), cutaneous leishmaniais (Dominican Republic), tuberculosis (Haiti), HIV (Haiti), and hepatitis B (Haiti and the Dominican Republic). There remains very limited risk of schistosomiasis in few areas. Other hazards for travelers include toxic fish poisoning

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area in Haiti or the Dominican Republic, continue taking your chloroquine for 4 weeks after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


MEXICO AND CENTRAL AMERICA

Date last revised: January 10, 2006

Countries in this region: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Mexico and Central America. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • Yellow fever, for travelers to endemic areas in Panama.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

Diseases found in Mexico and Central America (risk can vary by country and region within a country; quality of in-country surveillance also varies).

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Your risk of malaria may be high in these countries, including some cities. Travelers to malaria-risk areas, including infants, children, and former residents of Mexico and Central America, should take an antimalarial drug.

  • Chloroquine is the recommended drug for Mexico, Belize, Guatemala, El Salvador, Nicaragua, Honduras, Costa Rica, and the Bocas Del Toro Province of Panama.
  • Travelers to Darién Province and San Blas Province in Panama (including the San Blas Islands) should take one of the following antimalarial drugs: (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).

Yellow Fever

Yellow fever is present only in Panama in this region. A certificate of yellow fever vaccination may be required for entry into certain countries in the region if you have visited Panama, Trinidad & Tobago, or an endemic area in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout this region and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Gnathostomiasis (roundworms) has increased in Mexico, with many cases being reported from the Acapulco area, infection has been reported in travelers. Humans become infected by eating undercooked fish or poultry, or reportedly by drinking contaminated water.

Dengue, filariasis, leishmaniasis, onchocerciasis, and American trypanosomiasis (Chagas disease) are diseases carried by insects that also occur in this region. Myiasis (botfly) is endemic in Central America. Protecting yourself against insect bites will help to prevent these diseases.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


EASTERN EUROPE AND NORTHERN ASIA

Date last revised: January 13, 2006

Countries in this region: Albania, Armenia, Azerbaijan, Belarus, Bosnia/Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Macedonia, Moldova, Poland, Romania, Russia, Serbia/Montenegro, Slovakia (Slovak Republic), Slovenia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.

Outbreaks

Human Infection with Avian Influenza A (H5N1) Virus

Updated: February 24, 21, 17, 14, 8 and 3; and January 13, 2006; December 27; November 18 and 3; October 28, 26, 21, 18, and 5, 2005

Released: September 23, 2005

Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 infection among poultry and other birds and a list of countries reporting laboratory-confirmed human infections with H5N1 viruses, see the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/flu/avian/outbreaks/current.htm.

Situation updates and cumulative reports can also be found on the World Health Organization (WHO) website at http://www.who.int/csr/disease/avian_influenza/en/.

Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry in affected countries. Contact with sick or dead poultry as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Uncooked poultry or poultry products, including blood, should not be consumed.

CDC remains in communication with WHO and continues to closely monitor the H5N1 situation in countries reporting human cases and outbreaks among birds.

The public health threat of a pandemic arising from novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another. Such transmission has not yet been observed. However, a few cases of limited person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one instance of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.

H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. Most of the H5N1 viruses tested have been susceptible to the anti-viral medications oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistance has been reported. The effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see http://www.cdc.gov/flu/professionals/treatment/.

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: Cambodia, China, Indonesia, Thailand, Vietnam, Turkey, Iraq.

Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries: Niger, Nigeria, Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Mongolia, Thailand, Vietnam, Austria, Azerbaijan, Bosnia & Herzegovina, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Romania, Russia, Serbia and Montenegro, Slovak Republic, Slovenia, Switzerland, Turkey, Ukraine, Egypt, Iraq, Iran, India, Kazakhstan.

For additional information about these reports, visit the World Organization for Animal Health Web site.

For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Eastern Europe and Northern Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria and measles. Outbreaks of diphtheria have been reported in states of the former Soviet Union. Travelers to these areas should be sure that their diphtheria immunization is up to date.

Required Vaccinations

  • None

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.

All travelers to malaria-risk areas in Eastern Europe, including infants, children, and former residents of Eastern Europe, are at risk for malaria. Parts of the countries of Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan have malaria risk. Travelers to malaria-risk areas in Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan should take the antimalarial drug chloroquine to prevent malaria. In Uzbekistan, the risk of malaria is low and varies along its border with Tajikistan; travelers to Uzbekistan or their health care provider should contact CDC (Malaria Hotline, 770-488-7788) for risk and prevention advice.

There is no risk for malaria in Albania, Belarus, Bosnia/Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Macedonia, Moldova, Poland, Romania, Russia, Serbia/Montenegro, Slovakia (Slovak Republic), Slovenia, and Ukraine.

Yellow Fever

There is no risk for yellow fever in Eastern Europe and Northern Asia. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Eastern Europe and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). The risk of hepatitis A can be high in parts of the region.

Tickborne encephalitis, a viral infection of the central nervous system occurs in the southern part of the nontropical forest belt in Europe and Asia (to Pacific Ocean). Most intense transmission has been reported in Russia, Czech Republic, Latvia, Lithuania, Estonia, Hungary, Poland, and Slovenia. Travelers are at risk who visit or work in forested areas during the summer months and who consume unpasteurized dairy products. Vaccine for this disease is not available in the United States at this time. A number of rickettsial infections also occur in this region. To prevent tickborne infections travelers should take precautions to prevent tick bites.

Other infections that tend to occur more often in longer-term travelers (or in immigrants from the region) include tuberculosis, hepatitis B, hepatitis C (especially in Romania), and cutaneous and visceral leishmaniasis in parts of Azerbaijan and Tajikistan.

Outbreaks of diphtheria have been reported in states of the former Soviet Union. There is a vaccine available to prevent diphtheria.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects and ticks.
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (doxycycline or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


WESTERN EUROPE

Date last revised: November 3, 2005

Countries in this region: Andorra, Austria, Azores, Belgium, Denmark, Faroe Island, Finland, France, Germany, Gibraltar, Greece, Greenland, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Madeira, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland, United Kingdom

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

The following vaccines may be recommended for your travel to Western Europe. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling. You are not at increased risk in Northern, Western, and Southern Europe, including the Mediterranean regions of Italy and Greece.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • As needed, booster doses for tetanus-diphtheria.

Required Vaccinations

  • None.

The preventive measures you need to take while traveling in Western Europe depend on the areas you visit and the length of time you stay. For most areas of this region, you should observe health precautions similar to those that would apply while traveling in the United States.

Disease Risks

In 2004-2005 there has been a marked increase in reported cases of mumps in the United Kingdom. Tickborne encephalitis, a viral infection of the central nervous system, occurs in Austria, Germany, Finland, Sweden, Switzerland, Denmark (only on the island of Bornholm); a few cases have also been reported from Italy, Norway, and France. Travelers are at risk who visit or work in forested areas during the summer months and who consume unpasteurized dairy products. The vaccine for this disease is not available in the United States at this time. To prevent tickborne encephalitis, as well as Lyme disease, travelers should take precautions to prevent tick bites.

Leishmaniasis (cutaneous and visceral) is found in countries bordering the Mediterranean, with the highest number of cases from Spain, where it is an important opportunistic infection in HIV-infected persons.

Legionnaries disease, caused by the Legionella bacterium, is sporadic; some outbreaks have involved tourists at resort hotels.

Yellow Fever

There is no risk for yellow fever in Western Europe. A certificate of yellow fever vaccination is required for entry into the Azores, Madeira, and Malta if you are coming from countries in South America or sub-Saharan Africa where yellow fever is endemic. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Western Europe and can contaminate food or water.

Variant Creutzfeldt-Jacob (in animals bovine spongiform encephalopathy/mad-cow disease) cases have been reported primarily from the United Kingdom, though a small number of cases have been reported from other countries. Large outbreaks of trichinosis have occurred; outbreaks in France have been linked to horsemeat.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Insect repellent containing DEET during the summer.
  • Sunblock, sunglasses, hat during summer months.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Protect yourself from tick bites if visiting forested areas during the summer.
  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Do not

  • Do not eat food that is not well cooked to reduce risk of infection.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.Avoid dairy products, unless you know they have been pasteurized.

After You Return Home

If you become ill after your trip—even as long as a year after you return—tell your doctor where you have traveled.


MIDDLE EAST

Date last revised: January 20, 2006

Countries in this region: Bahrain, Cyprus, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, United Arab Emirates, and Yemen.

Outbreaks

Poliomyelitis

Updated: February 10, 2006; December 16, 2005

Released: November 9, 2005

According to the Global Polio Eradication Initiative (GPEI), as of January 2006, the polio outbreaks that began in 2003 and affected 21 previously polio-free countries have been successfully stopped in 15 of those countries. Only 6 of the affected countries reported cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). For information about these outbreaks and the Global Polio Eradication Initiative, see http://www.polioeradication.org/.

Additionally, of the 6 countries with indigenous polio (Afghanistan, Egypt, India, Niger, Nigeria and Pakistan), Egypt and Niger have not recorded poliovirus transmission for over 12 months, prompting GPEI to remove them from the list of endemic countries. India and Pakistan reported approximately half the number of cases in 2005 (64 and 27, respectively) compared with the same period in 2004.

Polio is an infectious disease caused by a virus. The disease mainly affects children under five years of age. It is spread person-to-person when the virus enters the mouth of a person who has come in contact with the stool of an infected person (for example, by changing diapers and not washing hands afterwards). Most people infected with the polio virus have no symptoms, but some severe infections cause paralysis and even death. Until the 1950s, polio crippled thousands of children in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV – Inactivated Polio Vaccine) and early 1960s (OPV – Oral Polio Vaccine), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.

OPV has not been used in the United States since 2000. However OPV is used in many other counties and has played a major role in eliminating polio from large parts of the world. Inactivated polio vaccine (IPV), which is given by intramuscular injection, is now used in the United States.

The Advisory Committee on Immunization Practices (ACIP) recommends that all infants and children in the United States should receive four doses of inactivated poliovirus vaccine (IPV), administered at 2, 4, and 6–18 months and 4–6 years of age. Adults should receive another dose of IPV if they have received a primary series with either IPV or oral polio vaccine and are traveling to polio-endemic or epidemic areas. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

For more information about polio and polio vaccine, see these websites:
http://www.cdc.gov/travel/diseases/polio.htm,
http://www.cdc.gov/nip/menus/diseases.htm#polio,
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules.

Human Infection with Avian Influenza A (H5N1) Virus

Updated: February 24, 21, 17, 14, 8 and 3; and January 13, 2006; December 27; November 18 and 3; October 28, 26, 21, 18, and 5, 2005

Released: September 23, 2005

Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 infection among poultry and other birds and a list of countries reporting laboratory-confirmed human infections with H5N1 viruses, see the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/flu/avian/outbreaks/current.htm.

Situation updates and cumulative reports can also be found on the World Health Organization (WHO) website at http://www.who.int/csr/disease/avian_influenza/en/.

Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry in affected countries. Contact with sick or dead poultry as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Uncooked poultry or poultry products, including blood, should not be consumed.

CDC remains in communication with WHO and continues to closely monitor the H5N1 situation in countries reporting human cases and outbreaks among birds.

The public health threat of a pandemic arising from novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another. Such transmission has not yet been observed. However, a few cases of limited person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one instance of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.

H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. Most of the H5N1 viruses tested have been susceptible to the anti-viral medications oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistance has been reported. The effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see http://www.cdc.gov/flu/professionals/treatment/.

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: Cambodia, China, Indonesia, Thailand, Vietnam, Turkey, Iraq.

Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries: Niger, Nigeria, Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Mongolia, Thailand, Vietnam, Austria, Azerbaijan, Bosnia & Herzegovina, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Romania, Russia, Serbia and Montenegro, Slovak Republic, Slovenia, Switzerland, Turkey, Ukraine, Egypt, Iraq, Iran, India, Kazakhstan.

For additional information about these reports, visit the World Organization for Animal Health Web site.

For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to the Middle East. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors. Risk is greater if you are visiting developing countries in this region.
  • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

  • Meningococcal vaccine is required for pilgrims to Mecca for the annual Hajj. However, CDC currently recommends the vaccine for all travelers to Mecca, including those traveling for the Umra. (For more information, please see Saudi Arabia Hajj Requirements.)
  • New polio immunization requirements for travelers from polio-affected areas to Saudi Arabia who are 15 years of age or younger. See complete announcement for details.

The preventive measures you need to take while traveling in the Middle East depend on the areas you visit and the length of time you stay. You should observe the precautions listed in this document in most areas of this region. However, in highly developed areas of Israel, you should observe health precautions similar to those that would apply while traveling in the United States.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Your risk of malaria may be high in these countries, including some cities. Travelers to malaria-risk areas, including infants, children, and former residents of the Middle East, should take an antimalarial drug. Travelers to some areas of Iran, Iraq, Oman, Saudi Arabia, the Syrian Arab Republic, Turkey, and Yemen may be at risk for malaria.

  • Chloroquine is the recommended antimalarial drug for Iraq, Syria, and Turkey.
  • Travelers to Iran, Saudi Arabia, and Yemen should take one of the following antimalarial drugs: (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).
  • In Oman, the risk of malaria is in the Musandam Province only; because the risk is very limited, no antimalarial drug is needed in this area.

There is no risk of malariain Bahrain, Cyprus, Israel, Jordan, Kuwait, Lebanon, Qatar, and the United Arab Emirates.

Yellow Fever

There is no risk for yellow fever in the Middle East. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the Middle East and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Cutaneous leishmaniasis is reported throughout the area; visceral leishmaniasis, although rare throughout most of the area, is common in central Iraq, in the southwest of Saudi Arabia, in the northwest of Syria, in Turkey (southeast Anatolia only), and in the west of Yemen. Many cases of leishmaniasis have been reported in the US military in Iraq. A rise in West Nile fever has been seen recently in Israel. Outbreaks of dengue occurred in Saudi Arabia and Yemen in 2002. Protecting yourself against insect bites will help to prevent these diseases.

Other infections that tend to occur more often in longer-term travelers (or immigrants from this region) include tuberculosis (Yemen), lymphatic filariasis and onchocerciasis (Yemen), hepatitis B, and schistosomiasis (Saudi Arabia, Yemen, Iraq, and Syria) To prevent schistosomiasis, do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. Polio has resurfaced in Yemen. Pilgrims to the Hajj in Saudi Arabia have acquired meningococcal infections caused by serotypes A and W-135, as well as influenza.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


NORTH AMERICA

Date last revised: January 10, 2006

Countries in this region: Canada, St. Pierre and Miquelon [France], United States [including Hawaii]

Disease Risks, United States and Canada

In 1994, an international commission certified the eradication of endemic wild poliovirus from the Americas. Ongoing surveillance in formerly endemic Central and South American countries (Tropical and Temperate) confirms that poliovirus transmission remains interrupted.

The incidence of communicable diseases is such that they are unlikely to prove a hazard for international travelers greater than that found in their own country. There are, of course, health risks, but in general, the precautions required are minimal.

Certain diseases occasionally occur, such as plague, rabies in wildlife, including bats, raccoons, foxes, and other wild animals. Rocky Mountain spotted fever, tularemia, arthropod-borne encephalitis, and seasonal outbreaks of influenza. The comprehensive CDC Influenza site answers questions raised about this 2003-2004 influenza season. Coccidioidomycosis is endemic in southwestern United States and can occur in visitors to the area. Histoplasmosis is highly endemic, especially in the Mississippi, Ohio, and the St. Lawrence river valleys.

Rodent-borne hantavirus pulmonary syndrome has been identified, predominantly in the western states of the United States. Lyme disease is endemic in the northeastern United States, Mid-Atlantic, and the upper Midwest and the southwestern provinces of Canada. Occasional cases have been reported from the Pacific Northwest. Recently, cases of West Nile virus have occurred throughout North America. During recent years, the incidence of certain foodborne diseases, e.g., E. coli O157:H7 and salmonellosis, has increased in some regions. Although the risk of hepatitis A infection is considered low in the United States and Canada, outbreaks have occurred in some areas. Other hazards include poisonous snakes, poison ivy, and poison oak. In the north, a serious hazard is the very low temperature in the winter.

In the United States, proof of immunization against diphtheria, measles, poliomyelitis, and rubella is now universally required for entry into school. In addition, the school entry requirements of most states include immunization against tetanus (49 states), pertussis (44 states), mumps (46 states), and hepatitis B (26 states). Haemophilus influenzae type b (Hib) vaccine is not required for school entry but is required in 49 states for attendance in day care facilities. Because the incidence of reported hepatitis A is substantially higher in 11 states, mostly in the west, some states now require hepatitis A vaccination for school or day care entry.

Isolated cases of bovine spongiform encephalopathy (BSE/mad cow disease) have been reported in Canada and the United States.


SOUTH AMERICA TEMPERATE

Date last revised: January 10, 2006

Countries in this region: Argentina, Chile, Falkland Islands (U.K.), and Uruguay.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Temperate South America. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.
  • Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • Yellow fever vaccination is recommended if you are traveling to northeastern forest areas in Argentina.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

  • None.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Your risk of malaria may be high in some provinces of Argentina. In Argentina, you are at risk for malaria only in rural areas in the northern provinces bordering Bolivia and Paraguay.

There is no risk for malaria in Chile, the Falkland Islands, and Uruguay.

Yellow Fever

Yellow fever is present only in the northeastern forest areas of Argentina in this region. A certificate of yellow fever vaccination may be required for entry into certain countries in the region if you have visited endemic areas in South or Central America, Trinidad & Tobago, or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Temperate South America and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Dengue, American trypanosomiasis (Chagas disease), and leishmaniasis are diseases carried by insects that also occur in this region. In 2002, locally transmitted cases of dengue fever occurred for the first time in Chile on Easter Island. Protecting yourself against insect bites will help to prevent these diseases. Rodent-borne hantavirus pulmonary syndrome has been identified in the north-central and southwestern regions of Argentina and in Chile.

If you visit the Andes Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sunblock rated at least 15 SPF, because the risk of sunburn is greater at high altitudes.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area in Argentina, continue taking your chloroquine for 4 weeks after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


TROPICAL SOUTH AMERICA

Date last revised: January 10, 2006

Countries in this region: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela.

Routine Vaccinations

Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). Some schedules can be accelerated for travel.

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to Tropical South America. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

  • Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
  • Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
  • Malaria: your risk of malaria may be high in these countries, including some cities. See your health care provider for a prescription antimalarial drug.
  • Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
  • Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors.
  • As needed, booster doses for tetanus-diphtheria and measles.

Required Vaccinations

Yellow fever is present in this region and vaccination is recommended if you travel to the endemic zones in any of these countries. A certificate of yellow fever vaccination may be required for entry into certain countries if you have visited an endemic area. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Your risk of malaria may be high in these countries, including some cities. Travelers to malaria-risk areas, including infants, children, and former residents of South America, should take an antimalarial drug.

  • Chloroquine is the recommended drug for Paraguay.
  • Travelers to Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname, and Venezuela should take one of the following antimalarial drugs: (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).

Yellow Fever

Yellow fever is present in this region and vaccination is recommended if you travel to the endemic zones. A certificate of yellow fever vaccination may be required for entry into certain countries if you have visited an endemic area. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements on the CDC website. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Tropical South America and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Brucellosis is occasionally seen in travelers, most commonly acquired through eating or drinking contaminated milk products.

Dengue, filariasis, leishmaniasis, onchocerciasis, and American trypanosomiasis (Chagas disease) are other diseases carried by insects that also occur in this region. Epidemics of viral encephalitis and dengue fever occur in some countries in this area. Bartonellosis, or Oroya fever (a sand fly-borne disease), occurs in arid river valleys on the western slopes of the Andes up to 3,000 meters (9,842 feet). Louse-borne typhus, a rickettsial infection is often found in mountain areas of Colombia and Peru. Protecting yourself against insect bites will help to prevent these diseases.

Schistosomiasis, a parasitic infection that can be contracted in fresh water in this region, is found in Brazil, Suriname, and north-central Venezuela. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries.

If you visit the Andes Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sunblock rated at least 15 SPF, because the risk of sunburn is greater at high altitudes.

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

What You Need To Bring With You

  • Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET.
  • Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
  • Always carry medications in their original containers, in your carry-on luggage.
  • Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea.

Staying Healthy During Your Trip

To stay healthy, do…

  • When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
  • Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
  • In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
  • Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
  • Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Protect yourself from mosquito insect bites:

  • Wear long-sleeved shirts, long pants, and hats when outdoors.
  • Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
  • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
  • If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

  • Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
  • Do not drink beverages with ice.
  • Avoid dairy products, unless you know they have been pasteurized.
  • Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.
  • Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.
  • Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

After You Return Home

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

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