A

CDC's International Travelers' Health Information
Geographic Health Recommendations

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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.

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CENTRAL AFRICA

Date last revised: October 20, 2004

Outbreaks

Polio Eradication Activities, Africa

Updated: October 20, 2004; August 31, 2004; July 8, 2004; May 28, 2004; May 7, 2004; March 4, 2004. Released October 23, 2003

The Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and national Ministries of Health, has reduced the number of cases worldwide from 350,000 in 1988 to fewer than 800 in 2004. Intensified immunization activities are now focused on the few countries where indigenous transmission continues to occur: Nigeria, India, Pakistan, Niger, Egypt, and Afghanistan. While global eradication efforts have been largely successful, this year the number of children paralyzed by polio in sub-Saharan Africa is three times higher than in 2003. Recent cases of poliomyelitis in Benin, Botswana, Chad, Côte d'Ivoire, Burkina Faso, Cameroon, Central African Republic, Guinea, and Sudan have been linked to outbreaks in the northern Nigerian state of Kano. Until last year, these countries had been considered polio-free.

On October 8, 2004, the Global Polio Eradication Initiative reported that 23 African countries would be launching a 4-day campaign to vaccinate 80 million children across sub-Saharan Africa. The synchronized campaign is in response to poliomyelitis outbreaks in African countries where the disease had been eradicated, as well as ongoing transmission in Niger and northern Nigeria, where vaccination efforts had been suspended in August 2003. The state resumed vaccination activities in July 2004.

According to the recommended childhood immunization schedule, all infants and children in the U.S. should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months of age and 4-6 years of age. Adults who are traveling to polio-endemic areas and have received a primary series with either IPV or OPV should receive another dose of IPV. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

Traveler's Diarrhea

Food and waterborne diseases are the number one 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers to Central Africa, including infants, children, and former residents of Central Africa, may be at risk for malaria. All 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 of these countries.

Other Diseases

Dengue, filariasis, leishmaniasis, and onchocerciasis are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

An outbreak of sleeping sickness (trypanosomiasis) has been reported in southern Sudan.

Schistosomiasis, a parasitic infection, is found in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in Central African countries.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Meningococcal (meningitis), if you plan to visit Central African Republic, Chad, and Sudan, from December through June.
• Yellow fever, if you plan to travel anywhere outside cities.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly 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. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

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 impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and portable water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check CDC web sites for more information about how to protect yourself against diseases that occur in Central Africa, including the following:

Diseases carried by insects

Dengue
Malaria
Plague
Yellow fever

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

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EAST AFRICA

Date last revised: October 20, 2004

Polio Eradication Activities, Africa

(Updated: October 20, 2004; August 31, 2004; July 8, 2004; May 28, 2004; May 7, 2004; March 4, 2004. Released October 23, 2003)

The Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and national Ministries of Health, has reduced the number of cases worldwide from 350,000 in 1988 to fewer than 800 in 2004. Intensified immunization activities are now focused on the few countries where indigenous transmission continues to occur: Nigeria, India, Pakistan, Niger, Egypt, and Afghanistan. While global eradication efforts have been largely successful, this year the number of children paralyzed by polio in sub-Saharan Africa is three times higher than in 2003. Recent cases of poliomyelitis in Benin, Botswana, Chad, Côte d'Ivoire, Burkina Faso, Cameroon, Central African Republic, Guinea, and Sudan have been linked to outbreaks in the northern Nigerian state of Kano. Until last year, these countries had been considered polio-free.

On October 8, 2004, the Global Polio Eradication Initiative reported that 23 African countries would be launching a 4-day campaign to vaccinate 80 million children across sub-Saharan Africa. The synchronized campaign is in response to poliomyelitis outbreaks in African countries where the disease had been eradicated, as well as ongoing transmission in Niger and northern Nigeria, where vaccination efforts had been suspended in August 2003. The state resumed vaccination activities in July 2004.

According to the recommended childhood immunization schedule, all infants and children in the U.S. should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months of age and 4-6 years of age. Adults who are traveling to polio-endemic areas and have received a primary series with either IPV or OPV should receive another dose of IPV. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

Traveler's Diarrhea

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

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Most travelers to East Africa, including infants, children, and former residents of East Africa, are at risk for malaria. All travelers at risk for malaria 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 vaccine may be required for entry into certain of these countries.

Other Diseases

Dengue, filariasis, leishmaniasis, onchocerciasis, trypanosomiasis (sleeping sickness), and Rift Valley fever are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

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.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Meningococcal (meningitis) vaccine, if you plan to visit the western half of Ethiopia from December through June.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• Yellow fever, if you travel anywhere outside urban areas.
• As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filter" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you travel to an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water, including Lake Malawi. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in East Africa, including the following:

Diseases carried by insects

Dengue
Malaria
Yellow fever

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

NORTH AFRICA

Date last revised: October 20, 2004

Traveler's Diarrhea

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

Malaria

Malaria is always a serious disease and may be a deadly illness. 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 to prevent mosquito bites.

Other Diseases

Dengue, filariasis, leishmaniasis, and onchocerciasis are diseases carried by insects that also occur in this region. Protecting yourself against 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.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months in the region, or be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly 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. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water, including the Nile. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in North Africa, including the following:

Diseases carried by insects

Dengue
Malaria
Plague

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

SOUTHERN AFRICA

Date last revised: October 20, 2004

Polio Eradication Activities, Africa

(Updated: October 20, 2004; August 31, 2004; July 8, 2004; May 28, 2004; May 7, 2004; March 4, 2004. Released October 23, 2003)

The Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and national Ministries of Health, has reduced the number of cases worldwide from 350,000 in 1988 to fewer than 800 in 2004. Intensified immunization activities are now focused on the few countries where indigenous transmission continues to occur: Nigeria, India, Pakistan, Niger, Egypt, and Afghanistan. While global eradication efforts have been largely successful, this year the number of children paralyzed by polio in sub-Saharan Africa is three times higher than in 2003. Recent cases of poliomyelitis in Benin, Botswana, Chad, Côte d'Ivoire, Burkina Faso, Cameroon, Central African Republic, Guinea, and Sudan have been linked to outbreaks in the northern Nigerian state of Kano. Until last year, these countries had been considered polio-free.

On October 8, 2004, the Global Polio Eradication Initiative reported that 23 African countries would be launching a 4-day campaign to vaccinate 80 million children across sub-Saharan Africa. The synchronized campaign is in response to poliomyelitis outbreaks in African countries where the disease had been eradicated, as well as ongoing transmission in Niger and northern Nigeria, where vaccination efforts had been suspended in August 2003. The state resumed vaccination activities in July 2004.

According to the recommended childhood immunization schedule, all infants and children in the U.S. should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months of age and 4-6 years of age. Adults who are traveling to polio-endemic areas and have received a primary series with either IPV or OPV should receive another dose of IPV. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

Traveler's Diarrhea

Food and waterborne diseases are the number one 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly 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 Southern Africa, including infants, children, and former residents of Southern Africa, are at risk for malaria. All travelers to a malaria-risk area should take one of the following drugs (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).

Other Diseases

Dengue, filariasis, leishmaniasis, onchocerciasis, and trypanosomiasis (sleeping sickness) are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

Schistosomiasis, a parasitic infection, is found in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in Southern African countries.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly 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. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

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 impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in Southern Africa, including the following:

Diseases carried by insects

Dengue
Malaria
Plague

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

WEST AFRICA

Date last revised: October 20, 2004

Polio Eradication Activities, Africa

(Updated: October 20, 2004; August 31, 2004; July 8, 2004; May 28, 2004; May 7, 2004; March 4, 2004. Released October 23, 2003)

The Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and national Ministries of Health, has reduced the number of cases worldwide from 350,000 in 1988 to fewer than 800 in 2004. Intensified immunization activities are now focused on the few countries where indigenous transmission continues to occur: Nigeria, India, Pakistan, Niger, Egypt, and Afghanistan. While global eradication efforts have been largely successful, this year the number of children paralyzed by polio in sub-Saharan Africa is three times higher than in 2003. Recent cases of poliomyelitis in Benin, Botswana, Chad, Côte d'Ivoire, Burkina Faso, Cameroon, Central African Republic, Guinea, and Sudan have been linked to outbreaks in the northern Nigerian state of Kano. Until last year, these countries had been considered polio-free.

On October 8, 2004, the Global Polio Eradication Initiative reported that 23 African countries would be launching a 4-day campaign to vaccinate 80 million children across sub-Saharan Africa. The synchronized campaign is in response to poliomyelitis outbreaks in African countries where the disease had been eradicated, as well as ongoing transmission in Niger and northern Nigeria, where vaccination efforts had been suspended in August 2003. The state resumed vaccination activities in July 2004.

According to the recommended childhood immunization schedule, all infants and children in the U.S. should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months of age and 4-6 years of age. Adults who are traveling to polio-endemic areas and have received a primary series with either IPV or OPV should receive another dose of IPV. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.

Traveler's Diarrhea

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

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers to West Africa, including infants, children, and former residents of West Africa, are at risk for malaria. All travelers should take one of the following drugs (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).

Yellow Fever

Yellow fever vaccination is recommended and may be required for entry into certain of these countries. If you travel to West Africa, the easiest and safest thing to do is get a yellow fever vaccination and a signed certificate.

Other Diseases

Dengue, filariasis, leishmaniasis, onchocerciasis, and trypanosomiasis (sleeping sickness) are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

Schistosomiasis, a parasitic infection, is found in fresh water in the region. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Meningococcal meningitis, for travel to most of these countries from December through June.
• Yellow fever.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly 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. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more details about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in West Africa, including the following:

Diseases carried by insects

Dengue
Malaria
Yellow fever

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

EAST ASIA

Date last revised: January 6, 2005

New Cases Avian Influenza, Asia: Advice for Travelers

(Updated January 6, 2005, October 8, 2004; September 16, 2004; August 14, 2004; July 14, 2004; Released April 23, 2004)

According to the World Health Organization (WHO), 2 new human cases of H5 avian influenza have been identified in Vietnam. The cases were confirmed through preliminary laboratory tests conducted in Vietnam. Both patients have died.

WHO also received informal reports in late December 2004 of another case, in a 16-year-old girl from Tay Ninh Province, Vietnam. She remains hospitalized. Further testing is being conducted for all 3 cases, and close contacts are being monitored for development of any symptoms. The cases have all occurred in the southern part of the country, where poultry outbreaks have been recurring since December 2004.

If the recently reported H5 cases are officially confirmed as H5N1, then as of January 6, 2005, 47 human cases of influenza A (H5N1) have occurred in Vietnam and Thailand, resulting in 34 deaths. Most confirmed H5N1 cases have been among children and young adults who had exposure to sick or dead poultry.

Both countries have been working closely with WHO to strengthen surveillance for human cases of H5N1 and to implement control and preparedness activities. The Centers for Disease Control and Prevention (CDC) remains in close communication with WHO about the evolving avian influenza situation in Asia and has been assisting with laboratory testing for H5N1.

Travelers to Cambodia, China, Indonesia, Laos, Malaysia, Thailand, and Vietnam are advised to follow standard health recommendations for Southeast and East Asia and, as a precaution, to avoid places such as poultry farms and bird markets where live poultry are raised or kept and to avoid contact with sick or dead poultry. As with other infectious illnesses, one of the most important preventive practices is careful and frequent hand washing. Cleaning your hands often, using either soap and water or waterless, alcohol-based hand rubs, removes potentially infectious materials from your skin and helps prevent disease transmission. Travelers returning with an illness from any area of the world are reminded to seek prompt medical attention.

For more information about recent outbreaks of avian influenza in Asia, see http://www.cdc.gov/flu/avian/outbreaks/asia.htm.

Another Japanese Encephalitis Case, Hong Kong, Special Administrative Region

(Updated December 1, 2004; Released November 8, 2004)

The Hong Kong Department of Health has reported another laboratory-confirmed Japanese encephalitis (JE) case in a 40-year-old man in Ap Lei Chau, a metropolitan area of Hong Kong. The patient, who had no recent history of travel, was hospitalized on November 3, 2004, and is reported to be in serious condition. Last month, a 4-year-old boy with confirmed JE was hospitalized, and earlier this year, three other confirmed cases—one fatal—occurred. All four previous cases were reported from the New Territories, a mixed agricultural area of Hong Kong.

The risk for JE among travelers to endemic areas is low, especially for short-term travelers and those who confine their travel to urban areas. Expatriates and travelers living for prolonged periods in rural areas where JE is endemic or epidemic are at greatest risk. Travelers with extensive unprotected outdoor, evening, and nighttime exposure in rural areas, such as might be experienced while bicycling, camping, or engaging in certain occupational activities, might be at high risk even during brief visits. Such travelers are advised to consult with a health-care provider prior to departure about vaccination and other measures to reduce their risk for infection, particularly if travel will extend to the New Territories.

General

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.

Traveler's Diarrhea

Travelers' diarrhea, the number one illness in travelers, can be caused by viruses, bacteria, or parasites, which 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Prevent this deadly 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, Hong Kong S.A.R. (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. The risk of malaria in Hong Kong S.A.R. is so limited that taking an antimalarial drug is not recommended. There is no risk of malaria in Japan, Taiwan, Macao S.A.R. (China), and Mongolia.

Other Diseases

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.

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.

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.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG), except travelers to Japan.
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• As needed, booster doses for tetanus-diphtheria and measles. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.

All travelers should take the following precautions, no matter the destination:

• Wash hands often with soap and water.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
• Don't eat or drink dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.

To stay healthy, do…

• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water (except for well-chlorinated swimming pools) in certain areas of China (southeast, east, and Yangtze River valley) to avoid infection with schistosomiasis. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects.
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

After you return home:

If you have visited a malaria-risk area in East Asia, continue taking your antimalarial drug for 4 weeks (chloroquine, 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 to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in East Asia, including the following:

Diseases carried by insects

Dengue
Japanese encephalitis
Malaria
Plague

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

SOUTHEAST ASIA

Date last revised: January 8, 2005

Traveler's Diarrhea

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

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including some cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. Travelers to malaria-risk areas, including infants, children, and former residents of Southeast Asia, should take an antimalarial drug.

Other Diseases

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.

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.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.

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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months in the region, or be exposed through medical treatment.
• Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region.
• As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, and Japanese encephalitis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more detailed information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in Southeast Asia, including the following:

Diseases carried by insects

Dengue
Japanese encephalitis
Malaria
Plague

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

AUSTRALIA AND THE SOUTH PACIFIC

Date last revised: October 14, 2004

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.

Traveler's Diarrhea

Travelers' diarrhea, the number one illness in travelers, can be caused by viruses, bacteria, or parasites, which 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Prevent this deadly 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. The other countries pictured do not have a risk of malaria.

Other Diseases

Dengue, filariasis, Ross River virus, and Murray Valley encephalitis are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG) (except for Australia and New Zealand).
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid (except for Australia and New Zealand), particularly if you are visiting developing countries in this region.
• As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. Hepatitis B vaccine is now recommended for all infants and for children 11–12 years of age who did not receive the series as infants.

All travelers should take the following precautions, no matter the destination:

• Wash hands often with soap and water.
• Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
• Don't eat or drink dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.

To stay healthy, do…

• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects.
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and portable water filters to purify water if bottled water is not available.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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 to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

For more information:

Ask your doctor or check CDC web sites for more information about how to protect yourself against diseases that occur in Australia and the South Pacific, including the following:

Diseases carried by insects

Dengue
Malaria
Encephalitis

Diseases carried in food or water

Escherichia coli diarrhea
Hepatitis A
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

CARIBBEAN

Date last revised: December 17, 2004

Advice for Travelers about Revised Recommendations for Malaria Prophylaxis in Dominican Republic

(Updated: December 17, 2004, December 6, 2004. Released November 24, 2004)

In November 2004, CDC received reports of 2 cases of malaria in U.S. travelers to the Dominican Republic whose visits were limited to resorts in Punta Cana (La Altagracia Province), and San Francisco de Macoris (Duarte Province). During the same period, cases were reported in European travelers who visited Punta Cana. As of December 17, 2004, a total of 8 cases have been identified among European travelers. In addition, Canadian health authorities have reported 6 cases of malaria among travelers who also visited Punta Cana.

CDC recommends that all travelers to La Altagracia Province and Duarte Province, including travelers to the Punta Cana resort area, should take an antimalarial drug. In addition, an antimalarial drug is recommended for travelers to rural areas in all parts of the country. Chloroquine is the recommended drug for the Dominican Republic.

Infection with the type of malaria found in the Dominican Republic, Plasmodium falciparum, may rapidly result in a severe, life-threatening illness if not promptly treated. If you have traveled to the Dominican Republic and you become ill with fever and other flu-like symptoms, you should immediately seek professional medical care; inform your health-care provider that you may have been in a malaria-risk area.

The Ministry of Health in the Dominican Republic has implemented malaria control measures, including intensified surveillance, prompt case management, and intensive mosquito control activities. There is no advisory against travel to the Dominican Republic or any other country where malaria occurs.

General

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.

Traveler's Diarrhea

Travelers' diarrhea, the number one illness in travelers, can be caused by viruses, bacteria, or parasites, which 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly 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 the Caribbean, including infants, children, and former residents of the Caribbean, are at risk for malaria. 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, especially in the provinces bordering Haiti, are at risk for malaria; malaria risk also exists in all areas in La Altagracia Province, including the Punta Cana area and in all areas of Duarte Province. No risk in resorts in the Dominican Republic, except in La Altagracia and Duarte provinces. The other Caribbean islands pictured are not malaria-risk areas. Travelers to Haiti and the risk areas of the Dominican Republic should take chloroquine to prevent malaria.

Yellow Fever

A certificate of yellow fever vaccination may be required for entry into certain areas of these countries if you are arriving from a tropical South American or sub-Saharan African country.

Other Diseases

Dengue, filariasis, and leishmaniasis are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

Schistosomiasis, a parasitic infection, is found in fresh water in parts of Antigua, the Dominican Republic, Guadeloupe, Martinique, Montserrat, Puerto Rico, and St. Lucia. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG) should be considered if travel to areas of questionable sanitation is anticipated.
• Hepatitis B, if you might be exposed to blood (for example, health-care workers) or travelers who have sexual contact with the local population, stay longer than 6 months in Haiti or the Dominican Republic, or might be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• Yellow fever, for travelers going outside urban areas in Trinidad and Tobago.
• As needed, booster doses for tetanus-diphtheria and measles. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.

All travelers should take the following precautions, no matter the destination:

• Wash hands often with soap and water.
• Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
• Don't eat or drink dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.

To stay healthy, do…

• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear whenever possible to prevent illnesses carried by insects (e.g., malaria, dengue, and leishmaniasis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and portable water filters to purify water if bottled water is not available.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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 your health care provider your travel history.

For more information:

Ask your doctor or check the CDC web sites for information about how to protect yourself against diseases that occur in the Caribbean, including the following:

Diseases carried by insects

Dengue
Malaria

Diseases carried in food or water

Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

MEXICO AND CENTRAL AMERICA

Date last revised: September 7, 2004

Traveler's Diarrhea

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

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.

Malaria risk exists in some parts of Mexico and Central America. 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

A yellow fever vaccination certificate may be required for entry into certain of these countries if you are traveling from a country in tropical South America or sub-Saharan Africa.

Other Diseases

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

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for immunizations to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• Yellow fever for travelers to Panama who will be going outside urban areas.
• As needed, booster doses for tetanus-diphtheria and measles. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you will be visiting an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
• Don't swim in fresh water. Salt water is usually safer.

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, and leishmaniasis).
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more details about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in Mexico and Central America, including the following:

Diseases carried by insects

Dengue
Malaria

Diseases carried in food or water

Escherichia coli diarrhea
Hepatitis A
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

EASTERN EUROPE

Date last revised: September 8, 2004

Traveler's Diarrhea

Food and waterborne diseases are the number one 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). Make sure your food and drinking water are safe.

Malaria

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly 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.

Other Diseases

An outbreak of diphtheria is occurring in all the states of the former Soviet Union. Travelers to these areas should be sure that their diphtheria immunization is up to date.

Tickborne encephalitis, a viral infection of the central nervous system occurs chiefly in Central and Western Europe. 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. To prevent tickborne encephalitis, as well as Lyme disease, travelers should take precautions to prevent tick bites.

Motor Vehicles

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid nighttime travel if possible and always use seat belts.

Yellow Fever

There is no risk for yellow fever in Eastern Europe and the Newly Independent States of the Former Soviet Union (NIS). 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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly 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. Hepatitis B vaccine is now recommended for all infants and for 11– to 12-year-olds who did not receive the series as infants.

To stay healthy, do…

• Wash hands often with soap and water.
• 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, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you are going to visit risk areas for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
• Protect yourself from mosquito bites
• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

To avoid getting sick…

• Don't eat food purchased from street vendors.
• Don't drink beverages with ice.
• Don't eat dairy products unless you know they have been pasteurized.
• Don't share needles with anyone.
• Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).

What you need to bring with you:

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects.
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available. See above for more information about water filters.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

After you return home:

If you have visited a malaria-risk area in Eastern Europe, 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.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in Eastern Europe and the NIS, including the following:

Diseases carried by insects

Lyme disease
Malaria

Diseases carried in food or water

Bovine spongiform encephalopathy ("mad cow disease")
Cholera
Escherichia coli diarrhea
Hepatitis A
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

---

WESTERN EUROPE

Date last revised: March 1, 2004

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.

Traveler's Diarrhea

Travelers' diarrhea, the number one illness in travelers, can be caused by viruses, bacteria, or parasites, which 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). Make sure your food and drinking water are safe.

Other Diseases

Tickborne encephalitis, a viral infection of the central nervous system, occurs chiefly in Central and Western Europe. 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.

Yellow Fever

There is no risk for yellow fever in Western Europe. 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.

Recommended Vaccines

CDC recommends the following vaccines (as appropriate for age): See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• Hepatitis A or immune globulin (IG). You are not at increased risk in Northern, Western, and Southern Europe, including the Mediterranean