CDC's International Traveler's Health Information
Geographic Health Recommendations

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

CENTRAL AFRICA
Date last revised: January 5, 2004
EAST AFRICA
Date last revised: January 5, 2004
NORTH AFRICA
Date last revised: January 5, 2004
SOUTHERN AFRICA
Date last revised: January 5, 2004
WEST AFRICA
Date last revised: January 5, 2004
EAST ASIA
Date last revised: January 30, 2004
SOUTHEAST ASIA
Date last revised: January 28, 2004
AUSTRALIA AND THE SOUTH PACIFIC
Date last revised: January 5, 2004
CARIBBEAN
Date last revised: January 5, 2004
MEXICO AND CENTRAL AMERICA
Date last revised: January 5, 2004
EASTERN EUROPE
Date last revised: January 5, 2004
WESTERN EUROPE
Date last revised: January 5, 2004
INDIAN SUBCONTINENT (SOUTH ASIA)
Date last revised: January 5, 2004
MIDDLE EAST
Date last revised: January 5, 2004
NORTH AMERICA
Date last revised: January 2, 2004
TEMPERATE SOUTH AMERICA
Date last revised: January 5, 2004
TROPICAL SOUTH AMERICA
Date last revised: January 5, 2004

CENTRAL AFRICA
Date last revised: January 5, 2004

Outbreaks

Poliomyelitis Africa: Togo, Burkina Faso, Ghana, and Chad
(Released October 23, 2003; Updated November 4, 2003)

According to the World Health Organization (WHO), there have been two confirmed cases of paralytic poliomyelitis due to type 1 poliovirus reported from Mayo-Kebbi and Logone Orientale provinces of southern Chad, near the border with Nigeria, Cameroon, and Central African Republic. These polio cases are the first reported from Chad since June 2000.

Togo, Burkina Faso, and Ghana were declared polio-free in recent years, but since they border countries where poliovirus transmission has continued, there is a high risk for passing along the virus. It is recommended that all infants and children 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 are unvaccinated or unsure of their vaccination status should receive IPV. For more information about polio and polio vaccine, see these websites:

http://www.cdc.gov/travel/diseases/polio.htm

http://www.cdc.gov/nip/menus/diseases.htm#polio

Yellow Fever: West and Central Africa
(Released October 23, 2003)

Since January 2003, the World Health Organization (WHO) has reported yellow fever cases from several West African countries and southern Sudan. From August through September, there have been 90 cases of yellow fever, including 10 deaths, in the seven districts in Sierra Leon

For more information on Yellow Fever, see: http://www.cdc.gov/travel/diseases/yellowfever.htm

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 (see meningitis map), 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 wellscreened 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.
• 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 to1 year), you should seek immediate medical attention and should tell the physician your travel history.

For more information:

Ask your doctor or check CDC websites 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

EAST AFRICA
Date last revised: January 5, 2004

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

Travelers' 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 (see meningitis map) 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 wellscreened 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.
• 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 to1 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 websites 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: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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 wellscreened 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.
• 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 websites 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: January 5, 2004

Countries in this region: Botswana, Lesotho, Namibia, South Africa, St. Helena (U.K.), Swaziland, Zimbabwe

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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 wellscreened 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.
• 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 to1 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 websites 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: January 5, 2004

Countries in this region: Benin, Burkina Faso, Cape Verde islands, Côte d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, São Tomé and Príncipe, Senegal, Sierra Leone, Togo

Outbreaks

Poliomyelitis Africa: Togo, Burkina Faso, Ghana, and Chad
(Released October 23, 2003; Updated November 4, 2003)

According to the World Health Organization (WHO), two confirmed cases of paralytic poliomyelitis due to type 1 poliovirus have been reported from Mayo-Kebbi and Logone Orientale provinces of southern Chad, near the border with Nigeria, Cameroon, and Central African Republic. These polio cases are the first reported from Chad since June 2000.

Togo, Burkina Faso, and Ghana were declared polio-free in recent years, but because they border countries where poliovirus transmission is ongoing, there is a high risk for importation of cases.

The Centers for Disease Control and Prevention (CDC) recommends that all infants and children 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 are unvaccinated or unsure of their vaccination status should receive IPV.

For more information about polio and polio vaccine, see these websites:

http://www.cdc.gov/travel/diseases/polio.htm

http://www.cdc.gov/nip/menus/diseases.htm#polio

Yellow Fever: West and Central Africa
(Released October 23, 2003)

Since January 2003, the World Health Organization (WHO) has reported yellow fever cases from several West African countries and southern Sudan. From August through September, 90 cases of yellow fever, including 10 deaths, were reported from seven in Sierra Leone.

For more information on Yellow Fever, see:

http://www.cdc.gov/travel/diseases/yellowfever.htm

Travelers' 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 wellscreened 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.
• 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 websites 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 30, 2004

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

Outbreaks

Outbreak Notice: Avian Influenza, Asia
(Updated January 30, 2004; Released January 28, 2004)

According the World Health Organization (WHO), on January 26, 2004, the Ministry of Health of Thailand announced 3 confirmed cases of avian influenza A (H5N1) in children; two of the patients have died. Two of the cases were from Suphanburi and Kanchanaburi provinces in Central Thailand, while the third case was from Sukhothai, a province further north.

In recent months, Vietnam has reported hospitalized cases of serious respiratory illness, primarily among children, most of whom have died. Eight of these patients were confirmed as having avian influenza A (H5N1), and 6 of the confirmed cases have been fatal. Two cases occurred in Ho Chi Minh City in the southern region of Vietnam, and 6 cases have occurred in Hanoi, a city in the north.

No definitive evidence has been found thus far of human-to-human transmission; no H5N1 infections have been documented among health-care workers. While it is unusual for people to get influenza infections directly from animals, such transmission has been documented several times in recent years. For information about previous avian influenza outbreaks, see http://www.cdc.gov/flu/about/avianflu.htm.

Advice for Travelers

• With all international travel, consult a health-care provider 4-6 weeks before travel for any necessary vaccines, medications, and additional advice.
• Currently, CDC does not recommend restrictions for travel to any of the countries affected by avian influenza A (H5N1).
• Travelers to regions experiencing outbreaks of this disease in poultry should avoid areas with live poultry, such as live animal markets and poultry farms. Large amounts of the virus are known to be excreted in the droppings from infected birds.
• Influenza viruses are destroyed by heat; therefore all foods from poultry, including eggs, should be thoroughly cooked.
• As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission.
• This notice will be updated as information becomes available. For more information on influenza, see the CDC Influenza site at http://www.cdc.gov/flu/.

Severe Acute Respiratory Syndrome

At this time, WHO and CDC have not issued any alerts or advisories for travel to China (www.cdc.gov/ncidod/sars/travel_alertadvisory.htm). Previous SARS research has shown that SARS can be controlled and contained through early detection, isolation of suspect cases, and tracing of their contacts.

On the basis of limited available data, it would be prudent for travelers to China to avoid visiting live food markets and avoid direct contact with civets and other wildlife from these markets. Although there is no evidence that direct contact with civets or other wild animals from live food markets has led to cases of SARS, viruses very similar to SARS-CoV—the virus that causes SARS—have been found in these animals. In addition, some persons working with these animals have evidence of infection with SARS-CoV or a very similar virus.

For additional information about the reported SARS cases in China, see the Websites of CDC (www.cdc.gov/sars) and WHO (www.who.int/en/).

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.

Travelers' 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.

High Altitude Conditions

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.

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.
• 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.
• Travelers visiting undeveloped areas should take the following precautions:

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 wellscreened 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.
• 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 websites 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 28, 2004

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

Outbreaks

Outbreak Notice: Avian Influenza, Asia
(Updated January 30, 2004; Released January 28, 2004)

According the World Health Organization (WHO), on January 26, 2004, the Ministry of Health of Thailand announced 3 confirmed cases of avian influenza A(H5N1) in children; two of the patients have died. Two of the cases were from Suphanburi and Kanchanaburi provinces in Central Thailand, while the third case was from Sukhothai, a province further north.

In recent months, Vietnam has reported hospitalized cases of serious respiratory illness, primarily among children, most of whom have died. Eight of these patients were confirmed as having avian influenza A(H5N1), and 6 of the confirmed cases have been fatal. Two cases occurred in Ho Chi Minh City in the southern region of Vietnam, and 6 cases have occurred in Hanoi, a city in the north.

No definitive evidence has been found thus far of human-to-human transmission; no H5N1 infections have been documented among health-care workers. While it is unusual for people to get influenza infections directly from animals, such transmission has been documented several times in recent years. For information about previous avian influenza outbreaks, see http://www.cdc.gov/flu/about/avianflu.htm.

Advice for Travelers

With all international travel, consult a health-care provider 4-6 weeks before travel for any necessary vaccines, medications, and additional advice.

Currently, CDC does not recommend restrictions for travel to any of the countries affected by avian influenza A (H5N1).

Travelers to regions experiencing outbreaks of this disease in poultry should avoid areas with live poultry, such as live animal markets and poultry farms. Large amounts of the virus are known to be excreted in the droppings from infected birds.

Influenza viruses are destroyed by heat; therefore all foods from poultry, including eggs, should be thoroughly cooked.

As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission.

This notice will be updated as information becomes available. For more information on influenza, see the CDC Influenza site at http://www.cdc.gov/flu/.

Travelers' 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 wellscreened 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.
• 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 websites 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: January 5, 2004

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

General

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.

Travelers' 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.
• Travelers visiting undeveloped areas should take the following precautions:

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 wellscreened 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.
• 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 websites 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: January 5, 2004

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

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.

Travelers' 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. Travelers to rural areas of the Dominican Republic, especially in the provinces bordering Haiti, are at risk for malaria. No risk in resorts in the Dominican Republic. The other Caribbean islands pictured are not malaria-risk areas. Travelers to Haiti and rural 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.
• Travelers visiting undeveloped areas should take the following precautions:

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 wellscreened 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.
• 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. See 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 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 to1 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 websites 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: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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 wellscreened 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.
• 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 to1 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 websites 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: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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.

Tick-borne 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 wellscreened 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.
• 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 websites 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: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

General

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.

Travelers' 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

Tick-borne 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 tick-borne 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 regions of Italy and Greece.
• 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 Southern Europe, or be exposed through medical treatment.
• As needed, booster doses for tetanus-diphtheria. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete 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.
• 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. (Travelers to Western Europe should also see the information on Bovine Spongiform Encephalopathy ["Mad Cow Disease"] and New Variant Creutzfeldt-Jakob Disease [nvCJD].)

Travelers to rural or undeveloped areas should take the following precautions:

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.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Protect yourself from mosquito bites:
  • Pay special attention to mosquito protection between dusk and dawn.
  • 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 wellscreened 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.
• 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. Do not drink beverages with ice.
• 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:

• 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 Food and Water Precautions and Travelers' Diarrhea Prevention and Risks from Food and Drink 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 become ill after your trip—even as long as a year after you return—tell your doctor where you have traveled.

For more information:

Ask your doctor or check the CDC websites for more information about how to protect yourself against diseases that occur in Western Europe, including the following:

Diseases carried by insects

Lyme disease

Diseases carried in food or water

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

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

INDIAN SUBCONTINENT (SOUTH ASIA)
Date last revised: January 5, 2004

Countries in this region: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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.

Travelers to malaria-risk areas, including infants, children, and former residents of the Indian Subcontinent, should take an antimalarial drug. NOTE: Chloroquine is NOT an effective antimalarial drug in the Indian Subcontinent and should not be taken to prevent malaria in this region. For additional information on malaria risk and prevention, see Malaria Health Information for Travelers to the Indian Subcontinent.

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.

High Altitude

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

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 the Indian Subcontinent. A certificate of yel low 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.
• 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. There have been recent reports of typhoid drug resistance in India and Nepal.
• As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. 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 are going to visit areas 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 wellscreened 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.
• 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).
• 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 (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 websites for more information about how to protect yourself against diseases that occur in the Indian Subcontinent, including the following:

Diseases carried by insects

Dengue
Japanese encephalitis
Malaria
Plague

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

MIDDLE EAST
Date last revised: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

General

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

Travelers' 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 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 the Middle East, should take an antimalarial drug. Travelers to some areas of Iran, Iraq, Oman, Saudi Arabia, the Syrian Arab Republic, Turkey, and Yemen may be at risk for malaria. There is no risk of malaria in Bahrain, Cyprus, Israel, Jordan, Kuwait, Lebanon, Qatar, and the United Arab Emirates.

Chloroquine is the recommended antimalarial drug for Iraq, Syria, and Turkey.

Travelers to Iran, Saudi Arabia, and Yemen should take one of the following antimalarial drugs: (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).

In Oman, the risk of malaria is in the Musandam Province only; because the risk is very limited, no antimalarial drug is needed in this area.

Other Diseases

Dengue, filariasis, leishmaniasis, onchocerciasis, and plague 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 the Middle East. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa.

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 vaccine is required for pilgrims to Mecca for the annual Hajj. However, CDC currently recommends the vaccine for all travelers to Mecca, including those traveling for the Umra.
• 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, 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 have not completed the series.

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.

Travelers visiting undeveloped areas should take the following precautions:

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 wellscreened 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.
• 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 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 (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 websites for more information about protecting yourself against diseases that occur in the Middle East, 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

NORTH AMERICA
Date last revised: January 2, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

General

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

Communicable Diseases

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

Other Diseases

Certain diseases occasionally occur, such as plague, rabies in wildlife, including bats, Rocky Mountain spotted fever, tularemia, arthropod-borne encephalitis, and seasonal outbreaks of influenza. The comprehensive CDC Influenza site answers questions raised about this 2003-2004 influenza season.

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

Immunization Requirements

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

BSE/Mad Cow Diseases

Isolated cases of bovine spongiform encephalopathy (BSE/mad cow disease) have been reported in Canada and the United States. For more information, see http://www.cdc.gov/ncidod/diseases/cjd/cjd.htm and http://www.usda.gov.

More information on health issues and outbreaks in Canada can be found on the Canadian Laboratory Centre for Disease Control website at http://www.hc-sc.gc.ca/pphbdgspsp/

TEMPERATE SOUTH AMERICA
Date last revised: January 5, 2004

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

Outbreaks

Please check the Center for Disease Control website (http://www.cdc.gov/travel/) for important updates on this region and other important information of the health topics listed in this article.

Travelers' 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 some provinces of Argentina. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.

In Argentina, you are at risk for malaria only in rural areas in the northern provinces bordering Bolivia and Paraguay. In Chile, the Falkland Islands, and Uruguay, there is no risk for malaria.

Yellow Fever

A certificate of yellow fever vaccination is not required for entry into the countries in this region.

Other Diseases

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

High Altitude

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

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).
• 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 vaccination is recommended only if you are traveling outside urban areas in Argentina.
• 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 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 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 wellscreened 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.
• 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 (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 in Argentina, continue taking your chloroquine for 4 weeks after leaving the risk area.

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

For more information:

Ask your doctor or check the CDC websites for more information about how to protect yourself against diseases that occur in Temperate South America, including the following:

Diseases carried by insects

Dengue
Malaria

Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Typhoid fever

Diseases from person-to-person contact

Hepatitis B
HIV/AIDS

TROPICAL SOUTH AMERICA
Date last revised: January 5, 2004

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

Outbreaks

Yellow Fever Outbreak, Colombia
(Updated January 23, 2004; Released October 23, 2003)

On January 22, 2004, the Colombian Ministry of Social Protection reported 16 new confirmed cases of yellow fever and 8 deaths, bringing the total number of confirmed cases to 27 since December 28, 2003. In addition, there are several hospitalized patients with suspected yellow fever who recently visited Sierra Nevada de Santa Marta, a popular tourist area along the Caribbean coast. One of the eight reported deaths was a 16-year-old boy who had visited Tayrona Park, also on the Caribbean coast.

Beginning in July 2003, there was an outbreak of yellow fever in five Latin America countries, including Colombia. That outbreak began to wane in mid-November; however, in the last two weeks of December, new cases were identified in the Colombian departments of Guajira, Magdalena, and Cesar; departments where Sierra Nevada and Tyrona parks are located. All three departments are located in historically endemic areas of the country. In addition, on January 8, 2004, the Pan American Health Organization (PAHO) confirmed the presence of a yellow fever epizootic among monkeys in Los Bestos Ecological Park, in Cesar, Colombia. The government of Colombia, with assistance from PAHO, has responded to the outbreak by conducting a mass vaccination campaign, instituting vector control measures, and establishing a national public information hotline.

For more information on yellow fever, see:

http://www.cdc.gov/travel/diseases/yellowfever.htm

Travelers' 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 universally 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 South America, should take an antimalarial drug.

Chloroquine is the recommended drug for Paraguay.

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

Yellow Fever

A certificate of yellow fever vaccination may be required for entry into certain of these countries.

High Altitude

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

Other Diseases

Dengue, filariasis, leishmaniasis, onchocerciasis, and American trypanosomiasis (Chagas disease) are other 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 >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.
• Yellow fever vaccination, if you will be traveling 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 complete the series as infants.

To stay healthy, do...

• Wash hands frequently 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 wellscreened 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.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use 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 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 for more information about how to protect yourself against diseases that occur in Tropical South America, 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