TRAVEL HEALTH PROGRAM <
FEBRUARY 2018 NEWSLETTER

Check out our Healthy Travel Checklist video below- Now in French!

Healthy Travel Checklist Video - Now in French - Watch Now!

Outbreaks & Security Concerns

  • Thousands of people around the world celebrate Carnival every year and the dates vary by destination. People have fun at Carnival and Mardi Gras, but these festivities are also associated with health risks, primarily from crime, excessive drinking, unsafe food, risky sex, and heat-related illness. Travelers to Carnival should follow simple CDC recommendations for a healthy celebration in addition to safety precautions when attending mass gatherings.
  • The 2018 Winter Olympics will take place in PyeongChang, South Korea, from February 9 to February 25, 2018. The Paralympic Games are scheduled for March 9 to March 18, 2018. Travelers to the Olympics or Paralympics should follow the CDC recommendations for health and safety.

Africa

  • The Nigeria Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Laboratory-confirmed yellow fever cases have been reported in at least seven states, and a number of people have died. CDC recommends anyone 9 months or older who travels to any part of Nigeria should be vaccinated against yellow fever. In addition, Nigerian authorities require proof of yellow fever vaccination from all people one year of age or older who are traveling to Nigeria and are arriving from a country with risk of yellow fever virus transmission. Because of current limitations in the availability of yellow fever vaccine in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel.
  • In early October, World Health Organization and the Madagascar Ministry of Health responded to an unusual outbreak of plague pneumonia in widespread areas of Madagascar, including in heavily populated cities of Antananarivo (the capital city and its suburbs) and Toamasina. In late November 2017, the Madagascar Ministry of Health declared the urban outbreak of plague pneumonia had been contained. However, bubonic plague occurs nearly every year in Madagascar, so travelers to the area should continue to take precautions to protect their health including prevention of flea bites and avoiding contact with dead animals.
  • Health officials in Cape Verde have reported a substantial increase in malaria in the capital city of Praia on São Tiago Island (also known as Santiago Island). CDC now recommends that travelers to the city of Praia on São Tiago Island take prescription medicine to prevent malaria before, during, and after their trip. 
  • Health officials in South Africa have reported limited cases of locally transmitted malaria in Gauteng Province, where Johannesburg and Pretoria are located. Local transmission means that mosquitoes in the area may have been infected with malaria and are spreading it to people. Malaria is not usually found in Gauteng Province, but rare outbreaks have been reported in the past. Because malaria is spread by mosquito bites, travelers to Gauteng Province should prevent mosquito bites including using insect repellent when outdoors, wearing protective clothing, and sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net. 
  • Cases of polio have been reported in Nigeria and the Democratic Republic of the Congo. The CDC recommends that all travelers to these countries be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Africa with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Asia

  • The Year of the Dog begins on February 16, 2018, and many people will travel to Asia to celebrate the Lunar New Year. Those traveling for the Lunar New Year should follow simple CDC recommendations for staying healthy and precautions for safely attending mass gatherings.
  • The Malaysian state of Sarawak has declared parts of three divisions to be rabies infectious areas. Five human rabies cases and almost 800 cases of people being bitten by rabid animals have been reported in Serian, Sri Aman, and Kutching divisions as of July 2017. All five people infected with rabies have died. If travelers anticipate possible contact with animals such as dogs, cats, bats, or other carnivores, they should consider rabies vaccination before travel. Even if the pre-exposure rabies vaccine has been received, travelers should still get immediate medical treatment if bitten or scratched by an animal during travel.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Asia with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Caribbean, Central and South America

  • Public health officials in Brazil have reported an outbreak of locally transmitted malaria in the town of Wenceslau Guimarães in Bahia State. At this time, CDC recommends that travelers to Wenceslau Guimarães take medicine to prevent malaria. All travelers to Brazil should also prevent mosquito bites by using insect repellent and wearing protective clothing when outdoors, and sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net.
  • In early 2017, the Brazilian Ministry of Health reported outbreaks of yellow fever in several eastern states including areas where yellow fever was not traditionally considered to be a risk. In mid-2017 there was a decrease in the virus spread, but cases have reappeared in several states. The World Health Organization has expanded the list of areas where yellow fever vaccination is recommended. Most recently, the city of São Paulo was added. In addition to areas in Brazil where yellow fever vaccination has been recommended since before the recent outbreaks, it is now also recommended for people who are traveling to or living in all of Espirito Santo State, all of Rio de Janeiro State, including the city of Rio de Janeiro, all of São Paulo State, including the entire city of São Paulo and a number of cities in Bahia State. Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever vaccine provider well in advance of travel.
  • Beginning on September 6, 2017, Hurricane Irma crossed the Caribbean, followed on September 16 by Hurricane Maria. These storms caused severe damage in a number of countries and territories, including Anguilla, Barbuda, the British Virgin Islands, Dominica, the Dominican Republic, Haiti, Puerto Rico, Saint Martin, Sint Maarten, and the US Virgin Islands. The extent of destruction across these countries and territories varies. Significant damage from the hurricanes has caused problems with water supplies, sanitation, food supply, electricity, transportation, shelter, communications, security, medical care, and mosquito control. Post-hurricane environmental conditions including contaminated drinking water and reduced access to safe water, food and shelter in some areas may pose an increased risk for the spread of infectious diseases. Potential visitors should postpone travel to severely affected areas. 
  • Three natural disasters in Mexico caused severe damage, injuries and deaths this fall. On September 7, 2017, an 8.1-magnitude earthquake struck the southwestern states of Oaxaca, Chiapas, and Tabasco, causing nearly 100 deaths. The next day, September 8, 2017, Category 1 Hurricane Katia made landfall on the eastern coast in Veracruz, causing a mudslide that resulted in several deaths. On September 19, a 7.1-magnitude earthquake struck the state of Puebla, about 75 miles from Mexico City. In addition to safety hazards caused by debris and unstable buildings, there may be problems with sanitation, food supply, electricity, transportation, shelter, communications, security, and medical care. US residents should postpone travel to severely affected areas. Those who must travel, including those who are traveling for humanitarian aid work, should adhere to recommendations for preventing illness and injury, avoiding bug bites, and following food and water safety precautions. 
  • Check the World Map of Areas with Risk of Zika to find out about countries in the Caribbean, Central and South America with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Europe

  • In addition to ItalyFrance, Ukraine, Greece and England, health officials have now reported an outbreak of measles in Serbia. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles. Before departure from the United States, infants (6 through 11 months of age) should have 1 dose of MMR vaccine, and adults and children over 1 year of age should have 2 doses of MMR vaccine separated by at least 28 days.
  • Italy has reported limited local transmission of malaria in the town of Ginosa in the Apulia region. Local transmission means that mosquitoes in the area may have been infected with malaria and are spreading it to people. Italy had been declared free of malaria by the World Health Organization in 1970. However, the mosquitoes that transmit malaria are present. Travelers should take steps to avoid mosquito bites.
  • Three cases of Plasmodium vivax malaria have been reported in UK residents who traveled to Esentepe (also known as Agios Amvrosios) in the Kyrenia District in Northern Cyprus. Cyprus was certified as malaria-free in 1967, and since then, there have been no reports of malaria in Cyprus until now. However, the mosquitoes that spread malaria are found in the area. CDC recommends that travelers to Esentepe (Agios Amvrosios) take medicine to prevent malaria. Effective options include atovaquone-proguanil, chloroquine, doxycycline, mefloquine, and primaquine. 
  • The World Health Organization (WHO) has reported locally transmitted cases of chikungunya in three areas of Italy: Rome, the coastal area of Anzio (about 30 miles south of Rome), and the city of Latina (about 15 miles east of Anzio). Local transmission means that mosquitoes in those areas of Italy have been infected with chikungunya and are spreading it to people. Travelers should take steps to avoid mosquito bites.
Middle East
  • Cases of vaccine-derived polio have been reported in Syria. Most cases have been reported in Mayadeen District, in Dayr az Zawr Province. CDC recommends that all travelers to Syria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.

Pacific Islands

  • Check the World Map of Areas with Risk of Zika to find out about Pacific Islands with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Traveler Health & Safety Tips

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The CDC recommends all travelers:

  • Visit a health care provider, ideally, 4 to 6 weeks before their trip for personalized health advice, vaccines, and medications.
  • Avoid bites from mosquitoes and other bugs by using an insect repellent and wearing long-sleeved shirts, long pants, closed shoes, and hats as much as possible.
  • Stay safe around animals. Do not pet, handle, or feed unfamiliar animals, even pets.
  • Be safe on international roads. Avoid overcrowded buses and cars, always wear a seat belt, and wear a helmet when riding a bike or motorcycle.
  • Wash their hands often with soap and water and use a hand sanitizer, as needed.

Current Zika Virus Recommendations

  • Check the World Map of Areas with Risk of Zika before you travel.
  • The recommendations for travelers to areas with risk of Zika are:
    • CURRENT PREGNANCY: Women who are pregnant (in any trimester) should not travel to areas with risk of Zika. Men who have traveled to an area with risk of Zika who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sexual intercourse for the duration of the pregnancy. 
    • MOSQUITO AVOIDANCE: Prevent mosquito bites while traveling to areas with Zika virus transmission, and for three weeks after returning to the U.S.
    • PLANNING PREGNANCY: If you or your partner are trying to get pregnant, consider avoiding travel to areas with a CDC Zika travel notice. Women should wait at least eight weeks after travel before trying to get pregnant. Men should either consistently and correctly use condoms during sexual intercourse or not have sexual intercourse for at least six months after travel to an area with Zika virus transmission. 
    • SYMPTOMS AFTER TRAVEL: Zika virus testing should be offered to people with symptoms of Zika virus disease, including pregnant women and others who develop symptoms during or following travel.

Resources

This email distribution tool is supported by funding from grant U01CK000175 of the U.S. Centers for Disease Control and Prevention (CDC) to the Massachusetts General Hospital. The tool attempts to capture up-to-date notices and alerts at the time of posting; however, components of this information are constantly changing. By using this tool, you agree that the Massachusetts General Hospital and tool developers/supporters are not liable for any adverse outcomes, including those relating to travel.

 

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