TRAVEL HEALTH PROGRAM
OCTOBER 2017 NEWSLETTER

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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 nonessential 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.

Outbreaks & Security Concerns

Africa

  • 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 above on how to prevent Zika virus infection when traveling to these countries.
  • Cases of polio have been reported in Nigeria.  The CDC recommends that all travelers to Nigeria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
  • Cases of polio have been reported in the Democratic Republic of the Congo.  The CDC recommends that all travelers to the Democratic Republic of the Congo be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
  • A pneumonic and bubonic plague outbreak has been reported in Madagascar, including in Antananarivo (the capital city and its suburbs) and Toamasina. CDC recommends that travelers to Madagascar should use insect repellent to prevent flea bites and avoid close contact with sick or dead animals. Travelers should also avoid close contact with ill people, especially those with cough or pneumonia. Plague can be prevented with antibiotics. Travelers who have had close contact with people with plague pneumonia or other high-risk exposures should immediately notify a health care provider. Exposed individuals may need to take antibiotics to prevent plague. During or after travel to Madagascar, travelers should be alert for symptoms of plague, and if they appear, seek medical care and inform the provider about their travel to Madagascar.

Asia

  • 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 above on how to prevent Zika virus infection when traveling to these countries.
  • Since the monsoon season began in August 2017, widespread flooding in Bangladesh, India, and Nepal has affected more than 40 million people. The floods have damaged crops and livestock, destroyed more than 100,000 homes, and caused more than 1,200 deaths. Water is still waist-deep in some areas, and more rain is expected. Monsoon season typically lasts through September. The extent of destruction across these countries differs, but all three countries are having problems with sanitation, food supply, electricity, transportation, shelter, communications, security, and medical care. US residents should postpone travel to affected areas. There are serious health and safety risks, medical care may not be available, and visitors could further strain limited local resources. 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. 
  • 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 your activities will bring you into contact with animals such as dogs, cats, bats, or other carnivores, you should consider rabies vaccination before travel. Even if you get the pre-exposure rabies vaccine, you should still get immediate medical treatment if you are bitten or scratched by an animal during travel.

Caribbean, Central and South America

  • Hurricanes Irma and Maria have caused severe damage in a number of countries and territories, including Anguilla, Antigua and Barbuda, the Bahamas, the British Virgin Islands, Cuba, Dominica, the Dominican Republic, Guadeloupe, Haiti, Martinique, Puerto Rico, Saint Barthelemy, Saint Martin, Sint Maarten, Turks and Caicos, and the US Virgin Islands. The extent of destruction across these countries and territories varies, with many areas flooded and inaccessible. Significant damage from the hurricane has caused problems with water supplies, sanitation, food supply, electricity, transportation, shelter, communications, security, medical care, and mosquito control. US residents should postpone travel to severely affected areas because serious health and safety risks may be present and medical care may be limited or unavailable. Postponing travel to these areas would also prevent further straining already limited local resources. 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. 
  • Three recent natural disasters have caused severe damage, injuries, and deaths in Mexico. 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. There are serious health and safety risks, medical care may not be available, and visitors could further strain limited local resources. 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 above on how to prevent Zika virus infection when traveling to these countries.
  • An ongoing outbreak of yellow fever has been reported in Brazil as of December 2016. Health authorities have expanded the list of areas in which yellow fever vaccination is recommended for travelers Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever provider well in advance of travel.

Europe

  • 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. 
  • Health officials in France have reported an outbreak of measles. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • 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.

North America

  • Brownsville, Texas was previously designated as a Zika cautionary area, but that designation was removed on August 29, 2017. This means that there are no longer any travel recommendations related to Zika virus for Brownsville, Texas. Although the level of risk of Zika virus transmission after a cautionary area is lifted is not known, it is likely to be low. However, sporadic cases may still occur in Brownsville or the surrounding areas (e.g., Lower Rio Grande Valley). For this reason, CDC recommends that people living in or traveling to Brownsville and the southernmost areas of the state continue to protect themselves from mosquito-borne illnesses. Please refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection.
  • Miami-Dade County was previously designated as a Zika cautionary area, but that designation was removed on June 2, 2017. This means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida. Although the level of risk of Zika virus transmission after a cautionary area desgination is removed is not known, it is likely to be low. However, sporadic cases may still occur. For this reason, CDC recommends that people living in or traveling to Miami-Dade County continue to protect themselves from mosquito-borne illnesses.

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 above 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.

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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