TRAVEL HEALTH PROVIDER INITIATIVE
OCTOBER 2018 NEWSLETTER
PREP: An Interactive Tool For The Clinician

Every year, unvaccinated travelers become infected with measles while they are in other countries and bring it back into the United States. Measles is highly contagious and can spread to people who are not protected against the disease, including those that are too young or have specific medical conditions preventing them from getting the vaccine. Currently, there are more measles cases than usual in some countries to which Americans often travel and therefore more measles cases are coming into the United States. The importation of measles to the U.S. can cause outbreaks in communities with unvaccinated people. There are known ongoing measles outbreaks in Africa, Asia, Europe and South America. CDC recommends travelers protect themselves, their families, and their communities with the measles-mumps-rubella (MMR) vaccine, especially before traveling internationally.


Protect yourself from measles.

Updates, Outbreaks & Security Concerns

Africa
  • An outbreak of Ebola has been reported in North Kivu (Kivu Nord) province in the Democratic Republic of the Congo. Travelers should take precautions to avoid contact with the blood and bodily fluids of infected individuals. The risk to most travelers is low. Those at highest risk of acquiring Ebola are family and friends caring for the sick and healthcare workers. This part of the country is 780 miles from the most recent outbreak and is identified as a "reconsider travel" zone by the U.S. State Department due to armed group activity and major outbreaks of violence targeting civilians.
  • There are currently outbreaks of polio in Somalia, Nigeria and the Democratic Republic of the Congo. The CDC recommends that all travelers to these countries be vaccinated against polio. Additionally, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine before travel. Long term travelers to Somalia (greater than 4 weeks) may be required to show proof of polio vaccination.
  • There is an outbreak of Rift Valley Fever (RVF) in Kenya. The outbreak has been confirmed in the countries of Wajir, Marsabit and Siaya. Travelers should avoid exposure to animals, animal blood and mosquito bites.
  • There is a severe water shortage in Cape Town, South Africa. Dam levels are extremely low. The city has implemented water restrictions of 50 liters of water per person per day (a little over 13 gallons). Travelers should reduce shower times to 90 seconds, avoid flushing toilets unless necessary, carry alcohol-based hand sanitizer for hand hygiene and should familiarize themselves with the most up to date water restrictions and recommendations for reducing water use.
  • Health officials have reported several cases of measles in the Democratic Republic of the Congo. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • The Nigeria Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Cases have been reported in at least seven states, and multiple 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.
  • 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
  • Health officials in Pakistan have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid that does not respond to most antibiotics. All travelers to Pakistan are at risk of acquiring typhoid fever, but those visiting friends and relatives are at highest risk.Travelers should receive the typhoid vaccine before departure to Pakistan and should take extra care to follow food and water guidelines as recommended by the CDC.
  • Health officials have reported an outbreak of measles in the Philippines and Indonesia. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • The Malaysian state of Sarawak has declared parts of three divisions to be rabies infectious areas. Travelers who anticipate contact with animals such as dogs, cats, bats, or other carnivores 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
  • There has been a breakdown of the medical infrastructure in Venezuela. There are shortages of food, water, electricity, medicine, and medical supplies that have contributed to an increasing humanitarian crisis affecting much of the country. Adequate health care is not available through the public health system. For this reason, in addition to crime and civil unrest, the US government has limited ability to provide emergency services to US citizens. Infectious diseases are on the rise, and several large outbreaks are occurring including measles, diphtheria and malaria. CDC recommends that travelers avoid all non-essential travel to Venezuela. Travelers that must go to Venezuela should protect themselves by following CDC recommendations. For more information, visit the Department of State Travel Advisory for Venezuela.
  • There is an outbreak of measles in Brazil. Over 5,000 cases have been reported in the states of Amazonas and Roraima. CDC recommends that travelers to Brazil, and the state of Amazonas in particular, should be fully vaccinated against measles.
  • There is a large, ongoing outbreak of yellow fever in multiples states of Brazil. Since early 2018, several unvaccinated travelers to Brazil have contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State). It is now recommended that travelers receive the yellow fever vaccine if visiting 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 yellow fever vaccine shortage in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel. People who have never been vaccinated against yellow fever should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.
  • 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 Middle East
  • MERS (Middle East Respiratory Syndrome) continues to be identified in multiple countries in the Arabian Peninsula. It is not clear how people are exposed to the virus, but evidence of transmission to humans from direct contact with camels has been steadily increasing. CDC does not recommend travelers change their plans due to MERS, but those that are concerned should discuss it with their doctor prior to departure. Travelers should follow CDC recommendations for preventing the spread of MERS.
  • 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

  • An outbreak of polio has been reported in Morobe Province, Papua New Guinea. Adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine before travel. CDC recommends that all travelers to Papua New Guinea be fully vaccinated against polio.
  • 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 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 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 three 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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