Download Time to Travel? or living in a hub country?

Time to Travel?
or living in
a hub country?
Protect yourself!
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Travelling abroad to foreign countries
whether on business or holiday is a
great experience. However, hygiene
and health conditions vary from
place to place and some places
present greater risks of developing
diseases that may be uncommon in
your home country.
Protect yourself against these key diseases
and enjoy your trip with a greater peace of
mind. Today, you can protect yourself against:
50-100 times more
infectious than HIV.8
• Hep B is
• In 2006, an estimated 290,000
people worldwide died of
tetanus.18
• In Singapore, >90% of children
and young adults below 25 years
old are at risk of Hepatitis A if
exposed to the virus.5
• An estimated 22 million cases
of typhoid fever and 200,000
related deaths occur worldwide
each year.6
Quick Facts on
the diseases
Hepatitis A
What is it?1
Hepatitis B
What is it?
The most common infection of the liver, and is caused by
Hepatitis B virus. It can lead to complications like:7
A viral infection that causes the liver to become enlarged,
inflamed and tender.
• Chronic hepatitis (permanent liver inflammation)
• Liver cirrhosis (permanent scarring and hardening of
the liver)/liver failure/liver cancer
Severity of disease range from a mild illness lasting a few
weeks to a severe illness lasting several months.1
How is it transmitted?
How is it transmitted?
1
• The virus is found in the stools of people infected
with the virus.
• Person-to-person
• Ingestion of contaminated food and water.
• Cold cuts, fruits and fruit juices, vegetables, salads,
undercooked shellfish and iced drinks
• Shellfish and salads are the most frequent sources.
What are the symptoms?2
Persons infected with the virus may not exhibit any symptoms.
If symptoms are present they may include:
• Dark urine
• Vomiting
• Fever
• Pale Coloured Stools
• Tiredness
• Abdominal discomfor t
• Loss of appetite
• Joint Pain
• Nausea
• Yellowing of the skin and
eyes (jaundice)
Who is at risk?3
• Anyone who have not been infected or
vaccinated previously can contract
hepatitis A.
• Other risk factors for the virus include:
• Injecting drugs
• living in a household with an infected
person, or being a sexual par tner of
someone with acute Hepatitis A infection.
• People who travel extensively can
impor t the infection.4
• Transmitted through contact with the blood or other
body fluids (i.e. semen and vaginal fluid) of an infected
person.
• Injecting drug use.
• HBV is a major infectious occupational hazard of health
workers (HBV is not spread by contaminated food or
water, and cannot be spread casually in the workplace.)
What are the symptoms?7-9
• Acute Symptoms: Jaundice, dark coloured urine,
abdominal pain, nausea & vomiting.
• Hepatitis B can also case a chronic liver infection that can
later develop into cirrhosis of the liver or liver cancer.
Who is at risk?
Situations or activities that may carry increased risk for HBV
infection for travelers while overseas include the following:6
• Travel to countries with moderate to high rates of
Hepatitis B
• An injury or illness that requires invasive medical
attention (e.g. injection, IV drip, transfusion, stitching)
• Dental treatment
• Unprotected sexual contact
• Sharing illegal drug injection equipment
• Skin-perforation practices (e.g. tattooing,
ear piercing, acupuncture)
• Cosmetic practices with risk for skin
perforation (e.g. manicure/pedicure)
• Sharing personal grooming items
(e.g. earrings, toothbrush, razor)
Quick Facts on the diseases
Seasonal
Influenza
(commonly known as “the flu”)
What is it?
• A viral infection of the
respiratory tract.
• At times, the infection can lead to
complications and even death.10
How is it transmitted?10,11
Typhoid Fever
What is it?
A life threatening illness, caused by Salmonella Typhi.
Serious complications of typhoid fever include mainly intestinal
hemorrhage or perforation, which can be life threatening.6
How is it transmitted?6
• Persons with typhoid fever carry the bacteria in their
bloodstream.
• The bacterium is usually spread
through contaminated
food and water.
• Through respiratory droplets when an infected person
coughs, sneezes, or speaks.
• The virus can also be spread indirectly when a person
touches a surface with flu viruses on it (for example, a door
knob) and then touches his or her nose or mouth.
What are the symptoms?6,10
Influenza typically has a sudden onset with headache, chills and
coughs, followed rapidly by a fever, appetite loss, muscle aches and
tiredness.
Severe cases of influenza can lead to pneumonia and other
complications such as bronchitis, sinusitis, ear infection and
meningitis10 (inflammation of the lining that covers the brain).
Who is at risk?6
• The risk for exposure to seasonal influenza during international
travel depends on the time of year and destination.
• Older people, young children, people with weakened immune
system, or those with hear t and lung diseases are at a higher risk.
• For protection against influenza, travelers should talk to
their doctors at least 1-2 weeks before depar ture.
What are the symptoms?13
• Sudden onset of sustained fever, severe headache, nausea,
loss of appetite, constipation or sometimes diarrhoea.
• In severe cases, mental dullness and meningitis are
common symptoms.
Who is at risk?6
Risk is greatest for travelers to South Asia (6 to 30 times higher
than all other destinations). Other areas of risk include East and
Southeast Asia, Africa, the Caribbean, and Central and South
America.
• The risk of acquiring typhoid fever increases with the
duration of stay but travelers have acquired typhoid fever
even during visits of less than 1 week.
Quick Facts on the diseases
Malaria
What is it?15
• Malaria is a life-threatening
mosquito-borne disease.
• Most malaria cases and deaths
occur in sub-Saharan Africa.
However, Asia, Latin America, and
to a lesser extent the Middle East and par ts of Europe
are also affected.
How is it transmitted?15
• Transmitted to humans through the bite of infected
mosquitoes.
What are the symptoms?15
• The first symptoms – fever, headache, chills and vomiting –
may be mild and difficult to recognize as malaria.
• If not treated within 24 hours, malaria can progress to
severe illness often leading to death.
• Children in endemic areas with severe disease frequently
develop severe anaemia, respiratory distress, or cerebral
malaria.
• In adults, multi-organ involvement is also frequent.
Who is at risk?15
• International travellers from non-endemic areas are at high
risk of malaria because they lack immunity.
• Non-immune/semi-immune pregnant women are at risk as
malaria causes high rates of miscarriage and maternal
death. An estimated 200 000 infants die annually as a result
of malaria infection during pregnancy.
• People with HIV/AIDS are at increased risk of malaria
disease when infected.
Meningococcal
Disease
What is it?16
A potentially fatal bacterial infection, expressed as either
meningococcal meningitis (inflammation of the membranes
surrounding the brain and spinal cord) or meningococcal
septicaemia (blood poisoning by the meningococcus bacteria).
How is it transmitted?6,16
• Symptoms include intense headache, fever, nausea,
vomiting, stiff neck, discomfor t looking into bright lights,
and rashes.
• In young infants, the classic symptoms of fever headache
and neck stiffness may be difficult to detect, and the infant
may only appear irritable and feed poorly. As the disease
progresses, seizures may occur, irrespective of age.
What are the symptoms?16
• Sudden onset of sustained fever, severe headache, nausea,
loss of appetite, constipation or sometimes diarrhoea.
• In severe cases, mental dullness and meningitis are
common symptoms.
Who is at risk?6,16
• Persons with compromised immunity, as well as travelers to
endemic areas of the world are at increased risk.
• Pilgrims, (or large populations of people movement) are
also at risk. The Hajj pilgrimage to Saudi Arabia has been
associated with outbreaks of meningococcal disease in
returning pilgrims and their contacts.
Quick Facts on the diseases
Yellow Fever
Tetanus
What is it?17
What is it?18
• Yellow fever is a viral disease that occurs in tropical regions of
Africa and in par ts of South America.
• An acute, often fatal, disease caused by an exotoxin produced by
the bacterium Clostridium tetani.
How is it transmitted?17
How is it transmitted?19
• Transmitted to humans through the bite of infected
mosquitoes.
• Usually via injuries from contaminated objects
• Tetanus has also been associated with apparently clean
superficial wounds, surgical procedures,
insect bites, dental infections, compound
fractures, chronic sores and
infections, and intravenous
drug use.
What are the symptoms?17
• Many yellow fever infections are mild, but the disease can
cause severe, life-threatening illness.
• Symptoms of severe infection are high fever, chills,
headache, muscle aches, vomiting, and backache.
• After a brief recovery period, the infection can lead to
shock, bleeding, and kidney and liver failure. Liver failure
causes jaundice (yellowing of the skin and the whites of
the eyes), which gives yellow fever its name. Severe yellow
fever infections can be fatal.
Who is at risk?17
• Travellers visiting places where yellow fever occurs.
What are the
symptoms?19
• Muscle rigidity and painful spasms,
often star ting in the muscles of
the jaw and neck.
• Severe tetanus can lead to respiratory
failure and death.
Who is at risk?17
• Everyone who has not had a
tetanus shot is at risk to this
• Revaccination is recommended
every 10 years.
disease.
Quick Facts on the diseases
Pertussis
What is it?18
• Per tussis, also known as whooping cough, is a highly contagious
acute bacterial disease involving the respiratory tract
• It is caused by the bacterium Bordetella per tussis
How is it transmitted?18
• Through respiratory droplets when an infected person coughs,
sneezes, or speaks
What are the symptoms?18
• Typical symptoms include severe cough of several weeks’
duration with a characteristic whoop, often with vomiting, and
appearance of blue or purple skin colouration due to low
oxygen level
• In young infants, the cough may be absent.
• Although per tussis can occur at any age, most serious cases and
fatalities are observed in early infancy. Major complications
include pneumonia, encephalitis and malnutrition (due to
repeated vomiting).
Who is at risk?18
• Unprotected young infants are at highest risk of severe per tussis
• Older children, adolescents and adults are also at risk if they are
not fully immunized
Vaccination Guide for Travellers
This is a US CDC recommended vaccination for travellers going
to different countries. Listed below are recommended
vaccinations when travelling to these countries. Please refer
overleaf for country groupings.
Preventable Diseases
Group A Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Malaria
Tetanus
# Yellow Fever
Group B Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Malaria
Tetanus
Polio
# Yellow Fever
Group C Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Malaria
Tetanus
Meningococcal
*Polio
# Yellow Fever
Group F Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Tetanus
*Polio
^Japanese Encephalitis
Group G Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Tetanus
*Meningococcal
Group H Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Tetanus
*Polio
# Yellow Fever
^Japanese Encephalitis
Group I Countries
Routine (DPT, MMR, Polio)
Hepatitis B
Rabies
Tetanus
^Japanese-Ecephalitis
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Typhoid
Malaria
Tetanus
^Japanese Encephalitis
*Polio
Group E Countries
Group J Countries
Group D Countries
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Rabies
Malaria
Tetanus
Polio
Routine (DPT, MMR, Polio)
Hepatitis A
Hepatitis B
Typhoid
Malaria
Tetanus
Group K Countries
Routine (DPT, MMR, Polio)
Hepatitis B
1) ‘Routine’ refers to DPT, MMR, Polio as per routine country vaccination guidelines
2) No Vaccine available for Malaria, preventive medicine available.
3) #,*, ^ indicate that only some countries require these vaccinations.
Please refer to the listing
Vaccination Guide for Travellers
The following countries are listed in alphabetical order. Please refer
to the correct prevention group on the previous page
Countries
Afghanistan
Albania
Algeria
American Samoa
Andorra
Anegada (see Virgin Islands, British)
Angola
Anguilla (U.K.)
Antartica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austral Islands (see French Polynesia{France})
Australia
Austria
Azerbaijan
Azores
Bahamas, The
Bahrain
Bangladesh
Barbados
Barbuda(see Antigua and Barbuda)
Belarus
Belgium
Belize
Benin
Bermuda (U.K.)
Bhutan
Bolivia
Bonaire (see Netherlands Antilles)
Bora-Bora (see French Polynesia {France})
Bosnia and Herzegovina
Botswana
Brazil
British Indian Ocean Territory (U.K.)
Brunei
Bulgaria
Burkina Faso
Burma (Myanmar)
Burundi
Caicos Islands (see Turks and Caicos Islands{U.K.})
Cambodia
Cameroon
Canada
Canary Islands(Spain)
Cape Verde
Cayman Islands (U.K.)
Central African Republic
Chad
Chile
China
Christmas Island (Australia)
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Cook Islands (New Zealand)
Costa Rica
Cote d’Ivoire
Croatia
Cuba
Curacao (see Netherlands Antilles)
Cyprus
Czech Republic
Group
B
F
A
G
D
H
B#
H
G*
H
A#
F*
H
G
K^
D
E
D
H
H
I*
H
H
F
D
A
C#*
H
I*
A#
H
G
D
A
A#
D
H^
F
C#*
I*
B#
H
I
C#*
D
D
B
H
C#*
C#*
H
I*
G
G
A#
H
B#
H
C#*
C#*
F
H
H
F
F
Countries
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Dubai (see United Arab Emirates)
Easter Island (Chile)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (U.K.)
Faroe Islands (Denmark)
Federated States of Micronesia
Fiji
Finland
France
French Guiana (France)
French Polynesia (Tahiti)
Gabon
Galapagos Islands (see Ecuador)
Gambia, The
Goergia
Germany
Ghana
Gibraltart (U.K.)
Greece
Greenland (Denmark)
Grenada
Grenadines (see Saint Vincent & the Grenadines)
Guadeloupe
Guam (U.S.)
Guatemala
Guernsey (see U.K.)
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See (see Italy)
Honduras
Hong Kong SAR (China)
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man (see U.K.)
Israel
Italy
Ivory Coast (see Côte d’Ivoire)
Jamaica
Japan
Jordan
Jost Van Dyke (see Virgin Islands, British )
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Group
B#
D
B
H
A
H
G
A#
H
A
B#
C*
F
C#*
G
D
G
H
D
D
A#
G
B#
A#
C#
E
D
C#
D
D
D
F
H
H
H
G
H
D
C#*
C#*
A#
H
D
A
H^
F
D
I*
I
H
E
D
D
F
D
C#*
H
K^
H
H
H*
C#*
G
E
G
B
I
F
H
H
Vaccination Guide for Travellers - Continued
Countries
Liechtenstein
Lithuania
Luxembourg
Macau SAR (China)
Macedonia
Madagascar
Madeira Islands (Portugal)
Malawi
Malaysia
Maldives
Mali
Malta
Marquesas Islands (see French Polynesia (France))
Marshall Islands
Martinique (France)
Mauritania
Mauritius
Mayotte (France)
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat (U.K.)
Moorea (see French Polynesia (France))
Morocco
Mozambique
Nauru
Nepal
Netherlands Antilles
Netherlands, The
New Caledonia (France)
New Zealand
Nicaragua
Niger
Nigeria
Niue (New Zealand)
Norfolk Island (Australia)
North Korea
Northern Ireland (see United Kingdom)
Northern Mariana Islands (U.S.)
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands (U.K.)
Poland
Portugal
Puerto Rico (U.S.)
Qatar
Réunion (France)
Romania
Rota (see Northern Mariana Islands (U.S.))
Rurutu (see French Polynesia (France))
Russia
Rwanda
Saba (see Netherlands Antilles)
Saint Barthelemy (France)
Saint Croix (see Virgin Islands, U.S.)
Saint Eustasius (see Netherlands Antilles)
Saint Helena (U.K.)
Saint John (see Virgin Islands, U.S.)
Saint Kitts and Nevis
Saint Lucia
Saint Martin (France) (see Guadeloupe)
Saint Pierre and Miquelon (France)
Group
D
F
D
H^
F
A
D
A
I
G
C#*
D
G
G
H
B#
H
H
A
F
D
H
F
H
G
H
A
G
I*
H
D
G
K
H
C#*
C#*
G
G
I
D
G
D
H
I*
G
A#
I
A#
A#
I
G
F
D
H
H
H
F
G
G
F^*
B#
H
H
H
H
H
H
H
H
H
D
Countries
Saint Thomas (see Virgin Islands, U.S.)
Saint Vincent and the Grenadines
Saipan (see Northern Mariana Islands (U.S.))
Samoa
San Marino
São Tomé and Príncipe
Saudi Arabia
Scotland (see United Kingdom)
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Society Islands (see French Polynesia (France))
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands (U.K.)
South Korea
South Sandwich Islands
(see South Georgia & South Sandwich Islands(U.K.))
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Tinian (see Northern Mariana Islands (U.S.))
Tobago (see Trinidad and Tobago)
Togo
Tokelau (New Zealand)
Tortola (see Virgin Islands, British )
Trinidad and Tobago
Tubuai (see French Polynesia (France))
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands (U.K.)
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City (see Italy)
Venezuela
Vietnam
Virgin Gorda (see Virgin Islands, British )
Virgin Islands, British
Virgin Islands, U.S.
Wake Island
Wales (see United Kingdom)
Wallis and Futuna Islands (France)
Western Sahara
Yemen
Zambia
Zanzibar (Tanzania)
Zimbabwe
Group
H
H
G
G
D
A#
C
D
C#*
F
H
B#
H^
F
F
G
J
B#
A
G
I
G
D
I
C#*
A#
A
D
D
H
C*
B
B#
H^
I
G
H#
C#*
G
H
H#
G
H
A
H*
H
G
C#*
F
H
D
D
H
B
J
D
A#
I
H
H
H
G
D
D
A
A
A
B#
A
References
1 Centre for Disease Control and Prevention (CDC) website 2010:
Hepatitis A: Information for the public http://www.cdc.gov/hepatitis/A/aFAQ.
htm#overview (Accessed 24th May 2010)
2 HPB online 2010: Hepatitis A
http://www.hpb.gov.sg/diseases/article.aspx?id=534 (Accessed 24th May 2010)
3 WHO website: Hepatitis A Factsheet 2010: http://www.who.int/mediacentre/
factsheets/fs328/en/index.html (Accessed 24th May 2010)
4 http://www.cfps.org.sg/sfp/24/242/articles/e242003.html
5 National Environment Agency, Singapore. News Release No. 04/2002. Date of
issue: July 11, 2002
6 Centre for Disease Control and Prevention (CDC) Yellow Book: The Pre-Travel
Consultation Travel-Related Vaccine-Preventable Diseases
http://wwwnc.cdc.gov/travel/content/yellowbook/home-2010.aspx
(Accessed 21st May 2010)
7 Health Promotion Board website 2010: Hepatitis B
http://www.hpb.gov.sg/diseases/article.aspx?id=536 (Accessed 21st May 2010)
8 WHO website: Hepatitis B Factsheet 2010: http://www.who.int/mediacentre/
factsheets/fs204/en/index.html (Accessed 21st May 2010)
9 Centre for Disease Control and Prevention (CDC) website 2010: Hepatitis B:
Information for the public
http://www.cdc.gov/hepatitis/B/bFAQ.htm#transmission
(Accessed 21st May 2010)
10 Health Promotion Board website: Influenza
http://www.hpb.gov.sg/diseases/article.aspx?id=552 (Accessed 21st May 2010)
11 Centre for Disease Control and Prevention (CDC) website 2010: Seasonal
Influenza (Flu) http://www.cdc.gov/flu/about/disease/ (Accessed 21st May 2010)
12 Chow, A, Ma S, Ling A-E et al (2006): Influenza-associated Deaths in Tropical
Singapore, Emerging Infectious Diseases, Vol 12 (1): 114-121
13 WHO website: Immunization, Vaccines and Biologicals: Typhoid 2010 http://www.
who.int/immunization/topics/typhoid/en/index.html (Accessed 21st May 2010)
14 Yew FS, Goh KT, Lim YS (1993): Epidemiology of typhoid fever in Singapore,
Epidemiol. Infect, 110(1): 63-70
15 World Health Organization. Malaria. 2011. [Retrieved online on 19 Sep 2011 from
http://www.who.int/mediacentre/factsheets/fs094/en/index.html.]
16 http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx
17 Centers for Disease Control and Prevention. Yellow Fever Fact Sheet. 11 June 2007.
[Retrieved online on 19 Sep 2011 from
http://www.cdc.gov/ncidod/dvbid/yellowfever/YF_FactSheet.html.]
18 Centre for Disease Control and Prevention (CDC) Yellow Book 2012.
http://wwwnc.cdc.gov/travel/page/yellowbook-2012-home.htm
(Accessed on 21 March 2012)
19 Centre for Disease Control and Prevention (CDC) Pink Book: Tetanus
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf
(Accessed on 21 March 2012)
To ensure optimal protection,
seek travel health advice 4 to 6
weeks before your travel!
The Clinic @ Campus
70 Stamford Road #B1-45 Singapore 178901
Tel: (65) 6333 9300
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1 George Street #05-05 Singapore 049145
Tel: (65) 63329086
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Tel: (65) 6474 6237
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Enquiry:
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