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Time to Travel? or living in a hub country? Protect yourself! r o f y d a e R p? i r t t a h t . -- checked . - made Passpor t at ions ---v r e s e R ed. l Hote --- conf ir m s g in k o ady. Flight bo ----- all re e g Lugga inute… ions? Wait a m h precaut lt a e h t u o What ab avel r t r u o Does y ecklist ch lth? a e h e d u incl 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 The Clinic @ One George Street 1 George Street #05-05 Singapore 049145 Tel: (65) 63329086 Healthtrends Family Clinic Tiong Bahru 18 Jalan Membina #02-08 Singapore 164018 Tel: (65) 6474 6237 Healthtrends Family Clinic Yishun Blk 747 Yishun Street 72 #01-106 Singapore 760747 Tel: (65) 67581750 Healthtrends Family Clinic Buena Vista Blk 25 Ghim Moh Link #01-04 Singapore 270025 Tel: (65) 64689664 Enquiry: [email protected]