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Afghanistan, Islamic Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is from May through November. Malaria may be encountered throughout the country below 2000 meters, to include urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus, the routine and special immunizations required or recommended below, and malaria as indicated above, the traveler should be aware that risk of exposure to the following diseases exists in this country. DISEASE RISK PROFILE Afghanistan Disease Avian Influenza (H5N1) Brucellosis Cholera Echinaococcosis Giardiasis Diarrheal Diseases Helminthic Infections Hepatitis, Viral Leishmaniasis Sandfly Fever Tapeworms Trachoma Trichinosis Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X X X X X X X X X Food/Water Safety Water, milk products, and cold food unsafe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under one year of age should not be vaccinated due to health considerations. Please refer to the discussion in Chapter 6.63 on avoiding yellow fever vaccination in this age group. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but this should be considered for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid Fever - Vaccination is recommended for all travelers for their protection. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Georgraphical distribution of the area of risk for this country is a small region in the extreme northeastern part of the country. Typhus - Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. Albania, Republic of INFECTIOUS DISEASE RISK Diseases of Special Risk In addition to the worldwide hazard of tetanus, the traveler should be aware that risk of exposure to the following diseases exists in this country. DISEASE RISK PROFILE Albania Disease Avian Influenza (H5N1) Brucellosis Echinaococcosis Encephalitis, Tick-Borne Leishmaniasis Rabies Sandfly Fever Typhus, Endemic Flea-Borne West Nile Fever Endemic X X X X X X X X X Risk Hazard Food/Water Safety Water probably safe, although not recommended. Milk and food safe. Dysentery, other diarrheas and typhoid fever are more common in the summer and autumn in southeastern and southwestern areas. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but this should be considered for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Algeria, People’s Democratic Republic of INFECTIOUS DISEASE RISK Malaria Risk Risk is present in the southeastern parts of the Sahara regions: Ain-Defla and Illizi departments. Risk period: March to October. Centers for Disease Control does not currently recommend preventative medication. Falciparum malaria represents <1% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider the use of primaquine upon return home only if considerable mosquito exposure and bites have been encountered. Diseases of Special Risk Infection is present in the Mediterranean coastal area east of Alger in the following villages: El Harrach, Reghaia, Khemis el Khechna, Gue de Constantine; foci of infection are present in the village of Jdiouia (southwest of El Asnam in the Tell mountain region); at Biskra; the oases of Djanet and near the border with Libya and at Aguedal-Anafid in the Wadi Saoura area (Beni Abbes region). Diarrheal diseases, to include helminthic infections and dysentery are common in this country. Hepatitis A and typhoid fever are common. In addition to the worldwide hazard of tetanus, the routine and special immunizations required or recommended below, and specific diseases indicated above, the traveler should be aware that risk of exposure to the following diseases exists in this country. DISEASE RISK PROFILE Algeria Disease Brucellosis Dengue Fever Echinococcosis Giardiasis Lassa Fever Leishmaniasis Rabies Relapsing Fever Sandfly Fever Trachoma Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Endemic Louse-Borne Endemic Risk X Hazard X X X X X X X X X X X X X X Food/Water Safety Water, milk products and cold food are not safe in this county. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but this should be considered for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. American Samoa, Territory of INFECTIOUS DISEASE RISK Malaria Risk None. Diseases of Special Risk This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. In addition to the worldwide hazard of tetanus and the routine and special immunizations required and recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. DISEASE RISK PROFILE American Samoa Disease Endemic Risk Hazard Dengue Fever Encephalitis, Japanese Filariasis Tuberculosis X X X X Food/Water Safety Water is safe, but is not recommended without treatment. Milk products and food safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Andorra, Principality of INFECTIOUS DISEASE RISK DISEASE RISK PROFILE Andorra Disease Food/Water Safety Endemic Risk Hazard Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Angola, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. Resistance has developed in this country to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Infection with both S.haematobium and S.mansoni is endemic throughout Angola. S.haematobium is predominant in the western half of the country while S.mansoni is more prevalent in eastern regions. In addition to the worldwide hazard of tetanus, the routine and special immunizations required or recommended below, and specific diseases indicated above, the traveler should be aware that risk of exposure to the following diseases exists in this country. DISEASE RISK PROFILE Angola Disease Cholera Dysentery Dracunculiasis/Guinea Worm Filariasis Giardiasis Hepatitis A Helminthic Infections Leishmaniasis Onchocerciasis Relapsing Fever Tapeworms Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic Risk Hazard X X X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Cholera - A cholera vaccination certificate is not required for entry to this country. The disease is active in this country, but the vaccine is not recommended for travelers protection. Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. CDC recommends a yellow fever vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the southern part of the country along the border with Nambia (middle third). Anguilla INFECTIOUS DISEASE RISK Malaria No malaria risk is present in this country. DISEASE RISK PROFILE Anguilla Disease Ciguatera Poisoning Endemic X Risk Hazard Food/Water Safety No reliable information exists with regard to safety of water, food, or dairy products. Discretion is advised. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Antigua and Barbuda INFECTIOUS DISEASE RISK Malaria Risk No malaria risk is present in this country. Diseases of Special Risk Schistosomiasis is present in this country. Antigua has only seasonal streams; however, the intermediate host is present in man-made pools, canals and reservoirs. No recent cases have been reported from the formerly infected areas of Sweet's, Liberta and Bendals. Currently only the area surrounding the settlement of John Hughs is infected with S.mansoni. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Antigua and Barbuda Disease Dengue Fever Hepatitis, Viral Rabies Endemic X X X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are generally safe to eat, however, bacillary and amoebic dysentary are encountered . VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. AIDS Information Aids testing is required for university students, persons intending on immigrating, those wishing to work, and those suspected of having the HIV virus. Contact Antigua's embassy for details. Argentina, Argentine Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is from October through May, only below 1200 meters. There is no risk of malaria in urban areas. Risk exists only in the rural areas of the extreme northwestern corner of the country bordering Bolivia: Province of Salta (northwestern corner of province): Departments of Santa Victoria, Iruya, Oran. Province of Jujuy (southeastern part of province): Departments of San Martin, Ledesma, Santa Barbara and San Pedro. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk IAMAT reports Chagas' disease is highly endemic in rural and suburban areas below 3600 meters in the following provinces: Catamarca, Chaco, Cordoba, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Salta, Santa Fe, San Juan, San Luis, Santiago del Estero, and Tucuman. Risk is also present in rural areas (below 3600 meters) of the provinces of Buenos Aires, Corrientes, Chubut (northern half), Entre Rios, Misiones, Neuquan, and Rio Negro. The main vectors in this country are Triatoma infestans and Triatoma sordida. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Argentina Disease Anthrax Giardiasis Hepatitis, Viral Rabies Tapeworms Tuberculosis Trachoma Endemic Risk X X Hazard X X X X X Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Salmonellosis is relatively common in suburban areas and is a particular risk in children below 5 years of age. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Yellow fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. CDC recommends vaccination for all persons over 9 months of age planning to visit the northeastern forest areas. Armenia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Armenia Disease Brucellosis Leishamaniasis (Cutaneous) Leishamaniasis (Visceral) Tuberculosis Endemic X X X X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Australia, Commonwealth of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Areas of greatest risk are along the coast from Cornavon to Port Darwin to Townsville and occasionally northern New South Wales. Lyme arthritis is present. Avoid ticks. Viral encephalitis may occur in some rural areas. mosquitoes. Avoid DISEASE RISK PROFILE Australia Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is considered infected. A vaccination certificate is required for children over one year of age. Vaccination certificate is required for travelers who have been in or passed through an infected yellow fever area within six days prior to arrival. Australia is not bound by International Health Regulations. Australian officials currently have added Cameroon, Ecuador, Ivory Coast, Senegal, Togo, Trinidad and Tobago, and Venezuela to the infected country list. Any country is considered infected when it has been so listed in the Weekly Epidemiological Record. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B among the local Aboriginal population in the interior (mainly in the Warburton Creek area of Central Australia), vaccination is recommended for persons working in health care, education, or in close contact with them. AIDS Information Testing is required for all applicants for permanent residence who are age 15 and over. All applicants who require a medical examination are tested if there is a clinical indication. Contact the Australian embassy for further details. Austria, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Austria Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in all forested areas of southern, eastern, and northern Austria (areas around Klagenfurt, Graz, Wiener Neustadt, Vienna, and Linz, extending to the border with Germany along the Danube). Azerbaijan, Republic of INFECTIOUS DISEASE RISK Malaria Risk Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. Hemorrhagic fever is encountered in southern Siberia. DISEASE RISK PROFILE Azerbaijan Disease Avian Influenza (H5N1) Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Tuberculosis Endemic X Risk Hazard X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Azores, Autonomous Region of the INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Azores Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Some milk is pasteurized and safe to drink, but caution is advised. Pasteurized butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are generally safe to eat. VACCINATIONS Required immunizations Yellow fever vaccination is required for all travelers over 1 year of age arriving from areas infected with this disease. This certificate is not required for travelers in transit at Santa Maria. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Viral Hepatitis A - Vaccination with gamma globulin is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country and for persons on working assignments in remote areas. Bahamas, Commonwealth of The INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Bahamas Disease Dengue Fever Dysentery Hepatitis, Viral Rabies Endemic X Risk Hazard X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. Ciguatera fish poisoning may prove to be a hazard. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in which this disease is active. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Bahrain, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Bahrain Disease Brucellosis Cholera Dracunculiasis/Guinea Worm Echinococcosis Hepatitis, Viral Leishmaniasis (cutaneous) Leishmaniasis (visceral) Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Endemic Risk X X X X X X X X X X X Hazard X Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. AIDS Information Foreign workers in specific job categories are screened for HIV after entry. Jobs such as hotel staff and hair dressers are included. Contact Bahrain's embassy for details. Bangladesh, People’s Republic of INFECTIOUS DISEASE RISK Malaria Risk The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Malaria is present in all parts of this country, including urban areas, with the exception of Dhaka City, where there is no risk. The risk in the remainder of this country exists all year. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. It should be noted that 58% of the country's 103 million people are infected with tuberculosis, causing 500,000 positive cases annually. DISEASE RISK PROFILE Bangladesh Disease Avian Influenza (H5N1) Brucellosis Cholera Dysenteries Echinococcosis Encephalitis, Japenese Filariasis Helminthic Diseases Hepatitis A Leishmaniasis (Visceral) Rabies Sandfly Fever Tuberculosis Endemic X Risk Hazard X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is infected. A yellow fever vaccination is also required from all countries the yellow fever endemic zones in South and Central America and Central Africa. It is also required from all persons arriving from Botswana, Malawi, Mauritania, Belize, Costa Rica, Guatemala, Honduras, and Nicaragua. When required, this vaccination must be obtained by persons of all ages (including infants) or they will face isolation up to 6 days. This vaccine should not be given to infants younger than 6 months. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Cholera immunization is only REQUIRED of Bangladesh nationals on leaving the country. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throughout the country. Period of transmission is all year, but greatest risk is June through October. You may obtain information about a vaccine for this disease from the CDC at (303) 221-6429. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Barbados INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Viral hepatitis occurs on this island. Animal rabies is present, particularly in the mongoose. DISEASE RISK PROFILE Barbados Disease Endemic Risk Hazard Food/Water Safety First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. Amoebic and bacillary dysenteries are common. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is infected. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Belarus, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Belarus Disease Endemic Risk Hazard Tuberculosis X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Belgium, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Heavy concentrations of bacterial contamination (salmonella) have caused authorities to warn against swimming in the Ourthe and Semois Rivers in the Ardennes. Officials report that 75% of the waterways in northern Belgium are heavily polluted. DISEASE RISK PROFILE Belgium Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Belize INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is year round. Malaria may be encountered throughout the country below 400 meters, except urban areas. There is no risk of malaria in in Belize City and the district of Belize. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is present in the sylvatic ecosystem, with sporadic cases of human infection being reported. The main vector is Triatoma dimidiata. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis has been reported in this country. Avoid swimming or wading in fresh water lakes or rivers unless an authoritative local source can assure you that the water is safe. DISEASE RISK PROFILE Belize Disease Brucellosis Dysentery (amoebic and Bacillary) Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X X X X AIDS Information Persons staying longer than three monthss require HIV antibody testing. Foreign tests are acceptable only if done within the preceding three months. Contact the Belize embassy for further details. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active yellow fever. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Although yellow fever is not active at this time, this country is in the endemic zone. Other countries may require a yellow fever certificate after visiting this country. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - as above. Benin, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 87% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk is present in the entire country, to include urban areas. S.haematobium is endemic throughout Benin. S.mansoni has been reported from Benassi and Parakou (Bourgou region); from Natitingou (Atakora region); from Savalou (Zou region) and from Cotonou on the Atlantic coast. Parasitic worm infections are common. Dysentery and diarrheal diseases, including giardiasis, typhoid fevers, and viral hepatitis, are widespread. DISEASE RISK PROFILE Benin Disease Dracunculiasis/Guinea Worm Echinococcosis Filariasis Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchoceriasis Rabies Relapsing Fever Tapeworms Trachoma Trypanosomiasis, African Endemic X Risk Hazard X X X X X X X X X X X Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk may be unsafe due to poor refrigeration, but other dairy products may be safe. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age, but the CDC recommends vaccinations for everyone over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. The entire country is in this zone. Bermuda INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. The is a very low incidence of communicable disease on this island. Rocky Mountain spotted fever, encephalitis, and tularemia all occur in low frequency. Snake bites and Portuguese man-of-war injuries occur. DISEASE RISK PROFILE Bermuda Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Bhutan, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is year around. Malaria may be encountered in the southern districts bordering India and only below 1600 meters. Risk is present in the southern half of the country, in the following districts: Chirang, Gaylegphug, Samchi, Samdrupjongkhar and Shemgang. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 10% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Bhutan Disease Brucellosis Cholera Echinococcosis Encephalitis, Japanese Giardiasis Helminthic Infections Hepatitis, Viral Leishmaniasis Sandfly Fever Tapeworms Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Bolivia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present below 2500 meters. The highlands of La Paz, the two southwestern provinces of Oruro and Potosi are risk free. Where found, the risk exists all year. Multi-drug-resistant P.falciparum malaria has been reported from the Guayaramerin area and the northeastern border areas with Brazil (Beni and Pando). Persons travelling into the Amazone basin and overland into Brazil should follow a suppressive regimen with Lariam because of the high incidence of multi-drug-resistant P. falciparum in that country. While chloroquine is the drug of choice of many experts for travel to most parts of Bolivia, the CDC recommends the use of mefloquine (Lariam), particularly when traveling in the above areas. Falciparum malaria represents 13% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chaga's Disease risk is present in rural and suburban areas below 3600 meters with very high human infection rates reported from the departments (including towns) of Cochabamba (including the city of Cochabamba), Sucre, Tarija, and Santa Cruz. The main vectors are the triatoma species infestans and sordida which are known locally as "vinchuca." Cholera has spread to Bolivia. is not recommended. Immunization with cholera vaccine Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Bolivia Disease Brucellosis Dysentery Echinococcosis Endemic X Risk X X Hazard Hepatitis, Viral Helminthic Infections Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Leishmaniasis (Visceral) Plague Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. Travelers' diarrhea is common. Also common are parasitic worm infections and viral hepatitis. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. CDC recommends vaccination of all persons over 9 months of age who go outside of urban areas. Yellow fever is currently active in this country and is present in the departments of Beni, Cochabamba, La Paz, Pando, Tarija, and Santa Cruz. Bolivia recommends obtaining yellow fever vaccination when visiting these areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is: along the border with Peru (middle third) north of Lake Titicac (province of La Paz) and the Cordillera Oriental between the provinces of Cochabama and Santa Cruz. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. AIDS Information All applicants for residency are tested. Foreign tests are accepted under certain conditions. Contact the Bolivian embassy for details. Bosnia and Herzegovina INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Bosnia and Herzegovina Disease Avian Influenza (H5N1) Diarrheal Diseases Endemic X X Risk Hazard Dysentery, Bacillary Encephalitis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas bordering Austria extending south to the areas around Ljubljana and Zagreb. Botswana, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is from November through May in the northern part of the country above 21 degrees south, including urban areas. The following districts and subdistricts are affected: Boteti, Chobe, Ngamiland, Okavango and Tutume. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 95% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The districts of Kgalagadi, Ghanzi and Central-Serowe (Kalahari Desert) are risk free. Infection with S.haematobium is present along the Limpopo river valley and its tributaries. Foci of infection with S.haematobium have also been reported from Mabule (on the Molopo river, Southern disrict), Francistown (North-East district). Xhumo and Nata (Letlhakane district), Pandamatenga, Kasane and Kavimba (Chobe district), Maun and Tsao (Ngamiland). Infection with S.mansoni is endemic in the northern districts of Okavango and Chobe, particulary along the Okavango river and marshlands and in the villages along the Chobe river. DISEASE RISK PROFILE Botswana Disease Plague Rabies Relapsing Fever Rift Valley Fever Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhus, Scrub Endemic X X X X X Risk Hazard X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Water, dairy products and food products are considered safe in Gaborone. Amoeba and typhoid fever are common problems associated with food ingestion in this country. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk is scattered throughout this country. Brazil, Federative Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is found below 900 meters in Acre, Amazonas, Goias, Maranhao, Mato Grosso, and Para States; Territories of Amapa, Rondonia, and Roraima. There is generally no risk in urban areas, except in the urban areas of the Amazon region. The following states are risk free (main cities in brackets): Alagoas (Maceio), Ceara (Fortalezza), Distrito Federal (Brasilia), Espirito Santo (Victoria), Paraiba (Joao Pessoa), Parana (Curitiba), Pernambuco (Recife), Rio Grande do Norte (Natal), Rio Grande do Sul (Porto Alegre), Rio de Janeiro (Rio de Janeiro), Santo Caterina (Florianopolis), Sao Paulo (Sao Paulo, Santos), Sergipe (Aracaju), and the Fernando de Noronha Archipelago. The urban centers of the following states are risk free (main cities): Amazonas (Manaus), Goias (Goiania), Maranhao (Sao Luis), Mato Grosso (Cuiaba), Mato Grosso do Sul (Campo Grande), Para (Santarem, Belem), Tocantins (Tocantina). Risk is also present in the following rural areas: Bahia (Salvador): areas bordering the states of Tocatins and Goias; Minas Gerais (Belo Horizonte): areas bordering state of Goias; Parana (Curitiba): areas bordering the state of Mato Grosso do Sul and Paraguay. High risk of multi-drug-resistant P.falciparum malaria is present in the following states and territories (main cities): Acre (Rio Branco); Amapa (Macapa), Rondonia (Porto Velho), Roraima (Boa Vista). The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 40% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Cholera has entered Brazil in the Solimoes River drainage. Jungle areas along the borders with Colombia and Peru are at greatest risk for this disease. Active disease has been reported in Amazonas State and Matto Grosso State. Immunization with cholera vaccine is not indicated for any traveler, but food and water safety precautions are urged. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Risk is limited to the coastal areas of the following states: Amapa, Para, Maranhao, Piaui. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Endemic areas of S.mansoni infection are present in the densely populated coastal regions, especilly around the numerous man-made water bodies and irrigation systems. Infection has been reported from all states except the following Amazonas, Mato Grosso do Sul, Rio Grande do Sul, Rondonia, Roraima. Areas of infection are present in: Acre: Recent indigenous cases of infection have been reported, put specific areas of risk are undetermined. Alagoas: the entire state is infected. Amapa: the state is free of risk except for the area of Macapa on the Canal do Norte. Bahia: the entire state is infected especially the coastal areas and all major river basins. Brasilia, D.F.: The federal district is infected. Ceara: Risk of infection is present in the area of Fortaleza and along the Choro River as far south as Quixada. Foci are also present in the southeastern part of the state in the areas of Iguatu and Juazeiro do Norte. Espirito Santo: the entire state is infected. Goias: Scattered areas of infection have been reported from all parts of the state except from the northwest. Travellers should consider the entire state as infected. Maranhao: Infection is present along the coastal regions from the border with Para State to Sao Luis (Bahia de Sao Marcos) and along the lower part of the Pindare river. There are additional foci present in the area of Pedreiras (Mearim river). Mato Grosso: a few scattered foci of infection are present in teh southern part of the state, the most significant at Caceres. Minas Gerais: the eastern half of the state is heavily infected. Foci of infection have been reported from all partes, therefore travellers should consider the entire state as infected. Para: infection is present in coastal areas around Braganca, Capanema and Primavera. Paraiba: The entire coastal area including Joao Pessoa, and as far west as Campina Grande is infected. There are a few scattered foci of risk present in the interior around Souza. Parana: Foci of infection are scattered throughout the state with heaviest concentration along the Paranapanema river valley. A foci of infection is present at Iguacu Falls. Pernambucco: The eastern half of the state is infected especially along the coastal areas including Recife and as fas west as Arcoverde, Buique and Bom Conselho. Scattered foci are present in the northwest of the state including the area of Afogados do Ingazeira, and along the Sao Francisco river. Piaui: Foci of infection are present in the area of Teresina and Barao de Grajau (on the Parnaiba river); in Campo Maior and Picos. Rio Grande Do Norte: The coastal areas from Macau to the border with Paraiba state including the area of Natal is infected. In the interior, there are scattered foci of low infection present. Rio De Janeiro: Foci of infection have been reported from all parts including Rio de Janeiro city. The entire state should be considered infected. Santa Catarina: recent reports indicate indigenous foci of infection, but no details are available. Sao Paulo: the eastern coastal regions along the Paraiba do Sul river, the Tiete Delta including Sao Paulo and Santos are infected. Infection is present along the Paranapanema river valley and in the area of Americana and Campianas. Sergipe: the entire state is infected. Tocantins: isolated foci of infection have been reported. Details are not available. Chaga's Disease risk is present in the rural areas of Alagoas, Bahia, Ceara, Espirito Santo, Goias, Maranhao, Mato Grosso do Sul, Minas Gerais, Paraiba, Parana, Pernambuco, Piaui, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Sao Oaulo, Sergipe, and the Federal District. New foci of human infection have recently been reported from the state of Para. Vectors and wild animal reservoirs are present throughout Brazil. Several insects are vectors, but all are known locally as "barbeiros." DISEASE RISK PROFILE Brazil Disease Brazilian Purpuric Fever Brucellosis Dengue Fever Echinococcosis Encephalitis, Venezuelan Equine Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Meningitis Onchocerciasis Plague Rabies Tapeworm Tuberculosis Endemic X Risk Hazard X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. Amoebic dysentery, diarrheal diseases, parasitic worms, and viral hepatitis associated with water and food supplies are common in this country. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone, see page HHH. A vaccination certificate is required for children over six months of age, however vaccination is not advised for children under nine months of age due to medical complications frequently encountered in the younger age group. CDC recommends vaccination of all persons over 9 months of age. Vaccination is recommended for travelers to the following states: Acre, Amazonas, Goias, Maranhao, Mato Grosso, Mato Grosso do Sul, Para, Rondonia, and the Territories of Amap and Roraima. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the northwestern part of the country in the provinces of Bahia and Ceara. A small focus is present in the area of Redonda (southern part of Minas Gerais). Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Brunei Darussalam INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Brunei Darussalam Disease Cholera Dengue Fever Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Melioidosis Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X Risk Hazard X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Amoebic and bacillary dysentery occurs in this country. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Vaccination certificate is required for travelers who have been in or passed through an infected yellow fever area within six days prior to arrival. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following immunizations are not required but are recommended for persons visitng this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. The following immunization is recommended for persons traveling on special assignments or engaged in certain activities: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Bulgaria, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to tick-borne encephalitis, rabies, and a viral hemorrhagic fever exists in this country. Hepatitis A is endemic in this country, with cases reported from all areas, but particularly from the districts of Varna and Burgas. Immunization with gamma globulin for protection against Hepatitis A is recommended for all travelers. DISEASE RISK PROFILE Bulgaria Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. AIDS Information All foreigners staying for more than 1 month for purposes of study or work are tested. Contact the Bulgarian embassy for full details. Burkina Faso INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is all year in all sections of this country, to include urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a 15% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S.haematobium infection is endemic throughtout the country. S.mansoni is present in the southwestern regions of Hauts-Bassin and Sud-Ouest and in isolated foci of Volta Noire, Centre-Ouest and Est. DISEASE RISK PROFILE Burkina Faso Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Meningitis Onchocerciasis Rabies Relapsing Fever Sandfly Fever Tapeworms Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X Risk Hazard X X X X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Amoebic dysentery, diarrheal diseases, parasitic worms, and viral hepatitis associated with water and food supplies are common in this country. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. The disease is currently active in this country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Burundi, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 80% of malaria, therefore there is a 20% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is present in this country. Avoid contact with contaminated fresh water. S.mansoni is endemic along Lake Tanganyika and the plain of Rusizi, including the capital Bujumbura. Infection is also present in all villages situated around Lake Cyohoha and Lake Rwihinda. The highlands of central, eastern and southern Burundi are risk free. Additional snail intermediate hosts: Biomphalaria choanomphalia and Biomphalaria stanleyi. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Burunda Disease Dracunculiasis/Guinea Worm Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Vaccination is recommended for travelers over 9 months of age for their protection. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningitis - Vaccination for all travlers is recommended due to the increased incidence of this disease. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Cambodia, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The city of Phnom Penh is risk free. The malaria in this couyntry is resistant to chloroquine and mefloquine. Use doxycycline for malaria prevention. Falciparum malaria represents 71% of malaria, therefore there is a 29% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk Schistoaomiasis is present in this country. Avoid contact with contaminated water systems. Known endemic areas are present in the eastern part of the country in the area of the provincial capital of Kratie and the surrounding villages on the Mekong river. The district of Stung Treng on the Mekong (north of Kratie) is also infected. The full extent of the infection is not known, but there are indications that the disease may be more widespread that previously believed. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Cambodia Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Melioidosis Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is scattered throughout the country. Cameroon, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a 15% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found throughout this country, including urban areas. Avoid contact with contaminated fresh water lakes, ponds, or streams. S.haematobium is highly endemic in the two northern Provinces (Sahel regions) with foci of infection reported from all other provinces except North-West Province. S.mansoni follows a similar pattern: it is highly endemic in the northern provinces. Foci of infection with low incidence rates of S.intercalatum have been reported from the Provinces of Centre and Littoral. Typhus - Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. Lake Nyos contains large amounts of dissolved carbon dioxide gas which represents a potential threat for the release of another cloud of asphyxiating gas. Caution is advised. DISEASE RISK PROFILE Cameroon Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Endemic X X Risk Hazard X X X Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all children over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is the northern third of the country. Canada INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Canada Disease Encephalitis Lyme Disease Rabies Rocky Mountain Spotted Fever Tularemia Endemic X X X X X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B among the local Inuit (Eskimo) population of northern Canada, vaccination is recommended for persons working in health care, education, or in close contact with them. Canary Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Food/Water Safety DISEASE RISK PROFILE Canary Islands Disease Tuberculosis Endemic X Risk Hazard Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Cape Verde, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is all year in the rural areas of Concelho de Santa Cruz (Sao Tiago Island). Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Cape Verde Disease Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Relapsing Fever Trachoma Tungiasis Endemic Risk Hazard X X X X X X X X X X X X X Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. The requirement does not apply to travelers arriving in Sao Vincente, Sal, Maio, Boa Vista, and Santiago. Vaccination is recommended for all travelers for their protection. Vaccination is not advised for children under nine months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Cayman Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Cayman Islands Disease Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Hepatitis, Viral Rabies Endemic X Risk Hazard X X X X Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Central African Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a 15% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is found throughout this country, including urban areas. Avoid contact with contaminated fresh water lakes, ponds, or streams. Tuberculosis, venereal disease, yaws, and leprosy are prevalent amongst the local population, but travelers are at very low risk in contracting these diseases. DISEASE RISK PROFILE Central African Republic Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Relapsing Fever Trachoma Trypanosomiasis, African Endemic X Risk Hazard X X X X X X X X X X X X X X Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April, but the danger extends from December through June. Local area of greatest danger is the northern third of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Chad, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in the entire country, all year long, including urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 78% of the malaria present in this country, therefore there is a risk of vivax exposure. Consider the use of primaquine upon your return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S.haematobium and S.mansoni are endemic throughout the southern half of the country. In the arid north, S.mansoni infection is present in and around the oasis of Faya-Largeau. High prevalence of infection is present in all highly populated areas of the south and southwestern district. The status of Schistosomiasis infection in many areas of the east and north of the country is unknown; therefore, travellers should consider as infected all oases, temporary and permanent water bodies. The local population suffers from leprosy, tuberculosis, influenza, tropical ulcers, eye diseases, pneumonia, measles, cholera, polio, and fungal infections. Travelers are low risk in contracting these illnesses. DISEASE RISK PROFILE Chad Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - Vaccination is recommended for all travelers for their protection. Vaccination is advised for all travelers over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April, but danger extends from December trough June. Local area of greatest danger is the southern half of this country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Chile, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Cholera has spread into this country from Peru. Immunization with cholera vaccine is not indicated for any traveler, but food and water precautions are urged. Chagas' Disease is following northern Atacama, Coquimbo, vector is Triatoma present in rural and suburban areas in the and central provinces: Tarapaca, Antofagasta, Valparaiso, Santiago, and O'Higgins. The main infestans. DISEASE RISK PROFILE Chile Disease Anthrax Echinococcosis Hepatitis, Viral Tapeworms Typhoid Fever Endemic Risk X Hazard X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. China, (Hong Kong) People’s Republic of INFECTIOUS DISEASE RISK Malaria Risk The urban areas of Hong Kong are risk free and there is no risk for travelers. Sporadic malaria cases have been reported from the northern rural border areas. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Hong Kong Disease Avian Influenza (H5N1) Dengue Fever Diarrheal Diseases Encephalitis, Japanese Hepatitis, Viral Tuberculosis Endemic X X X X X X Risk Hazard AIDS Information Government sources report 110 people have tested positive for HIV antibody and that 10 persons have died of this disease as of March 1988. Food/Water Safety First class hotels and restaurants serve purified drinking water and reliable food. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported, with period of transmission all year. China, (Macao) People’s Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Macao Disease Dengue Fever Endemic X Risk Hazard Diarrheal Diseases Encephalitis, Japanese Helminthic Diseases Hepatitis, Viral X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. China, (Mainland) People’s Republic of INFECTIOUS DISEASE RISK Malaria Risk In China malaria risk is present from June - November north of 33 degress North latitude; from May - December at 25 - 33 degrees North latitude; and all year south of 25 degrees North latitude. Malaria is found in parts of Anhui, Fujian, Guandong, Guangxi, There is no malaria risk in the following municipalities and provinces (main cities are listed in brackets): Beijing Shi (Beijing), Tianjin Shi (Tianjin), Gansu (Lanzhou), Heilongjiang (Harbin), Jilin (Changchun), Nei Mongol (Hohhot), Ningxia (Yinchuan), Qinghai (Xining). Malaria risk is present from July to November in the following rural areas: Hebei (Shigiazhuang): the southern parts of the province including the areas along the Bo Hai (Bo Sea); Liaoning (Shenyang, Luda): the entire southern peninsula (Liadong Bandao); Shandong (Jinan): the entire province; Xinjiang (Shihezi): risk is present in the Lli valley on the northwestern border with the USSR. In Northern China only vivax malaria infections are present. Take chloroquine as a suppressive medication regimen in these areas. Main vector: A. sinensis. Central China: Malaria risk exists throughout central China from May to December in rural areas of the following municipalities and provinces: Shanghai Shi (Shanghai); Anhui (Hefei), Henan (Zhengzhou), Hubei (Wuhan); in Shaanxi (Xi'an) the risk is present in the southern half of the province; in Sichuan (Chengdu, Chongqing) the eastern half of the province is infected with malaria. In central China vivax malaria infections are predominant. Take chloroquine 500 mg weekly for suppression, but carry a three tablet treatment dose of Fansidar since some chloroquine resistance has developed in this area. Main vectors: A. sinensis, A. minimus minimus. Southern China (including the southeastern tip of Tibet): Malaria risk is present throughout the year in rural areas of the following provinces: Fujian (Fuzhou), Guangdong (Guangzhou) including Hainan Island (Haikou), Guangxi (Nanning, Gueilin), Guizhou (Guiyang), Hunan (Changsha), Jiangxi (Nanchang), Zhejiang (Hangzhou), Yunnan (Kunming); and the extreme southeastern part of Tibet in the area bordering India (Arunachal Pradesh) and Burma. In southern China P. falciparum malaria is predominant. Chloroquine resistant P. falciparum malaria is present in parts of the provinces of Yunnan, Gungxi and Guangdong (including the island of Hainan). When travelling through the rural areas of Yunnan province bordering Burma, Laos and Vietnam; the southern parts of Guangxi province bordering Vietnam and the Gulf of Tonkin; the areas of Guangdong province southwest of Guangzhou (Canton) including the island of Hainan take Lariam for suppressive medication. Main vectors: A. minimus minimus, A. balabacensis balabacensis. Note: Persons flying into major cities and making only daytime excursions into the countryside do not need to take malaria suppressive medication, as all the malaria-carrying mosquitoes breed in the countryside. Persons travelling by car, train or extensively throughout the country must follow a suppressive medication regimen. This also applies to persons contemplating cruises on rivers, lakes or along the coast of China. Diseases of Special Risk This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Risk is limited to the southern provinces of Yunnan, Guangxi, and Guangdong. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Extensive control programs have successfully eradicated S.japonicum from many previously endemic areas. Today, the infection is present in the following areas: In the central and lower Chang (Yangtze) river valley including its tributaries and adjacent lakes. The area extends from the city of Yicheng in Hubei Province to the rural areas surrounding Shanghai in the east on the mouth of the river. To the north this endemic area extends in Jiangsu Province to the area of Lake Gaoyou, in Anhui Province to the area of Lake Chao (south of Hefei); in Hubei Province the area surrounding Wuhan, including all lakes and rivers are infected as far north as Xiangfan. In the south, Lake Dongting and the area of Changsha in Hunan Province are affected; in Jiangxi Province the infection is present around Lake Poyang, along the valleys of the Gan river and extending as far south as Fengcheng and Fuzhou. In Zhejiang Province the infection is present in the northern three quarters of the province including the area of the Bay of Hangshou. In Fujian Province a foci of infection exists in the area of the coastal town of Xiapu (Sandu Bay). In Sichuan Province the infection is present in a large area surrounding Chengdu (approx. 200 km radius), and along the lower Yalong river valley in the areas surrounding Zhaojue, Xichand and Hexi. In Yunnan province the risk of infection is present in the northwestern corner of the Province including the Jinsha (Yangtze) and the Lancang (Mekong) River Valleys, including the area of Er Lake and as far south as the area of Weishan. Polio epidemics occur sporadically in China. at 55 times the United States rate. Tuberculosis occurs In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE People's Republic of China Disease Avian Influenza (H5N1) Brucellosis Clonorchiasis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Encephalitis, Japanese Encephalitis, Tick-Borne Endemic X X X X Risk X X X X Hazard Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Visceral) Leptospirosis Paragonimiasis Plague Trachoma Tuberculosis Typhus, Scrub X X X X X X X X X X X AIDS Information Antibody testing is required for all persons staying longer than six months. Foreign tests are acceptable under certain circumstances. Contact the China embassy for further details. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Beijing (Peking), Guangzhou (Canton), Nanjing (Nanking), Tianjin (Tientsin), and Xi'in (Sian) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Cases have been reported from all provinces except Xinzang (Tibet), Xinjiang (Sinkiang) and Qinghai. Disease is most prevalent in central and eastern China. Period of transmission: June to October. High risk group: children under 15 years of age. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Rabies - This disease kills 5,000 persons yearly in mainland China. As many as 1 million yearly are bitten by possibly rapid dogs. Rabies vaccine in China is in short supply. Taiwan - Republic of China INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Taiwan-Republic of China Disease Avian Influenza (H5N1) Tuberculosis Food/Water Safety Endemic X X Risk Hazard All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Taipei serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Occasional outbreaks occur throughout the country. Period of transmission June to October. AIDS Information Tests are required for all persons staying for more than three months. Contact the Taiwan embassy for details. Christmas Island, Territory of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Christmas Island - Indian Ocean Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk and food products probably safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is infected with this disease. A vaccination certificate is required for children over one year of age. Vaccination certificate is required for travelers who have been in or passed through an infected yellow fever area within six days prior to arrival. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Colombia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present only below 800 meters in rural areas of Uraba (Antioquia), Bajo Cauca-Nechi (Cauca and Antioquia), Magdelana Medio, Caqueta (Caqueta), Sarare (Arauca), Catatumbo (Norte de Santander, Pacifico Central and Sur, Putumayo (Putumayo), Ariari (Meta), Alto Vaupes (Vaupes), and Amazonas. The risk exists all year. There is no malaria risk in Bogota and vacinity. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. The department of Bogota and the Caribbean islands of San Andres and Providencia are risk free. Note: The cities of Bogota, Cali, Manizales, Medellin and other cities and villages in the Andean highlands are risk free. On the Caribbean coast, the sea resort of Santa Marta and the cities of Barranquilla and Cartagena are risk free. Persons making excursions on the Magdalena River (south of Barranquilla), travelling along the Pacific coast, or travelling east of the Cordillera Oriental must take mefloquine (Lariam) for suppressive medication. Falciparum malaria represents 48% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Cholera has entered this country from Peru. Immunizations are not required for any traveler, but water and food precautions are urged. Chagas' Disease risk is present below 2500 meters in the following provinces: Boyaca, Caqueta, Cesar, Cundinamarca, Guajira, Huila, Magdalena, Meta, Santander del Norte, Santander del Sur, Tolima, and Valle del Cauca. The main vectors are Rhodnius prolixus and Triatoma dimidiata. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Bartonellosis exists on the western slopes of the Andes, primarily in river valleys, up to 3000 meters. DISEASE RISK PROFILE Colombia Disease Brucellosis Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Leishmaniasis (Visceral) Onchocerciasis Trypanosomiasis, American Chagas' Disease Tuberculosis Typhus, Scrub Endemic Risk X X X Hazard X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Bogota serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Yellow fever - Vaccination is recommended for all travelers for their protection. Vaccination is advised for all persons traveling outside of urban areas who are nine months or older. Yellow fever is frequently active in this country in Arauca, Caqueta, Casanare. Cucuta, Meta and Putumayo Intendencias; and Antioquia, Boyaca, Cundinamarca, Cesar, Guaviare, Santander and Norte de Santander Departments. Comoros, Union of the INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 88% of malaria, therefore there is a 12% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Comoros Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic and Bacillary Echinococcosis Filariasis Giardiasis Endemic X Risk Hazard X X X X Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Congo, Democratic Republic of the INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 94% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Bandundu and Kasai Oriental provinces do not report any infection. All other provinces report high incidence rates of infection, with S. mansoni being the prevalent species. Additional snail intermediate host for S. mansoni: Biomphalaria choanomphala, Biomphalaria smithi and Biophalaria stanleyi. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Dem. Rep. of Congo Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Plague Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic Risk X Hazard X X X X X X X X X X X X X X X X X X X X X X AIDS Information The health minister reports an AIDS exposure rate of 12% in Kinshasa and a 5% exposure rate in the rural towns in Shaba Province, including Lumbumbashi and Kolwezi. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Kinshasa (Leopoldville) and Lubumbashi (Elisabethville) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. The reqirement applies to travelers arriving in or destined for that part of the country south of 10 degrees south latitude. CDC recommends vaccination for all travelers over 9 months of age who will be traveling outside of urban areas. The Embassy of Zaire reports that a yellow fever vaccination is rquired for all travelers over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are present in the notheastern corner of the country bordering Uganda and Sudan. Congo, Republic of the INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a 10% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S.haematobium and S.mansoni are endemic throughout the country, with S.haematobium being predominant. Snail intermediate host for S.mansoni: Biomphalaria camerunensis. Onchocerciasis is encountered in the south of the country with the major concentration along the Djoue River and the bank regions of the River Congo downstream from Brazzaville. Typhus - Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Republic of the Congo Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. Vaccination is recommended for all travelers for their protection. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Cook Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Cook Islands Disease Diarrheal Disease Risk Dysentery, Amoebic Encephalitis, Japanese Filariasis Helminthic Diseases Typhoid Fever Endemic Risk X X Hazard X X X X Food/Water Safety Caution should be used with regard to water supplies. milk products probably safe, but caution advised. Food and VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Costa Rica, Republic of INFECTIOUS DISEASE RISK Malaria Risk San Jose and the central highlands are risk free. Malaria risk exists only below 500 meters, where it is present all year. It is present in the rural areas of Limon province (Caribbean coast) and in the northern provinces of Alajuela, Guanacaste and Puntarenas. Chloroquine is suggested for malaria prophylaxis in these areas. Falciparum malaria represents 27% of malaria, therefore there is an increased risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease risk is present in rural areas below 1300 meters along the Pacific coast and in the central plain. Guanacaste province reports the highest incidence rates. The main vector is Triatoma dimidiata. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Costa Rica Disease Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Paragonimiasis Rabies Trypanosomiasis, American Chaga's Disease Typhoid Fever Endemic X Risk Hazard X X X X X X X X X X AIDS Information Costa Rica has officially reported 39 AIDS cases through September 1987. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Cote D' Ivoire INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in this entire country, all year, to include urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 88% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis is present in the whole country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. Meningococcal meningitis may occur in the Sahelian savannah areas during the dry season from December until June. DISEASE RISK PROFILE Ivory Coast Disease Avian Influenza (H5N1) Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Abidjan serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Croatia, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Croatia Disease Avian Influenza (H5N1) Diarrheal Diseases Dysentery, Bacillary Encephalitis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas bordering Austria extending south to the areas around Ljubljana and Zagreb. Cuba, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue. the past make renewed activity or reintroduction of the virus possible. Intermittent epidemics in DISEASE RISK PROFILE Cuba Disease Diarrheal Disease Risk Dysentary, Amoebic/Bacillary Hepatitis, Viral Rabies Typhoid Fever AIDS Information Endemic X X X X X Risk Hazard AIDS antibody testing is required for all foreigners, excluding diplomats, staying in Cuba for 90 days or longer. Over one-fourth of the entire population has been screened for the HIV virus, with 248 persons having HIV positive tests and 28 persons ill with the disease. All donated blood in Cuba is screened for the HIV antibody. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Cyprus, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Cyprus Disease Avian Influenza (H5N1) Brucellosis Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Echinococcosis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Tapeworms Trachoma Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X X X X X X X X X X X X X X X X Risk Hazard AIDS Information HIV testing is performed upon arrival on all students and foreign nationals working Cyprus. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. At times refrigeration of dairy products during transport is unsatisfactory. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Czech Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Czech Republic Disease Avian Influenza (H5N1) Hepatitis, Viral Rabies Rocky Mountain Spotted Fever Endemic X X Risk Hazard X X AIDS Information All persons entering the country from areas of high risk are being tested for HIV antibody, including citizens returning from those areas. Areas considered high risk include all countries in Western Europe, North and South America, and Africa. All blood donors are being screened with HIV testing. This country reports 11 AIDS cases and 66 known carriers. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Water should be boiled in summer months and at other times when the water table falls to low levels. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Gamma globulin is recommended for all travelers. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas south of Prague, north of Brno, and the areas west of Plzin (Pilsen). Denmark, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Rabies is prevalent in wild animals, especially foxes. Diphyllobothrias (infection with fish tapeworm) is a risk in the Baltic Sea area. DISEASE RISK PROFILE Denmark Disease Avian Influenza (H5N1) Endemic Risk Hazard X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Djibouti, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria may be encountered throughout the country, to include urban areas. Risk is year around. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 80% of malaria, therefore there is a 20% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Meningococcal meningitis may occur during the dry season (December through June) in the savannah areas. DISEASE RISK PROFILE Djibouti Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X X Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Dominica, Commonwealth of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Dominica Disease Dengue Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Rabies Endemic X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Dominican Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is all year long. Malaria may be encountered throughout the country below 400 meters, but not in urban areas. Risk exists only along the border with Haiti in the following urban and rural areas: entire Province of Monte Cristi; entire Province of Dajabon; Province of Elias Pina: municipality of Banica, Comendador and El Llano; Province of Independencia: municipality of Jimani; Province of Barahona: municipalities of Barahona and Cabral; Province of Pedernales: municipality of Pedernales. There is no malaria risk in the resort areas of Puerta Plata, Punta Cana, San Pedro de Macoris, etc. Falciparum malaria represents 100% of malaria. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is limited to the area of Hato Mayor and the surrounding villages in the interior of the eastern part of the country. Other known foci of infection are present at El Seibo, Higuey and Nisibon. DISEASE RISK PROFILE Dominican Republic Disease Dengue Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Tuberculosis Endemic X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Santo Domingo serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. This disease is especially prevlent in the mongoose in this country. AIDS Information Testing is required for all foreigners applying for residency. Contact the Dominican Republic's embassy for full details. East Timor INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk No specific information is available. DISEASE RISK PROFILE East Timor Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety No specific information is available. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Ecuador, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is all year, only below 1500 meters, with minimal risk in urban areas. There is little or no risk in Quito vicinity and the Galapagos Islands. Malria risk is present in Esmeraldas, Guayas (including Guayaquil), Manabi, and El Oro; and rural areas of Los Rios, Morona Santiago, Napo, Pastaza, Pichincha, and Zamora Chinchipe. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Persons travelling to Coca or Lago Agrio for cruises on the Napo River and its tributaries in the upper Amazon jungle or travelling along the Pacific coast (including the city of Guyaquil) must follow these guidelines for suppressive medication. Falciparum malaria represents 22% of malaria, therefore there is a 78% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' Disease is present in rural areas throughout Ecuador. Risk is highest in the coastal provinces, including urban areas, of Esmeraldes, Guayas, El Oro, Los Rios, and Manabi. The vector, Triatoma dimidiata, is locally known as chinchorro. Cholera has appeared in this country, spreading from the epidemic in nearby Peru in March 1991. In May it had spread to the Galapagos Islands. Food and water precautions are advised as indicated below. The cholera vaccine is not required, nor recommended for travelers. Typhus - Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Ecuador Disease Bartonellosis Endemic X Risk Hazard Brucellosis Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Onchocerciasis Paragonimiasis Plague Tuberculosis X X X X X X X X X X X X AIDS Information All foreign visitors intending to stay longer than 60 days will be tested for HIV virus antibody, but the starting date of this testing period has not been announced. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Quito and Guayaquil serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Yellow fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. The Centers for Disease control recommend vaccination for all travelers over 9 months of age who plan travel outside of urban areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the southern part of the country in Loya Province. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Egypt, Arab Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is from June through October in the Nile Delta, El Faiyum area, the Oases and part of Southern (Upper) Egypt. Risk exists in the following areas, excluding urban centers: Nile Delta, the El Faiyum area, the oases, and part of Upper Egypt (southern Egypt). Note: The cities of Alexandria and Cairo inlcuding the archeological sites of Ghiza are risk free. As the risk of malaria infections is limited for persons visiting the archeological sites of Upper Egypt (Luxor, Karnak, etc.) there is no need for suppressant medication when not venturing to rural areas after sunset. However, persons contemplating Nile cruises (during June to October) should follow a chloroquine regimen since the boats pass through areas where malaria transmission can occur. Falciparum malaria represents 4% of malaria, therefore there is a 96% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Infection with S. haematobium is endemic throughout the entire length of the Nile valley including the El Faiyum area and along the Suez Canal. It is one of the world's most highly infected countries. Control measures have reduced the incidence rates in some areas, but the infection is spreading around Lake Nasser. In addition, S. mansoni infection is also endemic throughout the Nile Delta but does not extend further south than El Giza. DISEASE RISK PROFILE Egypt Disease Avian Influenza (H5N1) Brucellosis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis Rabies Relapsing Fever Rift Valley Fever Sandfly Fever Trachoma Tuberculosis Typhoid Fever Typhus Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X AIDS Information All foreigners living in Egypt longer than one month will be tested for HIV antibodies. All tests must be done by Egyptian authorities. In the case of families, only the head of the household will be tested - although it is possible that spouses may also be tested. An HIV antibody test will be required for all foreign contractors entering Egyptian military facilities. American organizations with qualified health personnel can collect their own blood samples which are then to be turned over to Egyptian authorities for testing. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water in first class hotels is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Treat all other sources of water or use bottled water. Milk products should be considered unsafe, other than canned, evaporated or dehydrated milk. Cold food is unsafe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Cholera - This vaccne is not required officially, but the U.S. Embassy reports that border officials may require this immunization if travelers arrive from cholera-infected areas. Special required immunizations - Visitors arriving from the Sudan have recently been required to have immunization against cholera, meningitis, and typhoid. This requirement was no longer official as of Jan 1990. Visitors from the Sudan are required to be on malaria prophylaxis and might be given anti-malria tablets to swallow before being admitted to Egypt. Visitors from all regions of the Sudan are required to have their yellow fever vaccination. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. The vaccinations listed are recommended for the traveler's protection. Meningitis - The Department of State recommends this vaccine for all persons posted to Egypt, but the CDC does not currently recommend this vaccine for travelers. Poliomyelitis - A poliomyelitis booster is indicated for this country. There are 300 cases of polio in this country yearly amongst the native population. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. El Salvador, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria exists in rural areas this country throughout the year, only below 1000 meters. There is no risk in urban areas. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 9% of malaria, therefore there is a 91% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Cholera is present throughout this country. Vaccination is not necessary or advised. Food and water precautions are important. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Chagas' disease is endemic throughout this country. Risk is present in rural areas, small and medium sized towns and suburbs. The main vectors are Triatoma dimidiata and Rhodnius prolixus. DISEASE RISK PROFILE El Salvador Disease Brucellosis Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over six months of age. Children under nine months of age should generally not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Rabies is especially found in dogs and bats. Equatorial Guinea, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a 15% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is endemic in this country. Avoid swimming or wading in fresh water sources such as lakes, rivers, or ponds. S. intercalatum has been reported from the area of Bata. Extent of infection is undetermined. The entire country should be considered infected. DISEASE RISK PROFILE Equatorial Guinea Disease Dengue Fever Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from countries with current infection. A vaccination is required for children of all ages. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Areas of risk are scattered throughout the country. Eritrea, State of INFECTIOUS DISEASE RISK Malaria Risk Malaria is found throughout the country, including urban areas, but excluding Addis Ababa, in all regions below 2000 meters. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 80% of malaria, therefore there is a 20% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The city of Addis Ababa is risk free. Foci of infection are scattered throughout the country. Well documented areas of infection are in the areas of Adwa and Adi Abun (along the Mai Assem and Mai Guagua streams), in the Upper and Lower Awash valley. Foci of infection are also present in Eritrea. More than 2.5 million natives are infected with this disease. There is a risk of meningococcal meningitis in the Sahelian savannah areas from December through June. Onchocerciasis (river blindness) affects more than 1.3 million natives. These disease is endemic in the western part of the country. There are 10,000 cases of relapsing fever in this country annually which is the highest rate of anywhere in the world. Travelers are at low risk from this louse borne disease. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Ethiopia Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Addis Ababa, Asmara, and Massawa serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Estonia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. Hemorrhagic fever is encountered in southern Siberia. AIDS Information Beginning Feb 1989, all persons staying longer than 3 months in the Soviet Union will be required to undergo HIV antibody testing. This includes diplomats, journalists, students, and businessmen. Reports from countries that have a "mutually accepted agreement" will be honored, but there is no list of which countries were included in this arrangement. Previously U.S. tests were not accepted. Any person who knowingly infects another with AIDS can be jailed up to 8 years. Conditions which contribute to the spread of AIDS in this country include improper sterilization of dental instruments, reuse of syringes and other medical supplies, lack of an adequate supply of condoms, and low reliability of the HIV screening tests being used. DISEASE RISK PROFILE Estonia Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Ethiopia, Federal Democratic Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is found throughout the country, including urban areas, but excluding Addis Ababa, in all regions below 2000 meters. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 80% of malaria, therefore there is a 20% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The city of Addis Ababa is risk free. Foci of infection are scattered throughout the country. Well documented areas of infection are in the areas of Adwa and Adi Abun (along the Mai Assem and Mai Guagua streams), in the Upper and Lower Awash valley. Foci of infection are also present in Eritrea. More than 2.5 million natives are infected with this disease. There is a risk of meningococcal meningitis in the Sahelian savannah areas from December through June. Onchocerciasis (river blindness) affects more than 1.3 million natives. These disease is endemic in the western part of the country. There are 10,000 cases of relapsing fever in this country annually which is the highest rate of anywhere in the world. Travelers are at low risk from this louse borne disease. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Ethiopia Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Addis Ababa, Asmara, and Massawa serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Falkland Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Falkland Islands Disease Echinococcosis Hepatitis, Viral Tapeworms Typhoid Fever Endemic X X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Faroe Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Faroe Islands Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Fiji Islands, Republic of the INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Active cases of dengue fever and dengue hemorrhagic fever have been reported from Fiji's central and western divisions. DISEASE RISK PROFILE Fiji Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Hepatitis, Viral Tuberculosis Typhoid Fever Endemic X X Risk Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Finland, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine immunizations recommended above, the traveler should be aware that rabies is prevalent in wild animals, especially foxes. DISEASE RISK PROFILE Finland Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. There is concern amongst some authorities that radioactive fallout from Chernobyl has contaminated northern reindeer herds. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas along the coast of the Gulf of Finland from Kotka to the border with the USSR, and all the islands south of Turku including the Aland islands. France, French Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country, primarily in the Mediterranean costal areas. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE France Disease Avian Influenza Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Sandfly Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X Risk Hazard AIDS Information 3,073 cases of AIDS have been reported, the highest level in Europe, with 40% of these cases being located in Paris. No testing of foreign travelers is required. Blood donors are being checked. Premarital HIV antibody testing is performed. Prenatal exams include HIV antibody testing. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. French Guiana INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention Falciparum malaria represents 70% of malaria, therefore there is a 30% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is present in all rural areas. is Rhodnius prolixus. The main vector DISEASE RISK PROFILE French Guiana Disease Endemic Risk Hazard Brucellosis Chikungunya Fever Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Encephalitis Filariasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Rabies Tuberculosis Trypanosomiasis, American X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. French Polynesia, Overseas Lands of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. An active epidemic of dengue and dengue hemorrhagic fever is present in this country at this time. DISEASE RISK PROFILE French Polynesia Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Gabon, Gabonese Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria exists all year, in all parts of the country below 1000 meters, including urban areas. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 95% of malaria, therefore there is a 5% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis is present in this country. Avoid contact with fresh water lakes, pounds, or rivers. Infection with S. haematobium and/or S. intercalatum has been reported from all populated regions of Gabon. S. haematobium is more prevalent in the western half of the country, while S. intercalatum is predominant in the eastern half. No research data is available from the northeastern interior. DISEASE RISK PROFILE Gabon Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub AIDS Information Endemic Risk X Hazard X X X X X X X X X X X X X X X X X X X X AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who go outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Polio is prevalent in this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Gambia, Republic of The INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in this entire country all year around. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a 15% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium is endemic along the Gambie valley. The snail intermediate host for S. haematobium: Bulinus jousseaumei and Bulinus guernei. S.mansoni is present in some villages south of Banjul along the border with Senegal. DISEASE RISK PROFILE Gambia Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Endemic X Risk Hazard X X X X X X Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Rift Valley Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. This disease is active presently in the Upper River Division. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Meningococcal infection is present in this country. Georgia INFECTIOUS DISEASE RISK Malaria Risk Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Georgia Disease Avian Influenza (H5N1) Tuberculosis Endemic Risk Hazard X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Germany, Federal Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following disease exists in this country. This list is not all inclusive, but it is a caution concerning the most likely endemic disease risk. Rabies is prevalent in wild animals, especially foxes. AIDS Information 1,760 cases of AIDS were reported through Jan 1988. No official requirement exists for testing travelers, but travelers suspected of carrying the HIV virus may be refused entry. The state of Bavaria requires an HIV antibody test for persons planning on staying there longer than 180 days. Results of US tests are not accepted. DISEASE RISK PROFILE Germany Disease Avian Influenza (H5N1) Endemic Risk Hazard X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the forested areas around Karlsruhe and Pforzheim, Stuttgart and Tubingen, and in areas around Regensburg, extending south to Landshut and to Passau on the border with Austria. Ghana, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria exists in all parts of this country, all year long. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis is found throughout this country, including urban areas. Avoid contact with contaminated fresh water lakes, ponds, or streams. Amoebic and bacillary dysentery, diarrheal diseases, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. DISEASE RISK PROFILE Ghana Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Echinococcosis Filariasis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Vaccination certificate is required for travelers who have been in or passed through an infected yellow fever area within six days prior to arrival. Vaccination is recommended for all travelers for their protection. The Centers for Disease Control recommends immunization for all travelers 9 months and over. Cholera - Cholera is present in this country. Risk to western travelers is low. Local officials may demand a cholera vaccination, therefore it is advisable to obtain one prior to arrival in this country. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is in the region bordering Burkina Faso. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Gibraltar INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Gibraltar Disease Brucellosis Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Sandfly Fever Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Greece, Hellenic Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Greece Disease Avian Influenza (H5N1) Brucellosis Diarrheal Disease Risk Dysentery, Bacillary Echinococcosis Encephalitis, Tick-Borne Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X X X Risk Hazard Special Note: Most medications with codeine have been banned in Greece. Obtain a physician's letter explaining the need for medications containing codeine (caution - many cough preparations contain codeine). Fines of $850 to $85,000 or prison terms of up to ten years can be levied on anyone attempting to bring codeine into the country without a doctor's justification. AIDS Information Foreign students receiving Greek government scholarships and performing artists must produce evidence of a negative HIV antibody test result. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over 6 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Greenland INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Rabies ocurs in this country in wildlife, especially bats. Tularemia is also endemic in Greenland. DISEASE RISK PROFILE Greenland Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of of hepatitis B among the local vaccination is recommended for education, or in close contact the high rate of healthy carriers Inuit (Eskimo) population, persons working in health care, with them. Grenada INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Amoebic and bacillary dysentery, diarrheal diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. Rabies is prevalent in this country, especially in the mongoose. AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. DISEASE RISK PROFILE Grenada Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Guadeloupe INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The entire island of Grande Terre is infected. All densely populated coastal areas of Basse Terr are infected, with only the interior highland forest areas free of risk. No data is available from the islands of Marie-Galante and La Desirade. Rabies has been reported, especially in the mongoose, in this country. Amoebic and bacillary dysentery, diarrheal diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. DISEASE RISK PROFILE Guadeloupe Disease Endemic Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Guam, Territory of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Guam Disease Dengue Fever Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X Food/Water Safety First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Guatemala, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk exists all year only below 1500 meters. The city of Guatemala and the high altitude areas of the central highland are risk free. It is found (a) (excluding urban areas) in Baja Verapaz, Chiquimula, Escuintla, Jalapa, El Peten, El Progreso, El Quiche, Santa Rosa, Suchitpequez, Zacapa; (b) Alta Verapaz, Huehuetenago, Izabal, Jutiapa, Retalhuleu; and in the Municipios of Coatepeque (Quetzaltenango Dep.) and Ocos (San Marcos Dept.) Note: Persons vacationing on the Pacific or Caribbean coasts, or contemplating trips to the archaeological sites of Sayache and Tikal and the jungle of Peten, or traveling throughout the interior should follow an antimalarial regimen. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 6% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk There has been a significant spread of cholera into much of this country. Cholera vaccination is not required or advised. Food and water precautions are essential. Chagas' disease risk is present in all rural areas below 1500 meters of the following departments: Alta Verapaz, Baja Verapaz, Chiquimula, El Progreso, Escuintla, Guatemala, Huehuetenango, Jalapa, Jutiapa, Sa, Marcos, Santa Rosa, and Zacapa. The main vectors are Triatoma dimidiata and Rhodnius prolixus. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Guatemala Disease Brucellosis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Onchocerciasis Trypanosomiasis, American Chaga's Disease Tuberculosis Typhoid Fever Endemic X X Risk Hazard X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Guatemala City serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is infected with yellow fever. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Rabies is most commonly found in this country in dogs and bats. AIDS Information Testing is required for all applicants for residence permits. Foreign tests are acceptable under certain circumstances. but contact the Guatemalan embasy for details. Guinea, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in this entire country, all year long. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 92% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium and S. mansoni are endemic throughout Guinea, except for the administrative regions of Conakry, Boffa, Dubreka, Telimele and Pita (coastal and western part of the country). Amoebic and bacillary dysentery, diarrheal diseases, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. DISEASE RISK PROFILE Guinea Disease Dracunculiasis/Guinea Worm Echinococcosis Filariasis Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Yellow fever is active in this country at this time. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Guinea-Bissau, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in this entire country, all year long. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S.haematobium is highly endemic throughout the northern half of the country, particulary in the valleys of the Cacheu and Geba rivers, and along the border with Guinea. Infection is not present along the saltwater marsh and mangrove areas of southwestern Guinea-Bissau and the outlying islands. Amoebic and bacillary dysentery, diarrheal diseases, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. DISEASE RISK PROFILE Guinea-Bissau Disease Dracunculiasis/Guinea Worm Echinococcosis Filariasis Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone, see page HHH. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Guyana, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in North West Region and Rupununi Region of this country below 900 meters, excluding urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 41% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Amoebic and bacillary dysentery, diarrheal diseases, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. The vector for Chagas' disease, Rhodnius prolixus, is present in rural areas, but due to the lack of investigations on Chagas' disease the extent of human infection cannot be determined. DISEASE RISK PROFILE Guyana Disease Brucellosis Echinococcosis Encephalitis Filariasis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Tuberculosis Trypanosomiasis, American Endemic X X X X X X X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Georgetown serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination is required for children of all ages. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Haiti, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in this country in all areas below 300 meters, including urban areas, all year long. Note: Persons vacationing in sea resorts or stopping overnight on a cruise in any port of the country must take malaria suppressant medication. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Haiti Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Filariasis Hepatitis, Viral Rabies Tuberculosis Tularemia Endemic Risk X Hazard X X X X X X AIDS Information Researchers report 1,000 to 2,000 cases of AIDS have been diagnosed, with between 100,000 to 200,000 persons estimated to be infected with the virus. Projections are that 1 million of the country's 6 million inhabitants will become infected with the virus within the next 5 years. 50% of Haitian prostitutes carry the AIDS virus. every 10 AIDS patients are female. Four out of Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with current infection. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Honduras, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no risk of malaria in the urban areas of the Central highlands. Malaria is found below 1000 meters from May through December in rural areas of Intibuca, La Paz, Lempira, and Olancho Departments. The city of Tegucigalpa is risk free. Note: Persons vactioning in the sea resorts of Ceiba and Tela or the Bay Islands (Islas de la Bahia), or travelling along the Pacific coast or extensively in the interior should take malaria suppressant medication. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 3% of malaria, therefore there is risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Cholera has appeared in this country along the Pacific coast. Vaccination is not required or recommended. Food and water precautions are urged. Chaga's Disease is present in rural areas below 1500 meters in the following departments: Choletucaca, Comayagua, Copan, El Paraiso, Francisco Morazan, Intibuca, La Paz, Lempira, Ocotepeque, Olancho, Santa Barbara, and Yoro. The main vectors are Triatoma dimidiata and Rhodnius prolixus. DISEASE RISK PROFILE Honduras Disease Brucellosis Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Tuberculosis Endemic X Risk X X X X X X X Hazard Typhoid Fever X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Tegucigalpa serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. Children under nine months of age should generally not be vaccinated with yellow fever vaccine due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Rabies frequently occurs in dogs and bats in this country. Hungary, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Hungary Disease Avian Influenza (H5N1) Diarrheal Disease Risk Dysentery, Bacillary Rabies Tuberculosis Typhoid Fever Endemic X X X X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas extending from the Austrian border east to the outskirts of Budapest. Iceland, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Iceland Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. India, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas, except the following northern states which are risk free: Himachal Pradesh, Jammu, Kashmir and Sikkim. Main vectors: northern India; A. minimus minimus; Ganges plane: A. stephensi stephensi and A. culicifacies; peninsular India: A culcifacies. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 19% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Meningococcal meningitis - There have been outbreaks in the New Delhi area. Consider vaccination for travel to this area. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk is limited to the area of the Gimvi village in Ratnagiri District, State of Maharashtra, in the hills along the Konkan coast, south of Bombay (approximately 16km from shore). Risk of transmission in other areas of India have not been confirmed. Snail intermediate host: Ferrissia tenuis. DISEASE RISK PROFILE India Disease Avian Influenza (H5N1) Brucellosis Chikungunya Fever Cholera Dengue Fever Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Encephalitis, Japanese Filariasis Helminthic Diseases Hemorrhagic Fevers Hepatitis, Viral Leishmaniasis (Visceral) Rabies Relapsing Fever Sandfly Fever Trachoma Tuberculosis Typhoid Fever Typhus Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information Proof of a negative HIV antibody test is required by all students over the age of 18 and other persons between 18 and 70 planning to stay for more than 1 year, excluding accredited journalists and those working in foreign missions. U.S. test results are accepted. These test results should be validated with the uniform stamp used to certify yellow fever and cholera vaccinations. Testing must be performed within 30 daysd of arrival. Health officials in Bombay have indicated that the number of AIDS carriers doubles in that city every six months. A survey of the country's blood supply in 1989 indicated that more than 1% of the country's blood supply is contaminated with the AIDS virus. There is a very poor blood donor screening program. Approximately 10,000 prostitutes in Bombay are believed to carry the AIDS virus. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Agra, Ahmadabad, Bangalore, Bombay, Calcutta, cochin, Darjeeling, Jaipur, madras, New Delhi, Simla, Srinagar, Udaipur, and Varanasi (Benaress) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Travelers leaving this country are required to possess a vaccination certificate on their departure to countries which still demand such a certificate. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone but to include all portions of the Sudan - not just that area south of 15 degrees north latitude. A vaccination is required for children up to six months of age. CDC recommends vaccination for all travelers over 9 months of age. Vaccination certificate is required for travelers who have been in or passed through an infected yellow fever area within six days prior to arrival. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. The disease is most prevalent in the north, northeast, and south. Period of transmission is all year, with the high risk group being children under 15 years of age. Time of greatest risk is June through October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the north: Himachal Pradesh and the northern part of Uttar Pradesh; in the south: the northwestern part of Tamil Nadu. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Indonesia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria exists in the rural areas only, and below 1200 meters. Risk is all year. There may be urban exposure in Irian Jaya. Jagkarta, Surabaya, Denpasar (Bali) and other large cities are risk free. Note: Persons travelling through rural areas, or making cruises between the islands should be aware of multi-drug-resistant P. falciparum malaria and should follow an antimalarial regimen. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. IAMAT has found evidence of malaria in Bali. Exposure to mosquitoes at night should be minimized with the use of insect repellant and/or netting. Falciparum malaria represents 40% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Only the centre of Sulawesi is considered endemic. Risk is present in the Lindu valley and localized around Lake Lindu (villages of Anca, Langko, Tomado and Puroo); and in the Napu valley (about 50 km southeast of Lindu valley) affecting the villages of Wuasa, Maholo, Winowanga, Alitupu and Watumaeta. Snail intermediate host is a subspecies: Oncomelania hupensis lindoensis. Amoebic and bacillary dysentery, diarrheal diseases, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. DISEASE RISK PROFILE Indonesia Disease Avian Influenza (H5N1) Chikungunya Fever Encephalitis, Japanese Fasciolopsiasis Filariasis Melioidosis Rabies Tuberculosis Trachoma Typhus, Scrub Endemic X X X X Risk Hazard X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Denpasar, Jakarta, Surabaya, and Yogyakarta serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination is required for children of all ages. Children under nine months of age should generally not be vaccinated due to health considerations. Please refer to the discussion on page III on avoiding yellow fever vaccination in this age group. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throughout the country all year long (highest instance in June through October), with the highest risk being in children younger than 15 years of age. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is on the island of Java south of Surakarta. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Iran, Islamic Republic of INFECTIOUS DISEASE RISK Malaria Risk Risk is present in rural areas throughout Iran, except the central and northern high altitude areas (above 1500 m). Chloroquine is the drug of choice for Iran in these areas. Chloroquine resistant P. falciparum malaria has been reported from Baluchistan (area bordering Pakistan) and Sistan (area bordering Afghanistan). Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 21% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium is present only in the plains of the province of Khuzestan on the southwestern border with Iraq. The following areas are affected: Dasht Mishan, Khorramshahr, Hamidieh, Ahwaz and the extensively irrigated areas of Dezful, Shushtar, Mian Ab, Haft Tappeh, including the area of Sardasht. The infection does not extend beyond the Zagros Mountains to the east. Amoebic and bacillary dysentery, diarrheal diseases, giardiasis, helminthic diseases, and viral hepatitis associated with water and food supplies are particularly common in this country. DISEASE RISK PROFILE Iran Disease Avian Influenza (H5N1) Brucellosis Echinococcosis Leishmaniasis Relapsing Fever Sandfly Fever Trachoma Tuberculosis Typhoid Fever Typhus Endemic Risk Hazard X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Abadan, Esfahan, Mashhad (Meshed), Shiraz, and Tehran serve purified drinking water and reliable food. the hazard is left to your judgement. However, VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of risk for this country are present in the northwest portion of the country in the areas around Manjil where the Talish Mountains meet the Elburz Mountains. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. AIDS Information AIDS testing is required for all persons staying longer than three months. Further information is available from the Iranian embassy. Iraq INFECTIOUS DISEASE RISK Malaria Risk Malaria is found below 1500 meters in the northern part of the country, including urban areas, in the Provinces of Duhok, Erbil, Kirkuk, Mawsil, Ninawa, and Sulaimaniya. Risk is also present in rural areas in the eastern half of the country along the border with Iran. Note: the city of Baghdad is risk free. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents <1% of malaria, therefore there is a significant risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The mountainous regions of the northeastern part of the country bordering Iran, namely the provinces of Irbil, Kirkuk and Sulaymaniyah are risk free. S. haematobium is endemic along the entire Euprhates and Tigris (as far north as Samarra) river systems, their tributaries, irrigation canals and marsh areas including urban areas. As isolated focus exists in the northern Province of Mawsil (Mosul) in the area of Tall Kayft. DISEASE RISK PROFILE Iraq Disease Avian Influenza (H5N1) Brucellosis Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Echinococcosis Hepatitis, Viral Hemorrhagic Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information Travelers planning on staying longer than 5 days must be tested for HIV antibody. Failure to have this test performed will result in a fine of $1,600 US. Foreign tests are acceptable under certain circumstances and can result in avoiding the $330 test fee. Conact the Iraqi embassy for further details. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Baghdad serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for all travelers coming from infected areas and from or in transit through countries with active infection. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Known areas of risk are present in the eastern part of the country, with a major focus of activity around Khanaqin. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Ireland INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Ireland Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Israel, State of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. A recent polio epidemic makes it advisable for everyone traveling to Israel to be current on polio immunization. DISEASE RISK PROFILE Israel Disease Avian Influenza (H5N1) Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X AIDS Information The government is debating the testing for HIV antibody in all foreign volunteers coming to work at kibbutzim, or communal farms. Some kibbutzim are currently conducting tests. Blood donors have been screened since 1986. The number of persons infected with the virus is known to be 237; persons with active AIDS disease 45; and deaths from AIDS, 33 through July 1987. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. There has been a steady increase in infectious hepatitis in recent years. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are generally safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat with caution as to the source. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Italy, Italian Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Italy Disease Avian Influenza (H5N1) Brucellosis Diarrheal Diseases Dysentery, Bacillary Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. This problem is more common in the summer months in the southern portion of the country. Water in the Adige River in northeastern Italy is contaminated with toxic chemicals and should not be drunk. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Hepatitis A is found with increasing risk in this country, therefore gamma globulin injection is recommended. Jamaica INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Scabies and head lice are frequent problems amongst the lower class native population. Dumping of raw sewage into the ocean at major resort areas and in Kingston Bay are potential health problems that may grow as the tourist business increases. DISEASE RISK PROFILE Jamaica Disease Endemic Risk Hazard Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Leptospirosis Rabies Typhoid Fever X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. A typhoid fever outbreak in the western regions of this country underscores the requirement for obtaining a safe water supply. The thyphoid fever area is not frequented by tourists. Sewage treatment is very poor and even many first class hotels dump waste directly into the ocean. Medical waste can be found on the south shore beaches. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Japan INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. In this country Schistosomiasis has been brought under control due to improved sanitation and irrigation systems, and widespread destruction of the snail intermediate host. No human cases have been reported sine 1978. Today, S. japonicum in Japan is a zoonsis (infection of animals) limited to the Kofu Basin, with cattle and rodents being the major parasite reservoirs. DISEASE RISK PROFILE Japan Disease Avian Influenza (H5N1) Clonorchiasis Dengue Fever Paragonimiasis Tuberculosis Typhoid Fever (Okinawa) Typhus, Scrub Endemic X X X X X X X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccination listed is recommended for the traveler's protection. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur in western and southern Japan, especially on the islands of Kyushu and Okinawa. Period of transmission is June through October, with the elederly being at the highest risk. Jordan, Hashemite Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. The Department of State recommends meningococcal meningitis immunization for travel to this country, but the CDC does not. DISEASE RISK PROFILE Jordan Disease Avian Influenza (H5N1) Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Dysentery, Amoebic Echinococcosis Giardiasis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Amman serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Kazakhstan, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Kazakhstan Disease Avian Influenza (H5N1) Tuberculosis Endemic X X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Kenya, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year, but only below 2500 meters. There is no risk of malaria in Nairobi and the highlands above 2500 meters of the central, Rift Valley, Eastern, Nyanza and Western provinces. Persons contemplating safaris or vacationing in Mombasa and the sea resorts along the coast must take suppressive medication. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Both S. haematobium and S. mansoni are endemic in Kenya, especially in irrigated agricultural zones and the densely populated rural and suburban areas around Lake Victoria (Kavirondo Gulf and Nyakach Bay), the islands of Mfangano and Rusinga, Kisumu and Kano Plain; on the Plateaux to the east, northeast and north of Nairobi, expecially in the districts of Kitui and Machakos; in the lower valley of the Tana river in the southeastern part of the country extending from the towns of Garissa to Galole; the Indian ocean coastal from Lamu to the border with Tanzania including the areas of Mombasa; Lake Jipe and surrounding areas including the areas of Taveta, Wundanyi and Voi. Foci of infection have also been reported from Wajir and W.Bor in North Eastern Province, and from Kimilili, Western Province. The full extent of the infection is not yet determined. Additional snail intermediate hosts; Bulinus ugandae, Bulinus tropicus, Bulinus nasutus for S. haematobium; Biophalaria choanomphala for S. mansoni. Meningococcal meningitis is at times epidemic in the savannah during the dry season from December until June. DISEASE RISK PROFILE Kenya Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Hemorrhagic Fever (Marburg) Plague Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information Government researchers randomly tested 200 Nairobi prostitutes and indicated that 85% were HIV antibody positive. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Malindi, Mombasa, Nanyuki, and Tsavo serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Vaccination is recommended for all travelers for their protection. CDC recommends vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal menigitis - Vaccination is recommended for all travelers to this country who might visit rural areas or areas with possible refugee activity. In general, this vaccination should be given to all travelers to this country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the areas around Nairobi and along the border with Tanzania (eastern part). Kiribati, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Kiribati Disease Dengue Fever Diarrheal Diseases Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Korea, Democratic People’s Republic of (North Korea) INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE North Korea Disease Dengue Fever Diarrheal Diseases Encephalitis, Japanese Encephalitis, Tick-Borne Hepatitis, Viral Tuberculosis Endemic X Risk X X X X X Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Pyongyang serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occasionally, with the period of transmission from June to October. Korea, Republic of (South Korea) INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE South Korea Disease Avian Influenza (H5N1) Clonorchiasis Dengue Fever Diarrheal Diseases Encephalitis, Japanese Encephalitis, Tick-Borne Filariasis Hepatitis, Viral Paragonimiasis Tuberculosis Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X AIDS Information AIDS antibody testing is required for foreigners working as entertainers who are staying longer than 90 days. Contact the South Korean embassy for further details. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Pusan and Soul (Seoul) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks reported from all provinces, especially the southwest, with the period of transmission from June to October. High risk groups are children and young adults. Kuwait, State of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Kuwait Disease Avian Influenza (H5N1) Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X AIDS Information AIDS antibody testing is required for persons applying for residence permits for periods longer than six months. U.S. test results are accepted. Conact the Kuwait embassy for further details. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Kyrgyzstan, Kyrgyz Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Kyrgyzstan Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Laos, Lao People's Democratic Republic INFECTIOUS DISEASE RISK Malaria Risk The city of Viangchan (Vientiane) is risk free. Falciparum malaria consitutes 93 percent of the malaria in this country. This malaria is resistant to chloroquine and the CDC recommends the use of weekly Lariam (mefloquine) for prophylaxis. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Known areas of infection are present on Khong Island in the Mekong river in the southwest of the country on the border with Cambodia. Risk exists also further north on the Mekong in the districts of Pakxe and Bassac. DISEASE RISK PROFILE Laos Disease Avian Influenza (H5N1) Chikungunya Fever Cholera Clonorchiasis/Opisthorchiasis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X X Risk Hazard X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Vientiane serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. The disease is endemic throughout the year. Period of transmission is all year. Latvia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Latvia Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Lebanon, Lebanese Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk is limited to the Litani River delta near As Sarafand between Sur (Tyre) and Sayda (Sidon). The infection has been brought under control as no cases of locally acquired human Schistosomiasis have been reported since 1969. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Lebanon Disease Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Tapeworms Trachoma Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic Risk Hazard X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. AIDS Information AIDS testing is required for all persons planning to live or work in Lebanon. Contact Lebanon's embassy for full details. Lesotho, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Locations of infection are not confirmed. DISEASE RISK PROFILE Lesotho Disease Diarrheal Disease Risk Dysentery, Amoebic Endemic Risk X X Hazard Plague Rabies Relapsing Fever Rift Valley Fever Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Scrub X X X X X X X X Food/Water Safety Water, milk, and food is safe in Maseru, but precautions should be taken in other areas of the country. AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. Children under nine months of age should not be vaccinated due to health considerations. The U. S. Embassy reports that the yellow fever certificate is generally not checked by officials upon entry to this countyr. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the western half of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Liberia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a 10% risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The coastal regions of Liberia are risk free, specifically the countries of Grand Cape Mount, Montserrado, Grand Bassa, Sinoe, Maryland and Grand Gedeh. The interior regions are heavily infected with both S. haematobium and S. mansoni. DISEASE RISK PROFILE Liberia Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Helminthic Diseases Hepatitis, Viral Lassa Fever Loiasis Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Endemic Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Libya, Great Socialist People’s Libyan Aran Jamahiriya INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country exceot in two small areas in the southwest corner of the country in the region of Fezzan. The CDC does not recommend taking any preventative medication for travel to this country. Falciparum malaria represents <1% of malaria, therefore the risk of exposure is limited to p. vivax malaria in the infected areas. Consider use of Primaquine upon return home, if travel and exposure in southwest Libia has occurred. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Triolitania and Cyrenaica are free from schistosomiasis, except for two isolated foci near the Mediterranean coast, one at Darnah (S. haematobium) located halfway between Benghazi and the Egyptian border, and the other at Tawurgha (S. mansoni), an oasis located south of Misratah. S. haematobium is highly endemic in the central part of Fezzan around Sabha, mainly in the villages along the wadis of Buanis, Shati, Ajal and Hufra. Risk is also present in the oases of Ghat, El Feuet and Al Birkah on the southwestern border with Algeria. DISEASE RISK PROFILE Libya Disease Brucellosis Dengue Fever Diarrheal Disease Risk Echinococcosis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis Polio Rabies Relapsing Fever Rift Valley Fever Sandfly Fever Trachoma Typhoid Fever Typhus Endemic Risk X Hazard X X X X X X X X X X X X X X X AIDS Information Proof of a negative HIV antibody test is required from persons seeking residence visas for work or study. Other visitors and official delegation members are reportedly exempt. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Al Jaghbub, Banghazi (Benghazi), and Tarabulus (Tripoli) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is around Tobruk (northeastern part of the country) and the areas around Sidra. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Liechtenstein, Principality of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk The traveler should be aware that risk of exposure to rabies occus in wild animals in this country. DISEASE RISK PROFILE Liechtenstein Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Lithuania, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Lithuania Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rural areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the western part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Luxembourg, Grand Duchy of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk The traveler should be aware that risk of exposure to rabies occus in wild animals, especially foxes, in this country. DISEASE RISK PROFILE Luxembourg Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Macedonia, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Macedonia Disease Avian Influenza (H5N1) Brucellosis Diarrheal Disease Risk Dysentery, Bacillary Echinococcosis Encephalitis, Tick-Borne Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X X X Risk Hazard Special Note: Most medications with codeine have been banned in Greece. Obtain a physician's letter explaining the need for medications containing codeine (caution - many cough preparations contain codeine). Fines of $850 to $85,000 or prison terms of up to ten years can be levied on anyone attempting to bring codeine into the country without a doctor's justification. AIDS Information Foreign students receiving Greek government scholarships and performing artists must produce evidence of a negative HIV antibody test result. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over 6 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Madagascar, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, below 1700 meters, including most urban areas. The risk exists all year. There is almost no risk of malaria in the town of Antananarivo and minimal risk in the outskirts. There is minimal risk in the towns of Antsirabe, Manjakandriana, and Anramasina. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Shistosomiasis is highly endemic in most areas of the country, except for the most northern tip of the Island (canton of Antsiranana) and the following cantons of the northeastern coast: Maroantsetra, Mananara, Soanierana-Ivongo, Andilamena, Ambatondrazaka, Manjakandriana; in the interior of the country the cantons of Anjozorobe, Amdramasina, Abatolampy, Betafo and Antsirabe are also risk free. S. haematobium is prevalent in the northern and western parts of the island, while S. mansoni is predominant in the eastern and southern parts. Madagascar has a high incidence of internal migration which facilitates the spreading of Shistosomiasis. Travellers should consider the entire country as infected. Additional snail intermediate host for S. haematobium: Bulinus obtusispira. DISEASE RISK PROFILE Madagascar Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Plague Polio Rabies Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Antananarivo (Tananarive) and Tamatave serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - A cholera vaccination certificate is recommended for travelers coming from or having been in transit through areas considered infected. Local officials frequently demand, however, that travelers show proof of cholera immunization, even though they have not been in infected areas. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and sometimes from or in transit through countries in the endemic yellow fever zone. A vaccination is required for children of all ages. Children under 9 months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the central highlands (Antananarivo and Fianarantsoa provinces). Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Country number 121 Madeira Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Madeira Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over one year of age. The requirement applies only to travelers arriving in or destined for the Azores and Madeira. No certificate is, however, required from transit passengers at Funchal, Porto Santo, and Santa Maria. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Malawi, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country in all areas, including urban settlements. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Malawi Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Meningitis Onchocerciasis Polio Rabies Relapsing Fever Trachoma Tuberculosis Trypanosomiasis, African Sleeping Sickness Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Blantyre serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Vaccination is recommended for all travelers for their protection. Vaccination is not advised for children under nine months of age. Although not officially required for travel to this country, officials sometimes demand that a cholera certificate of immunization be presented. This vaccine is not recommended, but the travel clinic may wish to stamp the immunization record on the cholera page indicating that the vaccine is not medically indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the southern half of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Malaysia INFECTIOUS DISEASE RISK Malaria Risk Malaria is present only below 1700 meters this country, in rural areas only. The risk exists all year. Urban and coastal areas of peninsular Malaysia including the Island of Pinang are risk free. Island of Borneo: Sarawak: Coastal and urban areas are risk free. Sabah: Risk is present in urban and rural areas throughout the year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 22% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Dengue fever is on an increase in this country and may be a particular hazard during 1990 and 1991. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Known foci of risk are present in the area of Fort Betau, (Pahang State) along the Kapor River (tributary to the Pahang) in central Malaysia, east of Kuala Lumpur, and in two camps of Orang Asli tribespeople: Pos Iskandar and Bukit Lanjan, east of Kuala Lumpur. Snail intermediate host: Robertsiella kaporensis. Due to the high incidence of tuberculosis in this country, and pre- travel and post-travel TB test is recommended when traveling to this country. DISEASE RISK PROFILE Malaysia Disease Avian Influenza (H5N1) Cholera Opisthorchiasis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Melioidosis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Kuala Lumpur and Pinang (George Town) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throughout the country, throughout the year. AIDS Information AIDS testing is required for foreign workers seeking employment such as construction, domestic, or plantation workers. Foreign test results are accepted under certain conditions. Contact the Malaysian embassy for full details. Maldives, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no risk of malaria in Male Island, Kaafu Atoll and resort areas. The CDC recommends a weekly dose of chloroquine when traveling to areas of risk in this country. Malaria in other areas is only 1% falciparum. Malaria risk is disappearing; the last indigenous cases have been reported in 1983. Note: There is no risk for persons vacationing in the resort areas.Consider use of Primaquine therapy upon return home if heavy exposure occurs. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Maldives Disease Brucellosis Cholera Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Helminthic Diseases Hemorrhagic Fever, Crimea-Congo Hepatitis, Viral Leishmaniasis (Visceral) Polio Rabies Endemic Risk X X X X X X Hazard X X X X X Sandfly Fever Typhoid Fever X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Mali, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found throughout this country, including urban areas. Avoid contact with contaminated fresh water lakes, ponds, or streams. The entire southern half of Mali (south of Lake Faguibine) is endemic for both S. haematobium and S. mansoni especially in the highly populated areas of the Niger and Senegal river basins and their tributaries. High incidence rates of infection have been reported from the urban areas of Bamako, Segou and Mopti regions. No information is available from the Gao area and the northern desert regions. Travellers should consider the entire country as infected. Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. DISEASE RISK PROFILE Mali Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Endemic X Risk Hazard X X X X X X X X Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. Except: travelers arriving from a non-infected area and staying less than two weeks in the country. Vaccination is recommended for all travelers for their protection, including those visiting the capital Bamako. This disease is active in this country at this time. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger in the southern half of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Malta, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Malta Disease Brucellosis Diarrheal Diseases Dysentery, Bacillary Echinococcosis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over six months of age. Children under nine months of age should not be vaccinated due to health considerations. If indicated on epidemiological grounds, infants under six months of age are subject to isolation or surveillance if coming from an infected area. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Marianas, Commonwealth of Northern INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Phillipines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Mariana Islands Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Marshall Islands, Republic of the INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Phillipines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Marshall Islands Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Martinique, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found throughout this country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Martinique Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Typhoid Fever Endemic Risk X X Hazard X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Water, milk, and food in Forte-de-France are considered safe, however, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Mauritania, Islamic Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no risk of malaria in the following areas north of 20 degrees north: Dakhlet-Nouadhibou, Inchiri, Adrar, and Tiris-Zemour. Malaria is present all year, throughout the country, except as noted. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 8% of malaria, therefore there is a significant risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection with S. haematobium has been reported from all regions including the capital of Nouakchott, except from Dakhlet Nouadhibou. The highest infection rates are reported from the populated areas along the Senegal river, the Karakoro river valley including the settlements along their tributaries and diversion canals, and from the Adrar mountain region in the center of the country. The nomadic life of Mauritanian herdsmen facilitates the spread of the infection. Travellers should consider all oases and settlements as infected. Additional snail intermediate host: Bulinus truncatus rohlfsi. Rift Valley fever is a risk to persons working with domestic animals and livestock, and from mosquito exposure, in the Tarza Region, especially in the Departments of Rosso and Keur Macene. DISEASE RISK PROFILE Mauritania Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Rabies Relapsing Fever Rift Valley Fever Trachoma Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. Except: travelers arriving from a non-infected area and staying less than two weeks in the country. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger in the southern third of the country. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the northwestern corner of the country along the border with Morocco. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Mauritius, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in the country in rural areas only in the following disticts: Pamplemousses, Plaines Wilhelms, Riviere du Rampart, Grand Port and Port Louis.. No malaria is found on Rodiguez Island. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 0% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found throughout this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Snail intermediate host for S. haematobium: Bulinus cernicus. Tuberculosis would be a risk if the traveler is in intimate contact with the native population over a period of time. Preand post-trip tuberculosis skin tests are advised under the above circu,stance. DISEASE RISK PROFILE Mauritius Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. AIDS Information Testing is required for all foreigners planning to work or to seek residency. Foreign tests are accepted under some circumstances. Contact this country's embassy for full details. Mayotte, Territorial Collectivity of INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Phillipines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Mayotte Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Mexico, United Mexican States INFECTIOUS DISEASE RISK Malaria Risk Malaria risk in Mexico has been increasing in recent years, doubling from 42,104 in 1980 to 85,501 in 1984 (the last year of current statistics). There is only limited risk of malaria in the major tourist developments of the Pacific and Gulf coasts. There is no risk of malaria in urban areas. It is only found in rural areas below 1000 meters in the following locations: the Pacific coastal areas from Guaymas to the southern border with Guatemala; months of risk: all, except for the states of Sonora and Sinaloa where the risk is present from May to October; the valleys fo central Mexico below 1000 m; months of risk: May to October.; the coastal areas along the Gulf of Mexico from Tampico to and including the Yucatan Peninsula; months of risk: all. Plasmodium vivax is predominant, Plasmodium falciparum malaria is present in small foci of Chiapas and Tabasco. Note: Visitors to the major resorts along both coasts (Acapulco, Puerto Vallarta, etc.) residing in hotels should use mosquito repellents (containing DEET) after sunset. They do not require an antimalarial regimen. Persons camping and hiking along the coasts should take a full course of suppressive medication. Archeological sites: Daytime excursions from cities to the following archeological sites do not require an antimalarial regimen. However, persons staying overnight in the vicinity or in nearby villages should take a full course of suppressive medication: Bonampak, El Cayo, La Mar, Palenque, Tonina, etc. in the state of Chiapas. (There is no risk in the cities of Villahermosa and Tuxtla Gutierrez); Becan, Calakmul, Edzna, Hochob, Xpuhil, etc. in the state of Campeche. (There is no risk in the city of Campeche); Coba, Muyil, Tulum, Xelha, etc. in the state of Quintana Roo. (There is no risk on Cozumel and Cancun.); Balahkanche Cave, Chichen Itza, Kabah, Labna, Mayapan, Sayil, Uxmal, etc. (There is no risk in the cities of Merida and Valladolid). Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of Primaquine upon return home if significant exposure in the areas at risk has been encountered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease risk is present below 1500 meters in the following states: Ðáãéæéã Ãïáóô: Sonora, Sinaloa, Nayarit, Jalisco, Colima, Michoacan, Guerrero, Oaxaca, Chiapas; Çõìæ ïæ Íåøéãï áîä Ãáòéââåáî ãïáóô: Veracruz, Tabasco, Campeche, Yucatan, Quintana Roo; Ãåîôòáì Íåøéãï: Durango, Guanajuata, Hidalgo, Zacatecas, San Luis Potosi, Mexico, Morelos, and Puebla. The main vectors Triatoma dimidiata is present in all infected areas and Rhodnius prolixus is present in Oaxaca and Chiapas. Cholera is now present throughout most of Mexico. Cholera vaccination is not recommended, but food and water precautions are important. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. During 1990 a measles epidemic in Juarez resulted in hundreds of cases and 9 deaths. under-reported. Case frequency has probably been Ozone levels have reached highly dangerous levels in Mexico City according to a World Health Organization news report in January 1991. The rodent problem in Mexico City is considered a serious health hazard. DISEASE RISK PROFILE Mexico Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Onchocerciasis Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis Endemic Risk X X Hazard X X X X X X X X AIDS Information As of 31 March 1991 a total of 6,510 AIDS cases have been reported. AIDS is spreading fastest amongst heterosexual women. One-third of the blood supply in Mexico comes from 25,000 professional donors who are running 10% HIV virus positive. The general population is running 0.8% positive. There is no requirement for HIV antibody test by travelers or those applying for work visas, but it is possible that those applying to immigrate must present proof of a negative HIV antibody test. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over six months of age. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. AIDS Information Testing is required for permanent residence visas. US test results are accepted under some circumstances. Contact the Mexican embassy for full details. Micronesia, Federated States of formerly Pacific Island Trust Territory, Truk Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Micronesia Disease Dengue Fever Diarrheal Diseases Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X Food/Water Safety On main islands: Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. AIDS Information Testing is required for persons staying over one year. Moldava, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. Hemorrhagic fever is encountered in southern Siberia. AIDS Information Beginning Feb 1989, all persons staying longer than 3 months in the Soviet Union will be required to undergo HIV antibody testing. This includes diplomats, journalists, students, and businessmen. Reports from countries that have a "mutually accepted agreement" will be honored, but there is no list of which countries were included in this arrangement. Previously U.S. tests were not accepted. Any person who knowingly infects another with AIDS can be jailed up to 8 years. Conditions which contribute to the spread of AIDS in this country include improper sterilization of dental instruments, reuse of syringes and other medical supplies, lack of an adequate supply of condoms, and low reliability of the HIV screening tests being used. DISEASE RISK PROFILE Moldava Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Monaco, Principality of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Monaco Disease Diarrheal Diseases Dysentery, Bacillary Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Mongolia INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Mongolia Disease Avian Influenza (H5N1) Dengue Fever Diarrheal Diseases Encephalitis, Japanese Hemorrhagic Fever Hepatitis, Viral Tuberculosis Endemic X X Risk Hazard X X X X X AIDS Information All foreign students and anyone staying longer than three months must show proof of negative HIV antibody tests. Results from the U.S. are acceptable. Contact the Mongolian embassy for further details. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk is scattered throughout the country. Montserrat INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present on the east coast in the areas of Trants, Farms, Behtel, Bramble and Tuitts. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Montserrat Disease Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Rabies Endemic X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. AIDS Information Testing is required for university students and for work or residency applicants. Foreign tests are accepted under some circumstances. Contact Montserrat's embassy for details. Morocco, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present from May through October in the rural areas of northern and central Morocco, mainly in the provinces of Chefchaouen, Beni Mellal, El Kelaa, Fes Khemisset, Khenifra, Khouribga, Meknes, Settat, Tanger, Taounate and Taza. There is no risk in urban areas. CDC recommends mosquito protection for prevention of malaria in this country. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home only if considerable mosquito exposure has occurred. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. An approximately 100 km deep coastal strip from Kenitra to Essaouira is risk free, as are the central areas of Meknes, Fez, Taza and the Middle Atlas. S. haematobium is endemic throughout the southern half of Morocco, with high incidence rates of infection expecially in the irrigated agricultural areas of Beni-Mellal, El Kelaa des Srarhna, Marrakech, Agadir, Taroudant, and Tiznit, the Anti Atlas and Haut Atlas regions of Ouarzazate and Er Rachidia. Travellers should consider all oases, settlements and temporary water bodies in southern Morocco as infected. In the north the infection is present in the Province of Tetouan affecting the areas of Dar Chaoui, Souk Tnine de Sidi el Yamani, Larache, Tleta Rissana, El Rhedira and Souk Tolba; in the Province of Kenitra the areas of Arbaoua, Lalla, Mimouna, Karia Aouda, Moulay Bousselham and Gnafda; in the Province of Nador the areas of Nador town, Segangane, Mont Arouia, Zaio, Hassi Berkane and Ras el Ma; in the Province of Oujda in the areas of Aklim, El Aioun, Jerada and Ain Benimathar. DISEASE RISK PROFILE Morocco Disease Brucellosis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis Rabies Relapsing Fever Trachoma Tuberculosis Tungiasis Typhoid Fever Typhus Endemic Risk X Hazard X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Agadir, Al Hoceima, Casablanca, Essaouira (Mogador), Fes (Fez), Ketama, Marrakech, Meknes, Rabat, Safi, Tanger (Tangier) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the southern part of the country (areas of former Spanish Sahara). Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Mozambique, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 95% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is found throughout this country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Mozambique Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Plague Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Beira and Maputo (Lourenco Marques) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is in the north of the country (all of Niassa province and the western part of Tete province). Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Myanmar, Union INFECTIOUS DISEASE RISK Malaria Risk Malaria is present only below 1000 meters in rural areas as noted: April - December in Tenasserim; May - December in Irrawaddy and Mandalay Division; June - December in Pegu and Rangoon Divisions, Arakan, Chin, Hachin, Karen, Mon and Shan States; June - October in Magwe and Sagaing Division. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Some authorities suggest the use of doxycycline 100 mg, taken 1 tablet daily as an alternate drug for malaria prophylaxis for this country, due to probable malaria resistance to mefloquine in this country. Falciparum malaria represents 88% of the malaria strains, therefore there is a risk of exposure to vivax malaria. Travelers may wish to consider the use of primaquine upon their return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Myanmar Disease Avian Influenza (H5N1) Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Leishmaniasis (Visceral) Melioidosis Plague Rabies Trachoma Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X X X X X Risk Hazard X X X X X X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Travelers leaving this country are required to possess a vaccination certificate on their departure to an infected area or to countries which still demand such a certificate. Burmese nationals are required to possess certificates of vaccination on their departure from an infected area. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The following vaccinations listed for this country are listed for the traveler's protection, but they are not required for entry: Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases occur throughout the year, with all ages being considered equally at high risk. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is west of Mandalay. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Namibia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk exists in the northern part of the country in the area bordering Angola (Ovamboland), Zambia and Botswana (Caprivi Strip) from November through May. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is only a slight risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present only in the north of the country along the border with Angola, Zambia and Botswana (Kavango and Caprivi Strip), affecting the villages along the Okavango, Chobe and Zambezi rivers. DISEASE RISK PROFILE Namibia Disease Diarrheal Disease Risk Dysentery, Amoebic Plague Relapsing Fever Rift Valley Fever Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water, milk, and food is considered safe in Swakopmund, Walvis Bay, and Windhoek. Elsewhere all tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Nauru, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Nauru Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Nepal INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is primarily in Terai district and hill districts below 1200 meters. The risk exists all year. There is no risk of malaria in urban areas. Kathmandu and the northern high altitude areas of the country are risk free. Chloroquine-resistant P.falciparum malaria (15% of total cases) has been reported from the malarious areas in the southern part of the country: the districts of Dhanukha, Mahotari, Sarlahi, Rautahat, Bara, Parsa, Rupendehi, Kapilvastu (Terai districts) and all areas along the border with India. Persons flying into Kathmandu and visiting the northern Himalayan districts do not need to take malaria suppressive medication. Persons travelling from India overland into Nepal and throughout the southern parts of the country must follow CDC guidelines for suppressive medication. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 15% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Nepal Disease Brucellosis Diarrheal Diseases Dysentery, Amoebic/Bacillary Echinococcosis Encephalitis, Japanese Helminthic Diseases Hepatitis, Viral Leishmaniasis (Visceral) Meningococcus Polio Sandfly Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Endemic Risk X X X X Hazard X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Kathmandu serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. All persons planning treks outside the Kathmandu Valley should receive the vaccine. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occasionally in the southern plains bordering India (Terai Districts). Period of transmission is June to October. High risk groups are all ages. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the western half of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Netherlands Antilles INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Netherlands Antilles Disease Dysentery, Amoebic/Bacillary Hepatitis, Viral Rabies Endemic X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Netherlands, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the other routine immunizations recommended above, the traveler should be aware that risk of exposure to rabies, primarily found in foxes, exists in this country. DISEASE RISK PROFILE Netherlands Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. New Caledonia and Dependencies, Territory of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Take precautions to avoid mosquito bites. DISEASE RISK PROFILE New Caledonia and Dependencies Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic X X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Cholera - Travelers from infected areas must complete a form for the Health Service. No immunization required. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. New Zealand INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE New Zealand Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Hydatid tapeworm infections can occur, but likelihood of infection is low. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B among Maori, vaccination is recommended for persons working in health care, education, or in close contact with them. Nicaragua, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria exists in rural areas below 1000 meters from May through December. There is some risk in the outskirt towns of Chinandega, Leon, Granada, Managua, Nandaime, and Tipitapa. The city of Managua is risk free. Only the centers of the cities of Bluefields, Bonanza, Chinandega, Granada, Leon, Puerto Cabeza, Rosita are risk free. Prophylaxis may not be needed if trips are restricted to urban areas. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 14% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home if heavy mosquito exposure was encountered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is present in rural areas below 1500 meters in the following departments: Chinandega, Esteli, Jinotega, Leon, Madriz, Managua, Masaya, Matagalpa, Nueva Segovia, and Rivas. The main vectors are Triatoma dimidiata and Rhodnius prolixus. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Nicaragua Disease Brucellosis Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Polio Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Managua serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever vaccination is required of any traveler older than 1 year of age arriving from areas infected with this disease. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Niger, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 82% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. High incidence rates of infection with S. haematobium rates of infection with S. haematobium have been reported from all populated areas in the southern part of the country, especially from the Niger river basin and surrounding areas, including the capital of Niamey; and from the departments of Niamey; and from the departments of Niamey, Dosso, Tahoua, Maradi, Zinder and Diffa. The infection has not been reported from the northern desert area of Agadez. S. mansoni is present in a foci in the area of Gaya in the southeast corner of Dosso on the border with Benin. DISEASE RISK PROFILE Niger Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Diarrheal Disease Risk Endemic X X Risk Hazard X Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is in the southern third of the country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Nigeria, Federal Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 83% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found throughout this country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Nigeria Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Polio Rabies Relapsing Fever Trachoma Endemic X Risk Hazard X X X X X X X X X X X X X X X X Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X AIDS Information From 8% to 85% of the blood supply is screened at the nation's nine blood banks as of February 1988. The Minister of Health has announced that Nigeria will reciprocate against any country that introduces mandatory testing for Nigerian travelers. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Enugu, Ibadan, Kano, and Lagos serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Travelers leaving this country are required to possess a vaccination certificate on their departure to an infected area or to countries which still demand such a certificate. Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. The CDC recommends vaccination of all travelers older than 9 months of age who will be traveling outside of urban areas. Yellow fever is currently active in this country in Benue, Cross River, Kaduna, Kwara, Ogum, Ondo, Dyo, and Lagos States. 1,320 deaths from yellow fever were reported in 1987. In 1989 49 deaths were reported from Imo State. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is the northern half of the country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Niue INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Niue Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are usually safe. Local meat, poultry, seafood, vegetables, and fruits are generally safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Norway, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Rabies is a risk in rural areas in wild animals, especially foxes. DISEASE RISK PROFILE Norway Disease Endemic Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in scattered areas around Bergen. Rabies - This disease is common in wild animals, primarily foxes, in rural areas. Oman, Sultanate of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present throughout the country including urban areas. Risk is present at all altitudes. The falciparum malaria is resistant to chloroquine in this country. It is recommended that Lariam (mefloquine) be used for prophylaxis. Falciparum malaria represents 86% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection has been reported from the region of the Dhorfar affecting the areas of Salalah, Arazat, Mirbat, and Taqah. In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Oman Disease Brucellosis Cholera Dracunculiasis/Guinea Worm Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Tapeworms Trachoma Endemic Risk Hazard X X X X X X X X X X X X Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. In 1988 an outbreak of polio resulted in at least 80 cases centered around the western towns of Rostaq and Jalan on the Batinah coast. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. AIDS Information Testing is required for some job and lenght of stay applicants. The blood supply in this county is not adequately screened. Pacific Islands Trust Territory of the U.S.A. INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Phillipines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Pacific Islands Trust Territory Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Pakistan, Islamic Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 23% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Leprosy and tuberculosis are present in this country. Risk to travelers is quite low, but pre- and post-trip TB tests are recommended if contact with the local population has been extensive. DISEASE RISK PROFILE Pakistan Disease Avian Influenza (H5N1) Brucellosis Diarrheal Diseases Dysentery, Amoebic/Bacillary Echinococcosis Giardiasis Helminthic Diseases Hepatitis, Viral Polio Rabies Trachoma Tuberculosis Typhoid Fever Endemic X Risk Hazard X X X X X X X X X X X X AIDS Information AIDS antibody testing is required for persons staying longer than one year. Foreign tests may be acceptable. Contact the Pakistani embassy for further details. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. - Æïïä/×áôåò Óáæåôù All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Karachi, Lahore, and Rawalpindi serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - A cholera vaccination certificate is required when coming from an infected area. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over six months of age. However, children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is northern Kashmir. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Palau, Republic of INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Phillipines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Palau Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Panama, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in rural areas of the eastern provinces (Darien and San Blas) and the northwestern provinces (Bocas Del Toro and Veraguas). The risk exists all year. Chloroquine resistant malaria has developed in all malarious areas east of the Canal Zone, including the San Blas Islands. The malaria in this country is resistant to chloroquine. There is no risk along the Panama Canal Zone, the cities of Panama and Colon and the central highlands above 800 meters. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 16% of the malaria encountered, therefore there is a risk of vivax exposure. Consider the use of primaquine upon return home if prolonged mosquito exposure was encountered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is present in the rural areas of the provinces of Chiriqui, Bocas del Toro, Cocle, Colon, Darien, and Panama. The highest incidence has been reported from the province of Chiriqui (bordering Costa Rica) and in the valley of the Rio Chagres (in central Panama) and the areas of the Canal Zone adjacent to Rio Chagres. The main vectors are Triatoma dimidiata and Rhodnius pallescens. Tuberculosis is endemic in this country. If the travekler will experience close contact with the native population, a pre- and post-trip TB skin test is advised. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Panama Disease Endemic Risk Hazard Diarrheal Disease Risk Dysentery, Amoebic Encephalitis, Venezuelan Equine Helminthic Diseases Hepatitis, Viral Leishmaniasis Paragonimiasis Rabies (esp dogs and bats) Trypanosomiasis, American Chaga's Disease Tuberculosis Typhoid Fever X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Water, milk, and food in Panama City is safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Yellow fever - A yellow fever vaccination certificate is recommended for all travelers going to the provinces of Bocas del Toro and Darien. Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Papua New Guinea, Independent State of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 73% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Papau New Guinea Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Endemic Risk X Hazard X X X X Typhoid Fever Typhus, Scrub X X AIDS Information Foreign workers and those seeking residency will be required to show proof of a negative HIV antibody test. Results from the U.S. will be accepted. Spread of AIDS in this country is following the African pattern, primarily via heterosexual contact. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Paraguay, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present from October through May in areas bordering Brazil, rural parts of Amambay, Canendiyu and Alto Parana Departments. There is no risk of malaria in urban areas. Caaguazu and San Pedro. Note: There is no malaria risk at Iguassu Falls reported by the government. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 6% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is highly endemic in all rural areas, with particularly high human incidence rates in the Chaco regions. The main vectors are Triatoma infestans and Triatoma sordida, know locally as "chincha timbuku" or "chincha guasu." DISEASE RISK PROFILE Paraguay Disease Endemic Risk Hazard Brucellosis Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Leishmaniasis (Visceral) Polio Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Asuncion serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. AIDS Information Tests are required for temporary or permanent residence status. Foreign tests are accepted under certain circumstances. Contact the Paraguay embassy for full details. Peru, Republic of INFECTIOUS DISEASE RISK Malaria Risk Risk exists in rural areas below 1500 m in the following parts of the country: Northwest Peru: along the coast in the Departments of Tumbes, Piura, Lambayeque, and La Libertad, Ancash and the Departments of Cajamarca, Amazonas, San Martin. Northeastern and Eastern Peru: the Departments of Loreto and Ucayali. Central and Southern Peru: Departments of Madre de Dios, Huanuco, Ayacuho, Apurimac and the following areas fo the Department of Cusco: La Convencion province; Department of Junin: Satipo and Chanchamayo provinces. Note: There is no malaria risk in Lima, and the Andean highlands (Cuzco, Machu Picchu, Puno, Ayacucho, Huancayo and other high-altitude areas). Peru reports almost exclusively P.vivax malaria infections and chloroquine is the drug of choice for travel within Peru. Sporadic cases of multi-drug-resistant P.falciparum malaria have been reported from the following border areas: Tumbes Department bordering Ecuador, Napo and Putumayo river valleys bordering Colombia; Yavari, Acre and Madre de Dios river valleys bordering Brazil and Bolivia. Persons travelling into the Amazone basin and overland into the neighboring countries of Ecuador, Colombia and Brazil must follow a mefloquine (Lariam) suppressive medication regimen because of the high incidence of multi-drug resistant P.falciparum malaria in these countries. Falciparum malaria represents 1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Peruvian health officials have confirmed over 300,000 cases of Cholera with over 2,000 deaths. Risk is considered as low to a traveler, but food and water precautions are urged. Immunization is not recommended. Chagas' disease is present in two seperate geographical areas: 1) Rural and suburban areas of the departments of Tumbes, Piura, Cajamarca, Loreto and Amazonas in the northern part of the country bordering Ecuador, with a foci in eastern Loreto in the areas of Javary and Amasonas rivers bordering Brazil (main vector: Triatoma dimidiata); 2) Rural and suburban areas under 3500 meters of the coastal departments of Tacna, Moquegua, Arequipa, and Ica. The main vector here is Triatoma infestans, locally known as "vinchuca" or "chirimacha." Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Peru Disease Bartonellosis Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Endemic X Risk X X X X X X X Hazard Leishmaniasis (Visceral) Polio Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis Typhus, Scrub X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Cuzco, Iquitos, and Lima serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over six months of age. CDC recommends vaccination for all travelers over 9 months of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is: the north of thr country; western part of Piura Department (Huancabama provine), all of Cajamarca Department, and the southern part of Ancash Department. Philippines, Republic of the INFECTIOUS DISEASE RISK Malaria Risk The islands of Bohol, Catanduanes, Cebu and Leyte and the plains of the islands of Negros and Panay (above 600 m) are risk free. Note: There is no risk in the city of Manila and other urban centres. Use of Chloroquine is recommended only for those travelers who will have outdoor exposure in rural areas during evening and nightime hours. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Chloroquine resistant malaria is found on the islands of Luzon, Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago. Falciparum malaria represents 69% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in Luzon: in the areas of Sorsogon in the Irosin-Juban valley on the southern tip of the island. Mindoro: in the area surrounding Lake Naujan, including the villages of Pola, Victoria and Naujan. Samar: along the entire western coastal area from Allen to Basey and along the northern coast from Lavezares to Palapag, extending south to Las Navas. Leyte: the entire island is infected except the southern quarter (the area south of Julita and Mac Arthur). Bohol:in the northern coastal areas of Talibon and Trinidad. Mindanao:in all villages along the Bay of Panquil from Dipolog to Lala (provinces of Misamis Occidental and Lanao del Norte); in all villages in the Agusan river valley from Butuan to Compostela; in the northern coastal peninsular area from Butuan to Tago including the area around Lake Maninit; in the area Davao and the Penal Colony on the Bay of Davao. Additional foci are present at Malaybalay, Maramag (Province of Misamis Oriental) and Pikit (Province of Cotabato). Penicillin resistant gonorrhea is common in the Philippines. The local population has a high incidence of tuberculosis. Persons in close contact with the native population should consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Phillippine Islands Disease Chikungunya Fever Cholera Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Helminthic Diseases Hepatitis, Viral Melioidosis Opisthorchiasis Paragonimiasis Polio Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X Risk Hazard X X X X X X X X X X X X X X X AIDS Information All applicants for permanent resident visas are required to show proof of a negative HIV antibody test. Results from a U.S. laboratory are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases are reported throuhgout the country. Period of transmission is all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Pitcairn Island INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Pitcairn Island Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Safety of milk and dairy products unknown. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Poland, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Rabies is frequent in wild animals in rural areas, especially in foxes. For those traveling into rural areas, there is risk of typhoid and hepatitis A from contaminate water supplies. Immunizations against these diseases is advisable. The fish tapeworm (diphyllobothriasis) is found in the Baltic Sea area. AIDS Information Blood donor screening has been started, but lack of funds has prevented full implementation of this program. Thirty seven cases have been reported. There are plans to broaden the extent of HIV antibody testing to persons arriving from countries "known for their bad epidemiological situation." Currently, proof of a negative HIV antibody test is required by all foreign students. Results of tests performed in the United States are accepted. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. DISEASE RISK PROFILE Poland Disease Avian Influenza (H5N1) Tuberculosis Endemic Risk Hazard X X Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the northern part of the country extending from the forested areas around Gdansk south and eastward to the Russian border, including the areas around Bialystock. Other areas of risk are forested lands around Warsaw, Lodz and Lukow, and along the border with Czechoslovakia south of Wroclaw. AIDS Information Testing is required for students, although results are not needed to gain entry. Contact the Polish embassy for details. Portugal, Portugese Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Due to a high incidence of tuberculosis amongst the local population, the traveler may need to consider a pre- and post-trip TB skin test. DISEASE RISK PROFILE Portugal Disease Brucellosis Diarrheal Diseases Dysentery, Bacillary Tuberculosis Typhoid Fever Endemic X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required only for travelers coming from infected areas and from or in transit through countries with active infection arriving in or destined for the Azores and Madeira. A vaccination certificate is required for children over one year of age. No certificate is, however, required from transit passengers at Funchal, Porto Santo, and Santa Maria. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Puerto Rico, Commonwealth of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Low infection rates have been reported from all parts of the island. Infection also occurs on the islands of Vieques and Culebra, both located off the eastern coast of Puerto Rico. DISEASE RISK PROFILE Puerto Rico Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Filariasis (Bancroftian) Hepatitis Endemic X X Risk X X Hazard Rabies X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Qatar, State of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Qatar Disease Brucellosis Cholera Diarrheal Diseases Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Endemic Risk X X X X X X X X Hazard X Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Ad Dawhah (Doha) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infections. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Reunion INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Reunion Disease Diarrheal Diseases Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub AIDS Information Endemic Risk Hazard X X X X X X X X X X X X X X X X AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Romania INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Romania Disease Avian Influenza (H5N1) Brucellosis Diarrheal Diseases Hepatitis, Viral Rabies Tuberculosis Endemic Risk Hazard X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the forested areas in the western part of the country. Russia, Russian Federation INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. Hemorrhagic fever is encountered in southern Siberia. AIDS Information Beginning Feb 1989, all persons staying longer than 3 months in the Soviet Union will be required to undergo HIV antibody testing. This includes diplomats, journalists, students, and businessmen. Reports from countries that have a "mutually accepted agreement" will be honored, but there is no list of which countries were included in this arrangement. Previously U.S. tests were not accepted. Any person who knowingly infects another with AIDS can be jailed up to 8 years. Conditions which contribute to the spread of AIDS in this country include improper sterilization of dental instruments, reuse of syringes and other medical supplies, lack of an adequate supply of condoms, and low reliability of the HIV screening tests being used. DISEASE RISK PROFILE Russia Disease Avian Influenza (H5N1) Tuberculosis Endemic Risk Hazard X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Rwanda, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of S. mansoni is present in the western half of the country including the Kigali area, Lake Kivu, Lake Ruhondo, Lake Bulera and Lake Cyohoha areas. The eastern highland areas including lakes Bugesera, Mugesera, Muhazi, Kagera and the valleys of Akagera and Kagitumba are free of Sshistosomiasis. Additional snail intermediate hosts: Biomphalaria choanomphala, Biomphalaria and Biomphalaria smithi. DISEASE RISK PROFILE Rwanda Disease Diarrheal Diseases Dracunculiasis/Guinea Worm Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information Approximately 30% of the adults between the ages of 18 and 45 in the capital city of Kigali are infected with the HIV virus. The countryside rate is between 2% and 3%, but increasing. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Kigali serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - Risk to western travelers is low. Avoid uncooked foods and untreated water. WHILE CHOLERA VACCINE IS NOT OFFICIALLY REQUIRED FOR ENTRY TO THIS COUNTRY, ACCORDING TO RECENT REPORTS BORDER OFFICIALS ARE INSISTING ON CHOLERA VACCINATION FOR ENTRY. Travelers arriving without a current cholera vaccination are having tickets for forward travel impounded until they obtain vaccination in country. This means that they must buy their own needle and syringe and report to a local hospital for vaccination. Yellow fever - A vaccination certificate is required on arrival from all countries, except passengers in transit who do not leave the airport. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Saint Helena INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE St. Helena Disease Diarrheal Diseases Dysentery, Amoebic Typhoid Endemic Risk X X X Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Saint Kitts and Nevis INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE St. Kitts and Nevis Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Rabies Endemic Risk X X Hazard X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. AIDS Information Tests are required for students, residency applicants, and those seeking employment. Contact the St Christopher embassy for details. Saint Lucia INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Projects for total eradication of Schistosomiasis are in progress and risk of infection is low. However, travellers should still consider all fresh water bodies as infected. DISEASE RISK PROFILE St. Lucia Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Endemic Risk X X Hazard X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Saint Pierre and Miquelon INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE St. Pierre and Miquelon Disease Encephalitis Plague Rabies Rocky Mountain Spotted Fever Tularemia Endemic X X X X X Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Saint Vincent and the Grenadines INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE St. Vincent and the Grenadines Disease Encephalitis Plague Rabies Rocky Mountain Spotted Fever Tuberculosis Endemic Risk X X Hazard X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Samoa, Independent State of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Samoa Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. San Marino, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE San Marino Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Sao Tome and Principe, Democratic Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Through the construction of a major irrigation project by workers from the African continent, S. haematobium has recently been introduced on the island of Sao Tome. The infection seems to be localized around the capital Sao Tome, but the extent of the infection has not been determined. The snail intermediate host has not been identified. DISEASE RISK PROFILE Sao Tome and Principe Disease Diarrheal Diseases Dracunculiasis/Guinea Worm Dysentery, Amoebic Echinococcosis Endemic Risk Hazard X X X X Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Trachoma Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. Except: travelers arriving from a non-infected area and staying less than two weeks in the country. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Saudi Arabia, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk The Eastern, Northern and Central Provinces and the high altitude areas of Asir Province (southwest) are risk free: Ad Dammam, Al Quatif, Al Jawf, Tabuk, Ar Riyad, etc. The urban areas of Western Province-Jiddah, Al Madinah, Makkah, Ta'if -are risk free. In other areas, including urban regions, malaria exists all year. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 51% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in contaminated fresh water lakes, haematobium and S. mansoni (the endemic throughout the country, this country. Avoid contact with ponds, or streams. S. latter predominant) are highly except for the Al Ahsa Plain on the Persian Gulf, the An Nafud desert (north) and the southern no-mans-land of Ar Rub'al Khali. Travellers should condider all oases, watering holes, irrigation canals and open wells as infected. Additional snail intermediate hosts for S. haematobium: Bulinus beccarrii, Bulinus reticulatus wrighti. DISEASE RISK PROFILE Saudi Arabia Disease Avian Influenza (H5N1) Brucellosis Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X AIDS Information Of the 4 different classifications of visas (work, business, visitor, and resident), only the application for a work visa requires accompanying proof of a negative HIV antibody test. Foreign workers will be re-tested for HIV antibody three months after their arrival. Blood transfusions are routinely tested for AIDS. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Ar Riyad (Riyadh), Az Zahran (Dhahran), and Juddah (Jidda) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries any part of which is infected. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Meningococcal meningitis - CDC and State Depertment confirmed active cases of meningococcal meningitis in Aug 1987 in this country. Active strains of menigitis serogroup A are most likely circulating among the population of this country. According to CDC comments "it would be prudent for future travelers to Saudi Arabia to receive meningococcal vaccine at least 10 days prior to departure." Vaccination may not be received more than 2 years prior to the arrival. Receipt of this vaccine is mandatory if arriving from Benin, Burkina Faso, Cameroon, Chad, Cote d' Ivoire, Egypt, Mautitania, Niger, Nigeria, Pakistan, Senegal, Sudan, Togo, Yemen, Ethiopia, India, Morocco, and the Syrian Arab Republic. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to ensure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Senegal, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home only if considerable mosquito exposure has occurred. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium is endemic along the entire Senegal River valley including the area of Lake Guiers; in the western regions of Cape Vert (including Dakar) Thies, Diourbel and Sine Saloum; in the two southern provinces of Senegal Oriental and Casamance. S. mansoni is endemic in areas along the border with Guinea (Province of Senegal Oriental), in two foci at Kolda and Bigona (Casamance Province) and in two foci in the north: at Fatich (Sine Saloum) and at Fandene-St Marcel (Thies). Additional snail intermediate host for S. haematobium: Bulinus jousseaumei, Bulinus guernei. DISEASE RISK PROFILE Senegal Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Endemic X Risk Hazard X X X X X X X Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Polio Rabies Relapsing Fever Rift Valley Fever Tapeworms Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Yellow Fever X X X X X X X X X X X X X X X X X X X AIDS Information Donated blood is currently screened for HIV antibodies at Dakar's principal hospital and the National Transfusion Center. Plans to test the entire country's blood supply have been announced, but the date of starting this screening was not set. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Dakar and St Louis serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - Vaccination is required for all travelers over 1 year of age coming from the endemic zones or infected areas. CDC recommends vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April, with risk being possible from December until June. Local area of greatest danger in in the northern third of the country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Serbia and Montenergro INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Serbia and Montenegro Disease Avian Influenza (H5N1) Diarrheal Diseases Dysentery, Bacillary Encephalitis Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X X Risk Hazard AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas bordering Austria extending south to the areas around Ljubljana and Zagreb. Seychelles, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Seychelles Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub AIDS Information Endemic Risk Hazard X X X X X X X X X X X X X X X X X X AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Sierra Leone, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 80% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. An approximate 100 km deep coastal strip is free of infection. Both S. haematobium and S. mansoni are highly endemic in the interior of the country. DISEASE RISK PROFILE Sierra Leone Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. CDC recommends vaccination for all travelers over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Singapore, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Singapore Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Rabies Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X Risk Hazard X X X X X X AIDS Information Foreigners without "permanent residence" status found to be carrying the HIV virus antibodies will be expelled. No compulsory testing guidelines were announced, however, except that all new foreign housemaids entering the city must present proof of a negative HIV antibody test. Blood donations have been tested since 1985. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Sinapore has been rated as one of the cleanest cities in Asia. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases occur on the island, all year. Slovakia, Slovak Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Slovakia Disease Avian Influenza (H5N1) Hepatitis, Viral Rabies Rocky Mountain Spotted Fever Endemic X X Risk Hazard X X AIDS Information All persons entering the country from areas of high risk are being tested for HIV antibody, including citizens returning from those areas. Areas considered high risk include all countries in Western Europe, North and South America, and Africa. All blood donors are being screened with HIV testing. This country reports 11 AIDS cases and 66 known carriers. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Water should be boiled in summer months and at other times when the water table falls to low levels. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Gamma globulin is recommended for all travelers. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas south of Prague, north of Brno, and the areas west of Plzin (Pilsen). Slovenia, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Slovenia Disease Avian Influenza (H5N1) Hepatitis, Viral Rabies Rocky Mountain Spotted Fever Endemic X X Risk Hazard X X AIDS Information All persons entering the country from areas of high risk are being tested for HIV antibody, including citizens returning from those areas. Areas considered high risk include all countries in Western Europe, North and South America, and Africa. All blood donors are being screened with HIV testing. This country reports 11 AIDS cases and 66 known carriers. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Water should be boiled in summer months and at other times when the water table falls to low levels. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Gamma globulin is recommended for all travelers. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in forested areas south of Prague, north of Brno, and the areas west of Plzin (Pilsen). Solomon Islands INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country below 400 meters, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 30% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Solomon Islands Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic X X Risk Hazard X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are generally safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Somalia INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 94% of malaria, therefore there is a 6% risk of p. vivax malaria exposure. Consider the use of primaquine upon return home only if considerable exposure to mosquitos has occurred. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. The northern provinces of North West, North East, Migiurtinia and Mudugh are free of infection. S. haematobium is highly endemic in the southern provinces of Hiran, Benadir, Lower Jubba and Upper Jubba, especially in the irrigated agricultual areas of the Shabeelle and Giuba (Jubba) river valleys. Snail intermediate host: Bulinus abyssinicus. Meningitis is a risk during the dry season in the Savannah protion of this country, from December through March. DISEASE RISK PROFILE Somolia Disease Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X Risk Hazard X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Mogadishu (Mogadiscio) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever A vaccination certificate is required for all travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Vaccination is recommended for all travelers for their protection. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Cholera - Cholera is possible in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Meningitis - Due to the current famine and unrest, this disease has become a hazard in the country and vaccination for all travelers is recommended. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. South Africa, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk exists throughout the year in rural areas (including game parks) in the north, east, and western low altitude areas of Transvaal and in the Natal coastal areas north of 28 degrees south latitude. The malaria in this country is resistant to chloroquine. More specifically, risk is present in the northeastern part of the country in the areas of Transvaal bordering Botswana, Zimbabwe and Mozambique including the Kruger National Park, and along the coast of Natal north of Tugela river. Note: Persons visiting the Kruger National Park must take malaria suppressive medication. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 99% of malaria, therefore there is only a slight risk of p. vivax malaria exposure. There is little need to consider using primaquine upon returning home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium and S. mansoni (the first predominant) are highly endemic in the northeastern part of the country, particularly in Northern Transvaal (including Bophuthatswana, Venda and the Kruger National Park) extending from the Limpopo river basin and it tributaries south to the northern part of the Witwatershed Mountain Chain. In the Southern Transvaal the infection is present in the northwest: Marico, Swartruggens and Rustenburg districts with foci in the southwest at Koster, Wolmaransstad and Bloemhof on the Vaal river; and the Piet-Retief district in the eastern part of the State (on the border with Swaziland). High rates of infection are present in Kwa Zulu and the entire plain and coastal areas of Natal (limited to the west by the Drakensberg mountain chain). This endemic area extends south into Transkei to the area of Port St. Johns. Foci of infection are present in Ciskel in the area of East London, and in Eastern Cape in the area of Utterhage, north of Port Elizabeth. Recently, foci of infection have been reported from the lower Orange River in northern Cape Province along the border with Namibia. Note: S. matthei is mainly an infection of animals and rarely transmitted to humans. DISEASE RISK PROFILE South Africa Disease Diarrheal Disease Risk Dysentery, Amoebic Plague Relapsing Fever Rift Valley Fever Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Scrub West Nile Fever Endemic Risk X X Hazard X X X X X X X X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone in Africa. A vaccination certificate is required for children over one year of age. Travelers on scheduled airlines, whose flights have originated outside the areas regarded as infected and who are in transit through these areas, are not required to possess a certificate provided they have remained at the scheduled airport or in the adjacent town during transit. Children under one year of age are subject to isolation or surveillance, if indicated. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are present along the northern and western border with Lesotho and in Mountain Zebra National Park north of Port Elizabeth. Spain, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Due to a high incidence of tuberculosis in the native population, persons with prolonged contact with local individuals should consider a pre- and post-trip tuberculosis skin tets. DISEASE RISK PROFILE Spain Disease Avian Influenza (H5N1) Brucellosis Diarrheal Diseases Dysentery, Amoebic Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Sandfly Fever Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub West Nile Fever Endemic X X X X X X X X X X X X Risk Hazard AIDS Information Authorities report 624 persons with AIDS through September 1987. Deaths from the disease total 322, with Madrid reporting 195 cases and 102 deaths and Catalonia reporting 127 cases and 61 deaths. No updated information has been received as of January 1993. . Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Sri Lanka, Democratic Socialist Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country below 800 meters, including urban areas, but excluding Colombo and the District of Nuwara Eliya (180 m). The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 27% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Sri Lanka Disease Brucellosis Chikungunya Fever Cholera Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Encephalitis, Japanese Helminthic Diseases Hepatitis, Viral Leishmaniasis (Visceral) Polio Rabies Sandfly Fever Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Anuradhapura, Colombo, Kandy, Nuwara Eliya, and Trincomalee serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Sporadic cases occur throughout the country with prevalence in the west. Period of transmission all yaer. High risk group is children under 15 years of age. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Sudan, Republic of the INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 99% of malaria, therefore there is only a slight risk of p. vivax malaria exposure. There is little need to consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found throughout this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. S. haematobium and S. mansoni are endemic throughout all populated areas of Sudan except for the Province of Red Sea. S. haematobium is predominant in the north and west, while S. mansoni is prevalent in the east and south of the country. DISEASE RISK PROFILE Sudan Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X X Risk Hazard X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Khartoum serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - A cholera vaccination certificate is required when coming from an infected area. Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Travelers leaving this country are required to possess a vaccination certificate on their departure to an infected area or to countries which still demand such a certificate. Vaccination is recommended for all travelers for their protection. CDC recommends vaccination for all travelers over 9 months of age who will travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is the southern two thirds of the country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of areas of risk for this country are present in the southern part along the border with Zaire and Uganda. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Suriname, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas, except Paramaribo district and coastal areas north of 5 degrees North latitude. The risk exists all year. The cities of Paramaribo, Commewijine, Totness, Nieuw Amsterdam north are risk free. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 95% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home only if considerable mosquito exposure has been experienced. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease vector is present in rural areas, but the exact extent of the infectionis unknown. The vector is Rhodnius prolixus. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is present in the central part of the coastal region in the cultivated swamp and shell sand bar areas surrounding Paramaribo. This endemic areas extends from the delta area of the Commewijne river to the marsh areas north of Wageningen (Nickerie district). DISEASE RISK PROFILE Suriname Disease Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Encephalitis, Venezuelan Equine Filariasis (Bancroftian) Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Polio Rabies Trypanosomiasis, American Chaga's Disease Tuberculosis Endemic X Risk Hazard X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Water is safe to drink, food safe, but milk not safe without the above precautions in Paramaribo. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. CDC recommends vaccination for all travelers over 9 months of age, who may travel beyond urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Swaziland, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present from December through March in the northern border areas of Bordergate, Lomahasha, Mhlume, and Tshaneni. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 99% of malaria, therefore there is very little risk of p. vivax malaria exposure. The traveler should probably not need to consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is present in the whole country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Swaziland Disease Diarrheal Disease Risk Dysentery, Amoebic Hepatitis, Viral Plague Rabies Relapsing Fever Rift Valley Fever Tuberculosis Typhoid Fever Typhus, Scrub Endemic Risk X X X Hazard X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Water, dairy products, and foods are safe in the city of Mbabane. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Sweden, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Fishing has been banned in Lake Opptjarn in central Sweden, due to high radiation levels detected in fish caught there, presumed to be due to the Chernobyl nuclear accident. Diphyllobothrium, fish tapeworm, may contaminate the waters of the Baltic Sea area and caution is advised. DISEASE RISK PROFILE Sweden Disease Avian Influenza (H5N1) Endemic Risk Hazard X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the forested areas around Uppsala down to Krisitanstad, including the islands of Gotland and Oland, and in the wooded areas around Goteborg. Switzerland, Swiss Confederation INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE Switzerland Disease Avian Influenza (H5N1) Endemic Risk Hazard X Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wooded areas around Schaffhausen and north of Winterhur, and around the western shore of Lake Thun. Syria, Syrian Arab Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria is present from May through October in this country below 600 meters, except Deir-es-Zor and As Suwayda. There is no risk of malaria in urban areas. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home if heavy exposure to mosquitos has been encountered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of S. haematobium is present in the northeastern part of the ocuntry of the country along the Belikh and lower Euphrates river basins. In Ar Raqqah sector the infection extends from Tall al Abyad along Wadi Belikh and Euphrates to Khamisia, continuing in Dayr az Zawr sector along the Euprates to Abu Kamai on the border with Iraq. In Al Hasakah sector the infection is limited to a foci around Khatuniyah (close to the Iraqi border). Meningitis is a potential threat to travelers in this country. The CDC does not recommend this vaccine for travelers here at this time. The Department of State recommends that its personnel receive meningococcal meningitis vaccine. The WHO reports active disease. DISEASE RISK PROFILE Syrian Arab Republic Disease Brucellosis Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic Risk Hazard X X X X X X X X X X X X X X X X X X AIDS Information All persons applying for foreign work permits and all foreign students must undergo HIV antibody testing at official government approved laboratories upon their arrival in Syria. Contact the Syrian embassy for further details. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Dimashq (Damascus) and Halab (Aleppo) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are present in the northern and eastern parts of the country bordering Iraq. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Tajikistan, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Tajikistan Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Tanzania, United Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home if an unusual amount of mosquito exposure was encountered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Known areas of infection are present in the northern part of the country along the eastern and southern shore of Lake Victoria including the islands; and in the Tanga District in the northeastern part of the country. Infection has also been reported from the area of Kasulu, Kigoma District near the northern shore of Lake Tanganyika; the area of Lake Rukwa and the area of Songea in southwestern Tanzania; foci are present in Kidodi, Kitatu and Ruaha, northeast of Iringa. The islands of Zanzibar and Pemba are infected. The Centers for Disease Control recommends travelers to the northern portions of this country receive meningococcal vaccine as an epidemic of meningitis occurred during late 1989 in the Arusha area. No cases of meningitis has been reported in travelers, but this area includes the most popular tourist destinations in the country. DISEASE RISK PROFILE Tanzania Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Plague Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Arusha, Dar Es Salaam, Moshi, and Zanzibar serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Cholera - A cholera vaccination certificate is required for travelers intending to enter the islands of Pemba and Zanzibar. Although cholera vaccination certificate is not officially required for entering Tanzania, travelers may be asked to show proof of cholera vaccination upon arrival. (Complaints to that effect have been lodged by tourists.) To avoid harassment IAMAT suggests vaccination. One injection is sufficient to satisfy health officials, but it must be obtained 10 days prior to arrival. Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Vaccination is recommended for all travelers for their protection. CDC recommends vaccination for all travelers over 9 months of age who are going to northwestern forest regions. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Meningitis - Due to the local epidemic of meningococcal disease, vaccination is recommended by the CDC for all travelers to this country. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are present south of Lake Victoria and along the eastern part of the border with Kenya (Tanga Province). Thailand, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. Resistance has developed in this country to chloroquine, Fansidar, and mefloquine particularly in refugee camp areas. There is no risk of malaria in urban areas. Prophylaxis in not necessary if your trip is confined to these areas. Note: There is no malaria risk in the cities of Bangkok, Chiang Mai, Songhkla and the resort areas of Pattaya and Phuket. Persons flying into cities and making only daytime excursions to rural areas do not need to take malaria suppressive medication. Persons travelling by car, boat or train through rural areas of the interior, forested and hilly areas, and to mining and refugee camps should be aware of the presence of multi-drug resistant malaria. Current prophylaxis recommendations can be obtained from Malaria Branch, Centers for Disease Control by your physician. Doxycycline 100 mg taken once daily has been a recent recommendation for prophylaxis in this area. Falciparum malaria represents 70% of malaria, therefore there is a 30% risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Infection with S. mekongi is limited to two foci. The first is present in the area of Chongmek (near the confluence of the Mae Nam Mun and the Mekong) on the border with Laos. Ubon Province, and the second in the southern province of Nakhon Si Thammarat in a few villages of the Chawang, Chang Klang and Toong Song cantons. DISEASE RISK PROFILE Thailand Disease Avian Influenza (H5N1) Chikungunya Fever Cholera Opisthorchiasis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Polio Rabies Trachoma Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X X Risk Hazard X X X X X X X X X X X X AIDS Information There are 10,000 cases of HIV antibody positive carriers and known cases amongst drug users in Thailand. The virus is spreading rapidly amongst female prostitutes. Heterosexual women now make up the second largest group of persons infected with the virus. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Bangkok (Krung Thep), Chiang Mai, and Sattahip serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur mostly in the northern region (Chiang Mai valley), with sporadic cases reported from the areas of Sukhothai and Phitsanulok and the southern region. Period of transmission in the north: June to October; in the south: all year. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Togo, Togolese Republic INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 85% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. Schistosomiasis is present in the whole country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Togo Disease Avian Influenza (H5N1) Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Endemic X Risk Hazard X X X X X X X X X X Leishmaniasis (Visceral) Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Tungiasis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Lome serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from all countries. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who plan to go outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Meningococcal meningitis - Vaccination is advised for persons traveling extensively or on working assignements in the meningitis belt of Africa's northern savannah, which stretches from the Red Sea to the Atlantic Ocean. Peak season is March and April. Local area of greatest danger is in the northern third of the country. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Tokelau INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Tokelau Islands Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Typhoid Fever Endemic Risk X Hazard X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Tonga, Kingdom of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Tonga Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. Food, water, and milk products in Nuku'alofa on Togatapu Island are considered safe, however, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Trinidad and Tobago, Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Dengue fever is active in this country. The World Health Organization reported 1,200 cases through mid-February 1990. deaths were reported. Mosquito protection is important. No DISEASE RISK PROFILE Trinidad and Tobago Disease Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Hepatitis, Viral Rabies Endemic Risk X X Hazard X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. CDC recommends vaccination for all travelers over 9 months of age who may travel outside of urban areas. Some countries will require a yellow fever vaccination to enter their country after visiting this country. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. Tunisia, Tunisian Republic INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Extensive control measures have reduced the once extensive endemic area to the following foci of low risk: Governate of Gabes: El Hamma, Zarat, Matamta; Governate of Gafsa: Ouled Tlijane and Ouled Majed. DISEASE RISK PROFILE Tunisia Disease Brucellosis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Giardiasis Helminthic Diseases Hepatitis, Viral Lassa Fever Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Sandfly Fever Trachoma Tungiasis Typhoid Fever Typhus Endemic Risk X Hazard X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Bizerte, Hamamet, Jerba (Djerba), Sfax, Sousse, and Tunis serve purified drinking water and reliable food. However, the hazard is left to your judgement. The water, food, and dairy products in the city of Quairouan are considered safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Turkey, Republic of INFECTIOUS DISEASE RISK Malaria Risk Risk exists in southeastern Anatolia from March to end of November in the following provinces (including cities): Adana, Hatai, Icel (plain of Cucurova), Hakkari and Siirt. There is no risk of malaria is Istanbul, Ankara and other major cities. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents <1% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Turkey Disease Avian Influenza (H5N1) Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Dysentery, Amoebic Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water unsafe in Middle East, but may be safe in European Turkey (Istanbul, Edirne), but cautions are advised. Milk products and cold food is unsafe in Middle East, but considered safe in European Turkey. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Turkmenistan INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Turkmenistan Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Turks and Caicos Islands INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue. the past make renewed activity or reintroduction of the virus possible. Intermittent epidemics in DISEASE RISK PROFILE Turks and Caicos Disease Diarrheal Disease Risk Dysentary, Amoebic/Bacillary Hepatitis, Viral Rabies Typhoid Fever Endemic X X X X X Risk Hazard AIDS Information AIDS antibody testing is required for all foreigners, excluding diplomats, staying in Cuba for 90 days or longer. Over one-fourth of the entire population has been screened for the HIV virus, with 248 persons having HIV positive tests and 28 persons ill with the disease. All donated blood in Cuba is screened for the HIV antibody. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Tuvalu INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. This country must be considered receptive to dengue fever. Intermittent epidemics in the past make renewed activity or reintroduction of the virus possible. DISEASE RISK PROFILE Tuvalu Disease Diarrheal Disease Risk Encephalitis, Japanese Filariasis Helmenthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries in the endemic yellow fever zone. is required for children over one year of age. A vaccination certificate Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Uganda, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas, below 1800 meters. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 82% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Louse-borne typhus is cosmopolitan in distribution and is present wherever groups of persons are crowded together under conditions of poor sanitation and malnutrition. Risk exists for persons living or working in remote areas of the country (anthropologists, archeologists, geologists, medical personnel, missionaries, etc.). Freedom from louse infestation is the most effective protection against typhus. DISEASE RISK PROFILE Uganda Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Onchocerciasis Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X AIDS Information Official government sources report that 1 in 10 residents of the capital city of Kampala is infected with the HIV virus. The eastern towns of Malaba and Busia have enormous infection rates with 80% of women and 30% of men. The country has reported 2,300 cases of AIDS, the third highest per capita rate behind the United States and Haiti. AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Fort Portal, Gulu, and Kampala serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required on arrival from any country in the yellow fever endemic zone for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who will be traveling outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Meningitis - Due to the increased number of cases of meningococcal meningitis in Kampala, the CDC has indicated that vaccination against meningitis is a reasonsable precaution, but has not issued a formal recommendation for routine vaccination for travelers. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distributions of the areas of risk for this country are present along the border with Zaire and Sudan. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Ukraine INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Ukraine Disease Avian Influenza (H5N1) Tuberculosis Endemic Risk Hazard X X Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). United Arab Emirates INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all nearly parts of this country, including urban areas. The risk exists all year. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. There is no risk of malaria in the cities of Dubai, Sharjah, Ajman, Umm al Qaiwan and Emirate of Abu Dhabi. Falciparum malaria represents 55% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE United Arab Emirates Disease Brucellosis Cholera Diarrheal Diseases Dracunculiasis/Guinea Worm Echinococcosis Endemic X X X X Risk Hazard X Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Rabies Relapsing Fever Tapeworms Trachoma Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub X X X X X X X X X X AIDS Information HIV antibody test results are required for all persons applying for work visas or residency permits. Results of US tests are not acceptable. Screening of workers wishing to renew their permits is performed. Contact the United Arab Emirates' embassy for further information. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Dubai (Dubayy) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. United Kingdom INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk DISEASE RISK PROFILE United Kingdom Disease Avian Influenza (H5N1) Endemic X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. AIDS Information Testing is required for work permit applicants and for all persons staying longer than six months. Foerign test results are accepted under some circumstances. Contact the UK embassy for details. United States of America INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE United States of America Disease Encephalitis Giardiasis Helminthic Diseases Hepatitis, Viral Lyme Disease Plague Rabies Rocky Mountain Spotted Fever Tularemia Endemic X X X X X X X X X Risk Hazard AIDS Information Tourist visas will no longer be denied visitors to the United States who have AIDS. AIDS has been removed from the list of contagious diseases which serve a grounds for preventing issuance of visas for tourists or permanent residents. Visitors the the United States may be assured that the blood supply is highly regulated, but that high risk behavior (such as the use of illegal injectable drugs, multiple sexual partners) is especially risky for possible exposure to the AIDS virus. Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of of hepatitis B among the local vaccination is recommended for education, or in close contact the high rate of healthy carriers indigenous populations of Alaska, persons working in health care, with them. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in remote areas of many of the western states. Rabies - Vaccination is recommended only for persons who may be occupational exposed to wild or rabid animals (vetenarians, select game wardens) or persons cave exploring in areas with rapid bat populations. Uruguay, Oriental Republic of INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Chagas' disease is present in all rural and suburban areas except the Atlantic coastal areas. The main vector is Triatoma infestans, locally known as "vinchuca." Uruguay has generally good health conditions. Hepatitis and anthrax can be a risk and endemic diseases include tapeworms, typhoid fever, and echinococcosis. AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. DISEASE RISK PROFILE Uruguay Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety Local water is considered safe without further treatment. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Uzbekistan, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present in a few scattered border areas with Iran and Afghanistan. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Giardia is a problem in the western portions of the country, especially in Leningrad. Cutaneous leishmaniasis is encountered in southern sections of the country. Scrub (tick borne) typhus is found in eastern and central Siberia. Rabies is prevalent in many rural areas, especially in foxes. The fish tape worm, diphyllobothrium, is common in the Baltic Sea area. DISEASE RISK PROFILE Uzbekistan Disease Tuberculosis Endemic X Risk Hazard Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Cold foods may be safe, but are not recommended. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. Outbreaks occur occassionally in the southeast between the border with China and the Sea of Japan, with prevalence in the area of Vladivostok. Period of transmission is June to October. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are in Azerbaijan, Armenia and Georgia; in the Kazakh SSR; on the northern shores of the Caspian Sea, the northeastern shores of the Aral Sea and the southern shores of Lake Balkash. In Turkmen SSR a large focus of activity is present east of the Caspian Sea. Tick-borne encephalitis - (Central European encephalitis) Vaccination is recommended for persons involved in recreational activities in forested areas (camping, hiking) or working in forestry occupations. Risk season: March to November. Risk is present in the wetsern part of the country and in eastern Siberia (Russian Far Eastern encephalitis). Vanuatu, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas and Futuna. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 75% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Vanuatu Disease Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Encephalitis, Japanese Filariasis Helminthic Diseases Tuberculosis Typhoid Fever Endemic Risk X Hazard X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Venezuela, Bolivarian Republic INFECTIOUS DISEASE RISK Malaria Risk Northern Venezuela: There is no malaria risk in the cities and sea resorts of northern Venezuela (Caracas, Maracaibo, Macuto, Puerto La Cruz, Isla de Margarita). Sporadic cases are reported from rural areas below 600 m. Western Venezuela: Malaria risk exists in the following areas: state of Apure: the extreme western part of the state (the areas west of the city of Guasdualito) and all rural and urban areas south of the Azauca river; state of Barina: the western third of the state excluding the city of Barinas; state of Merida: all rural areas below 600 m bordering the surrounding states of Barinas, Trujilo, Tachira and Zulia; state of Tachira: risk is present in all rural areas along the shore of Lake Maracaibo; state of Zulia: rural areas of the southern Maracaibo basin (south of the city of Machiques). Main vector: A. nunez-tovari. Southern Venezuela: Federal Territory of Amazonas: Malaria risk is present in all areas below 600 m of the Orinoco River basin and its tributaries; state of Bolivar; Malaria risk exists along the Orinoco River in the areas bordering the states of Apure and Guarico (west of Las Bonitas). Risk is present in the central and southern parts of the state below 600 m in the valleys of the Paraqua and Caroni Rivers. Main vectors: A.darlingi. Eastern Venezuela: Malaria risk is present in the Federal Territory of Amacuro including the delta Amacuro (bordering Guyana). Main vector: A.darlingi. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 14% of malaria, therefore there is a risk of p. vivax malaria exposure. Consider the use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Current risk of dengue fever exists. The virus is present in this country at all times and is currently responsible for a major outbreak. The World Health Organization reported 5,416 cases with 51 deaths through 1/22/90. Cases have been reported from 16 of the 22 states and the Federal District. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. Risk of infection is limited to the highly populated agricultural areas surrounding Lake Valencia (States of Carabobo and Aragua) extending from Valencia in the west to La Victoria in the east, and southwards to Manuare, Belen, and San Juan de los Morros (Guarico State). Foci of infection are present in the following in the following areas: Federal District, Caraballeda and Rosalia; State of Mirand, Cua (on Rio Tuy) and Guatire (on Rio Tuy) and Guatire (on Rio Caucagua); and in the center of the State of Aragua: Boca del Negro. Chagas' disease is present throughout rural areas, except the southern parts of Amazonas and Bolivar. The main vectors are known as vinchuca locally, but consist of two species, Rodnius prolixus and Triatoma maculata beetles. DISEASE RISK PROFILE Venezuela Disease Diarrheal Disease Risk Dysentery, Amoebic Echinococcosis Encephalitis, Venezuelan Equine Filariasis (Bancroftian) Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Mucocutaneous) Onchocerciasis Polio Rabies Tuberculosis Endemic Risk X X Hazard X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Viral Hepatitis A - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Typhoid fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. Yellow fever - Vaccination is recommended when traveling outside the areas usually visited by tourists, traveling extensively in the interior of the country (trekkers, hikers) and for persons on working assignments in remote areas. CDC recommends vaccination for all travelers over 9 months of age who may travel outside of urban areas. Other countries may require a yellow fever certificate after visiting this country. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B among the local Yucpa Indian population of western Zulia State on the Venezuela-Columbia border, vaccination is recommended for persons working in health care, education, or in close contact with them. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Vietnam, Socialist Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country. The risk exists all year. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. There is no risk, however, in urban areas. Prophylaxis is not necessary if your trip is confined to these areas. There is no risk of malaria in the delta region in the north. Falciparum malaria represents 55% of the malaria encountered. There is therefore a risk of vivax exposure and consideration must be given to the use of primaquine upon returning home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Vietnam Disease Avian Influenza (H5N1) Chikungunya Fever Cholera Clonorchiasis/Opisthorchiasis Dengue Fever Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Encephalitis, Japanese Fasciolopsiasis Filariasis Hepatitis, Viral Plague Polio Rabies Trachoma Tuberculosis Typhoid Fever Typhus, Scrub Endemic X X X X X Risk Hazard X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Hanoi and Ho Chi Minh City (Saigon) serve purified drinking water and reliable food. However, the hazard is left to your judgement. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Cholera - Cholera is present in this country. Risk to western travelers is low. Immunization is not required or recommended for travel to this country due to its low effectiveness. Avoid uncooked foods and untreated water. Vaccination is advised only for persons living or working under inadequate sanitary conditions and for those with impaired defense mechanisms. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Japanese encephalitis - Vaccination is indicated for persons traveling extensively in rual areas or living and working near rice growing rural and suburban areas and other irrigated land, when exposure to the disease carrying mosquitoes is high. Children are especially susceptible to the infection. The disease is endemic throughout the country during the entire year. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are around Da Nang extending south to the areas around Cam Ranh. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Virgin Islands (UK) INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. DISEASE RISK PROFILE Virgin Islands (UK) Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. AIDS Information All persons staying for more than six months and all applicants for work permits are tested for aids. Conact the British Virgin Island's embassy for full details. Virgin Islands (USA) INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Potential risk of dengue fever exists. The virus is present in this country at all times and may give rise to major outbreaks. Viral hepatitis, bacillary dysentery, amoebic dysentery, and other diarrheal diseases can occur. Rabies, especially in the mongoose population, has been reported. DISEASE RISK PROFILE Virgin Islands (USA) Disease Endemic Risk Hazard Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Wake Island INFECTIOUS DISEASE RISK Malaria Risk There is no malaria risk in this country. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. DISEASE RISK PROFILE Wake Island Disease Dengue Fever Diarrheal Diseases Encephalitis, Japanese Filariasis Helminthic Diseases Endemic X Risk Hazard X X X X Tuberculosis Typhoid Fever X X Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. No vaccinations are required to enter this country. Yemen, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present from September through February below 1400 meters throughout the country, except Hajja and Sada provinces. The cities of 'Adan and Sana'a' are risk free. Prevent malaria with treatment of clothing with permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in the risk area, and continuing for 4 weeks post exposure. Falciparum malaria represents 99% of malaria, therefore there is only a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home only if heavy exposure to mosquitos was encounered. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis may be found in this country. Avoid contact with contaminated fresh water lakes, ponds, or streams. All populated areas of the country are highly endemic with both S. haematobium and S. mansoni. Travellers should consider all oases, open wells and temporary water bodies in the desert areas as infected. Additional snail intermediate hosts for S. haematobium: Bulinus beccari and Bulinus wrighti. DISEASE RISK PROFILE Yemen Arab Republic Disease Brucellosis Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Echinococcosis Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Tapeworms Trachoma Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Scrub Endemic Risk Hazard X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected. A vaccination certificate is required for children over one year of age. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the area of risk for this country is the northern half of the country. Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Zambia, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria is present in all parts of this country, including urban areas. The risk exists from November through May. In the Zambezi valley risk is present throughout the year. Persons visiting Victoria Falls must take malaria suppressive medication. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 90% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is present in the whole country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Zambia Disease Cholera Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Loiasis Onchocerciasis Plague Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub AIDS Information Endemic Risk X X Hazard X X X X X X X X X X X X X X X X X X X X X X AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety All tap water used for drinking, brushing teeth, and making ice cubes should be boiled prior to use. Insure that bottled water is uncapped in your presence. Milk should be boiled to insure safety. Powdered and evaporated milk are available and safe. Avoid butter and other dairy products. All meat, poultry and seafood must be well cooked and served while hot. Pork is best avoided. Vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid cold buffets, custards, and any frozen dessert. First class hotels and restaurants in Ndola serve purified drinking water and reliable food. However, the hazard is left to your judgement. Food, dairy products, and water is considered safe in Livingtone (Maramba) and Lusaka. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active disease. A vaccination certificate is required for children over one year of age. CDC recommends vaccination for all travelers over 9 months of age who may travel outside of urban areas. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Geographical distribution of the areas of risk for this country are present in the western part of the country (near Bulawayo). Rabies - In this country, where rabies is a constant threat, a pre-exposure rabies vaccination is advised for persons planning an extended stay or on working assignments (naturalists, agricultural advisors, archeologists, geologists, etc.). Although this provides adequate initial protection, a person bitten by a potentially rabid animal would still require post exposure immunization. Children should be cautioned not to pet dogs, cats, or other mammals. Zimbabwe, Republic of INFECTIOUS DISEASE RISK Malaria Risk Malaria risk is present from November through May, throughout the country, including urban areas. Harare (1472 m) is risk free. In the Zambezi valley risk is present throughout the year. Persons visiting Victoria Falls must take malaria supressive medication. The malaria in this country is resistant to chloroquine. Prevent malaria with treatment of clothing with permethrin and use a topical insect repellent on skin. Several oral medications are available to prevent malaria in the country. See malaria prevention. Falciparum malaria represents 91% of malaria, therefore there is a slight risk of p. vivax malaria exposure. Consider use of Primaquine upon return home. Diseases of Special Risk In addition to the worldwide hazard of tetanus and the routine and any special immunizations recommended below, the traveler should be aware that risk of exposure to the following diseases exists in this country. This list is not all inclusive, but it is a caution concerning the more likely endemic disease risks. Schistosomiasis is present in the whole country, including urban areas. Avoid contact with fresh water lakes, ponds, or streams. DISEASE RISK PROFILE Zimbabwe Disease Dracunculiasis/Guinea Worm Diarrheal Disease Risk Dysentery, Amoebic/Bacillary Echinococcosis Filariasis Giardiasis Helminthic Diseases Hepatitis, Viral Leishmaniasis (Cutaneous) Leishmaniasis (Visceral) Polio Rabies Relapsing Fever Trachoma Trypanosomiasis, African Sleeping Sickness Tuberculosis Typhoid Fever Typhus, Endemic Flea-Borne Typhus, Epidemic Louse-Borne Typhus, Scrub Endemic X Risk Hazard X X X X X X X X X X X X X X X X X X X AIDS Information AIDS is of concern in the blood supply. Single use syringes and needles may be unavailable. Medical treatment should be deferred until reaching a facility where adequate safeguards can be assured. Food/Water Safety Water is probably safe, but due to local variations in bacterial counts, using bottled water for the first few weeks will help the traveler adjust and decrease the chance of traveler's diarrhea. Local meat, poultry, seafood, vegetables, and fruits are safe to eat. Milk is pasteurized and safe to drink. Butter, cheese, yogurt and ice-cream are safe. VACCINATIONS Yellow fever - A vaccination certificate is required for travelers coming from infected areas and from or in transit through countries with active infection. A vaccination is required for children of all ages. Children under nine months of age should not be vaccinated due to health considerations. Routine immunizations should be current. A rubeola (measles) booster should be considered. Persons age 16 to 65 should receive a booster of tetanus and diphtheria every ten years. Healthy adults under age 65 do not require pneumococcal vaccine, but it is appropriate for those with chronic medical conditions. Influenza vaccine may be considered for those providing essential community services, health care workers, and those wishing to reduce the likelihood of becoming ill with influenza. Adults over 65 years of age are urged to obtain yearly influenza immunization, and to insure that their tetanus and diphtheria immunizations are current. Pneumococcal vaccination is also suggested for this age group. The vaccinations listed are recommended for the traveler's protection. Poliomyelitis - A poliomyelitis booster is indicated for this country. Viral Hepatitis A - Vaccination is recommended for all travelers for their protection. Typhoid fever - Vaccination is recommended for all travelers for their protection. Selective vaccinations - These apply only to specific groups of travelers or persons on specific working assignments: Viral Hepatitis B - Because of the high rate of healthy carriers of hepatitis B in this country, vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or working in close contact with the local population (teachers, missionaries, Peace Corps), or persons foreseeing sexual relations with local inhabitants. Plague - Vaccination is recommended only for persons who may be occupationally exposed to wild rodents (anthropologists, geologists, medical personnel, missionaries, etc). The standard vaccination course must be completed before entering the plague infested area. Occasional cases are reported from the northeastern part of the country (Muchinga Mountains) and in the southwestern part bordering Botswana and Angola).