African Tick-Bite Fever

African tick-bite fever is a bacterial infection that is spread through the bite of infected ticks. Symptoms usually appear within 2 weeks after a tick bite and often include fever, headache, muscle soreness, and a rash. At the site of the tick bite will be a red skin sore with a dark center.

Who is at risk?

Travelers to sub-Saharan Africa and the West Indies are at risk of infection. You may be at higher risk for African tick-bite fever if your travel plans include outdoor activities such as camping, hiking, and game hunting in wooded, brushy, or grassy areas. Ticks that are infected with tick-bite fever are usually most active from November through April.

What can travelers do to prevent African tick-bite fever?

There is no vaccine or medicine that prevents African tick-bite fever. Travelers can protect themselves by preventing tick bites.

Prevent tick bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Tuck in shirts, tuck pants into socks, and wear closed shoes instead of sandals to prevent bites. Avoid wooded and brushy areas with high grass, brush, and leaves. Walk in the center of hiking trails.

Use a repellent that contains 20% or more DEET for protection that lasts up to several hours. Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon.

Always follow product directions and reapply as directed.

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.

If treating items yourself, follow the product instructions carefully. Do not use permethrin directly on skin.

Find and remove ticks from your body:

Bathe or shower as soon as possible after coming indoors. Check your entire body (under your arms, in and around your ears, in your belly button, behind your knees, between your legs, around your waist, and especially in your hair). Use a hand-held or full-length mirror to view all parts of your body.

Be sure to remove ticks properly. Parents should check their children for ticks. Check your pets and belongings. Ticks can be on outdoor equipment and clothes.

African Trypanosomiasis (African Sleeping Sickness)

African trypanosomiasis, also called African sleeping sickness, is a parasitic disease spread by the tsetse fly. Symptoms include fatigue, high fever, headaches, and muscle aches. If the disease is not treated, it can cause death.

Who is at risk?

Travelers who go to sub-Saharan Africa are at risk (see map). External Web Site IconTravelers who plan to spend a lot of time outdoors or who go to game parks are at increased risk.

What can travelers do to prevent African trypanosomiasis?

There is no vaccine or medicine that prevents African trypanosomiasis. Travelers can protect themselves by preventing tsetse fly bites.

Prevent tsetse fly bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

American Trypanosomiasis (Chagas Disease)

American trypanosomiasis, also called Chagas disease, is a disease spread by contact with triatomine bugs (also called reduviid bugs, "kissing" bugs, or assassin bugs). This disease can also be spread through contaminated blood products and contaminated food and drink.

Most people with this disease do not develop symptoms immediately after exposure to the triatomine bug, but remain infected throughout their lives. When symptoms after initial exposure do develop, the most common symptoms are redness and swelling at the bite wound or swelling of the eyelid a few days to weeks later. Other symptoms can include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, or vomiting. About 25% of infected people, regardless of whether they had early symptoms, will develop more severe symptoms later in life, including heart conditions or gastrointestinal problems.

Who is at risk?

Travelers who go to Mexico, Central America, or South America, especially rural areas, are at potential risk. However, Chagas disease acquired during typical tourist travel is thought to be quite rare. Travelers who sleep outdoors or who stay in poorly constructed housing are at greatest risk.

What can travelers do to prevent American trypanosomiasis?

There is no vaccine or medicine that prevents American trypanososmiasis. Travelers can protect themselves by preventing bites from triatomine bugs.

Prevent bug bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

Avian Flu (Bird Flu)

What is avian flu (bird flu)?

Avian flu (sometimes called bird flu) is a respiratory disease that usually infects birds, not people. There are different types of avian flu, such as H5N1 and H7N9. People rarely get bird flu, but when they do it usually happens after contact with infected birds (such as chickens, turkeys, geese, pigeons, and pheasants). Human illness from avian flu has ranged from mild eye infections and flu-like symptoms to pneumonia and death.

Who is at risk?

The risk of bird flu to travelers is extremely low. People who come in contact with live poultry may be at higher risk. H5N1 bird flu is widespread in poultry and wild birds in several countries in Asia and the Middle East. Outbreaks with H5N1 bird flu also have been reported in Europe and Africa. H7N9 bird flu has been found in China. See the CDC Avian Flu website for more information on bird flu in specific countries.

What can travelers do to prevent avian flu?

There is no vaccine to prevent avian flu. (However, there is a vaccine for the strains of flu virus that are commonly seen in humans.) While you are traveling in countries affected by bird flu, you should avoid contact with poultry and all birds.

Do not touch birds or other animals:

Do not touch animals whether they are alive or dead.

Avoid live bird or poultry markets.

Avoid other markets or farms with animals (wet markets).

Eat food that is fully cooked:

Eat meat and poultry that is fully cooked (not pink) and served hot.

Eat hard-cooked eggs (not runny).

Don’t eat or drink dishes that include blood from any animal.

Don’t eat food from street vendors.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging or sharing eating utensils or cups with people who are sick.

Chikungunya

What is chikungunya?

Chikungunya is an illness caused by a virus that spreads through mosquito bites. Symptoms of chikungunya include fever, headache, tiredness, nausea, vomiting, rash, and muscle or joint pain. Symptoms usually last for a few days to a few weeks, but some people may feel tired for several weeks.

Who is at risk?

Travelers who go to Asian or African countries are at risk of getting chikungunya. The mosquito that carries chikunguya can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas.

Since 2004, millions of cases have occurred in countries near the Indian Ocean. From 2004 to 2009, 105 cases of chikungunya fever were reported in travelers returning to the United States.

What can travelers do to prevent chikungunya?

There is currently no vaccine or medicine to prevent chikungunya. Travelers can protect themselves by preventing mosquito bites.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

Dengue

What is dengue?

Dengue is an illness caused by a virus that is spread through mosquito bites. Symptoms include fever, headache, nausea, vomiting, rash, and pain in the eyes, joints, and muscles. After you are bitten by an infected mosquito, symptoms can take up to 2 weeks to develop but usually end in a week. In severe cases, symptoms may include intense stomach pain, repeated vomiting, bleeding from the nose or gums, and death.

Who is at risk?

Travelers who go to tropical and subtropical regions are at risk of getting dengue. These areas include parts of the Caribbean, Central and South America Adobe PDF file, Western Pacific Islands, Australia, Southeast Asia, and Africa. The mosquito that carries the dengue virus can bite during the day and night, both indoors and outdoors and often lives around buildings in urban areas. Dengue is not usually seen at altitudes above 4,500 feet (1,500 meters).

What can travelers do to prevent dengue?

There is currently no vaccine or medicine to prevent dengue. Travelers can protect themselves by preventing mosquito bites.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

Diphtheria

What is diphtheria?

Diphtheria is an illness that is spread through coughing and sneezing. If an infected person has skin sores, it can also be spread by touching the sores. Symptoms of diphtheria include fever, sore throat, and a thick coat in the throat and nose. Neck swelling and skin sores can also occur. In severe disease, swelling of the heart and nerves can occur, as well as trouble breathing. Death occurs in 5%-10% of cases with breathing problems. People who have diphtheria with skin sores usually recover.

Who is at risk?



Travelers going to developing countries are at highest risk for diphtheria. (See Table 3-01). Industrialized countries have low rates of diphtheria due to the availability of a vaccine that prevents the disease.

What can travelers do to prevent diphtheria?

Get a diphtheria vaccine:

In the United States, diphtheria vaccine is only available in combination with other vaccines that protect you against diseases such as tetanus and pertussis. The diphtheria vaccine comes in three forms: Tdap and Td (for adults), and DTaP (for children).

Tdap is similar to Td but also contains protection against pertussis. Adolescents 11 through 18 years old (preferably at age 11-12 years) and adults 19 or older should receive a single lifetime dose of Tdap.

Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or sometimes after an exposure.

DTaP vaccine is given to children younger than 7. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Flu (Influenza)

Flu (Influenza)

What is the flu?

The flu (influenza) is a contagious respiratory disease caused by flu viruses. It is spread from person to person by coughing or sneezing. It can also be spread by touching contaminated surfaces.

Symptoms of flu include fever* or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, and tiredness. Nausea, vomiting, and diarrhea also can occur but are more common in children than adults. Young children, senior citizens, and people who have chronic health conditions are at risk for serious complications. These complications can include pneumonia, ear infections, sinus infections, dehydration, worsening of chronic medical conditions, and death.

*It’s important to note that not everyone with flu will have a fever.

Who is at risk?



Flu is common throughout the world. The flu season lasts from October through May in the Northern Hemisphere and from April through September in the Southern Hemisphere. In tropical countries, flu can be spread year-round.

International travel does not increase your risk of getting the flu, but travel to tropical countries or countries in the Southern Hemisphere and contact with people from these places can put you at risk for the flu outside the regular flu season in the United States.

What can travelers do to prevent the flu?

Get a flu vaccine:

A yearly flu vaccine as the first and most important step in protecting against flu viruses.

A flu vaccine protects against the three viruses that research suggests will be most common.

Everyone 6 months of age and older should get a flu vaccine as soon as the current season’s vaccines are available.

The flu vaccine is available as either a short or a nasal spray.

Vaccination of high risk people decreases their risk of severe flu illness.

People at high risk for developing flu-related complications include:

children younger than 5, but especially children younger than 2 years old

Adults 65 years of age and older

Pregnant women

American Indians and Alaskan Natives

People who have medical conditions such as asthma, lung disease or heart disease



Stop the spread of germs:

Try to avoid close contact with sick people.

If you get sick with flu-like illness, stay home for at least 24 hours after the fever is gone except to get medical care or for other necessities. The fever should be gone without the use of a fever-reducing medicine.

While sick, limit contact with others as much as possible to keep from infecting them. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.

Avoid touching your eyes, nose and mouth. Germs spread this way. Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Hand, Foot, and Mouth Disease

What is hand, foot, and mouth disease (HFMD)?

Hand, foot, and mouth disease (HFMD) is a contagious disease that is caused by different viruses. It usually affects infants and children under 5 years old. Adults can also get the disease. Symptoms of hand, foot, and mouth disease include fever, painful blister-like sores in the mouth, and a rash that may appear as blisters. HFMD is usually mild, and nearly all infected people recover in 7 to 10 days.

HFMD spreads through close personal contact, such as kissing or hugging, coughing and sneezing, contact with feces, and touching objects or surfaces that have the virus on them then putting your fingers in your eyes, nose or mouth.

Who is at risk?

Viruses that cause HFMD occur worldwide and happen more frequently in summer and fall in temperate climates. Large outbreaks of severe HFMD occur frequently in some countries in Asia. Thousands of people often can get infected during these outbreaks.

What can travelers do to prevent HFMD?

There is no vaccine to prevent HFMD. Travelers are advised to practice good hygiene, including hand washing, to lower the risk of getting sick.

Practice hygiene and cleanliness:

Wash your hands often, especially before eating.

If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Disinfect dirty surfaces and soiled items:

If you are able, first wash the items with soap and water, then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach with 4 cups of water) or a cleaning product that contains bleach.

Hepatitis A

What is hepatitis A?

Hepatitis A is a liver disease spread by contaminated food and water. It can also be spread from the hands of a person with hepatitis A. It is rarely spread through sexual contact.

Symptoms include a sudden onset of fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, and jaundice (yellowing of the skin and eyes). Some people have no symptoms, while others have symptoms that last 1-6 months. Most people recover with no lasting liver damage.

Who is at risk?

Hepatitis A is a common infection among travelers to developing countries. Travelers going to rural areas in developing countries have a higher risk of getting hepatitis A infections than other travelers. However, hepatitis A infections can happen in urban areas with “standard” tourist accommodations as well.

People 1 year of age and older who are traveling to or working in countries where they would have a high or intermediate risk of hepatitis A virus, should strongly consider the Hepatitis A vaccine. These areas include all parts of the world except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.

What can travelers do to prevent disease?

Get a hepatitis A vaccine:

Ask your doctor or nurse about hepatitis A vaccine.

The hepatitis A vaccine is given in 2 doses, 6 months apart. The vaccine is nearly 100% effective and has been a routine childhood vaccine in the United States since 2005.

Eat safe foods:

Food that is cooked and served hot

Hard-cooked eggs

Fruits and vegetables you have washed in clean water or peeled yourself

Pasteurized dairy products

Don't eat

Food served at room temperature

Food from street vendors

Raw or soft-cooked (runny) eggs

Raw or undercooked (rare) meat or fish

Unwashed or unpeeled raw fruits and vegetables

Peelings from fruit or vegetables

Condiments (such as salsa) made with fresh ingredients

Salads

Unpasteurized dairy products

”Bushmeat” (monkeys, bats, or other wild game)

Drink safe beverages:

Bottled water that is sealed (carbonated is safer)

Water that has been disinfected (boiled, filtered, treated)

Ice made with bottled or disinfected water

Carbonated drinks

Hot coffee or tea

Pasteurized milk

Don't drink

Tap or well water

Ice made with tap or well water

Drinks made with tap or well water (such as reconstituted juice)

Flavored ice and popsicles

Unpasteurized milk

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Hepatitis B

What is hepatitis B?

Hepatitis B is a contagious virus that is transmitted through blood, blood products, and other body fluids (such as semen). Travelers can become infected through unprotected sex with an infected person, injection drug use, and transfusions with unscreened blood.

Symptoms include a sudden fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, dark urine, joint pain, and yellowing of the skin and eyes (jaundice). Symptoms may last from several weeks to several months. Some people who get hepatitis B develop lifelong (chronic) hepatitis B. This can cause people to die early from liver disease and liver cancer.

Who is at risk?

Hepatitis B is most common in some countries in Asia, Africa, South America and the Caribbean (see map Adobe PDF file). However, it occurs in nearly every part of the world. The risk to most travelers is low, but travelers could become infected if they have sex with an infected person, receive a transfusion of unscreened blood, have medical or dental procedures, get tattoos or piercings or receive acupuncture with needles that are not sterile.

What can travelers do to prevent disease?

Get hepatitis B vaccine:

Ask your doctor or nurse about hepatitis B vaccine. The vaccine is recommended for extended stay travelers, people with chronic conditions, older people, healthcare workers, and people who participate in high-risk activities (such as injection drug use and unprotected sex). Other travelers may consider the vaccine, especially since some countries may not screen their blood supply, and travelers could become infected by a blood transfusion.

This vaccine is a 3 dose vaccine. The second vaccine is given 1-2 months after the first dose and the third dose is 6-12 months later than the first dose.

Talk to your doctor about accelerated dosing and the combination vaccine with hepatitis A. Routine booster doses are not routinely recommended for any age group.

The vaccine is over 90% effective, and has been considered a routine childhood vaccine since 1995.

Protect yourself:

Use latex condoms correctly.

Do not inject drugs.

Limit alcohol consumption. People take more risks when intoxicated.

Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.

If you do get tattoos or piercings, make sure equipment is sterile.

If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Consider medical evacuation insurance:

An injury or illness that requires invasive medical or dental treatment (e.g. injection, IV drip, transfusion, stitching) could result in hepatitis B infection if the blood supply is not properly screened.

Hepatitis C

What is hepatitis C?

Hepatitis C is a contagious disease that causes liver damage. Hepatitis C is usually spread by blood contact. Rarely, it can be spread by sexual contact.

Hepatitis C can be a short-term (acute) illness; however, for most people acute infection leads to long-term (chronic) infection which is a serious disease than can result in death. Many people who get the hepatitis C virus have no symptoms at first. Those who do have symptoms may have appetite loss, stomach pain, tiredness, nausea, dark urine, or yellowing of the skin and eyes (jaundice). Even if they don’t have initial symptoms, most people who are infected develop long-term illness that can result in serious liver disease, such as scarring and other damage to the liver (cirrhosis), liver failure, or liver cancer.

Who is at risk?

Hepatitis C is most common in some countries in Asia and Africa, but it occurs in nearly every part of the world (See Map 3-05). The risk to most travelers is low, but travelers could become infected if they receive a transfusion of unscreened blood, have medical or dental procedures in a developing country, get tattoos or piercings or receive acupuncture with needles that are not sterile, or have sex with an infected person.

What can travelers do to prevent hepatitis C?

There is currently no vaccine to prevent hepatitis C. Travelers can protect themselves by following these steps:

Protect yourself:

Use latex condoms correctly.

Do not inject drugs.

Limit alcohol consumption. People take more risks when intoxicated.

Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture. If you do get tattoos, piercings or acupuncture in another country make sure the equipment used is sterile.

If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

An injury or illness that requires invasive medical or dental treatment (e.g., injection, IV drip, transfusion, stitching) could result in hepatitis C infection if the blood supply is not properly screened.

Hepatitis E

What is hepatitis E?

Hepatitis E is a liver disease spread by contaminated food and water. Usually, hepatitis E is spread by contaminated water; however, in developed countries eating uncooked or undercooked animal products can also cause hepatitis E.

Some people who get hepatitis E do not ever feel sick. Others have symptoms that include a sudden onset of fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, and yellowing of the skin and eyes (jaundice). Symptoms usually last less than 2 months but can last for up to 6 months. Pregnant women are most at risk of serious illness if they get hepatitis E. Most people recover with no lasting liver damage.

Who is at risk?

Hepatitis E is seen worldwide except for a few countries. Travelers to the developing world are especially at risk for hepatitis E. Hepatitis E is common in developing countries because many developing countries do not have the same food and water safety standards that the United States does. Large outbreaks of hepatitis E have occurred in south and central Asia, tropical east Asia, Africa, and Central America.

What can travelers do to prevent hepatitis E?

There is no vaccine or medicine to prevent hepatitis E. Travelers should follow safe food and water guidelines and practice cleanliness and hygiene.

Drink safe beverages:

Drink

Bottled water that is sealed (carbonated is safer)

Water that has been disinfected (boiled, filtered, treated)

Ice made with bottled or disinfected water

Carbonated drinks

Hot coffee or tea

Pasteurized milk

Don't drink

Tap or well water

Ice made with tap or well water

Drinks made with tap or well water (such as reconstituted juice)

Flavored ice and popsicles

Unpasteurized milk

Eat safe foods:

Eat

Food that is cooked and served hot

Hard-cooked eggs

Fruits and vegetables you have washed in clean water or peeled yourself

Pasteurized dairy products

Don't eat

Food served at room temperature

Food from street vendors

Raw or soft-cooked (runny) eggs

Raw or undercooked (rare) meat or fish

Unwashed or unpeeled raw fruits and vegetables

Peelings from fruit or vegetables

Condiments (such as salsa) made with fresh ingredients

Salads

Unpasteurized dairy products

”Bushmeat” (monkeys, bats, or other wild game)

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

HIV

What is HIV?

HIV (human immunodeficiency virus) is a contagious, deadly virus that is spread through blood, blood products, and other body fluids, such as semen.

Early symptoms of HIV infection include cough, body aches, headaches, nasal congestion, sore throat, and cough. Some people have no early symptoms at all and may appear healthy. However, untreated HIV infection is connected to many diseases, including heart disease, kidney disease, liver disease, and cancer. HIV infection can lead to AIDS (acquired immune deficiency syndrome). AIDS causes people to have difficulty fighting infections and other diseases and eventually leads to death.

Who is at risk?

Travelers are generally at low risk for HIV unless they participate in risky behaviors, such as sex with unfamiliar partners or injection drug use. Some developing countries may not adequately screen their blood supplies, and travelers could become infected by a blood transfusion.

HIV occurs worldwide. Sub-Saharan Africa remains the most affected part of the world, but there have been increases in cases in Eastern Europe, Asia, and Central and South America.

What can travelers do to prevent HIV?

Protect yourself:

Use latex condoms correctly.

Do not inject drugs.

Limit alcohol consumption. People take more risks when intoxicated.

Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.

If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Consider medical evacuation insurance:

An injury or illness that requires invasive medical or dental treatment (e.g., injection, IV drip, transfusion, stitching) could result in HIV infection if the blood supply is not properly screened.

Japanese Encephalitis

What is Japanese encephalitis?

Japanese encephalitis (JE) is a disease spread through mosquito bites. Symptoms usually take 5-15 days to develop and include fever, headache, vomiting, confusion, and difficulty moving. Symptoms that develop later include swelling around the brain and coma. JE is a serious disease that may cause death.

Who is at risk?

Travelers who go to Asia are at risk for getting Japanese encephalitis. For most travelers the risk is extremely low but depends on where you are going, the time of year, your planned activities, and the length of the trip. You are at higher risk if you are traveling to rural areas, will be outside frequently, or will be traveling for a long period of time. In mild climates in northern Asia the risk for JE is greater in the summer and fall. In tropical and subtropical areas, there is a risk year-round.

What can travelers do to prevent Japanese encephalitis?

Travelers can protect themselves from JE by getting JE vaccine and preventing mosquito bites.

Get JE vaccine, if recommended:

Talk to your doctor about your travel plans:

Your doctor can help you decide if you need the JE vaccine based on the length of your trip, the areas where you will be traveling, and your planned activities.

See your doctor at least 6 weeks before your trip:

The JE vaccine is given in 2 or 3 doses that are spaced over a month. You should get the last dose at least 10 days before your trip.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

Malaria

What is malaria?

Malaria is a disease spread through mosquito bites. Symptoms usually appear within in 7-30 days but can take up to one year to develop. Symptoms include high fevers, shaking chills, and flu-like illness. Without treatment, malaria can cause severe illness and even death.

Who is at risk?

Malaria occurs in Africa, Central and South America, parts of the Caribbean, Asia, Eastern Europe, and the South Pacific. People spending time outdoors, including sleeping outside, are at higher risk for malaria. Every year about 1500 cases of malaria and 5 deaths occur among international travelers from the United States. Read stories of people who have had malaria.

What can travelers do to prevent malaria?

Travelers can protect themselves from malaria by taking prescription medicine and preventing mosquito bites.

Take prescription medicine if recommended for your destination:

Talk to your doctor about which medicine is best for you.

There are prescription medicines you can take to prevent malaria. Take this medicine before, during, and after your trip.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.

Measles

What is measles?

Measles is a disease caused by a virus that is spread through the air by breathing, coughing, or sneezing. Measles virus is highly contagious and can remain so for up to 2 hours in the air or on surfaces.

Symptoms of measles are rash, high fever, cough, runny nose, and red, watery eyes. Some people who become sick with measles also get an ear infection, diarrhea, or a serious lung infection, such as pneumonia. Although severe cases are rare, measles can cause swelling of the brain and even death. Measles can be especially severe in infants and in people who are malnourished or who have weakened immune systems (such as from HIV infection or cancer or from certain drugs or therapies).

Who is at risk?

Measles remains a common disease in many parts of the world, including Europe, the Middle East, Asia, the Pacific, and Africa. In the United States, most measles cases result from international travel. The disease is brought into the United States by people who get infected in other countries. Measles outbreaks can result when returning travelers spread the disease to people who have not been vaccinated or have not had measles as a child. Anyone who is not protected against measles is at risk of getting infected when he or she travels internationally.

What can travelers do to prevent measles?

Get the measles vaccine:

People who cannot show that they were vaccinated as children and who have never had measles should be vaccinated.

Infants 6-11 months of age should have 1 dose of measles vaccine if traveling internationally.

Children in the United States routinely receive measles vaccination at 12-15 months of age.

Infants vaccinated before 12 months of age should be re-vaccinated on or after the first birthday with 2 doses, separated by at least 28 days.

Children 12 months of age or older should have 2 doses, separated by at least 28 days.

Adolescents and adults who have not had measles or have not been vaccinated should get 2 doses, separated by at least 28 days.

Two doses of MMR (measles, mumps & rubella) vaccine is nearly 100% effective at preventing measles.

The only measles vaccines available in the United States are the measles-mumps-rubella (MMR) and the measles-mumps-rubella-varicella (MMRV) vaccines. MMR has been used safely and effectively since the 1970s. A few people experience mild, temporary adverse reactions, such as joint pain, from the vaccine, but serious side effects are extremely rare. There is no link between MMR and autism.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Meningococcal Disease (Neisseria meningitidis)

What is meningococcal disease?

Meningococcal disease can refer to any illness that is caused by the type of bacteria called Neisseria meningitidis. Meningococcal disease is a contagious infection spread by close contact with an infected person, such as living together or kissing. Quick medical attention is extremely important if meningococcal disease is suspected.

The symptoms of meningococcal disease can vary based on the type of illness that develops. Common symptoms of meningococcal meningitis include sudden fever, headache, and stiff neck. Other symptoms can include nausea, vomiting, increased sensitivity to light, and confusion. Children and infants may show different signs, such as inactivity, irritability, vomiting, or poor reflexes. Meningococcal disease can also cause an infection of the blood which can lead to tiredness, vomiting, cold hands and feet, chills, severe aches and pain, fast breathing, diarrhea, and a dark purple rash. Meningococcal disease is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours.

Who is at risk?

Anyone can get meningococcal disease, but certain groups of people are at increased risk. Although meningococcal disease is found worldwide, the “meningitis belt” of sub-Saharan Africa Adobe PDF file has the highest rates in the world. Rates of meningococcal disease are several times higher in the meningitis belt than in the US. The disease is most common in these countries during the dry season (December through June). Travelers who spend a lot of time with local populations in the meningitis belt during a large outbreak have the highest risk of contracting the disease.

In addition to the meningitis belt, travelers to the Hajj pilgrimage in Saudi Arabia are also at risk. The Hajj has been associated with outbreaks of meningococcal disease in returning pilgrims and people in close contact with them.

What can travelers do to prevent meningococcal disease?

Get a meningococcal vaccine:

A dose of meningitis vaccine is recommended for people traveling to countries in the “meningitis belt”.

Even if you have received this vaccine in the past, you may need a booster dose, usually every 5 years.

Travelers to the Hajj must show proof of vaccination in the past 3 years.

Infants and young children will need more than one dose of vaccine.

Infants who received MenHibRix® and are traveling to areas with high endemic rates of meningococcal disease are not protected against serogroups A and W and should receive 1 or 2 doses of a quadrivalent meningococcal vaccine licensed for children aged ?9 months before travel.

It takes approximately 7-10 days after receiving the vaccine before a person can develop protection against the disease.

Reduce your exposure to germs:

Wash your hands often.

If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid contact with people who are sick.

Mumps

What is mumps?

Mumps is a contagious disease that is spread when infected people cough, sneeze, or talk. Sharing items, like cups or drink cans, with infected people can also spread the virus. The virus can also live on items and surfaces touched by an infected person for several hours.

Symptoms of mumps are fever, headache, muscle aches, tiredness, loss of appetite, and swollen and tender salivary glands under the ears or jaw on one or both sides of the face (parotitis). Most people with mumps recover fully. However, mumps can occasionally cause complications, such as swelling of the brain, testicles (in males), and ovaries and breasts (in females), and temporary or permanent deafness.

Who is at risk?

Because the mumps vaccine is not used everywhere, mumps is a common disease in many countries. The risk of mumps for travelers is high in many countries of the world, including industrialized countries, such as the United Kingdom, which has had several outbreaks since 2004, and Japan, which does not routinely vaccinate against mumps. Risk is especially high for travelers older than 1 year who have not had mumps vaccine.

What can travelers do to prevent mumps?

Get a mumps vaccine:

People who cannot show that they were vaccinated as children and who have never had mumps should be vaccinated.

The only mumps vaccines available in the United States are the measles-mumps-rubella (MMR) and the measles-mumps-rubella-varicella (MMRV) vaccines.



Adolescents and adults who have not had mumps or have not been vaccinated with MMR should get 2 doses, separated by at least 28 days.

Infants 6 months through 11 months of age should have 1 dose of MMR vaccine if traveling internationally.

Children in the United States routinely receive MMR vaccination at age 12-15 months.

Children 12 months of age or older should have 2 doses, separated by at least 28 days.

MMR has been used safely and effectively since the 1970s. A few people experience mild, temporary adverse reactions, such as joint pain, from the vaccine, but serious side effects are extremely rare. There is no link between MMR and autism.

Two doses of this vaccine are nearly 90% effective at preventing mumps.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Pertussis (Whooping Cough)

What is pertussis?

Pertussis, also known as “whooping cough,” is a contagious disease spread when infected people cough and sneeze near others.

Early symptoms are similar to a cold and include runny nose, low fevers, mild cough, and a pause in breathing for babies. Later symptoms of the disease include “fits” of many rapid coughs followed by a high-pitched “whoop,” vomiting, and exhaustion. Pertussis is very serious for babies. Among babies younger than 1 year of age who get pertussis, more than half will be hospitalized and 1 in 100 will die.

Who is at risk?

Pertussis is seen in all countries, so all travelers are at risk. Pertussis rates are the highest in developing countries where very few people have had the vaccine. Babies who are too young to have had their first 3 pertussis shots are most at risk. Adults, even those who received pertussis vaccines as children, should be re-vaccinated with a one-time dose of Tdap vaccine. It is estimated that 30–50 million people get pertussis and 300,000 people die from pertussis every year worldwide.

What can travelers do to prevent pertussis?

Get a pertussis vaccine:

Adults 19 or older should receive a single dose of Tdap vaccine. Confirm with your doctor that you have received the vaccine for pertussis.

In the United States, pertussis vaccine is only available in combination with other vaccines that protect you against diseases such as diphtheria and tetanus. They are DTaP and Tdap.

DTaP vaccine is given to children younger than 7 years of age.

Children should get 5 doses of DTaP, one dose at each of the following ages: 2 months, 4 months, 6 months, and 15-18 months and 4-6 years.

Tdap vaccine is given to adolescents and adults.

Adolescents 11-18 years of age should receive a booster dose, preferably at 11-12 years of age.

Adults 19 years of age and older should receive a one-time booster dose.

Note: Do not confuse this with the Td (tetanus/diphtheria) vaccine which you should receive every 10 years or after an exposure to tetanus.

Pregnant women should get a dose of Tdap during each pregnancy, preferably at 27 through 36 weeks gestation.

For children 7-10 years of age who are not fully immunized against pertussis, a single dose of Tdap should be given.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Pneumococcal Disease (Streptococcus pneumoniae)

What is pneumococcal disease?

Pneumococcal disease is a contagious infection caused by Streptococcus pneumoniae bacteria (“pneumococcus”). These bacteria can cause many types of illnesses, including: pneumonia (infection of the lungs), ear infections, sinus infections, meningitis (infection of the covering around the brain and spinal cord), and bacteremia (blood stream infection). Pneumococcal disease is spread through coughing, sneezing, and close contact with an infected person.

Symptoms of pneumococcal disease depend on the part of the body that is infected. They can include fever, cough, shortness of breath, chest pain, stiff neck, confusion and disorientation, sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. In severe cases, pneumococcal disease can cause brain damage, hearing loss, the loss of arms or legs, and death.

Who is at risk?

Pneumococcal disease occurs around the world. Travelers may be at higher risk if spending time in crowded settings or in close contact with children in countries where pneumococcal conjugate vaccine is not routinely used. Pneumococcal disease is more common in developing countries. Pneumococcal disease is also more common during winter and early spring but occurs year-round in the tropics. Outbreaks of pneumococcal disease are uncommon but may occur in certain situations, such as in nursing homes, childcare centers, or other institutions.

Certain people are more likely to become ill with pneumococcal disease. This high-risk group includes adults 65 years of age or older and children younger than 25 years of age. People who have conditions that weaken the immune system, like diabetes, heart disease, lung disease, and HIV/AIDS, or people who smoke cigarettes or have asthma are also at increased risk for getting pneumococcal disease.

What can travelers do to prevent pneumococcal disease?

Get a pneumococcal vaccine:

The pneumococcal vaccine can protect you from pneumococcal disease.

Adults 65 years and older should get the 23-valent pneumococcal polysaccharide vaccine (PPSV23).

Younger adults who are smokers or who have certain medical conditions mentioned above should also get PPSV23.

Children up through 5 years of age routinely receive a different pneumococcal vaccine (13-valent pneumococcal conjugate vaccine, PCV13), with the number of doses depending on age. Make sure your child is has received all the recommended doses of PCV13.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Polio

What is polio?

Polio is a disease caused by a virus that is mainly spread by person-to-person contact and eating or drinking items contaminated with the feces of an infected person. Polio can also be spread through water, other drinks, and raw or undercooked food.

Most people with polio do not feel sick. Some people have only minor symptoms, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. Most people recover completely. In rare cases, polio causes permanent loss of muscle function in the arms or legs (usually the legs) or death.

From the late 1940s to the early 1950s, polio crippled around 35,000 people each year in the United States alone, making it one of the most feared diseases of the 20th century. By 1979, the United States was polio free.

The Global Polio Eradication Initiative was launched in 1988, with CDC as a leading partner to stop the spread of polio. Substantial progress has been made in recent years, and only 3 countries remain where polio has never been stopped: Afghanistan, Nigeria, and Pakistan. The affected areas in these 3 countries have become smaller. Until polio is stopped everywhere, even polio-free countries are at risk for outbreaks.

Who is at risk?

Travelers going to certain parts of Africa and Asia may be at risk for polio. Everyone should be up-to-date with their routine polio vaccination series. In addition, a one-time adult polio vaccine booster dose is recommended for travelers to certain countries. See individual destination pages for vaccine recommendation information.

What can travelers do to prevent polio?

Get the polio vaccine:

Ask your doctor or nurse to find out if you are up-to-date with your polio vaccination and whether you need a booster dose before traveling. Even if you were vaccinated as a child or have been sick with polio before, you may need a booster dose to make sure that you are protected.

Make sure children are vaccinated.

Eat safe foods:

Eat

Food that is cooked and served hot

Hard-cooked eggs

Fruits and vegetables you have washed in clean water or peeled yourself

Pasteurized dairy products

Don't Eat

Food served at room temperature

Food from street vendors

Raw or soft-cooked (runny) eggs

Raw or undercooked (rare) meat or fish

Unwashed or unpeeled raw fruits and vegetables

Peelings from fruit or vegetables

Condiments (such as salsa) made with fresh ingredients

Salads

Unpasteurized dairy products

”Bushmeat” (monkeys, bats, or other wild game)

Drink safe beverages:

Drink

Bottled water that is sealed (carbonated is safer)

Water that has been disinfected (boiled, filtered, treated)

Ice made with bottled or disinfected water

Carbonated drinks

Hot coffee or tea

Pasteurized milk

Don't Drink

Tap or well water

Ice made with tap or well water

Drinks made with tap or well water (such as reconstituted juice)

Flavored ice and popsicles

Unpasteurized milk

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Rabies

What is rabies?

Rabies is a deadly disease caused by a virus that is spread in the saliva of infected animals. All mammals can get rabies. People usually get rabies from licks, bites, or scratches from infected dogs and other animals such as bats, foxes, raccoons, and mongooses.

Rabies affects the central nervous system, ultimately causing brain disease and death. Once symptoms of rabies appear, the disease is nearly always fatal, so prevention is especially important.

Who is at risk?

Rabies is found around the world, except Antarctica. Travelers who may come into contact with wild or domestic animals are at risk for rabies. This includes travelers spending a lot of time outdoors (such as campers and cavers), travelers with occupational risks (such as veterinarians and wildlife professionals), and long-term travelers and expatriates. Children are also at higher risk because they often play with animals, might not report bites, and are more likely to be bitten on the head and neck.

In many countries the risk of rabies is similar to the United States, including most of Europe, Japan, Canada, and Australia. However, in many other parts of the world, rabies in dogs is still a problem, and access to preventive treatment may be hard. These areas include much of Africa, Asia, and Central and South America. If traveling to a country where there is an increased risk of rabies, especially in dogs, rabies vaccination may be recommended before your trip.

What can travelers do to prevent rabies?

Get a rabies vaccine, if recommended:

Talk to your doctor about your travel plans. If your activities will bring you into contact with animals such as dogs, cats, bats, or other carnivores, you should consider pre-exposure rabies vaccination, which is a 3-shot series (days 0, 7, and 21 or 28) given before travel.

Even if you receive pre-exposure vaccination, you should still get immediate medical treatment if you are bitten or scratched by an animal.

Avoid animal bites:

Avoid touching all animals, including wild animals and pets. Pets in other countries may not be vaccinated against rabies.

Supervise children closely, especially around dogs, cats, and wildlife such as monkeys.

If you are traveling with your pet, supervise your pet closely and do not allow it to play with local animals, including local pets and especially avoid stray animals.

Avoid bringing animals home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or months after you first encounter them.

Routine Vaccines

What are "routine vaccines"?

Routine vaccines are those that are recommended for everyone in the United States, depending on age and your vaccine history. (See routine vaccine schedules.) Most people think of these as childhood vaccines that you get before starting school, but some vaccines are routinely recommended for adults, and some are recommended every year (a flu vaccine) or every 10 years (a tetanus booster).

Routine childhood vaccines include Hepatitis B, Rotavirus, DTaP, Hib, Pneumococcal, Polio, Flu, MMR, Chickenpox, Hepatitis A, Meningococcal and HPV .

Adult routine vaccines include Flu, Td/Tdap, HPV, Shingles, Pneumococcal, Meningococcal, Hepatitis A and Hepatitis B.

Why are routine vaccines important for travelers

Because of good vaccine coverage of children in the United States, some of the diseases prevented by routine vaccines rarely occur here. However, these diseases can be much more common in other countries, even in areas where you wouldn’t normally worry about travel-related illnesses. For example, in 2011, there was a large outbreak of measles in Europe, and many unvaccinated American travelers were infected. Some even brought it back home and spread it to other unvaccinated people in their communities. Being up-to-date on your routine vaccines will give you the best protection against these illnesses.

What routine vaccines do I need?

What vaccines you need depends on your age, health, and what vaccines you have already had. For most adults who received all their recommended vaccines as children, only a yearly flu vaccine and a tetanus booster every 10 years are needed. However, you should talk to your doctor about what’s best for you. If you did not receive all your vaccines as a child—or if you can’t remember—your doctor may recommend giving them again, just to be safe. For older adults, vaccination against pneumococcal disease or shingles might be advised.

Rubella

What is rubella?

Rubella, also called German measles, is a disease spread by the coughs and sneezes of infected people. Symptoms include rash and fever for 2 to 3 days. Some people do not feel sick. If a pregnant woman gets rubella virus, her baby could have birth defects such as deafness, cataracts, heart defects, mental disabilities, and organ damage.

Who is at risk?

Rubella has been eliminated in the United States. Travelers going outside the United States are at risk for rubella. Because rubella infections without symptoms are common, travelers may be unaware that they have been in contact with an infected person.

What can travelers do to prevent rubella?

Get a rubella vaccine:

People who cannot show that they were vaccinated as children and who have never had rubella should be vaccinated.

The only rubella vaccines available in the United States are the measles-mumps-rubella (MMR) and the measles-mumps-rubella-varicella (MMRV) vaccines.

Adolescents and adults who have not had rubella or have not been vaccinated with MMR should get 2 doses, separated by at least 28 days.

Infants 6 months through 11 months of age should have 1 dose of MMR vaccine if traveling internationally.

Children in the United States routinely receive MMR vaccination at age 12–15 months.

Children 12 months of age or older should have 2 doses, separated by at least 28 days.

MMR has been used safely and effectively since the 1970s. A few people experience mild, temporary adverse reactions, such as joint pain, from the vaccine, but serious side effects are extremely rare. There is no link between MMR and autism.

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Schistosomiasis

What is schistosomiasis?

Schistosomiasis is a disease people can get when they are exposed to contaminated freshwater (such as rivers and lakes) in certain parts of Africa, South America, the Middle East, Asia, and the Caribbean. Sometimes people with schistosomiasis do not feel sick. Early symptoms can include rash and itchy skin, fever, chills, cough, or muscle aches. If schistosomiasis is not treated, it can cause serious health problems later.

Who is at risk?

Travelers going to certain parts of Africa, South America, the Middle East, Asia, and the Caribbean are at risk for schistosomiasis. High-risk areas include rivers and other water sources in sub-Saharan Africa, such as the Banfora region of Burkina Faso, areas populated by the Dogon people in Mali, Lake Malawi, Lake Tanganyika, Lake Victoria, the Omo River, the Zambezi River, and the Nile River. Many of these areas are popular tourist destinations.

What can travelers do to prevent schistosomiasis?

There is no vaccine or medicine to prevent schistosomiasis. If you are in an area where schistosomiasis occurs, you should avoid having your skin exposed to freshwater sources, such as lakes, rivers, ponds, and wetlands. If you get potentially contaminated freshwater on your skin during a trip to areas where schistosomiasis occurs, talk to your doctor about getting tested and treated.

Avoid wading, swimming or bathing in freshwater in countries where schistosomiasis occurs.

Swimming in the ocean or in well-chlorinated pools is safe.

If you have to use freshwater, such as lake or river water, for bathing, treat the water in one of 3 ways to avoid infection:

Filtering water with fine mesh filters (pore size of 30 ?m or smaller) will remove the parasite.

Heating bathing water to 50?C for 5 minutes will kill the parasite.

Keeping water in a storage tank for at least 24 hours before use will kill the parasite.

Tetanus

What is tetanus?

Tetanus is an illness that can occur after an injury with a contaminated object. The bacteria that cause tetanus are commonly found in soil and can get into the body through any type of break in the skin, such as wounds, burns, or animal bites.

Tetanus is often called “lockjaw” because the jaw muscles tighten, and the person cannot open their mouth. Other symptoms of tetanus include headache, painful muscle stiffness, trouble swallowing, seizures, fever, and high blood pressure. Tetanus is very dangerous. It can cause difficulty breathing and paralysis. Even with intensive care, 10%–20% of people with tetanus die.

Who is at risk?

Tetanus occurs throughout the world, and international travel generally does not increase the risk. However, people who are doing humanitarian aid work, such as constructing or demolishing buildings, may be at higher risk. Anyone who is not vaccinated against tetanus is at risk if he or she is injured by a contaminated object, uses injection drugs, or has a medical procedure in an unhygienic setting.

What can travelers do to prevent tetanus?

Get a tetanus vaccine:

It is recommended to obtain a tetanus vaccine before you travel, especially if you are going to an area where it may be difficult to access health care services.

In the United States, tetanus vaccine is only available in combination with other vaccines that protect you against diseases such as diphtheria and pertussis. The tetanus vaccine comes in three forms: Td, Tdap (both for adults), and DTaP (for children).

Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also contains protection against pertussis (whooping cough). Adolescents 11 through 18 years of age (preferably at age 11–12 years) and adults 19 or older should receive a single lifetime dose of Tdap.

DTaP vaccine is given to children younger than 7 years of age.

Children should get 5 doses of DTaP, one dose at each of the following ages: 15–18 months 2, 4, 6, and 4–6 years.

Tick-borne Encephalitis

What is tick-borne encephalitis (TBE)?

Tick-borne encephalitis (TBE) is an illness caused by a virus spread through tick bites. You can also get TBE by eating or drinking unpasteurized dairy products (such as milk and cheese) from infected goats, sheep, or cows.

Symptoms include fever, achiness, loss of appetite, headache, nausea, and vomiting. Swelling of the brain and/or spinal cord, confusion, and sensory disturbances occur in 20-30% of people with TBE. One percent of people die from this infection.

Who is at risk?

TBE is found in many parts of Europe and Asia (from eastern France to northern Japan and from northern Russia to Albania). Several thousand cases are reported each year, but there are probably many other cases that do not get reported. The highest number of cases occurs in Russia. Other countries with high risk for disease are Czech Republic, Estonia, Germany, Hungary, Latvia, Lithuania, Poland, Slovenia, Sweden, Switzerland, China, Japan, Mongolia, and South Korea. Travelers are more likely to get TBE from April through November (mostly in early and late summer) and when traveling to forested areas where ticks are common.

What can travelers do to prevent TBE?

There is no vaccine that prevents TBE that is available in the United States, but it is available in some other countries. Travelers anticipating high-risk activities may consider being vaccinated in Canada or Europe. High-risk activities include working or camping in forested areas or farmland, adventure travel, or living in countries where TBE is present for an extended period of time.

All travelers should take these steps to prevent TBE:

Eat only pasteurized dairy products (such as milk and cheese).

Prevent tick bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Tuck in shirts, tuck pants into socks, and wear closed shoes instead of sandals to prevent bites. Avoid wooded and brushy areas with high grass, brush, and leaves. Walk in the center of hiking trails.

Use a repellent that contains 20% or more DEET for protection that lasts up to several hours. Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon.

Always follow product directions and reapply as directed.

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.

If treating items yourself, follow the product instructions carefully. Do not use permethrin directly on skin.

Find and remove ticks from your body:

Bathe or shower as soon as possible after coming indoors. Check your entire body (under your arms, in and around your ears, in your belly button, behind your knees, between your legs, around your waist, and especially in your hair). Use a hand-held or full-length mirror to view all parts of your body.

Be sure to remove ticks properly. Parents should check their children for ticks. Check your pets and belongings. Ticks can be on outdoor equipment and clothes.

Tuberculosis (TB)

What is tuberculosis (TB)?

Tuberculosis (TB) is a disease caused by a type of bacteria that usually affects the lungs, but can occur in any part of the body. It is spread through the air from one person to another when a person with TB coughs, sneezes, speaks, or sings. Not everyone infected with TB becomes sick. Symptoms of TB include a cough that last 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or tiredness, weight loss, lack of appetite, chills, fever, and sweating at night. Bovine TB (a form of TB usually found in cattle) is a risk in travelers who consume unpasteurized dairy products in countries where TB in cattle is common.

Who is at risk?

TB occurs throughout the world. Travelers who go to areas of sub-Saharan Africa, Asia, and parts of Central and South America are at greatest risk. Globally, nearly 9 million new TB cases and nearly 1.5 million TB-related deaths occur each year.

What can travelers do to prevent tuberculosis?

Although a TB vaccine exists, The CDC does not recommend it for travelers. The vaccine has limited effectiveness at preventing TB. Instead the CDC recommends the travelers take the following steps to prevent TB:

Avoid close contact or extended time with people who have TB.

This is especially important if you will be in a crowded environment, such as a clinic, hospital, prison, or homeless shelter.

Try to avoid close contact with people who are coughing and look sick.

Take special precautions if you will be around people with TB (such as those who will be working in hospitals, prisons, or homeless shelters).

Talk to your doctor about being tested for TB infection before you leave the United States.

If your test is negative, have another test 8 to 10 weeks after you return to the United States.

People working in health care settings should talk to an infection control or occupational health expert about procedures for preventing exposure to TB, such as being fit for an N95 respirator.

Avoid eating or drinking unpasteurized dairy products.

Typhoid Fever

What is typhoid fever?

Typhoid fever is a serious disease spread by contaminated food and water. Symptoms of typhoid include lasting high fevers, weakness, stomach pains, headache, and loss of appetite. Some patients have constipation, and some have a rash. Internal bleeding and death can occur but are rare.

Who is at risk?

Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan, so travelers to the developing world should consider taking precautions. Travelers to Asia, Africa, and Latin America are especially at risk, and the highest risk for typhoid is in south Asia.

About 300 people get typhoid fever in the United States each year, and most of these people have recently traveled. About 22 million cases of typhoid fever and 200,000 related deaths occur worldwide each year.

What can travelers do to prevent typhoid fever?

Get vaccinated for typhoid:

Ask your doctor or nurse about a typhoid vaccine. This could be pills or a shot, and your doctor will help you decide which one is best for you.

Typhoid vaccine is only 50%-80% effective, so you should still be careful about what you eat and drink.

Eat safe foods:

Eat

Food that is cooked and served hot

Hard-cooked eggs

Fruits and vegetables you have washed in clean water or peeled yourself

Pasteurized dairy products

Don't Eat

Food served at room temperature

Food from street vendors

Raw or soft-cooked (runny) eggs

Raw or undercooked (rare) meat or fish

Unwashed or unpeeled raw fruits and vegetables

Peelings from fruit or vegetables

Condiments (such as salsa) made with fresh ingredients

Salads

Unpasteurized dairy products

”Bushmeat” (monkeys, bats, or other wild game)

Drink safe beverages:

Drink

Bottled water that is sealed (carbonated is safer)

Water that has been disinfected (boiled, filtered, treated)

Ice made with bottled or disinfected water

Bottled and sealed carbonated and sports drinks

Hot coffee or tea

Pasteurized milk

Don't Drink

Tap or well water

Ice made with tap or well water

Drinks made with tap or well water (such as reconstituted juice)

Flavored ice and popsicles

Unpasteurized milk

Fountain drinks

Practice hygiene and cleanliness:

Wash your hands often.

If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).

Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.

Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.

Yellow Fever

What is yellow fever?

Yellow fever is a disease caused a virus, which is spread through mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

Who is at risk?

You should receive a yellow card called the International Certificate of Vaccination or Prophylaxis (ICVP) to prove that you have had yellow fever vaccine. Some countries require all travelers to show proof of yellow fever vaccination before they can enter the country. Other countries require proof of vaccination only if travelers have been in a risk area, so if you are visiting multiple countries, the order of travel may be important. Proof of vaccination is not valid until 10 days after you get the vaccine, so plan to get the vaccine early if you need it.

Travelers to certain parts of South America Adobe PDF file and Africa Adobe PDF file are at risk for yellow fever. See the box below for specific information about the country where you are traveling.

What can travelers do to prevent yellow fever?

Travelers can protect themselves from yellow fever by getting yellow fever vaccine and preventing mosquito bites.

Get yellow fever vaccine if recommended or if required:

Visit a yellow fever vaccination (travel) clinic and ask for a yellow fever vaccine.

You should receive this vaccine at least 10 days before your trip.

After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you when you travel.

The vaccine lasts for 10 years.

In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.

Note: U.S. CDC’s recommendation is different from some country’s requirement. A vaccine recommendation is designed to keep you from getting yellow fever; a vaccine requirement is the country’s attempt to keep travelers from bringing the yellow fever virus into the country.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Clothing fabric should be at least medium weight because the tsetse fly can bite through thin fabric.

Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.

Avoid bushes during the day, when the tsetse fly is less active. It rests in bushes and will bite if disturbed.

Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles. Although there is limited evidence that insect repellent works against tsetse flies, you should use an appropriate insect repellent as directed. Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon), Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US]),

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals) IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second. Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last. If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin. Stay and sleep in screened or air conditioned rooms.