80 July 2016 Pulse TRAVEL MEDICINE GUIDE Tick-borne encephalitis Recommended regimen Alternative regimen Risk areas and seasons Main parasitic hazards Japanese enceph Mening/ACWY Yellow fever Rabies Hepatitis B Tuberculosis Diptheria Polio Cholera Hepatitis A Typhoid Malaria Destination Tick-borne encephalitis Recommended regimen Alternative regimen Risk areas and seasons Main parasitic hazards Japanese enceph Mening/ACWY Yellow fever Rabies Hepatitis B Tuberculosis Diptheria Polio Cholera Hepatitis A Typhoid Malaria Destination Abu Dhabi S R S S S No Le Afghanistan R R S R R S S S C Yes, below 2000m, May-Nov ME or Do or MON PC Le Albania R S S C S No Le Algeria S R S S S C Yes, low risk vivax in South W Sh Le Angola R R S R S S S M Yes, high risk ME or DO or MON PC Sh Ta Antigua & Barbuda S C No Argentina S R S S S Minimal risk in north & Iguaçu W Armenia S R S S S S No W Australia C S No Austria S No Azerbaijan S R S S S Low risk SW border Jun-Oct W Le Bahamas R S C No Bahrain S R S S C No Le Bali R R R S S S C S Minimal risk W Bangladesh R R S R S S S C S Yes, SE and Chittagong Hill Tracts. ME or DO or MON PC Le Elsewhere, low risk W Barbados S S C No Belarus R S S S S S No Belize S R S S S C Low risk W Benin Republic R R S S S S S M S Yes, high risk ME or DO or MON PC Sh Le Bermuda S No Bhutan R R S S S S C S Yes, southern districts ME or DO or MON DRF Le Bolivia R R R S S S R Yes, high risk in Amazon basin. ME or DO or MON PC Variable risk on Paraguayan and Argentine borders PC DRF Borneo R R S S S S S C S Minimal risk coastal areas. Low W risk inland Sabah, Sarawak and ME or DO or MON PC all of Indonesian Kalimantan for high risk groups Bosnia R S S S S S No Le Botswana R R S S S C High risk Northern half ME or DO or MON PC Sh Ta Brazil S R S S S S S High risk in NW half in Amazonia ME or DO or MON PC Sh Le Tc states. Elsewhere, very low W Brunei R S S S C S Minimal risk W Bulgaria R S S S No Burkina Faso R R S S S S M S Yes, high risk ME or DO or MON PC Sh Le Ta Burundi R R S S S S M S Yes, high risk ME or DO or MON PC Sh Ta Cambodia R R S R S S S C S Yes North-East area DO or MON PC Low risk elsewhere with ME or DO or MON PC chemoprophylaxis only for high risk groups (see Travax map) Minimal risk Phnom Pehn, W Angkor Wat, Siem Reap and close to Tonle Sap Lake Cameroon R R S R R S S S M S Yes, high risk ME or DO or MON PC Sh Ta Canada S No Cape Verde Islands R R S S S C Yes, very low risk Aug-Nov W Le Cayman Islands S No Central African Rep. R R S R S S S M S Yes, high risk ME or DO or MON PC Sh Ta Chad R R S R S S S R S Yes, high risk ME or DO or MON PC Sh Ta Chile R S S No Tc China (Mainland) S R S S S S C S S Yes, in Yunnan W Sh Elsewhere very low/no risk China (Hong Kong) R S S S No China (Macao) R S S S No Colombia S R S R Yes, high Eastern half and ME or DO or MON PC Le Ta coastal areas. Very low around Medellin, W Bogota & Cartagena Comoros R R S S S S Yes, high risk ME or DO or MON PC Le Congo R R S R S S S M Yes, high risk ME or DO or MON PC Sh Ta Congo-Dem. Rep. R R S R S S S M S Yes, high risk ME or DO or MON PC Sh Ta Cook Islands R S No Costa Rica R S S C Low risk W Le Tc Croatia S S No Le Cuba R S S S No Cyprus S No Le Czech Republic S S No Djibouti R R S S S S S C Yes, high risk ME or DO or MON PC Sh Le Dominican Republic R R S R S S S Yes, high risk along Haitian C P Sh Le border, variable risk elsewhere Dubai S R S S S No Le East Timor (Timor Leste) R R R S S S C S Yes, high risk ME or DO or MON PC Le Ecuador R R S S S R Yes - high risk coastal provinces and ME or DO or MON PC Tc on Peru and Colombia borders. Elsewhere low risk W Egypt R R S S C No El Salvador R R S S S C Yes, low risk W Equatorial Guinea R R S R R S S S R Yes, high risk ME or DO or MON PC Sh Ta Eritrea R R S R S S S S S Yes, High risk below 2200 metres, ME or DO or MON PC Sh Le no risk in Asmara Estonia S S No Ethiopia R R S R R S S S R S Yes, high risk below 2,000m ME or DO or MON PC Sh (No risk in Addis Ababa) Falklands (Tristan da C.) No Fiji R R S S S C No Finland S No France S No Le French Guiana S R S S S M High risk west & south. ME or DO or MON PC Sh Tc Coast and central inland low risk W French Polynesia R S No Gabon R R S R S S S M Yes, high risk ME or DO or MON PC Sh Gambia R R S S S S R S Yes, high risk ME or DO or MON PC Sh Ta Georgia R S S S Yes, v. low risk SE villages July-Oct W Germany S No Ghana R R S R S S S M S Yes, high risk ME or DO or MON PC Sh Ta Goa R R S S S S S C S Low risk W Le Greece and Islands S S Low risk Evrotas Delta W Le Greenland S S S No Grenada S S C No Guadeloupe S C No Guam R S S No Guatemala S R S S S C Yes, low risk below 1500 metres W Guinea R R S R S S S S R S Yes, high risk ME or DO or MON PC Sh Ta Guinea Bissau R R S S S S S M S Yes, high risk ME or DO or MON PC Sh Ta Guyana S R S S S R Yes, high risk all areas except ME or DO or MON PC Sh coastal strip Haiti R R S R S S S C Yes, high risk throughout country ME or DO or MON PC Hawaii No Honduras R R S S S C Yes, risk variable in central and W/C P Le eastern regions Hungary S S No India R R S S S S S C S High risk in east and Assam ME or DO or MON PC Le Complex central zone W, see Travax & advice Low risk north and south zones W Indonesia R R S R S S S C S Very low Bali and cities W Risk assess in other areas Usually W (see Travax) High risk on islands to ME or Do or MON PC West of Sulawesi Iran S R S S S S C Yes, rural SE provinces Mar-Nov ME or Do or MON PC Sh Le Iraq R R S R R S S S C Yes, v. low risk rural north May-Nov W P Sh Le Israel R R S S No Le Italy S No Le Ivory Coast R R S R S S S M S Yes, high risk ME or DO or MON PC Ta Jamaica S R S S C No Japan S S S No Sh Jordan S S S C No Le Kazakhstan S R S S S C S No Le Kenya R R S R R S S S R S Yes, high risk ME or DO or MON PC Sh Le Ta (Nairobi and highlands low risk) Kiribati S R S S S S C No Korea (North) R R S S S S C S Yes, limited risk extreme south W Korea (South) S R S S S S Yes, limited risk extreme north W Kosovo R S S S S No Le Kuwait S R S No Kyrgyzstan S R S S S C S Yes, low risk some S & W areas W Le Laos R R S R R S S S C S Yes, high risk (minimal risk ME or DO or MON PC Vientiane) Latvia S S S S S No Key M = immunisation mandatory R = immunisation recommended as risk of infection is substantial S = immunisation sometimes recommended: – for more than three visits in a one-year period – a stay of more than three months in a rural area – for high-risk occupational groups – for backpackers staying more than one month – when entering the limited geographical risk area for the target disease C = See Yellow fever, next column Where S appears for cholera, it indicates that only high-risk travellers, usually healthcare workers in areas of known epidemics, should be immunised. Vaccinations information Tetanus Five tetanus doses are considered protective for life by the DH, although there is no evidence base for this.Travellers at risk of tetanus-prone wounds should be given 10-yearly boosters if they is an information service provided by Health Protection Scotland (www.travax.nhs.uk; telephone 0141 300 1130). NaTHNaC should also be consulted. NaTHNaC and Travax are independently administered and may occasionally differ in the advice offered. The chart is updated regularly. Readers are advised to use the latest chart only, to ensure that their practice reflects the most recent advice. Travel vaccinations and malaria information author Dr Michael Jones, Consultant in Infectious Diseases, Edinburgh. Parasitic infections Short-term travellers staying in good conditions are usually at low risk of acquiring parasitic infections. Schistosomiasis is common and potentially serious. Leishmaniasis and trypanosomiasis are less common but potentially lethal. Expatriates in remote areas at risk of other rare diseases are not shown in this chart. Sh = schistosomiasis.Travellers should avoid swimming in freshwater lakes and rivers in endemic areas. are going to poorer countries in Africa,Asia and South America where specific immunoglobulin may be unavailable. Polio All travellers should have completed the British vaccination schedule for polio immunisation in childhood or as adults. Yellow fever ⦁ An international certificate of vaccination may be required for those entering from, or transiting through airports in YF endemic countries where C, S, R or M appears indicated in the yellow fever column. For details consult CDC Yellow Book at tinyurl.com/lnxngfwt ⦁ M = Mandatory generally indicates that all travellers aged >12 months should carry an international certificate of vaccination. Country specific ages are indicated on the CDC web site above. ⦁ Although WHO has indicated that one yellow fever vaccination protects for life numerous countries have not incorporated this into their recommendations. A complete list of country certificate requirements is available at http:// www.who.int/ith/2016-ith-annex1.pdf Information source and updates This chart is based on information from the UK TRAVAX website and other databases.TRAVAX Ta = African trypanosomiasis (sleeping sickness). Transmitted by tse-tse flies, and a risk in some African game parks and rural areas.Travellers should use insect repellents, close windows if fly swarms approach and seek medical attention for any signs of infection around bites one to three weeks later. Tc = South American trypanosomiasis (Chagas’ disease).Transmitted by reduvid bugs that feed at night and reside in the thatch and crevices of rural dwellings.Travellers should avoid sleeping in huts. Le = Leishmaniasis.Transmitted by sandflies in arid areas (including Mediterranean coastal areas), mostly at night.Travellers should use insecticide-impregnated mosquito nets and insect repellent. Key to malaria prophylaxis regimens Regimen MON Malarone (atovaquone/proguanil), one tablet daily. Begin 1-2 days before departure, continue while in malarious area and for 7 days after return. Advisory Committe on Malaria Prophylaxis suggest Malarone is safe in continuous use of at least 1 year and possibly