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Canada,
St. Pierre and Miquelon [France],
United States [including Hawaii]
In 1994, an international
commission certified the eradication
of endemic wild poliovirus
from the Americas. Ongoing
surveillance in formerly endemic
Central and South American
countries (Tropical and Temperate)
confirms that poliovirus transmission
remains interrupted.
The incidence of communicable
diseases is such that they
are unlikely to prove a hazard
for international travelers
greater than that found in
their own country. There are,
of course, health risks, but
in general, the precautions
required are minimal.
Certain diseases occasionally
occur, such as plague, rabies
in wildlife, including bats,
Rocky Mountain spotted fever,
tularemia, arthropod-borne
encephalitis, and seasonal
outbreaks of influenza. Rodent-borne
hantavirus has been identified,
predominantly in the western
states of the United States.
Lyme disease is endemic in
the northeastern United States,
Mid-Atlantic, and the upper
Midwest and the southwestern
provinces of Canada. Occasional
cases have been reported from
the Pacific Northwest. Recently,
cases of West Nile virus have
occurred around the New York
City area. During recent years,
the incidence of certain foodborne
diseases, e.g., E. coli O157:H7
and salmonellosis, has increased
in some regions. Other hazards
include poisonous snakes (see
Animal-Associated Hazards
on the Making Travel Safe
page), poison ivy, and poison
oak. In the north, a serious
hazard is the very low temperature
in the winter.
In the United States, proof
of immunization against diphtheria,
measles, poliomyelitis, and
rubella is now universally
required for entry into school.
In addition, the school entry
requirements of most states
include immunization against
tetanus (49 states), pertussis
(44 states), mumps (46 states),
and hepatitis B (26 states).
Haemophilus influenzae type
b (Hib) vaccine is not required
for school entry but is required
in 49 states for attendance
in day care facilities.
All travelers should take
the following precautions,
no matter the destination:
- Wash
hands often with soap and
water.
- Because
motor vehicle crashes are
a leading cause of injury
among travelers, walk and
drive defensively. Avoid
travel at night if possible
and always use seat belts.
- Always
use latex condoms to reduce
the risk of HIV and other
sexually transmitted diseases.
- Don’t
eat or drink dairy products
unless you know they have
been pasteurized.
- Don’t
share needles with anyone.
- Eat
only thoroughly cooked food
or fruits and vegetables
you have peeled yourself.
Remember: boil it, cook
it, peel it, or forget it.
Never eat undercooked ground
beef and poultry, raw eggs,
and unpasteurized dairy
products. Raw shellfish
is particularly dangerous
to persons who have liver
disease or compromised immune
systems.
Travelers visiting undeveloped
areas should take the following
precautions:
To stay healthy, do...
- Drink
only bottled or boiled water,
or carbonated (bubbly) drinks
in cans or bottles. Avoid
tap water, fountain drinks,
and ice cubes. If this is
not possible, make water
safer by BOTH filtering
through an “absolute 1-micron
or less” filter AND adding
iodine tablets to the filtered
water. “Absolute 1-micron
filters” are found in camping/outdoor
supply stores.
- If
you visit an area where
there is risk for malaria,
take your malaria prevention
medication before, during,
and after travel, as directed.
(See your doctor for a prescription.)
- Protect
yourself from insects by
remaining in well-screened
areas, using repellents
(applied sparingly at 4-hour
intervals), and wearing
long-sleeved shirts and
long pants from dusk through
dawn.
- To
prevent fungal and parasitic
infections, keep feet clean
and dry, and do not go barefoot.
To avoid getting sick...
- Don’t
eat food purchased from
street vendors.
- Don’t
drink beverages with ice.
- Don’t
share needles with anyone.
- Don’t
handle animals (especially
monkeys, dogs, and cats),
to avoid bites and serious
diseases (including rabies
and plague).
What you need to bring
with you:
- Long-sleeved
shirt and long pants to
wear while outside whenever
possible, to prevent illnesses
carried by insects.
- Insect
repellent containing DEET
(diethylmethyltoluamide),
in 30%–35% strength for
adults and 6%–10% for children,
as well as a bed net impregnated
with the insecticide permethrin.
(Bed nets can be purchased
in camping or military supply
stores.)
- Over-the-counter
antidiarrheal medicine to
take if you have diarrhea.
- Iodine
tablets and portable water
filters to purify water
if bottled water is not
available.
- Sunblock,
sunglasses, hat.
- Prescription
medications: make sure you
have enough to last during
your trip, as well as a
copy of the prescription(s).
After you return home:
If you have visited a malaria-risk
area, continue taking your
antimalarial drug for 4 weeks
(Lariam®, doxycycline)
or seven days (Malarone™)
after leaving the risk area.
Travelers who become ill with
a fever or flu-like illness
while traveling in a malaria-risk
area and up to one year after
returning home should seek
prompt medical attention and
should tell the physician
their travel history.
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