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Destination
Health Precautions for
North America
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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