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Zika virus infection: Global Update

Travel Health Notice

The Public Health Agency of Canada recommends that pregnant women and those planning a pregnancy avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.

The World Health Organization Zika situation report lists countries where there is reported mosquito-borne Zika virus transmission (countries listed under category 1 and 2 of Table 1[pdf, 396 kb).

The United States have reported cases of Zika virus infection transmitted locally by mosquitoes in the states of Florida and Texas.

  • Pregnant women and those planning a pregnancy should avoid travel to the affected areas of Florida (see CDC map), and Texas (see CDC map)
  • There is potential transmission of Zika virus in and around areas with reported locally transmitted cases, even if cases are not yet reported.
  • Pregnant women and those planning a pregnancy should consider postponing travel to other areas in Florida.

All travellers should protect themselves from mosquito bites.  For additional recommendations please see the section below.

Zika virus infection is caused by a virus which is primarily spread by the bite of an infected mosquito. It can also be transmitted from an infected pregnant woman to her developing fetus. In addition, Zika virus can be sexually transmitted, and the virus can persist for an extended period of time in the semen of infected males.  Cases of sexual transmission from an infected male to his partner have been reported. Only one case of sexual transmission has been reported from an infected female to her partner.

Symptoms of Zika virus can include fever, headache, conjunctivitis (pink eye) and skin rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days and the majority of those infected do not have symptoms. There is no vaccine or medication that protects against Zika virus infection.

Experts agree that Zika virus infection causes microcephaly (abnormally small head) in a developing fetus during pregnancy and Guillain-Barré Syndrome (a neurological disorder).  Several countries have reported cases of microcephaly and Guillian-Barré Syndrome.  Brazil, in particular, has reported a significant increase in the number of newborns with microcephaly.

Zika virus is occurring in many regions of the world although local transmission of Zika virus was first reported in the Americas in 2015.  There have been travel-related cases of Zika virus reported in Canada in returned travellers from countries with ongoing Zika virus outbreaks.

On November 18, 2016, the World Health Organization announced that the Zika virus, microcephaly and other neurological disorders still pose a significant public health challenge, however, no longer meet the criteria of a Public Health Emergency of International Concern.   For Canadian women of childbearing age and their sexual partners, the risks associated with travel to countries reporting local mosquito-borne transmission, remain the same.

This travel health notice will be updated as more information becomes available.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

  • Pregnant women and those planning a pregnancy should avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.
    • If travel cannot be avoided or postponed strict mosquito bite prevention measures should be followed due to the association between Zika virus infection and increased risk of serious health effects on their developing fetus.
  • Travellers returning from countries and areas in the United States with reported mosquito-borne Zika virus:
    • For pregnant women, if you develop symptoms that could be consistent with Zika virus infection, you should consult a health care provider. 
    • For women planning a pregnancy, it is strongly recommended that you wait at least 2 months before trying to conceive to ensure that any possible Zika virus infection has cleared your body.
    • For male travellers, Zika virus can persist for an extended period of time in the semen of infected males, therefore:
      • It is strongly recommended that, if you have a pregnant partner, you should use condoms or avoid having sex for the duration of the pregnancy.
      • It is strongly recommended that you and your partner wait to conceive for 6 months by using a condom or by avoiding having sex.
      • It is recommended that you should consider using condoms or avoid having sex with any partner for 6 months.
  • Most people who have Zika virus illness will have mild symptoms that resolve with simple supportive care. If you are pregnant, or you have underlying medical conditions, or you develop more serious symptoms that could be consistent with Zika virus infection, you should see a health care provider and tell them where you have been travelling or living.
Read More
Zika virus infection

Zika virus infection: Global Update

Travel Health Notice

The Public Health Agency of Canada recommends that pregnant women and those planning a pregnancy avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.

The World Health Organization Zika situation report lists countries where there is reported mosquito-borne Zika virus transmission (countries listed under category 1 and 2 of Table 1, [ pdf, 396KB]).

The state of Florida in the United States has reported cases of Zika virus infection transmitted locally by mosquitoes in areas of Florida.

  • Pregnant women and those planning a pregnancy should avoid travel to the affected areas of Florida (see CDC map).
  • There is potential transmission of Zika virus in and around areas with reported locally transmitted cases, even if cases are not yet reported.
  • Pregnant women and those planning a pregnancy should consider postponing travel to other areas in Florida.

All travellers should protect themselves from mosquito bites.  For additional recommendations please see the section below.

Zika virus infection is caused by a virus which is primarily spread by the bite of an infected mosquito. It can also be transmitted from an infected pregnant woman to her developing fetus. In addition, Zika virus can be sexually transmitted, and the virus can persist for an extended period of time in the semen of infected males.  Cases of sexual transmission from an infected male to his partner have been reported. Only one case of sexual transmission has been reported from an infected female to her partner.

Symptoms of Zika virus can include fever, headache, conjunctivitis (pink eye) and skin rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days and the majority of those infected do not have symptoms. There is no vaccine or medication that protects against Zika virus infection.

Experts agree that Zika virus infection causes microcephaly (abnormally small head) in a developing fetus during pregnancy and Guillain-Barré Syndrome (a neurological disorder).  Several countries have reported cases of microcephaly and Guillian-Barré Syndrome.  Brazil, in particular, has reported a significant increase in the number of newborns with microcephaly.

Zika virus is occurring in many regions of the world (pdf, 396KB) although local transmission of Zika virus was first reported in the Americas in 2015.  There have been travel-related cases of Zika virus reported in Canada in returned travellers from countries with ongoing Zika virus outbreaks.

On June 14, 2016 the World Health Organization declared that the clusters of microcephaly cases and other neurological disorders, continues to constitute aPublic Health Emergency of International Concern. 

This travel health notice will be updated as more information becomes available.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

  • Pregnant women and those planning a pregnancy should avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.
    • If travel cannot be avoided or postponed strict mosquito bite prevention measures should be followed due to the association between Zika virus infection and increased risk of serious health effects on their developing fetus.
  • Travellers returning from countries and areas in the United States with reported mosquito-borne Zika virus:
    • For pregnant women, if you develop symptoms that could be consistent with Zika virus infection, you should consult a health care provider. 
    • For women planning a pregnancy, it is strongly recommended that you wait at least 2 months before trying to conceive to ensure that any possible Zika virus infection has cleared your body.
    • For male travellers, Zika virus can persist for an extended period of time in the semen of infected males, therefore:
      • It is strongly recommended that, if you have a pregnant partner, you should use condoms or avoid having sex for the duration of the pregnancy.
      • It is strongly recommended that you and your partner wait to conceive for 6 months by using a condom or by avoiding having sex.
      • It is recommended that you should consider using condoms or avoid having sex with any partner for 6 months.
  • Most people who have Zika virus illness will have mild symptoms that resolve with simple supportive care. If you are pregnant, or you have underlying medical conditions, or you develop more serious symptoms that could be consistent with Zika virus infection, you should see a health care provider and tell them where you have been travelling or living.
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WHO temporary polio vaccine recommendations

Recommendations for travellers

Consult a health care provider or visit a travel health clinic, preferably six weeks before you travel outside of Canada.
Follow the WHO temporary recommendations:

  1. The WHO temporary recommendations apply to long term travellers (more than 4 weeks) to Afghanistan and Pakistan. These countries have been designated as “states currently exporting wild poliovirus or cVDPV” by the WHO IHR Emergency Committee. The WHO recommendations state that these countries should ensure that long term travellers to these countries:
    • Be fully vaccinated against polio.
    • Receive an additional dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel.
    • Be aware that a polio booster may be required to exit a designated country or enter into another, even if you already received an adult booster dose over a year ago.
    • Carry the appropriate documentation. It is recommended that you carry a written vaccination record in the event that evidence of vaccination is requested for country entry or exit requirements. Your proof of vaccination should be documented in the International Certificate of Vaccination or Prophylaxis which you can get from a Yellow Fever Vaccination Centre.
  2. The WHO temporary recommendations also apply to long term travellers (more than 4 weeks) to countries “infected with wild poliovirus or cVDPV but not currently exporting” (Burma (Myanmar), Guinea, Laos, Madagascar and Nigeria).  The WHO recommendations state that these countries should encourage that long term travellers to these countries:
    • Be fully vaccinated against polio.
    • Receive an additional dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to international travel.
    • Should carry appropriate documentation of their vaccination status, such as a card or booklet.
  3. Consult the Travel Health Notice on Polio: Global Update for further recommendations for travellers.

For additional information, WHO has developed frequently asked questions for travellers about the temporary recommendations.

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Zika virus infection

Zika virus infection: Global Update

Travel Health Notice

The Public Health Agency of Canada recommends that pregnant women and those planning a pregnancy avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.

The World Health Organization Zika situation report lists countries where there is reported mosquito-borne Zika virus transmission (countries listed under category 1 and 2 of Table 1).

The state of Florida in the United States has reported cases of Zika virus infection transmitted locally by mosquitoes in areas of Florida.

  • Pregnant women and those planning a pregnancy should avoid travel to the affected areas of Florida (see CDC map).
  • There is potential transmission of Zika virus in and around areas with reported locally transmitted cases, even if cases are not yet reported.
  • Pregnant women and those planning a pregnancy should consider postponing travel to other areas in Florida.All travellers should protect themselves from mosquito bites.  For additional recommendations please see the section below.

    Zika virus infection is caused by a virus which is primarily spread by the bite of an infected mosquito. It can also be transmitted from an infected pregnant woman to her developing fetus. In addition, Zika virus can be sexually transmitted, and the virus can persist for an extended period of time in the semen of infected males.  Cases of sexual transmission from an infected male to his partner have been reported. Only one case of sexual transmission has been reported from an infected female to her partner.

    Symptoms of Zika virus can include fever, headache, conjunctivitis (pink eye) and skin rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days and the majority of those infected do not have symptoms. There is no vaccine or medication that protects against Zika virus infection.

    Experts agree that Zika virus infection causes microcephaly (abnormally small head) in a developing fetus during pregnancy and Guillain-Barré Syndrome (a neurological disorder).  Several countries have reported cases of microcephaly and Guillian-Barré Syndrome.  Brazil, in particular, has reported a significant increase in the number of newborns with microcephaly.

    Zika virus is occurring in many regions of the world although local transmission of Zika virus was first reported in the Americas in 2015.  There have been travel-related cases of Zika virus reported in Canada in returned travellers from countries with ongoing Zika virus outbreaks.

    On June 14, 2016 the World Health Organization declared that the clusters of microcephaly cases and other neurological disorders, continues to constitute aPublic Health Emergency of International Concern.

    This travel health notice will be updated as more information becomes available.

    Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

  • Pregnant women and those planning a pregnancy should avoid travel to countries or areas in the United States with reported mosquito-borne Zika virus.
    • If travel cannot be avoided or postponed strict mosquito bite prevention measures should be followed due to the association between Zika virus infection and increased risk of serious health effects on their developing fetus.
  • Travellers returning from countries and areas in the United States with reported mosquito-borne Zika virus:
    • For pregnant women, if you develop symptoms that could be consistent with Zika virus infection, you should consult a health care provider. 
    • For women planning a pregnancy, it is strongly recommended that you wait at least 2 months before trying to conceive to ensure that any possible Zika virus infection has cleared your body.
    • For male travellers, Zika virus can persist for an extended period of time in the semen of infected males, therefore:
      • It is strongly recommended that, if you have a pregnant partner, you should use condoms or avoid having sex for the duration of the pregnancy.
      • It is strongly recommended that you and your partner wait to conceive for 6 months by using a condom or by avoiding having sex.
      • It is recommended that you should consider using condoms or avoid having sex with any partner for 6 months.
  • Travellers should protect themselves from mosquito bites at all times, as the Zika virus is transmitted by a mosquito that can bite in daylight and evening hours. These mosquitoes generally do not live or transmit disease at elevations above 2,000 meters. A list of how to prevent insect bites is available on the Government of Canada’s website.
  • Most people who have Zika virus illness will have mild symptoms that resolve with simple supportive care. If you are pregnant, or you have underlying medical conditions, or you develop more serious symptoms that could be consistent with Zika virus infection, you should see a health care provider and tell them where you have been travelling or living.
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WHO certifies Sri Lanka malaria-free

WHO certifies Sri Lanka malaria-free

Colombo, 5 September 2016: In a remarkable public health achievement, Sri Lanka was today certified by WHO on having eliminated malaria, a life-threatening disease which long affected the island country.

“Sri Lanka’s achievement is truly remarkable. In the mid-20th century it was among the most malaria-affected countries, but now it is malaria-free. This is testament to the courage and vision of its leaders, and signifies the great leaps that can be made when targeted action is taken. It also demonstrates the importance of grass-roots community engagement and a whole-of-society approach when it comes to making dramatic public health gains,” WHO Regional Director, Dr Poonam Khetrapal Singh, said here.

Sri Lanka’s road to elimination was tough, and demanded well-calibrated, responsive policies. After malaria cases soared in the 1970s and 80s, in the 1990s the country’s anti-malaria campaign adjusted its strategy to intensively target the parasite in addition to targeting the mosquito.

The change in strategy was unorthodox, but highly effective. Mobile malaria clinics in high transmission areas meant that prompt and effective treatment could reduce the parasite reservoir and the possibility of further transmission. Effective surveillance, community engagement and health education, meanwhile, enhanced the ability of authorities to respond, and mobilized popular support for the campaign.

The adaptation/ flexibility of strategies and support from key partners such as WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria fast-tracked success. By 2006, the country recorded less than 1 000 cases of malaria per year, and since October 2012, the indigenous cases were down to zero. For the past three-and-a-half years, no locally transmitted cases have been recorded.

To maintain elimination and ensure the parasite is not reintroduced to the country, the anti-malaria campaign is working closely with local authorities and international partners to maintain surveillance and response capacity and to screen high-risk populations entering the country.

Sri Lanka is the second country in the WHO South-East Asia Region to eliminate malaria after Maldives. The announcement of Sri Lanka’s victory over malaria was made at the WHO South-East Asia Region’s annual Regional Committee meeting in the presence of health ministers and senior health officials from all 11 Member States.

The Regional Director said WHO will continue to support the efforts of Sri Lanka’s health authorities as they relate to malaria, as well as the country’s wider public health mission. This outstanding achievement should be a springboard to further public health gains in the country and the South-East Asia Region as a whole.

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Interim Canadian recommendations for the use of a fractional dose of yellow fever vaccine during a vaccine shortage

Summary

This statement outlines interim recommendations intended for use during yellow fever vaccine shortages only. The recommendations differ from the standard recommendations for yellow fever vaccination in the Canadian Immunization Guide and in the Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement for Travellers and Yellow Fever.

Introduction

Yellow fever vaccine shortages pose a challenge. Travel clinics may be allotted a small fraction of the number of vaccines typically ordered, or in some cases, travel clinics will not have access to the yellow fever vaccine until a new supply of the vaccine is available. There is currently only one licensed marketer of the vaccine in Canada. In 2016, there have been calls for the use of a fractional dose of yellow fever vaccine to address a global yellow fever vaccine shortage, a measure which would allow for immunization of a greater number of people during the vaccine shortage (1-3). This suggestion is primarily based on three studies which have shown that doses in the range of 1/10 to 1/5 of the usual 0.5 ml subcutaneous dose are protective based on laboratory criteria. On 17 June 2016, the World Health Organization (WHO) released a statement that the WHO Strategic Advisory Group of Experts (SAGE) on Immunization found that the use of a fifth of a standard vaccine dose (0.1 ml instead of 0.5 ml) would provide protection against yellow fever for at least 12 months based on a review of existing evidence (4). The WHO states that the fractional dose of yellow fever vaccine can be considered a safe and effective approach to control an urban outbreak in case of vaccine shortages. CATMAT formed a working group to review the evidence and make interim recommendations on the use and documentation of fractional doses of yellow fever vaccine in Canada intended for use during yellow fever vaccine shortages only. Each member was a volunteer, and none declared a relevant conflict of interest. The recommendations differ from the standard recommendations for yellow fever vaccination in the Canadian Immunization Guide (5) and in the Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement for Travellers and Yellow Fever (6).

Methods

A literature search for evidence related to the immunogenicity of a fractional dose of yellow fever vaccine was conducted. Evidence was retrieved by performing searches in electronic databases (Ovid MEDLINE, Embase, Global Health and Scopus). The search spanned the initial date for each database until June 2016 and 49 results were identified. Titles and abstracts of these results were reviewed and selected for inclusion based on relevancy to the research question.

Results

In 2008, Roukens et al studied the effect of a one-fifth dose of yellow fever vaccine administered intradermally. All subjects developed titres of neutralizing antibody considered to be protective (7). The average subject age was 27 years with a wide adult age range (18 to 70 years). In 2013, Martins et al studied seroconversion and viremia responses to the use of full dose and five different dilutions of the usual human dose of 17-DD yellow fever vaccine administered subcutaneously (8). There was little difference in immune response down to a dilution of 1:50. In a 2014 extension of the Martins study (using the same patient data and collected blood), Campi-Azevedo studied serum biomarkers of cellular immunity responses using fractional doses (9). There was evidence of protection at dilutions down to 1:50. However, consistent findings of equivalency to a full dose across all markers of immunity (serology, viremia and cellular immunity) were found down to a 1:10 dilution. In the Martins and Campi-Azevedo investigations, all subjects were healthy young males with an average age of 19 years. Although the results of these studies are encouraging, this constitutes a limited evidence base. Further research is needed to determine the effectiveness of fractional doses, especially in young children.

Recommendations

Under normal circumstances, a recommendation for use of fractional dose of yellow fever vaccine would not be made for travellers. However, some travellers going to yellow fever endemic or epidemic regions may not have access to a full dose of yellow fever vaccine, and as such, these travellers face the choice of not receiving a vaccine or receiving a fractional dose of vaccine. In view of this situation, CATMAT makes the following recommendations, applicable to individuals for whom the standard yellow fever vaccine recommendations apply, including young children:

• For travel to a region of a country with risk of yellow fever, health care professionals should first emphasize the importance of receiving a full dose of vaccine or otherwise postponing the trip. This is especially critical for travel to areas experiencing an ongoing outbreak of the disease.

• If a traveller must travel to an endemic area, especially to areas experiencing an ongoing outbreak of yellow fever, and a full dose cannot be located after reasonable efforts, a fractional dose may be administered. The dose should be 1/5 of the usual dose (0.1 ml instead of 0.5 ml) administered by the traditional subcutaneous route. As with a full dose, a fractional dose is considered protective 10 days after it is administered to a person who has never before received the yellow fever vaccine.

• If a traveller planning a high risk itinerary receives a fractional dose of yellow fever vaccine, and then later finds that a full dose has become available, this dose may be administered and the International Certificate of Vaccination or Prophylaxis (ICVP) may be issued.

• Once reconstituted, the vaccine vial should be stored between 2° and 8° Celsius, and used within one hour. Thus, it will be necessary to vaccinate several people within that hour in order to efficiently use the contents of the vial in the allotted time. The health care professional may find that the use of disposable 1 cc insulin syringes with non-detachable needle wastes less vaccine. Four, possibly five, doses may be obtained from one vial. Strict aseptic technique should be observed.

• If fewer than five doses are being administered, it is recommended that the entire contents of the vial be used, equally distributed among those being immunized. This will allow for the administration of somewhat more than 0.1 ml per person.

• Based on available data, a fractional dose (1/5) should be considered protective for one year. Protection may be longer, however long term data is lacking. No recommendation is made at this time regarding repeat fractional dose immunization for subsequent travel.

• Once the supply of yellow fever vaccine is restored in Canada, the use of fractional doses should be discontinued.

• Practitioners are reminded that the WHO now considers a single full dose of yellow fever vaccine protective for life regardless of when it is administered.

Documentation of fractional dose yellow fever vaccination

The WHO states that a fractional dose of the yellow fever vaccine would not qualify for a yellow fever certificate under the International Health Regulations (IHR) (4). Therefore CATMAT does not recommend that practitioners use the official International Certificate of Vaccination or Prophylaxis (ICVP) card to document a fractional dose. One option for documentation is the use of the Certificate of Medical Contraindication to Vaccination provided by the Public Health Agency of Canada. An explanation can be written inside informing that a fractional dose of 0.1 ml of the yellow fever vaccine was administered subcutaneously due to a severe vaccine shortage.

Additional resources and useful links Government of Canada

– Yellow Fever Vaccinations Centres in Canada. http://www.phac-aspc.gc.ca/tmp-pmv/yf-fj/index-eng. php World Health Organization

– Vaccination requirements and recommendations for international travellers. http://www.who. int/ith/en/

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Middle East Respiratory Syndrome Coronavirus (MERS-Cov)

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Updated: July 12, 2016

Travel Health Notice

Middle East Respiratory Syndrome (MERS-CoV) is an infectious disease caused by a virus from the coronaviruses family. Coronaviruses are one of the causes of the common cold but can also be the cause of more severe illnesses including Severe Acute Respiratory Syndrome (SARS). People who have been infected with MERS-CoV have experienced clinical symptoms of fever, cough and shortness of breath. Many have also reported gastrointestinal symptoms such as diarrhea. There is no vaccine or medication that protects against MERS-CoV.

The current understanding of MERS-CoV is that the virus has spread to humans from direct or indirect contact with infected camels or humans.

Some of the infections have occurred in groups of individuals in close contact with one another (for example: within the same household or work environment) and an increasing number of outbreaks have occurred within health care settings among patients and health care workers, indicating the importance of followingstrict infection control practicesExternal link.  Based on the current available evidence, the public health risk posed by MERS-CoV to Canadians remains low.

Where is MERS-CoV a concern?

Since September 2012, the following countries in the Middle East have reported cases of MERS-CoV: Bahrain, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates and Yemen.

Several other countries have also reported cases in individuals who have travelled to the Middle East: Algeria, Austria, China, Egypt, France, Germany, Greece, Hong Kong, Italy, Malaysia, the Netherlands, the Philippines, South Korea, Thailand, Tunisia, Turkey, the United Kingdom and the United States. Limited local transmission among close contacts of these travellers has also been reported.

In June 2016, the World Health Organization (WHO) reported an outbreak of MERS-CoV occurring in a hospital in the Riyadh region of Saudi Arabia.

For the latest updates on MERS-CoV, including the total number of cases and deaths, please visit the World Health Organization’s websiteExternal link. There continue to be no travel restrictions as the risk to travellers remains low.

The Public Health Agency of Canada recommends that those travelling practise usual precautions as outlined in the recommendations section below.

Recommendations

  1. Be aware that the risk may be higher for travellers with chronic medical conditions (for example: diabetes, heart disease, kidney disease, respiratory disease).
    • If you have chronic medical conditions, your risk may be higher.
  2. Practise safe food and water precautions.
    • Avoid food that may be contaminated with animal secretions.
    • Avoid raw or undercooked (rare) camel meat. Only eat foods that are well cooked and served hot.
    • Avoid unpasteurized dairy products such as raw camel milk.
    • Avoid drinking camel urine (a practice associated with medicinal purposes in certain regions).
  3. Avoid close contact with all wild or farmed animals, such as bats and camels.
    • If you must visit a farm or market, make sure you practise good hygiene and wash your hands before and after contact with animals.
  4. Protect yourself and others from the spread of germs and flu-like illness.
    • Avoid close contact with people who are sick and coughing
      • There may be increased risk for travellers who require medical care in facilities where hospital-associated cases of MERS-CoV are occurring.
      • Travellers should monitor the recommendations from local authorities related to health care facilities in countries currently experiencing cases of MERS-CoV.
    • If you are sick with flu-like symptoms, delay travel or stay home:
      • Travellers should recognize signs and symptomsExternal link of flu-like illness, and delay travel or stay home if not feeling well.
      • If you are a close contact of a MERS-CoV patient, you should not travel during the time you are being monitored for the development of symptoms.
      • Travellers should note that they may be subject to quarantine measures in some countries if showing flu-like symptoms.
    • Wash your hands frequently:External link
      • Avoid touching your eyes, nose and mouth with your hands as germs can be spread this way. For example, if you touch a doorknob that has germs on it then touch your mouth, you can get sick.
      • Wash your hands with soap under warm running water for at least 20 seconds, as often as possible.
      • Use alcohol-based hand sanitizer if soap and water are not available. It’s a good idea to always keep some with you when you travel.
    • Practise proper cough and sneeze etiquette:
      • Cover your mouth and nose with your arm to reduce the spread of germs. If you use a tissue, dispose of it as soon as possible and wash your hands afterwards.
  5. Stay up-to-date with your vaccinations
  6. Monitor your health
    • If you develop flu-like symptoms such as fever, cough and/or shortness of breath within 14 days after your return to Canada from countries in the Middle EastExternal link, especially if you have a chronic medical condition, seek medical attention.
    • It is recommended that you call ahead to your health care provider or urgent care facility to inform them of your symptoms and which countries you have visited while travelling. Also, inform them if you have been in a healthcare facility while abroad. This way, the health care provider can arrange to see you without exposing others.
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Countries with Yellow Fever Virus Transmission – Date Of Last Outbreak

Africa Yr of last outbreak # of Cases
Angola 1988/2016 37 / 861
Benin 2004 31
Burkina Faso 2011 1024
Burundi 1995 260
Cameroon 11/12/13/14 29 & 31 &15& 3
Central African Republic 2011/2013 7 & 4
Chad 11/12/13/2016 122 /48 / 5 /?
Congo 2011/2012/2013 188 & 1 & 1
Cote d”Ivoire 11/12/13/14 10 & 4 & 6 & 21
Democratic Republic of Congo 11/12/13/14/2016 195 / 1/& 9 / 3 / 9
Equatorial Guinea 2008 10
Ethiopia 2013 223
Gabon 2006 57
Gambia 2012 1
Ghana 11/12/13/2016 30 & 3 & 7 & 4
Guinea 2010/2013/2014 2 & 2 & 2
Guinea Bissau 1999 4
Kenya 1995 11
Liberia 2012/2014 17 & 1
Mali 2010/2014 3 & 1
Mauritania 2003 10
Niger 2011 20
Nigeria 2011 387
Rwanda 0
Senegal 2011/2012/2013 7 & 1 & 2
Sierre Leone 2011/2012/2013 361 & 94 & 3
South Sudan 2011 128
Sudan 2012/2013 849/148
Togo 2012 12
Uganda 2011/2012/2016 66 & 32 & 7
 
South America Yr of last outbreak # of Cases
Argentina 2008 8
Bolivia 12/11/2013 2 & 3 & 1
Brazil 10/13/14/15/2016 2 /3/ 1/ 5/?
Colombia 2009/2013/2016 5 / 1 / ?
Ecuador 2012 1
French Guiana 0
Guyana 0
Panama 0
Paraguay 2008 28
Peru 11/12/13/14/15/16 13 /9/ 21/ 15 /17/ 14
Suriname 0
Trinidad & Tobago 0
Venezuela 2005 12
Other Countries (*Imported Cases)
Canada 2012/2014 3 & 5
China 2016 11
DR of C 2016 59
Georgia 2004 1
Haiti 2011 6
Kenya 2016 2
Namibia 2008 3
Spain 2009 1
 Source:
http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidenceyfever.html
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Yellow Fever Requirements in Brazil

“Temporary Requirement” by the Brazilian Ministry of Health (from the 1st half of July 2016) for travellers coming from or intended to arrive from the Democratic Republic of Congo and Angola. The measure is a
recommendation of the World Health Organization (WHO) Emergency Committee, because of urban yellow fever outbreaks ongoing in both countries since December last year [2015].

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traveling china vaccination

Traveling to China, What You Need to Know

According to the World Tourism Organization, tourism is increasing in China and the country is set to become the world’s largest tourist destination by the year 2020. The Chinese government is opening more attractions and regions in the country to foreign tourists. Even though tourism in the country is opening up it can still be challenge to travel in the country due to language barriers and travel restrictions. Today most travelers opt for guided tours.

What Vaccinations will I Need to Travel to China?

The Public Health Agency of Canada recommends travelers get vaccinated for the following diseases before traveling to China:

Hepatitis A – this disease is spread through contaminated food, water, or contact with an infected person. This vaccine is especially recommended if you plan to sample some of the many street food offerings during your travels.

Hepatitis B – is a serious liver disease that can be spread through the exchange of bodily fluids, sexual intercourse, and the use of an infected piercing tool or needle.

Rabies – Travelers to China should be vaccinated against rabies as the country has one of the highest numbers of reported cases of rabies in the world. Rabies is spread through the saliva of an infected animal.

Japanese Encephalitis – This disease is prevalent in most Asian countries. Vaccination is recommended for travelers who plan to spend time in the southern parts of China where irrigation is still done through flooding or travelers who plan to spend a lot of time outdoors.

Polio – China has not had a reported case of polio since 1994 but the country borders on Pakistan and Afghanistan where the polio virus is still epidemic.

Are there Other Infections I should Know About?

Travelers should be aware mosquitoes carrying the Malaria virus have been found in the Yunnan Province near the China and Myanmar border. The risk is low to most travelers.

Avian Influenza has been reported in humans since 2013 in China. Most cases of the avian influenza have occurred in the southern and eastern parts of China including Taiwan and Hong Kong. Two travelers from Canada were reported to have contracted the virus after a trip to China in 2015.

How Safe is China

Travel is relatively safe in China. The risk of violent crime is very low in China as is the chance of being robbed or raped. Travelers should be aware pick pocketing is very common in tourist destinations and at transit stations.

Train stations and subways have bag scanners and police at the gates to scan bags for sharp objects and check the content of water bottles. For the most part, officials are checking for domestic terrorism threats.

Domestic terrorism is a concern in the westernmost part of China in the Xinjiang Uyghur region where political and religious unrest has led to violence in recent years.

The biggest threat to travelers in China is the traffic. Cars have the right of way in China, exercise caution when crossing streets. Ask for a business card from your hotel in both Chinese and English to help you get back to the hotel if you become lost.

A travel specialist at Markham Travel Health can help answer all of your questions about your trip to China.

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