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Your Survival Guide to Safe and Healthy Travel

Every year more and more Americans are traveling internationally — for vacation, business, and volunteerism, and to visit friends and family. Whatever your reason for traveling, the information on this page will help you to be Proactive, Prepared, and Protected when it comes to your health—and the health of others—while you are traveling.

BE PROACTIVE!

Take steps to anticipate any issues that could arise during your trip. The information in this section will help you plan for a safe and healthy trip.

BE PREPARED!

Family walking through airport with luggage

No one wants to think about getting sick or hurt during a trip, but sometimes these things happen. You may not be able to prevent every illness or injury, but you can plan ahead to be able to deal with them.

BE PROTECTED!

It is important to practice healthy behaviors during your trip and after you return home. This section outlines how you can protect yourself and others from illness during your trip.

hiker

For more information on your responsibilities as a traveler, listen to “The Three P’s of Safe and Healthy Travel” podcast.


Page last reviewed: January 13, 2011 Content source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)

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Need travel vaccines? Plan ahead.

Vaccines protect travelers from getting diseases abroad that may not normally be found in the United States.

Visiting another country can put you at risk for diseases that may not normally be found in the United States. Getting vaccinated against certain diseases is one of the most effective things you can do to protect your health abroad. Plan to get the travel vaccines you need at least a month before your trip. Most vaccines need to be given ahead of time to give you full protection against a disease. If you need a yellow fever vaccine, plan to travel some distance away from where you live to get it. Only a limited number of clinics have the vaccine.

What vaccines do I need before I travel?

  • You should be up to date on your routine vaccines. Depending on where you travel, you may come into contact with diseases that are rare in the United States. For example, although measles is rare in the United States, it is more common in other countries. Measles outbreaks happen frequently in many popular destinations in Europe and beyond—don’t go unprotected!
  • You may need other vaccines before you travel depending on your destination, your medical history, your planned activities, and other health concerns. Discuss your itinerary with your health care provider to make sure you get any destination-specific vaccines and medicines, such as yellow fever vaccine or medicine to prevent malaria.

What is the difference between routine, required, and recommended vaccines?

CDC divides vaccines for travel into three categories: (1) routine, (2) required, and (3) recommended.

  • Routine vaccines are those that are recommended for everyone in the United States based on their age, health condition, or other risk factors. You may think of these as the childhood vaccines that you get before starting school, but some are routinely recommended for adults, and some are recommended every year (like the flu vaccine) or every 10 years (like the tetanus booster for adults).
  • A required vaccine is one that travelers must have in order to enter a country, based on that country’s government regulations. In most circumstances, yellow fever is the only vaccine required by certain countries. Keep in mind that yellow fever vaccine can be recommended by CDC to protect your health, as well as required by a country. CDC’s recommendation is different from the 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. Vaccine requirements can change at any time, because country governments control those decisions.
  • Recommended vaccines are those that CDC recommends travelers get to protect their health, even though they aren’t required for entry by the government of the country you are visiting. Recommended vaccines are not part of the routine vaccination schedule. They protect travelers from illnesses that are usually travel-related. For example, a typhoid vaccine can prevent typhoid, a serious disease spread by contaminated food and water, which is not usually found in the United States. The vaccines recommended for a traveler depend on several things, including age, health, and itinerary.

Where can I go to get travel vaccines?

There are many providers for pre-travel health care. If you are traveling to a country with health risks similar to those in the United States, you may be able to see your family doctor or nurse for needed vaccines. Your city or county health department may also provide travel vaccines.

However, many travelers will need to see a travel medicine specialist. This might be the case if you are visiting several countries or countries with many health risks, or if you have a pre-existing health condition. To learn more about where to get travel vaccines, see Find a Clinic.

If yellow fever vaccine is recommended for or required by your destination, you’ll need to go to a vaccine center authorized to give yellow fever vaccinations. Many yellow fever vaccine centers also provide other pre-travel health care services. Find an authorized US yellow fever vaccine center.

How far ahead should I get any needed travel vaccines?

You should make an appointment with a travel medicine specialist or your health care provider ideally at least a month before your trip to get needed vaccines and medicines. Even if you’re a last-minute traveler, there may be options for getting the vaccines and medicines you need.

If you need a yellow fever vaccine, keep in mind that it is currently available only at a limited number of clinics in theUnited States.The nearest yellow fever vaccination clinic may be some distance away from where you live, and appointments may be limited. Find the nearest clinic and contact it ahead of time to make sure it has the vaccine.

How long does immunity from travel vaccines last (when do I need to get a booster dose)?

How long travel vaccines last depends on the vaccine. If you’re traveling outside the United States, you should see a health care provider who is familiar with travel medicine to talk about your upcoming trip. He or she will be able to provide you with advice for any vaccines and vaccine boosters based upon where you are going and when you got your previous vaccinations. Be sure to bring your vaccine records to your appointment!

Can I get travel vaccines in a country outside the United States to save on costs?

CDC does not recommend getting travel vaccines in another country because:

  • Most vaccines need to be administered ahead of time to give you full protection against a disease.
  • Vaccines available in other countries may be different from the ones used in the United States and may be less effective.
  • If you’re concerned about the cost of travel vaccines and medicines, check to see if your city or county health department has a travel medicine clinic. It may cost less to visit a doctor there than to go to a private doctor.

Page last reviewed: October 11, 2018 Content source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)

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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.
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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, [ 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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