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Things to Know When Preparing to Travel

Spring 2000

Yellow fever is a viral disease found in parts of Africa and South America. It is transmitted to humans by a mosquito bite. Even though there is no risk of becoming infected while traveling in countries outside of tropical South America or sub-Saharan Africa (i.e., Central, East, Southern, and West), certain countries REQUIRE a yellow fever vaccination. Some countries require a yellow fever vaccination for all travelers, while others require only a vaccination if a traveler is coming FROM either areas infected with yellow fever or areas where yellow fever transmission has occurred (called "endemic" areas). The endemic areas are found in tropical South America and Africa.

In general, if you are traveling only from the United States to countries in Europe (Western or Eastern), North Africa, the Middle East, the Indian subcontinent, East or Southeast Asia, Australia and the South Pacific, the Caribbean, most of Central America, or temperate South America, CDC does not recommend, and you are not required to have, a yellow fever vaccination.

Travelers who have a medical reason not to receive the yellow fever vaccine should obtain a medical waiver.

However, if your travel plans include traveling to or from a South American or African country that is infected with yellow fever or is located in areas where yellow fever transmission has occurred, then the easiest and safest thing to do is to get a yellow fever vaccination and a signed certificate.

Yellow fever vaccination, a 1-dose shot, may be administered to adults and to children over 9 months of age. This vaccine is administered only at designated yellow fever centers, usually your local health department. If at continued risk, a booster is needed every ten years.

MEDICAL REASONS NOT TO RECEIVE THE VACCINE:


Yellow Fever Certificate

After immunization, an International Certificate of Vaccination is issued and is valid 10 days after vaccination to meet entry and exit requirements for all countries. The certificate is good for 10 years. You must take the certificate with you.

Most countries will accept a medical waiver for persons with a medical reason not to receive the vaccine. When required, CDC recommends obtaining written waivers from consular or embassy officials before departure. A physician's letter clearly stating the medical reason not to receive the vaccine might be acceptable to some governments. It should be written on letterhead stationery and bear the stamp used by a health department or official immunization center to validate the International Certificate of Vaccination. Check embassies or consulates for specific waiver requirements.

For more information on yellow fever and traveling contact the CDC Topics A-Z: www.cdc.gov.


Malaria

Malaria is a significant global health concern. Each year, 25 to 30 million people from non-tropical regions visit malarial areas, resulting in 30,000 cases of malaria among North Americans and Europeans alone.

Visit a doctor with experience in travel medicine to learn how to protect yourself.

Malaria is a serious infection caused by microscopic parasites and transmitted through the bite of an infected mosquito. Upon infection, the parasite nests in the liver, where it breeds before rushing into the blood to infect and destroy red blood cells as it reproduces. Malaria is characterized by attacks of severe flu-like symptoms, fever, chills, severe headaches, and often fatal complications. When malaria stays in the body a long time, it can cause chronic anemia, kidney failure, and even death.

All people planning a trip to a tropical country must find out if there is a risk of malaria associated with their destination, and visit a doctor with experience in travel medicine to learn how to protect themselves.

Malaria can effectively be prevented and treated. Travelers are advised to reduce contact with mosquitoes by staying indoors at night, sleeping under mosquito nets, wearing clothing that covers most of the body, and using insect repellent. In addition, the CDC suggests the use of preventative prescription medications such as mefloquine (Lariam (R)). The CDC recommends the use of mefloquine alone for travel to the vast majority of malarial areas. Studies have shown Lariam to be highly effective at preventing malarial infection.

The most common adverse reactions to Lariam are nausea, vomiting, and dizziness, which are generally mild and may decrease with prolonged use.

Lariam should not be prescribed for prophylaxis in patients with active depression or with a history of psychosis or convulsions. It should not be given in combination with certain other antimalarial medications because of the risk of serious cardiovascular or convulsive events. Lariam should be discontinued if signs of acute anxiety, depression, restlessness, or confusion occur during prophylactic use. Before traveling, a patient should consult with a physician with experience in travel medicine.


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