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Outbreaks Information on outbreaks of
concern to international travelersAccording to the World Health Organization (WHO), as
of May 27, 2002, the Malawian Ministry of Health has
reported a total of 71 cases of bubonic plague in the
district of Nsanje since the onset of the outbreak on
April 16, 2002. The outbreak has affected 26 villages
- 23 in the Ndamera area, 2 in Chimombo, and 1 village
in neighboring Mozambique.
Malawian and Mozambican health teams are collaborating
on the outbreak. WHO is assisting the Malawian Ministry
of Health surveillance unit to contain the outbreak
by providing supplies, technical support, and training
of health care workers.
Plague is caused by a bacterium that can be transmitted
to humans through the bite of infected rodent fleas.
Cases of plague have been reported in the past from
many parts of the world including the western third
of the United States. The risk of travelers contracting
plague is very low, especially for those who stay in
relatively modern lodging facilities in larger cities.
Those who must work or travel in plague-affected rural
areas can further reduce their risk of plague by 1)
avoiding sick or dead animals and 2) spraying exposed
skin and clothing with insect repellant containing DEET
and or clothing with permethrin to reduce the likelihood
of being bitten by infectious fleas.
WHO and CDC recommend no special restrictions on travel
or trade to or from Malawi.
Diseases
Information about specific diseases that can affect
travelers.
African
Sleeping Sickness (African Trypanosomiasis)
Description
Trypanosomiasis is a systemic disease cause by the parasite
Trypanosoma brucei. It is transmitted by the bite of
the tsetse fly, a gray-brown insect about the size of
the honeybee. Signs and symptoms are initially nonspecific
(fever, skin lesions, rash, edema, or lymphadenopathy);
however, the infection progresses to meningoencephalitis.
Symptoms generally appear within 1 to 4 weeks of infection.
East African trypanosomiasis (caused by T. b. rhodesiense)
is more acute clinically than the West African form
of the disease (caused by T. b. gambiense), and central
nervous system involvement occurs earlier.
Occurrence
African trypanosomiasis is confined to tropical Africa
between 15° north latitude and 20° south latitude, or
from north of South Africa to south of Algeria, Libya,
and Egypt.
Risk
for Travelers Tsetse flies inhabit rural areas only,
living in the woodland and thickets of the savannah
and the dense vegetation along streams. Although infection
of international travelers is rare, cases have occurred
and travelers visiting game parks and remote areas should
be advised to take precautions. Travelers to urban areas
are not at risk.
Preventive
Measures No vaccine is available to prevent this
disease. Tsetse flies are attracted to moving vehicles
and dark, contrasting colors. They are not affected
by insect repellents and can bite through lightweight
clothing. Areas of heavy infestation tend to be sporadically
distributed and are usually well known to local inhabitants.
Avoidance of such areas is the best means of protection.
Travelers at risk should be advised to wear clothing
of wrist and ankle length that is made of medium-weight
fabric in neutral colors that blend with the background
environment.
Treatment
Travelers who sustain tsetse fly bites and develop high
fever or other manifestations of African trypanosomiasis
should be advised to seek early medical attention. The
infection can usually be cured by an appropriate course
of anti-trypanosomal therapy. Travelers should be advised
to consult an infectious disease or tropical medicine
specialist.
Vaccinations
CDC’s vaccination recommendations for travelers of all
ages.
Vaccine
Recommendations for Infants and Children
Age
at Which Immunobiologics Are Administered
Factors
that influence recommendations concerning the age at
which a vaccine is administered include the age-specific
risks of the disease and its complications, the ability
of people of a given age to respond to the vaccine,
and the potential interference with the immune response
by passively transferred maternal antibody. Vaccines
are recommended for the youngest age group at risk of
developing the disease whose members are known to develop
an adequate antibody response to vaccination.
The
routine immunization recommendations and schedules for
infants and children in the United States (Tables 1-2
and 1-3) do not provide specific guidelines for infants
and young children who will travel internationally before
the age when specific vaccines and toxoids are routinely
recommended. The following section, "Immunization Schedule
Modifications for International Travel for Inadequately
Immunized Infants and Younger Children," provides revised
recommendations and schedules for active and passive
immunization of such infants and children. .
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