Chikungunya

Vector – Bite from an infected mosquito (Aedes Aegypti and Aedes Albopictus)

103 Countries – Considered ‘at risk’ of Chikungunya

Symptom – Abrupt onset of high fever, joint pain (usually involving multiple joints and typically bilateral and symmetric), muscle pain, headache, nausea, fatigue and rash

Severe Case – Uncommon, in some cases, joint pain can be debilitating and persist for several months, or even years

As there are no vaccines available in Canada, basic precautions should be taken.

• Take preventive measures when mosquitoes are most active (during daylight/ light hours)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens

Fact: Chikungunya means to become contorted and describes the stooped appearance of sufferers with severe joint pain

Vaccine:

Saint-Herblain (France), Sao Paulo, (Brazil), May 5, 2020 – Valneva SE (“Valneva” or “the Company”), a specialty vaccine company, and Instituto Butantan, producer of immunobiologic products, today announced the signing of a binding term sheet for the development, manufacturing and marketing of Valneva’s single-shot chikungunya vaccine, VLA1553, in Low and Middle Income Countries (LMICs).

https://valneva.com/chikungunya-vaccine-approaches-phase-3-study/

Dengue Fever

Vector – Bite from an infected mosquito (Aedes aegypti and Aedes albopictus)

390 million cases – worldwide annually (estimated)

Symptom – High fever (>40C) with at least two of the following: severe headache, pain behind eyes, muscle and joint pains, nausea, vomiting, swollen glands, rash

Severe Case – Occurs occasionally and includes symptoms such as plasma leakage, fluid accumulation in the lungs, respiratory problems, severe bleeding, organ impairment, death

As there are no vaccines available in Canada, basic precautions should be taken.

• Take preventive measures when mosquitoes are most active (during daylight/ light hours)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens

Fact: An estimated 500,000 people with severe dengue required hospitalization each year

Vaccine:

There is no specific treatment for dengue fever but medical care can help with recovery and the control of symptoms.

https://travel.gc.ca/travelling/health-safety/diseases/dengue

Diphtheria

Respiratory – Person-to-person through close contact with someone infected with C. diphtheria, or their possessions

4,778 Cases – worldwide annually (estimated)

Symptom – Mild fever (rarely > 38.3 C), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness

Severe Case – Pseudo-membranes form in the throat, tonsils, pharynx and larynx causing a potentially fatal obstruction of the airway and breathing difficulties

Precautions against diphtheria, including good hygiene measures and vaccination, should be considered:

• Ensure diphtheria vaccinations are up-to-date or obtain a booster if travelling to endemic areas
• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms or respiratory illness
• Avoid sharing personal items such as eating/drinking utensils, toothbrushes and towels

Fact: An estimated 5-10% of people who get the infection will die from complications

Vaccine:

There are a few vaccines available depending on age and need:

• DTaP– Protects against tetanus, diphtheria and pertussis, designed for children.
• Tdap– A booster immunization designed for preteens, teens and adults.
• Td – Protects against only tetanus and diphtheria. It is a popular booster for those needing protection against just one type of infection

Hepatitis B

Percutaneous, Mucosal, Sexual – person-to-person through close contact with someone infected with Hepatitis B, or their possessions, as well as intravenous drug use

240 million cases – globally are chronically infected

Symptom – Jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain

Severe Case – Acute liver failure (which can result in death), cirrhosis of the liver, liver cancer

Precautions against Hepatitis B, including safe injection techniques, safe sex practices and vaccination, should be considered:

• Practice safe injection and avoid needle-stick ‘risk’ situations, such as getting tattoos or body piercings
• Practice safer sex (including using condoms and minimizing the number of partners)
• Avoid sharing personal items that could be infected with blood, such as toothbrushes and razors

Fact: More than 686,000 people die every year due to complications of Hepatitis B, including cirrhosis and liver cancer

Vaccine:

A hepatitis B vaccine is the best form of protection against the virus. The injectable vaccine provides lifelong protection, if boosters are completed. Five different version of the vaccine are available in Canada, all of which are very safe.

Lyme Disease (Lyme borreliosis)

Vector – bite from an infected tick

Cases – an endemic in Canada with 917 reported cases in 2015. The greatest risk occurs where ticks carrying the Lyme disease-causing agent are found. Surveillance in recent years indicates that established populations of black-legged ticks are spreading

Symptom – red circular, expanding rash (with or without central clearing), fatigue, fever, headache, mild stiff neck, joint pain, muscle pain

Severe Case – neurologic conditions (meningitis, radiating nerve pain, facial paralysis), cardiac abnormalities (inflammation of the heart muscle with atrioventricular heart block), arthritis

As there are no vaccines available, basic precautions should be taken:

• Avoid tick habitats, such as long grass
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, and closed shoes
• Carry a tick remover or fine-tooth tweezers
• Carefully check every day for attached ticks
• If found, remove the tick by gently gripping it as close to the skin as possible and pulling away steadily without twisting or crushing the tick. Ensure the entire tick – including head and mouthparts – is removed
• Wash your skin with water and soap afterwards, and apply an antiseptic cream around the bite

Fact: The red, bullseye shaped rash (also known as erythema migrans) can develop in up to 90% of cases within 2-30 days (average is about 7 days) of the tick bite

Vaccine:

Rabies

Percutaneous – bite or scratch from an infected animal, including bats, foxes, monkeys and other free roaming animals. Dogs are the source of the vast majority of human rabies death.

Cases – 55,000 deaths (vast majority occurring in rural areas of Africa and Asia) worldwide annually

Symptoms – Fever, wound site pain, unusual tingling pricking or burning sensation around the wound site

Severe Cases – Inflammation of the brain and spinal cord, hyperactivity, hydrophobia, loss of consciousness, death

Precautions against rabies, including avoiding animal bites and vaccination (pre-exposure for travellers to endemic areas), should be considered

• Pre-exposure immunization does not eliminate the need for careful wound management and post-exposure immunization

Avoiding risk situations for animal bites

• Thorough wound cleaning, initiated as soon as possible after exposure

Vaccination and immunoglobin (post-exposure, for all exposed people)

• It is important to consider the destination, the purpose and the duration of the trip as well as the patient’s access to healthcare and availability of rabies biologics
• For post-exposure vaccination to work, it is essential that medical expertise be available on an urgent basis

Fact: Rabies is a viral disease, which occurs in more than 150 countries and territories. Once symptoms are present, rabies is almost always fatal

Vaccine:

Rabies vaccines (Rab)

• IMOVAX^® Rabies (inactivated, human diploid cell rabies vaccine). Sanofi Pasteur Ltd. (HDCV)
• RabAvert^® (inactivated, purified chick embryo cell rabies vaccine), Novartis Vaccines and Diagnostics (manufacturer), Novartis Pharmaceuticals Canada Inc. (distributor). (PCECV)

Rabies immunoglobulins (RabIg)

• IMOGAM^® Rabies Pasteurized (rabies immunoglobulin [human]), Sanofi Pasteur Ltd.
• HYPERRAB^® (150 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.
• HyperRAB^® (300 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.*

KamRAB^TM (rabies immunoglobulin [human]), Kamada Ltd.*

Tetanus (Lockjaw)

Percutaneous – infection with Clostridium tetani introduced into the body through a scratch or wound that is contaminated with soil, animal or human feces or dust

Since tetanus is caused by a neurotoxin, it is not transmitted person-to-person

Cases – more than 10,000 reported cases worldwide in 2015 with more than 72,000 estimated deaths worldwide in <5 years reported in 2011

Symptoms – Stiffness in the jaw muscles (lockjaw), painful muscle spasms (affecting swallowing and breathing), fever, sweating, rapid heartbeat

Severe cases – suffocation, cardiac arrest, death          

The case-fatality ratio varies between 10-80% in unvaccinated cases, and its highest among infants and the elderly

Precautions against tetanus, including learning about appropriate wound care and vaccination, should be considered

Fact: Tetanus is caused by a neurotoxin produced by the bacterium Clostridium tetani. Clostridium tetani spores are widely distributed in soil worldwide and in animal intestinal tracts. Many Canadians, especially those who are older or were born outside of Canada, do not have protective concentrations of Tetanus anti-toxin

Vaccine:

Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off.

For clean, minor wounds, people who have been vaccinated in the last 10 years don’t need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot.

Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin.

Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib (Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheria-tetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

Tuberculosis (TB)

Respiratory – person-to-person close contact with someone infected with Mycobacterium tuberculosis

Cases – 10.4 million worldwide cases in 2015

Symptoms – generally mild including persistent cough with sputum and blood, fever, chest pains, night sweats, weight loss

The majority of people infected never become symptomatic or ill and are said to have a latent tuberculosis infection. Overall, approximately 10% of those infected will ultimately develop active tuberculosis

Sever cases – if untreated, slow disease progressions, death

Precautions against TB, including avoiding people infected with TB and vaccination, should be considered:

• Discuss preventative options with a doctor for those with an immunocompromising condition
• Avoid exposure to potential TB sufferers in crowded or enclosed environments. Among specific facilities, working in hospitals in high incidence countries is associated with a particularly high risk
• Canadian travellers visiting friends and family are likely to represent a group at higher risk, perhaps due to their closer contact with the local population
• Vaccination may be considered for certain long-term travellers to high-prevalence countries in exceptional circumstances

Fact: 1 in 3 of the world’s population have been infected with the TB bacteria but have not (yet) become ill as a result (known as latent TB)

Zika Virus

Vector, Sexual – bite from an infected mosquito, mainly Aedes Aegypti/ sexual transmission also occurs

Cases – 57 countries/territories where local, vector-borne transmission of Zika virus disease has been recorded

Symptoms – fever, skin, rashes, conjunctivitis, muscle pain, joint pain, malaise, headache

            Symptoms usually last between 2-7 days

Severe cases – microcephaly (in children of infected mothers), Gullain-Barre syndrome. Further investigation concerning links with a range of neurological disorders are underway

• Take preventive measures when mosquitos are most active (during the day and peaking in the early morning and late afternoon)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens
• If pregnant, avoid travel to endemic areas
• Women planning a pregnancy should wait at least 2 months after their return from an area of risk before trying to conceive. For couples where the male partner has travelled in a risk area, it is reasonable to delay trying to conceive for 6 months
• In the case of an ongoing pregnancy, if a male partner has been in a risk area, couples should practice abstinence or use barrier methods for the duration of the pregnancy
• Male travellers are advised to use a condom during vaginal, anal and oral sex whilst travelling. This is also advised for 8 weeks post-return if not symptomatic, or 6 months from the point of symptoms being identified

Fact: Zika virus has recently emerged as a disease of significant public health concern. The Aedes mosquito that transmits Zika is the same mosquito that also transmits Dengue, Chikungunya and Yellow Fever

Vaccine:

At this time, there is no specific treatment or vaccine

Chikungunya

Vector – Bite from an infected mosquito (Aedes Aegypti and Aedes Albopictus)

103 Countries – Considered ‘at risk’ of Chikungunya

Symptom – Abrupt onset of high fever, joint pain (usually involving multiple joints and typically bilateral and symmetric), muscle pain, headache, nausea, fatigue and rash

Severe Case – Uncommon, in some cases, joint pain can be debilitating and persist for several months, or even years

As there are no vaccines available in Canada, basic precautions should be taken.

• Take preventive measures when mosquitoes are most active (during daylight/ light hours)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens

Fact: Chikungunya means to become contorted and describes the stooped appearance of sufferers with severe joint pain

Vaccine:

Saint-Herblain (France), Sao Paulo, (Brazil), May 5, 2020 – Valneva SE (“Valneva” or “the Company”), a specialty vaccine company, and Instituto Butantan, producer of immunobiologic products, today announced the signing of a binding term sheet for the development, manufacturing and marketing of Valneva’s single-shot chikungunya vaccine, VLA1553, in Low and Middle Income Countries (LMICs).

https://valneva.com/chikungunya-vaccine-approaches-phase-3-study/

Cholera

Fecal Oral – Infection is acquired primarily by ingesting water of food contaminated with the bacterium Vibrio cholera; person-to-person transmission is not likely

Symptoms – Copious, painless, and watery diarrhea

Severe Case – A minority develop severe dehydration, which can lead to death if left untreated

Precautions against cholera, including good hygiene measures, frequent handwashing, safe eating and drinking habits and vaccination, should be considered depending on the destination, type of travel and patient profile.

Watch what you eat, drink and do

Don’t drink

• Tap water
• Drinks with ice cubes (including alcoholic beverages served or shaken with ice cubes)
• Drinks with crushed ice

Don’t eat

• Fruits that can’t be peeled
• Uncooked vegetables, including salad
• Undercooked or raw meat or fish
• Unpasteurized or unrefrigerated dairy products
• Food sold by street vendors

Fact: Cholera is an important public health problem worldwide

Vaccine:

Dukoral is the cholera vaccination currently recommended for Canadian travelers. The vaccine is administered orally in two doses: one taken up to six weeks prior to departure and the second taken at least one week before the trip. It will provide protection one week after immunization and is effective in up to 85% of cholera cases and 25% of travelers’ diarrhea cases.

The vaccination will protect against travelers’ diarrhea for up to three months and from cholera infection for up to two years. A single booster dose every three months is recommended for travelers staying in an at-risk destination for a longer time period.

Dengue Fever

Vector – Bite from an infected mosquito (Aedes aegypti and Aedes albopictus)

390 million cases – worldwide annually (estimated)

Symptom – High fever (>40C) with at least two of the following: severe headache, pain behind eyes, muscle and joint pains, nausea, vomiting, swollen glands, rash

Severe Case – Occurs occasionally and includes symptoms such as plasma leakage, fluid accumulation in the lungs, respiratory problems, severe bleeding, organ impairment, death

As there are no vaccines available in Canada, basic precautions should be taken.

• Take preventive measures when mosquitoes are most active (during daylight/ light hours)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens

Fact: An estimated 500,000 people with severe dengue required hospitalization each year

Vaccine:

There is no specific treatment for dengue fever but medical care can help with recovery and the control of symptoms.

https://travel.gc.ca/travelling/health-safety/diseases/dengue

Diphtheria

Respiratory – Person-to-person through close contact with someone infected with C. diphtheria, or their possessions

4,778 Cases – worldwide annually (estimated)

Symptom – Mild fever (rarely > 38.3 C), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness

Severe Case – Pseudo-membranes form in the throat, tonsils, pharynx and larynx causing a potentially fatal obstruction of the airway and breathing difficulties

Precautions against diphtheria, including good hygiene measures and vaccination, should be considered:

• Ensure diphtheria vaccinations are up-to-date or obtain a booster if travelling to endemic areas
• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms or respiratory illness
• Avoid sharing personal items such as eating/drinking utensils, toothbrushes and towels

Fact: An estimated 5-10% of people who get the infection will die from complications

Vaccine:

There are a few vaccines available depending on age and need:

• DTaP– Protects against tetanus, diphtheria and pertussis, designed for children.
• Tdap– A booster immunization designed for preteens, teens and adults.
• Td – Protects against only tetanus and diphtheria. It is a popular booster for those needing protection against just one type of infection

Hepatitis A

Fecal Oral – Ingestion or contaminated food or water, close personal or sexual contact with an infected person intravenous drug use

126 million cases – worldwide annually (estimated in 2005)

Symptoms – fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice

Sever case – in rare instanced acute liver failure that can result in death

Precautions against Hepatitis A, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered

• Personal hygiene practices, such as regular handwashing with safe water after using the toilet and before preparing food
• Exercise caution when consuming food that could have been prepared be someone with the infection who hasn’t washed their hands properly, or drinks made with contaminated water or ice cubes
• Avoid eating raw or undercooked shellfish

Fact: Recovery from the illness can take people weeks or months, leading to time absent from work, school, or daily life

Vaccine:

Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.

Hepatitis B

Percutaneous, Mucosal, Sexual – person-to-person through close contact with someone infected with Hepatitis B, or their possessions, as well as intravenous drug use

240 million cases – globally are chronically infected

Symptom – Jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain

Severe Case – Acute liver failure (which can result in death), cirrhosis of the liver, liver cancer

Precautions against Hepatitis B, including safe injection techniques, safe sex practices and vaccination, should be considered:

• Practice safe injection and avoid needle-stick ‘risk’ situations, such as getting tattoos or body piercings
• Practice safer sex (including using condoms and minimizing the number of partners)
• Avoid sharing personal items that could be infected with blood, such as toothbrushes and razors

Fact: More than 686,000 people die every year due to complications of Hepatitis B, including cirrhosis and liver cancer

Vaccine:

A hepatitis B vaccine is the best form of protection against the virus. The injectable vaccine provides lifelong protection, if boosters are completed. Five different version of the vaccine are available in Canada, all of which are very safe.

Lyme Disease (Lyme borreliosis)

Vector – bite from an infected tick

Cases – an endemic in Canada with 917 reported cases in 2015. The greatest risk occurs where ticks carrying the Lyme disease-causing agent are found. Surveillance in recent years indicates that established populations of black-legged ticks are spreading

Symptom – red circular, expanding rash (with or without central clearing), fatigue, fever, headache, mild stiff neck, joint pain, muscle pain

Severe Case – neurologic conditions (meningitis, radiating nerve pain, facial paralysis), cardiac abnormalities (inflammation of the heart muscle with atrioventricular heart block), arthritis

As there are no vaccines available, basic precautions should be taken:

• Avoid tick habitats, such as long grass
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, and closed shoes
• Carry a tick remover or fine-tooth tweezers
• Carefully check every day for attached ticks
• If found, remove the tick by gently gripping it as close to the skin as possible and pulling away steadily without twisting or crushing the tick. Ensure the entire tick – including head and mouthparts – is removed
• Wash your skin with water and soap afterwards, and apply an antiseptic cream around the bite

Fact: The red, bullseye shaped rash (also known as erythema migrans) can develop in up to 90% of cases within 2-30 days (average is about 7 days) of the tick bite

Vaccine:

Malaria

Vector – bite from a female Anopheles mosquito infected with malaria parasites called Plasmodium. There are different types of Plasmodium parasites that can cause malaria: falciparum, vivax, ovale, malariae, and knowlesi.

Cases – 214 million cases annually

Symptoms – Fever, headache, chills vomiting

Symptoms usually appear between 7 – 18 days, but can also take up to a year to develop

Severe case – seizures, mental confusion, kidney failure, acute respiratory distress syndrome, coma, and death

The most important factors determining patient survival are early diagnosis and appropriate therapy

Involves several steps, known as the A, B, C, D of malaria prevention

• Awareness of the risk before travelling
• Bite prevention
  • Take preventative measures when mosquitos are most active, particularly from sunset to sunrise
  • Use a recommended insect repellent containing either Icaridin (20%) or DEET
  • Wear appropriate clothing (long sleeved shirt, long pants)
  • Use physical barriers, such as bed nets and window screens
• Check whether chemoprophylaxis is needed (use appropriate malaria prevention tablets)
• Diagnosis (seek immediate medical attention if displaying symptoms)

Fact: In 2015, nearly half of the world’s population – 3.2 billion people – was at risk of malaria.

Vaccine:

There is currently no commercially available malaria vaccine

Rabies

Percutaneous – bite or scratch from an infected animal, including bats, foxes, monkeys and other free roaming animals. Dogs are the source of the vast majority of human rabies death.

Cases – 55,000 deaths (vast majority occurring in rural areas of Africa and Asia) worldwide annually

Symptoms – Fever, wound site pain, unusual tingling pricking or burning sensation around the wound site

Severe Cases – Inflammation of the brain and spinal cord, hyperactivity, hydrophobia, loss of consciousness, death

Precautions against rabies, including avoiding animal bites and vaccination (pre-exposure for travellers to endemic areas), should be considered

• Pre-exposure immunization does not eliminate the need for careful wound management and post-exposure immunization

Avoiding risk situations for animal bites

• Thorough wound cleaning, initiated as soon as possible after exposure

Vaccination and immunoglobin (post-exposure, for all exposed people)

• It is important to consider the destination, the purpose and the duration of the trip as well as the patient’s access to healthcare and availability of rabies biologics
• For post-exposure vaccination to work, it is essential that medical expertise be available on an urgent basis

Fact: Rabies is a viral disease, which occurs in more than 150 countries and territories. Once symptoms are present, rabies is almost always fatal

Vaccine:

Rabies vaccines (Rab)

• IMOVAX^® Rabies (inactivated, human diploid cell rabies vaccine). Sanofi Pasteur Ltd. (HDCV)
• RabAvert^® (inactivated, purified chick embryo cell rabies vaccine), Novartis Vaccines and Diagnostics (manufacturer), Novartis Pharmaceuticals Canada Inc. (distributor). (PCECV)

Rabies immunoglobulins (RabIg)

• IMOGAM^® Rabies Pasteurized (rabies immunoglobulin [human]), Sanofi Pasteur Ltd.
• HYPERRAB^® (150 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.
• HyperRAB^® (300 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.*

KamRAB^TM (rabies immunoglobulin [human]), Kamada Ltd.*

Tetanus (Lockjaw)

Percutaneous – infection with Clostridium tetani introduced into the body through a scratch or wound that is contaminated with soil, animal or human feces or dust

Since tetanus is caused by a neurotoxin, it is not transmitted person-to-person

Cases – more than 10,000 reported cases worldwide in 2015 with more than 72,000 estimated deaths worldwide in <5 years reported in 2011

Symptoms – Stiffness in the jaw muscles (lockjaw), painful muscle spasms (affecting swallowing and breathing), fever, sweating, rapid heartbeat

Severe cases – suffocation, cardiac arrest, death          

The case-fatality ratio varies between 10-80% in unvaccinated cases, and its highest among infants and the elderly

Precautions against tetanus, including learning about appropriate wound care and vaccination, should be considered

Fact: Tetanus is caused by a neurotoxin produced by the bacterium Clostridium tetani. Clostridium tetani spores are widely distributed in soil worldwide and in animal intestinal tracts. Many Canadians, especially those who are older or were born outside of Canada, do not have protective concentrations of Tetanus anti-toxin

Vaccine:

Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off.

For clean, minor wounds, people who have been vaccinated in the last 10 years don’t need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot.

Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin.

Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib (Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheria-tetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

Traveller’s Diarrhea

Currently there is no information available. We will add it as soon as possible.

Tuberculosis (TB)

Respiratory – person-to-person close contact with someone infected with Mycobacterium tuberculosis

Cases – 10.4 million worldwide cases in 2015

Symptoms – generally mild including persistent cough with sputum and blood, fever, chest pains, night sweats, weight loss

The majority of people infected never become symptomatic or ill and are said to have a latent tuberculosis infection. Overall, approximately 10% of those infected will ultimately develop active tuberculosis

Sever cases – if untreated, slow disease progressions, death

Precautions against TB, including avoiding people infected with TB and vaccination, should be considered:

• Discuss preventative options with a doctor for those with an immunocompromising condition
• Avoid exposure to potential TB sufferers in crowded or enclosed environments. Among specific facilities, working in hospitals in high incidence countries is associated with a particularly high risk
• Canadian travellers visiting friends and family are likely to represent a group at higher risk, perhaps due to their closer contact with the local population
• Vaccination may be considered for certain long-term travellers to high-prevalence countries in exceptional circumstances

Fact: 1 in 3 of the world’s population have been infected with the TB bacteria but have not (yet) become ill as a result (known as latent TB)

Typhoid

Fecal Oral – consumption of food or water contaminated with feces from an infected individual or chronic carrier

Cases – 21 million worldwide cases annually (estimated)

            Several studies have identified travelling children, those visiting friends and relatives, achlorhydria or use of acid suppression therapy, and longer duration of travel to be factors that increase the risk of travel associated typhoid

Symptoms – fever, fatigue, headache, abdominal pain, constipation or diarrhea (depending on age)

Severe cases – brain dysfunction, delirium, intestinal perforation, death

            The case fatality ratio is approximately 10% for untreated cases in low income setting and less than 1% for patients receiving care in high income countries

Precautions against typhoid fever, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered  

• Eat food that been thoroughly cooked and that are still hot
• Avoid raw/undercooked fruit or vegetables that cannot be peeled
• Avoid drinking tap water (including fruit drinks), as well as drinks containing ice
• Frequent hand washing

Fact: Typhoid fever is caused by Salmonella enterica serovar, which only lives in humans

Vaccine:

In Canada there are two types of vaccines recommended to prevent typhoid fever. One is an oral vaccine called Vivotif which involves capsule pills taken over the course of four doses. The other option is through injectable typhoid vaccines.

Yellow Fever

Vector – bite from an infected mosquito, primarily Aedes or Haemagogus species

Cases – based on a modelling study, up to 170,000 severe cases worldwide (estimated in 2013)

Symptoms – fever, muscle pain with prominent backache, headache, chills, loss of appetite, nausea or vomiting

            Most patients improve after the initial presentation. After a brief remission of hours to a day, approximately 15% of patients progress to a more serious of toxic form of the disease

Severe cases – high fever, with the liver and kidneys affected, jaundice, dark urine, abdominal pain with vomiting, bleeding from the mouth, nose eyes or stomach, and eventually shock and multisystem organ failure

Precautions against yellow fever, including avoiding mosquito bites and vaccination, should be considered

• Vaccination
• Vaccination certification may be required depending on destination
• Take preventative measures when mosquitoes are most active (during daylight hours)
• All diagnosis of yellow fever made in Canada are required to be reported to public health authorities
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens
• Infected patients should be protected from further mosquito exposure during the first few days of illness to avoid contributing to the transmission cycle

Fact: Yellow fever refers to the jaundice that affects some patients. Is an endemic and intermittently epidemic in parts of Africa and South America. 20-50% of people who experience a severe case may die as a result

Vaccine:

• In Canada, the vaccine is available only at designated centers.
• The single-dose vaccine against yellow fever is safe, effective and recommended for most people who are over nine months of age.
• The vaccine is generally not recommended for pregnant or breastfeeding women, children under the age of nine months, adults 60 years and older (especially those who have not previously received the vaccine) and people with weakened immune systems.
• If you are receiving the vaccine for the first time, be aware that it takes ten days for it to become effective (the International Certificate of Vaccination or Prophylaxis will only be valid ten days after the date of vaccination).

Zika Virus

Vector, Sexual – bite from an infected mosquito, mainly Aedes Aegypti/ sexual transmission also occurs

Cases – 57 countries/territories where local, vector-borne transmission of Zika virus disease has been recorded

Symptoms – fever, skin, rashes, conjunctivitis, muscle pain, joint pain, malaise, headache

            Symptoms usually last between 2-7 days

Severe cases – microcephaly (in children of infected mothers), Gullain-Barre syndrome. Further investigation concerning links with a range of neurological disorders are underway

• Take preventive measures when mosquitos are most active (during the day and peaking in the early morning and late afternoon)
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens
• If pregnant, avoid travel to endemic areas
• Women planning a pregnancy should wait at least 2 months after their return from an area of risk before trying to conceive. For couples where the male partner has travelled in a risk area, it is reasonable to delay trying to conceive for 6 months
• In the case of an ongoing pregnancy, if a male partner has been in a risk area, couples should practice abstinence or use barrier methods for the duration of the pregnancy
• Male travellers are advised to use a condom during vaginal, anal and oral sex whilst travelling. This is also advised for 8 weeks post-return if not symptomatic, or 6 months from the point of symptoms being identified

Fact: Zika virus has recently emerged as a disease of significant public health concern. The Aedes mosquito that transmits Zika is the same mosquito that also transmits Dengue, Chikungunya and Yellow Fever

Vaccine:

At this time, there is no specific treatment or vaccine

Cholera

Fecal Oral – Infection is acquired primarily by ingesting water of food contaminated with the bacterium Vibrio cholera; person-to-person transmission is not likely

Symptoms – Copious, painless, and watery diarrhea

Severe Case – A minority develop severe dehydration, which can lead to death if left untreated

Precautions against cholera, including good hygiene measures, frequent handwashing, safe eating and drinking habits and vaccination, should be considered depending on the destination, type of travel and patient profile.

Watch what you eat, drink and do

Don’t drink

• Tap water
• Drinks with ice cubes (including alcoholic beverages served or shaken with ice cubes)
• Drinks with crushed ice

Don’t eat

• Fruits that can’t be peeled
• Uncooked vegetables, including salad
• Undercooked or raw meat or fish
• Unpasteurized or unrefrigerated dairy products
• Food sold by street vendors

Fact: Cholera is an important public health problem worldwide

Vaccine:

Dukoral is the cholera vaccination currently recommended for Canadian travelers. The vaccine is administered orally in two doses: one taken up to six weeks prior to departure and the second taken at least one week before the trip. It will provide protection one week after immunization and is effective in up to 85% of cholera cases and 25% of travelers’ diarrhea cases.

The vaccination will protect against travelers’ diarrhea for up to three months and from cholera infection for up to two years. A single booster dose every three months is recommended for travelers staying in an at-risk destination for a longer time period.

Diphtheria

Respiratory – Person-to-person through close contact with someone infected with C. diphtheria, or their possessions

4,778 Cases – worldwide annually (estimated)

Symptom – Mild fever (rarely > 38.3 C), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness

Severe Case – Pseudo-membranes form in the throat, tonsils, pharynx and larynx causing a potentially fatal obstruction of the airway and breathing difficulties

Precautions against diphtheria, including good hygiene measures and vaccination, should be considered:

• Ensure diphtheria vaccinations are up-to-date or obtain a booster if travelling to endemic areas
• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms or respiratory illness
• Avoid sharing personal items such as eating/drinking utensils, toothbrushes and towels

Fact: An estimated 5-10% of people who get the infection will die from complications

Vaccine:

There are a few vaccines available depending on age and need:

• DTaP– Protects against tetanus, diphtheria and pertussis, designed for children.
• Tdap– A booster immunization designed for preteens, teens and adults.
• Td – Protects against only tetanus and diphtheria. It is a popular booster for those needing protection against just one type of infection

Hepatitis A

Fecal Oral – Ingestion or contaminated food or water, close personal or sexual contact with an infected person intravenous drug use

126 million cases – worldwide annually (estimated in 2005)

Symptoms – fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice

Sever case – in rare instanced acute liver failure that can result in death

Precautions against Hepatitis A, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered

• Personal hygiene practices, such as regular handwashing with safe water after using the toilet and before preparing food
• Exercise caution when consuming food that could have been prepared be someone with the infection who hasn’t washed their hands properly, or drinks made with contaminated water or ice cubes
• Avoid eating raw or undercooked shellfish

Fact: Recovery from the illness can take people weeks or months, leading to time absent from work, school, or daily life

Vaccine:

Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.

Hepatitis B

Percutaneous, Mucosal, Sexual – person-to-person through close contact with someone infected with Hepatitis B, or their possessions, as well as intravenous drug use

240 million cases – globally are chronically infected

Symptom – Jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain

Severe Case – Acute liver failure (which can result in death), cirrhosis of the liver, liver cancer

Precautions against Hepatitis B, including safe injection techniques, safe sex practices and vaccination, should be considered:

• Practice safe injection and avoid needle-stick ‘risk’ situations, such as getting tattoos or body piercings
• Practice safer sex (including using condoms and minimizing the number of partners)
• Avoid sharing personal items that could be infected with blood, such as toothbrushes and razors

Fact: More than 686,000 people die every year due to complications of Hepatitis B, including cirrhosis and liver cancer

Vaccine:

A hepatitis B vaccine is the best form of protection against the virus. The injectable vaccine provides lifelong protection, if boosters are completed. Five different version of the vaccine are available in Canada, all of which are very safe.

Malaria

Vector – bite from a female Anopheles mosquito infected with malaria parasites called Plasmodium. There are different types of Plasmodium parasites that can cause malaria: falciparum, vivax, ovale, malariae, and knowlesi.

Cases – 214 million cases annually

Symptoms – Fever, headache, chills vomiting

Symptoms usually appear between 7 – 18 days, but can also take up to a year to develop

Severe case – seizures, mental confusion, kidney failure, acute respiratory distress syndrome, coma, and death

The most important factors determining patient survival are early diagnosis and appropriate therapy

Involves several steps, known as the A, B, C, D of malaria prevention

• Awareness of the risk before travelling
• Bite prevention
  • Take preventative measures when mosquitos are most active, particularly from sunset to sunrise
  • Use a recommended insect repellent containing either Icaridin (20%) or DEET
  • Wear appropriate clothing (long sleeved shirt, long pants)
  • Use physical barriers, such as bed nets and window screens
• Check whether chemoprophylaxis is needed (use appropriate malaria prevention tablets)
• Diagnosis (seek immediate medical attention if displaying symptoms)

Fact: In 2015, nearly half of the world’s population – 3.2 billion people – was at risk of malaria.

Vaccine:

There is currently no commercially available malaria vaccine

Lyme Disease (Lyme borreliosis)

Vector – bite from an infected tick

Cases – an endemic in Canada with 917 reported cases in 2015. The greatest risk occurs where ticks carrying the Lyme disease-causing agent are found. Surveillance in recent years indicates that established populations of black-legged ticks are spreading

Symptom – red circular, expanding rash (with or without central clearing), fatigue, fever, headache, mild stiff neck, joint pain, muscle pain

Severe Case – neurologic conditions (meningitis, radiating nerve pain, facial paralysis), cardiac abnormalities (inflammation of the heart muscle with atrioventricular heart block), arthritis

As there are no vaccines available, basic precautions should be taken:

• Avoid tick habitats, such as long grass
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, and closed shoes
• Carry a tick remover or fine-tooth tweezers
• Carefully check every day for attached ticks
• If found, remove the tick by gently gripping it as close to the skin as possible and pulling away steadily without twisting or crushing the tick. Ensure the entire tick – including head and mouthparts – is removed
• Wash your skin with water and soap afterwards, and apply an antiseptic cream around the bite

Fact: The red, bullseye shaped rash (also known as erythema migrans) can develop in up to 90% of cases within 2-30 days (average is about 7 days) of the tick bite

Vaccine:

Polio

Fecal Oral – transmitted from person-to-person, primarily through the fecal-oral route and less frequently through close personal contact with infected respiratory secretions or saliva

Cases – 72 cases reported in 2 endemic countries in 2015

Symptoms – fever, fatigue, headache, vomiting, stiffness of the neck, pain in the limbs

Severe cases – paralysis (in the legs, muscles used for breathing), death

Precautions against polio, including good hygiene measures and vaccination, should be considered.

• Travellers should practice good hygiene measures, including frequent hand washing
• Travellers with unimmunized infants/children should be advised to seriously consider delaying travel to endemic areas, ideally until full immunization have been obtained

Fact: Polio is a highly infectious disease, viral disease. Although polio is asymptomatic in the majority of cases, in approximately 1% of cases, it attacks the central nervous systems and leads to paralysis. Canada was declared free of wild poliovirus in 1994 by WHO. There is still a risk to travellers going to regions outside those in which polio has been eliminated

Vaccine:

Poliomyelitis vaccines used in Canada contain three types of wild poliovirus and are available as trivalent inactivated polio vaccines (IPV) or in combination vaccines.

• Routine immunization of children is recommended at 2, 4, and 18 months of age with a booster dose at 4-6 years of age. It is also acceptable to give an additional dose of IPV at 6 months of age for convenience of administration in combination with DTap and Hib.
• Similar to vaccination of children, vaccination of adults is recommended to prevent the introduction and circulation of polio.

Primary immunization for non-immune adults and a booster is recommended for adults travelling to epidemic or endemic areas or for those with other exposure risks

Rabies

Percutaneous – bite or scratch from an infected animal, including bats, foxes, monkeys and other free roaming animals. Dogs are the source of the vast majority of human rabies death.

Cases – 55,000 deaths (vast majority occurring in rural areas of Africa and Asia) worldwide annually

Symptoms – Fever, wound site pain, unusual tingling pricking or burning sensation around the wound site

Severe Cases – Inflammation of the brain and spinal cord, hyperactivity, hydrophobia, loss of consciousness, death

Precautions against rabies, including avoiding animal bites and vaccination (pre-exposure for travellers to endemic areas), should be considered

• Pre-exposure immunization does not eliminate the need for careful wound management and post-exposure immunization

Avoiding risk situations for animal bites

• Thorough wound cleaning, initiated as soon as possible after exposure

Vaccination and immunoglobin (post-exposure, for all exposed people)

• It is important to consider the destination, the purpose and the duration of the trip as well as the patient’s access to healthcare and availability of rabies biologics
• For post-exposure vaccination to work, it is essential that medical expertise be available on an urgent basis

Fact: Rabies is a viral disease, which occurs in more than 150 countries and territories. Once symptoms are present, rabies is almost always fatal

Vaccine:

Rabies vaccines (Rab)

• IMOVAX^® Rabies (inactivated, human diploid cell rabies vaccine). Sanofi Pasteur Ltd. (HDCV)
• RabAvert^® (inactivated, purified chick embryo cell rabies vaccine), Novartis Vaccines and Diagnostics (manufacturer), Novartis Pharmaceuticals Canada Inc. (distributor). (PCECV)

Rabies immunoglobulins (RabIg)

• IMOGAM^® Rabies Pasteurized (rabies immunoglobulin [human]), Sanofi Pasteur Ltd.
• HYPERRAB^® (150 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.
• HyperRAB^® (300 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.*

KamRAB^TM (rabies immunoglobulin [human]), Kamada Ltd.*

Tetanus (Lockjaw)

Percutaneous – infection with Clostridium tetani introduced into the body through a scratch or wound that is contaminated with soil, animal or human feces or dust

Since tetanus is caused by a neurotoxin, it is not transmitted person-to-person

Cases – more than 10,000 reported cases worldwide in 2015 with more than 72,000 estimated deaths worldwide in <5 years reported in 2011

Symptoms – Stiffness in the jaw muscles (lockjaw), painful muscle spasms (affecting swallowing and breathing), fever, sweating, rapid heartbeat

Severe cases – suffocation, cardiac arrest, death          

The case-fatality ratio varies between 10-80% in unvaccinated cases, and its highest among infants and the elderly

Precautions against tetanus, including learning about appropriate wound care and vaccination, should be considered

Fact: Tetanus is caused by a neurotoxin produced by the bacterium Clostridium tetani. Clostridium tetani spores are widely distributed in soil worldwide and in animal intestinal tracts. Many Canadians, especially those who are older or were born outside of Canada, do not have protective concentrations of Tetanus anti-toxin

Vaccine:

Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off.

For clean, minor wounds, people who have been vaccinated in the last 10 years don’t need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot.

Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin.

Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib (Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheria-tetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

Tick-borne Encephalitis

Vector – bite from an infected tick, belonging to the family Ixodes species, particularly, Ixodes recinus and Ixodes persulcatus

Most cases occur in April through November, with peaks in early and later summer when ticks are active

Most TBE viral infections result from tick bites acquired in forested areas through activities, such as camping, hiking, fishing, bicycling and outdoor occupations

Cases – 5-13,000 cases worldwide annually. Actual number is thought to be much higher

Symptoms – fever, headache muscle pain, fatigue. Approximately 2/3 of infections are asymptomatic

Severe case – infections of the CNS leading to meningitis encephalitis and myelitis. Disease severity increases with age

Precautions against TBE, including avoiding tick bites and vaccination, should be considered

• A vaccine exists but is only available in countries where the disease is present. No TBE vaccine currently exists in Canada
• Avoid tick habitats, such as long grass
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, and closed shoes
• Carry a tick remover or find tooth tweezers
• Carefully check every day for attached ticks
• If found, remove the tick by gently gripping it as close to the skin as possible and pulling away steadily without twisting or crushing the tick. Ensure the entire tick – including head and mouthparts – is removed
• The date of the tick bite should be documented
• Wash your skin with water and soap afterwards, and apply antiseptic cream around the bite

Fact: TBE is a viral disease affecting the central nervous system

Vaccine:

A vaccine against TBE does exist but is only available in countries where the disease is present. Travelers at high risk can consult a health care provider at their destination to discuss the benefits of getting vaccinated.

Traveller’s Diarrhea

Currently there is no information available. We will add it as soon as possible.

Tuberculosis (TB)

Respiratory – person-to-person close contact with someone infected with Mycobacterium tuberculosis

Cases – 10.4 million worldwide cases in 2015

Symptoms – generally mild including persistent cough with sputum and blood, fever, chest pains, night sweats, weight loss

The majority of people infected never become symptomatic or ill and are said to have a latent tuberculosis infection. Overall, approximately 10% of those infected will ultimately develop active tuberculosis

Sever cases – if untreated, slow disease progressions, death

Precautions against TB, including avoiding people infected with TB and vaccination, should be considered:

• Discuss preventative options with a doctor for those with an immunocompromising condition
• Avoid exposure to potential TB sufferers in crowded or enclosed environments. Among specific facilities, working in hospitals in high incidence countries is associated with a particularly high risk
• Canadian travellers visiting friends and family are likely to represent a group at higher risk, perhaps due to their closer contact with the local population
• Vaccination may be considered for certain long-term travellers to high-prevalence countries in exceptional circumstances

Fact: 1 in 3 of the world’s population have been infected with the TB bacteria but have not (yet) become ill as a result (known as latent TB)

Typhoid

Fecal Oral – consumption of food or water contaminated with feces from an infected individual or chronic carrier

Cases – 21 million worldwide cases annually (estimated)

            Several studies have identified travelling children, those visiting friends and relatives, achlorhydria or use of acid suppression therapy, and longer duration of travel to be factors that increase the risk of travel associated typhoid

Symptoms – fever, fatigue, headache, abdominal pain, constipation or diarrhea (depending on age)

Severe cases – brain dysfunction, delirium, intestinal perforation, death

            The case fatality ratio is approximately 10% for untreated cases in low income setting and less than 1% for patients receiving care in high income countries

Precautions against typhoid fever, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered  

• Eat food that been thoroughly cooked and that are still hot
• Avoid raw/undercooked fruit or vegetables that cannot be peeled
• Avoid drinking tap water (including fruit drinks), as well as drinks containing ice
• Frequent hand washing

Fact: Typhoid fever is caused by Salmonella enterica serovar, which only lives in humans

Vaccine:

In Canada there are two types of vaccines recommended to prevent typhoid fever. One is an oral vaccine called Vivotif which involves capsule pills taken over the course of four doses. The other option is through injectable typhoid vaccines.

Cholera

Fecal Oral – Infection is acquired primarily by ingesting water of food contaminated with the bacterium Vibrio cholera; person-to-person transmission is not likely

Symptoms – Copious, painless, and watery diarrhea

Severe Case – A minority develop severe dehydration, which can lead to death if left untreated

Precautions against cholera, including good hygiene measures, frequent handwashing, safe eating and drinking habits and vaccination, should be considered depending on the destination, type of travel and patient profile.

Watch what you eat, drink and do

Don’t drink

• Tap water
• Drinks with ice cubes (including alcoholic beverages served or shaken with ice cubes)
• Drinks with crushed ice

Don’t eat

• Fruits that can’t be peeled
• Uncooked vegetables, including salad
• Undercooked or raw meat or fish
• Unpasteurized or unrefrigerated dairy products
• Food sold by street vendors

Fact: Cholera is an important public health problem worldwide

Vaccine:

Dukoral is the cholera vaccination currently recommended for Canadian travelers. The vaccine is administered orally in two doses: one taken up to six weeks prior to departure and the second taken at least one week before the trip. It will provide protection one week after immunization and is effective in up to 85% of cholera cases and 25% of travelers’ diarrhea cases.

The vaccination will protect against travelers’ diarrhea for up to three months and from cholera infection for up to two years. A single booster dose every three months is recommended for travelers staying in an at-risk destination for a longer time period.

Diphtheria

Respiratory – Person-to-person through close contact with someone infected with C. diphtheria, or their possessions

4,778 Cases – worldwide annually (estimated)

Symptom – Mild fever (rarely > 38.3 C), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness

Severe Case – Pseudo-membranes form in the throat, tonsils, pharynx and larynx causing a potentially fatal obstruction of the airway and breathing difficulties

Precautions against diphtheria, including good hygiene measures and vaccination, should be considered:

• Ensure diphtheria vaccinations are up-to-date or obtain a booster if travelling to endemic areas
• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms or respiratory illness
• Avoid sharing personal items such as eating/drinking utensils, toothbrushes and towels

Fact: An estimated 5-10% of people who get the infection will die from complications

Vaccine:

There are a few vaccines available depending on age and need:

• DTaP– Protects against tetanus, diphtheria and pertussis, designed for children.
• Tdap– A booster immunization designed for preteens, teens and adults.
• Td – Protects against only tetanus and diphtheria. It is a popular booster for those needing protection against just one type of infection

Hepatitis A

Fecal Oral – Ingestion or contaminated food or water, close personal or sexual contact with an infected person intravenous drug use

126 million cases – worldwide annually (estimated in 2005)

Symptoms – fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice

Sever case – in rare instanced acute liver failure that can result in death

Precautions against Hepatitis A, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered

• Personal hygiene practices, such as regular handwashing with safe water after using the toilet and before preparing food
• Exercise caution when consuming food that could have been prepared be someone with the infection who hasn’t washed their hands properly, or drinks made with contaminated water or ice cubes
• Avoid eating raw or undercooked shellfish

Fact: Recovery from the illness can take people weeks or months, leading to time absent from work, school, or daily life

Vaccine:

Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.

Hepatitis B

Percutaneous, Mucosal, Sexual – person-to-person through close contact with someone infected with Hepatitis B, or their possessions, as well as intravenous drug use

240 million cases – globally are chronically infected

Symptom – Jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain

Severe Case – Acute liver failure (which can result in death), cirrhosis of the liver, liver cancer

Precautions against Hepatitis B, including safe injection techniques, safe sex practices and vaccination, should be considered:

• Practice safe injection and avoid needle-stick ‘risk’ situations, such as getting tattoos or body piercings
• Practice safer sex (including using condoms and minimizing the number of partners)
• Avoid sharing personal items that could be infected with blood, such as toothbrushes and razors

Fact: More than 686,000 people die every year due to complications of Hepatitis B, including cirrhosis and liver cancer

Vaccine:

A hepatitis B vaccine is the best form of protection against the virus. The injectable vaccine provides lifelong protection, if boosters are completed. Five different version of the vaccine are available in Canada, all of which are very safe.

Malaria

Vector – bite from a female Anopheles mosquito infected with malaria parasites called Plasmodium. There are different types of Plasmodium parasites that can cause malaria: falciparum, vivax, ovale, malariae, and knowlesi.

Cases – 214 million cases annually

Symptoms – Fever, headache, chills vomiting

Symptoms usually appear between 7 – 18 days, but can also take up to a year to develop

Severe case – seizures, mental confusion, kidney failure, acute respiratory distress syndrome, coma, and death

The most important factors determining patient survival are early diagnosis and appropriate therapy

Involves several steps, known as the A, B, C, D of malaria prevention

• Awareness of the risk before travelling
• Bite prevention
  • Take preventative measures when mosquitos are most active, particularly from sunset to sunrise
  • Use a recommended insect repellent containing either Icaridin (20%) or DEET
  • Wear appropriate clothing (long sleeved shirt, long pants)
  • Use physical barriers, such as bed nets and window screens
• Check whether chemoprophylaxis is needed (use appropriate malaria prevention tablets)
• Diagnosis (seek immediate medical attention if displaying symptoms)

Fact: In 2015, nearly half of the world’s population – 3.2 billion people – was at risk of malaria.

Vaccine:

There is currently no commercially available malaria vaccine

Meningococcal Meningitis

Respiratory – person-to-person through droplets of respiratory or throat secretions from someone infected with N. meningitidis, or their possessions

Close and prolonged contact, such as:

• Kissing, sneezing or coughing on someone
• Living in close quarters, such as dormitory, or sharing eating/drinking utensils with an infected person

Cases – it is believed that 10-20% of the population carry the bacteria in their throat at any given times

Symptoms – stiff neck, high fever, sensitivity to light, confusion, headaches, vomiting

Severe Cases – brain damage, blood poisoning, hearing loss, rash, amputation, learning disability in 10-20% of survivors, death

Precautions against meningococcal meningitis, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered

• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms of respiratory illness
• Avoid sharing personal items such as eating/drinking utensils and toothbrushes

Fact: Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the ting lining that surrounds the brain and spinal cord. The extended meningitis belt of sub-Saharan Africa stretches from Senegal in the West to Ethiopia in the east. Group A meningococcus accounts for the majority of cases of meningococcal meningitis in the meningitis belt.

Vaccine:

Available

Polio

Fecal Oral – transmitted from person-to-person, primarily through the fecal-oral route and less frequently through close personal contact with infected respiratory secretions or saliva

Cases – 72 cases reported in 2 endemic countries in 2015

Symptoms – fever, fatigue, headache, vomiting, stiffness of the neck, pain in the limbs

Severe cases – paralysis (in the legs, muscles used for breathing), death

Precautions against polio, including good hygiene measures and vaccination, should be considered.

• Travellers should practice good hygiene measures, including frequent hand washing
• Travellers with unimmunized infants/children should be advised to seriously consider delaying travel to endemic areas, ideally until full immunization have been obtained

Fact: Polio is a highly infectious disease, viral disease. Although polio is asymptomatic in the majority of cases, in approximately 1% of cases, it attacks the central nervous systems and leads to paralysis. Canada was declared free of wild poliovirus in 1994 by WHO. There is still a risk to travellers going to regions outside those in which polio has been eliminated

Vaccine:

Poliomyelitis vaccines used in Canada contain three types of wild poliovirus and are available as trivalent inactivated polio vaccines (IPV) or in combination vaccines.

• Routine immunization of children is recommended at 2, 4, and 18 months of age with a booster dose at 4-6 years of age. It is also acceptable to give an additional dose of IPV at 6 months of age for convenience of administration in combination with DTap and Hib.
• Similar to vaccination of children, vaccination of adults is recommended to prevent the introduction and circulation of polio.

Primary immunization for non-immune adults and a booster is recommended for adults travelling to epidemic or endemic areas or for those with other exposure risks

Rabies

Percutaneous – bite or scratch from an infected animal, including bats, foxes, monkeys and other free roaming animals. Dogs are the source of the vast majority of human rabies death.

Cases – 55,000 deaths (vast majority occurring in rural areas of Africa and Asia) worldwide annually

Symptoms – Fever, wound site pain, unusual tingling pricking or burning sensation around the wound site

Severe Cases – Inflammation of the brain and spinal cord, hyperactivity, hydrophobia, loss of consciousness, death

Precautions against rabies, including avoiding animal bites and vaccination (pre-exposure for travellers to endemic areas), should be considered

• Pre-exposure immunization does not eliminate the need for careful wound management and post-exposure immunization

Avoiding risk situations for animal bites

• Thorough wound cleaning, initiated as soon as possible after exposure

Vaccination and immunoglobin (post-exposure, for all exposed people)

• It is important to consider the destination, the purpose and the duration of the trip as well as the patient’s access to healthcare and availability of rabies biologics
• For post-exposure vaccination to work, it is essential that medical expertise be available on an urgent basis

Fact: Rabies is a viral disease, which occurs in more than 150 countries and territories. Once symptoms are present, rabies is almost always fatal

Vaccine:

Rabies vaccines (Rab)

• IMOVAX^® Rabies (inactivated, human diploid cell rabies vaccine). Sanofi Pasteur Ltd. (HDCV)
• RabAvert^® (inactivated, purified chick embryo cell rabies vaccine), Novartis Vaccines and Diagnostics (manufacturer), Novartis Pharmaceuticals Canada Inc. (distributor). (PCECV)

Rabies immunoglobulins (RabIg)

• IMOGAM^® Rabies Pasteurized (rabies immunoglobulin [human]), Sanofi Pasteur Ltd.
• HYPERRAB^® (150 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.
• HyperRAB^® (300 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.*

KamRAB^TM (rabies immunoglobulin [human]), Kamada Ltd.*

Tetanus (Lockjaw)

Percutaneous – infection with Clostridium tetani introduced into the body through a scratch or wound that is contaminated with soil, animal or human feces or dust

Since tetanus is caused by a neurotoxin, it is not transmitted person-to-person

Cases – more than 10,000 reported cases worldwide in 2015 with more than 72,000 estimated deaths worldwide in <5 years reported in 2011

Symptoms – Stiffness in the jaw muscles (lockjaw), painful muscle spasms (affecting swallowing and breathing), fever, sweating, rapid heartbeat

Severe cases – suffocation, cardiac arrest, death          

The case-fatality ratio varies between 10-80% in unvaccinated cases, and its highest among infants and the elderly

Precautions against tetanus, including learning about appropriate wound care and vaccination, should be considered

Fact: Tetanus is caused by a neurotoxin produced by the bacterium Clostridium tetani. Clostridium tetani spores are widely distributed in soil worldwide and in animal intestinal tracts. Many Canadians, especially those who are older or were born outside of Canada, do not have protective concentrations of Tetanus anti-toxin

Vaccine:

Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off.

For clean, minor wounds, people who have been vaccinated in the last 10 years don’t need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot.

Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin.

Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib (Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheria-tetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

Traveller’s Diarrhea

Currently there is no information available. We will add it as soon as possible.

Tuberculosis (TB)

Respiratory – person-to-person close contact with someone infected with Mycobacterium tuberculosis

Cases – 10.4 million worldwide cases in 2015

Symptoms – generally mild including persistent cough with sputum and blood, fever, chest pains, night sweats, weight loss

The majority of people infected never become symptomatic or ill and are said to have a latent tuberculosis infection. Overall, approximately 10% of those infected will ultimately develop active tuberculosis

Sever cases – if untreated, slow disease progressions, death

Precautions against TB, including avoiding people infected with TB and vaccination, should be considered:

• Discuss preventative options with a doctor for those with an immunocompromising condition
• Avoid exposure to potential TB sufferers in crowded or enclosed environments. Among specific facilities, working in hospitals in high incidence countries is associated with a particularly high risk
• Canadian travellers visiting friends and family are likely to represent a group at higher risk, perhaps due to their closer contact with the local population
• Vaccination may be considered for certain long-term travellers to high-prevalence countries in exceptional circumstances

Fact: 1 in 3 of the world’s population have been infected with the TB bacteria but have not (yet) become ill as a result (known as latent TB)

Typhoid

Fecal Oral – consumption of food or water contaminated with feces from an infected individual or chronic carrier

Cases – 21 million worldwide cases annually (estimated)

            Several studies have identified travelling children, those visiting friends and relatives, achlorhydria or use of acid suppression therapy, and longer duration of travel to be factors that increase the risk of travel associated typhoid

Symptoms – fever, fatigue, headache, abdominal pain, constipation or diarrhea (depending on age)

Severe cases – brain dysfunction, delirium, intestinal perforation, death

            The case fatality ratio is approximately 10% for untreated cases in low income setting and less than 1% for patients receiving care in high income countries

Precautions against typhoid fever, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered  

• Eat food that been thoroughly cooked and that are still hot
• Avoid raw/undercooked fruit or vegetables that cannot be peeled
• Avoid drinking tap water (including fruit drinks), as well as drinks containing ice
• Frequent hand washing

Fact: Typhoid fever is caused by Salmonella enterica serovar, which only lives in humans

Vaccine:

In Canada there are two types of vaccines recommended to prevent typhoid fever. One is an oral vaccine called Vivotif which involves capsule pills taken over the course of four doses. The other option is through injectable typhoid vaccines.

Yellow Fever

Vector – bite from an infected mosquito, primarily Aedes or Haemagogus species

Cases – based on a modelling study, up to 170,000 severe cases worldwide (estimated in 2013)

Symptoms – fever, muscle pain with prominent backache, headache, chills, loss of appetite, nausea or vomiting

            Most patients improve after the initial presentation. After a brief remission of hours to a day, approximately 15% of patients progress to a more serious of toxic form of the disease

Severe cases – high fever, with the liver and kidneys affected, jaundice, dark urine, abdominal pain with vomiting, bleeding from the mouth, nose eyes or stomach, and eventually shock and multisystem organ failure

Precautions against yellow fever, including avoiding mosquito bites and vaccination, should be considered

• Vaccination
• Vaccination certification may be required depending on destination
• Take preventative measures when mosquitoes are most active (during daylight hours)
• All diagnosis of yellow fever made in Canada are required to be reported to public health authorities
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)
• Use physical barriers, such as bed nets and window screens
• Infected patients should be protected from further mosquito exposure during the first few days of illness to avoid contributing to the transmission cycle

Fact: Yellow fever refers to the jaundice that affects some patients. Is an endemic and intermittently epidemic in parts of Africa and South America. 20-50% of people who experience a severe case may die as a result

Vaccine:

• In Canada, the vaccine is available only at designated centers.
• The single-dose vaccine against yellow fever is safe, effective and recommended for most people who are over nine months of age.
• The vaccine is generally not recommended for pregnant or breastfeeding women, children under the age of nine months, adults 60 years and older (especially those who have not previously received the vaccine) and people with weakened immune systems.
• If you are receiving the vaccine for the first time, be aware that it takes ten days for it to become effective (the International Certificate of Vaccination or Prophylaxis will only be valid ten days after the date of vaccination).

Cholera

Fecal Oral – Infection is acquired primarily by ingesting water of food contaminated with the bacterium Vibrio cholera; person-to-person transmission is not likely

Symptoms – Copious, painless, and watery diarrhea

Severe Case – A minority develop severe dehydration, which can lead to death if left untreated

Precautions against cholera, including good hygiene measures, frequent handwashing, safe eating and drinking habits and vaccination, should be considered depending on the destination, type of travel and patient profile.

Watch what you eat, drink and do

Don’t drink

• Tap water
• Drinks with ice cubes (including alcoholic beverages served or shaken with ice cubes)
• Drinks with crushed ice

Don’t eat

• Fruits that can’t be peeled
• Uncooked vegetables, including salad
• Undercooked or raw meat or fish
• Unpasteurized or unrefrigerated dairy products
• Food sold by street vendors

Fact: Cholera is an important public health problem worldwide

Vaccine:

Dukoral is the cholera vaccination currently recommended for Canadian travelers. The vaccine is administered orally in two doses: one taken up to six weeks prior to departure and the second taken at least one week before the trip. It will provide protection one week after immunization and is effective in up to 85% of cholera cases and 25% of travelers’ diarrhea cases.

The vaccination will protect against travelers’ diarrhea for up to three months and from cholera infection for up to two years. A single booster dose every three months is recommended for travelers staying in an at-risk destination for a longer time period.

Diphtheria

Respiratory – Person-to-person through close contact with someone infected with C. diphtheria, or their possessions

4,778 Cases – worldwide annually (estimated)

Symptom – Mild fever (rarely > 38.3 C), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness

Severe Case – Pseudo-membranes form in the throat, tonsils, pharynx and larynx causing a potentially fatal obstruction of the airway and breathing difficulties

Precautions against diphtheria, including good hygiene measures and vaccination, should be considered:

• Ensure diphtheria vaccinations are up-to-date or obtain a booster if travelling to endemic areas
• Regular and thorough hand hygiene
• Minimize contact with people showing symptoms or respiratory illness
• Avoid sharing personal items such as eating/drinking utensils, toothbrushes and towels

Fact: An estimated 5-10% of people who get the infection will die from complications

Vaccine:

There are a few vaccines available depending on age and need:

• DTaP– Protects against tetanus, diphtheria and pertussis, designed for children.
• Tdap– A booster immunization designed for preteens, teens and adults.
• Td – Protects against only tetanus and diphtheria. It is a popular booster for those needing protection against just one type of infection

Hepatitis A

Fecal Oral – Ingestion or contaminated food or water, close personal or sexual contact with an infected person intravenous drug use

126 million cases – worldwide annually (estimated in 2005)

Symptoms – fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice

Sever case – in rare instanced acute liver failure that can result in death

Precautions against Hepatitis A, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered

• Personal hygiene practices, such as regular handwashing with safe water after using the toilet and before preparing food
• Exercise caution when consuming food that could have been prepared be someone with the infection who hasn’t washed their hands properly, or drinks made with contaminated water or ice cubes
• Avoid eating raw or undercooked shellfish

Fact: Recovery from the illness can take people weeks or months, leading to time absent from work, school, or daily life

Vaccine:

Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.

Hepatitis B

Percutaneous, Mucosal, Sexual – person-to-person through close contact with someone infected with Hepatitis B, or their possessions, as well as intravenous drug use

240 million cases – globally are chronically infected

Symptom – Jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain

Severe Case – Acute liver failure (which can result in death), cirrhosis of the liver, liver cancer

Precautions against Hepatitis B, including safe injection techniques, safe sex practices and vaccination, should be considered:

• Practice safe injection and avoid needle-stick ‘risk’ situations, such as getting tattoos or body piercings
• Practice safer sex (including using condoms and minimizing the number of partners)
• Avoid sharing personal items that could be infected with blood, such as toothbrushes and razors

Fact: More than 686,000 people die every year due to complications of Hepatitis B, including cirrhosis and liver cancer

Vaccine:

A hepatitis B vaccine is the best form of protection against the virus. The injectable vaccine provides lifelong protection, if boosters are completed. Five different version of the vaccine are available in Canada, all of which are very safe.

Japanese Encephalitis

Vector – Bite from an infected mosquito, primarily Culex species

Cases – 67,900 worldwide annually

Symptoms – fever, chills, headache, muscle pain, mental confusion, spasms in the back and spine, muscle weakness

Severe case – Long-term neurologic, psychosocial, intellectual and/or physical disabilities in about 30-50% of survivors of severe cases; death

Precautions against JE, including avoiding mosquito bites and vaccination, should be considered:

• Take preventative measures when mosquitos are most active, particularly from sunset to sunrise
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Wear appropriate clothing (long sleeved shirt, long pants)

Fact: JE virus is the most important cause of viral encephalitis in Asia. Usually asymptomatic; however, when clinical disease develops, the case-fatality ratio is 20-30% and 30-50% of survivors of severe cases will continue to have neurologic, cognitive or psychiatric symptoms

Vaccine:

IXIARO^®: inactivated, Japanese encephalitis vaccine, Vero cell culture-derived, adsorbed. Intercell AG (manufacturer), Novartis Pharmaceuticals Canada Inc.(distributor) (JE)

Malaria

Vector – bite from a female Anopheles mosquito infected with malaria parasites called Plasmodium. There are different types of Plasmodium parasites that can cause malaria: falciparum, vivax, ovale, malariae, and knowlesi.

Cases – 214 million cases annually

Symptoms – Fever, headache, chills vomiting

Symptoms usually appear between 7 – 18 days, but can also take up to a year to develop

Severe case – seizures, mental confusion, kidney failure, acute respiratory distress syndrome, coma, and death

The most important factors determining patient survival are early diagnosis and appropriate therapy

Involves several steps, known as the A, B, C, D of malaria prevention

• Awareness of the risk before travelling
• Bite prevention
  • Take preventative measures when mosquitos are most active, particularly from sunset to sunrise
  • Use a recommended insect repellent containing either Icaridin (20%) or DEET
  • Wear appropriate clothing (long sleeved shirt, long pants)
  • Use physical barriers, such as bed nets and window screens
• Check whether chemoprophylaxis is needed (use appropriate malaria prevention tablets)
• Diagnosis (seek immediate medical attention if displaying symptoms)

Fact: In 2015, nearly half of the world’s population – 3.2 billion people – was at risk of malaria.

Vaccine:

There is currently no commercially available malaria vaccine

Polio

Fecal Oral – transmitted from person-to-person, primarily through the fecal-oral route and less frequently through close personal contact with infected respiratory secretions or saliva

Cases – 72 cases reported in 2 endemic countries in 2015

Symptoms – fever, fatigue, headache, vomiting, stiffness of the neck, pain in the limbs

Severe cases – paralysis (in the legs, muscles used for breathing), death

Precautions against polio, including good hygiene measures and vaccination, should be considered.

• Travellers should practice good hygiene measures, including frequent hand washing
• Travellers with unimmunized infants/children should be advised to seriously consider delaying travel to endemic areas, ideally until full immunization have been obtained

Fact: Polio is a highly infectious disease, viral disease. Although polio is asymptomatic in the majority of cases, in approximately 1% of cases, it attacks the central nervous systems and leads to paralysis. Canada was declared free of wild poliovirus in 1994 by WHO. There is still a risk to travellers going to regions outside those in which polio has been eliminated

Vaccine:

Poliomyelitis vaccines used in Canada contain three types of wild poliovirus and are available as trivalent inactivated polio vaccines (IPV) or in combination vaccines.

• Routine immunization of children is recommended at 2, 4, and 18 months of age with a booster dose at 4-6 years of age. It is also acceptable to give an additional dose of IPV at 6 months of age for convenience of administration in combination with DTap and Hib.
• Similar to vaccination of children, vaccination of adults is recommended to prevent the introduction and circulation of polio.

Primary immunization for non-immune adults and a booster is recommended for adults travelling to epidemic or endemic areas or for those with other exposure risks

Rabies

Percutaneous – bite or scratch from an infected animal, including bats, foxes, monkeys and other free roaming animals. Dogs are the source of the vast majority of human rabies death.

Cases – 55,000 deaths (vast majority occurring in rural areas of Africa and Asia) worldwide annually

Symptoms – Fever, wound site pain, unusual tingling pricking or burning sensation around the wound site

Severe Cases – Inflammation of the brain and spinal cord, hyperactivity, hydrophobia, loss of consciousness, death

Precautions against rabies, including avoiding animal bites and vaccination (pre-exposure for travellers to endemic areas), should be considered

• Pre-exposure immunization does not eliminate the need for careful wound management and post-exposure immunization

Avoiding risk situations for animal bites

• Thorough wound cleaning, initiated as soon as possible after exposure

Vaccination and immunoglobin (post-exposure, for all exposed people)

• It is important to consider the destination, the purpose and the duration of the trip as well as the patient’s access to healthcare and availability of rabies biologics
• For post-exposure vaccination to work, it is essential that medical expertise be available on an urgent basis

Fact: Rabies is a viral disease, which occurs in more than 150 countries and territories. Once symptoms are present, rabies is almost always fatal

Vaccine:

Rabies vaccines (Rab)

• IMOVAX^® Rabies (inactivated, human diploid cell rabies vaccine). Sanofi Pasteur Ltd. (HDCV)
• RabAvert^® (inactivated, purified chick embryo cell rabies vaccine), Novartis Vaccines and Diagnostics (manufacturer), Novartis Pharmaceuticals Canada Inc. (distributor). (PCECV)

Rabies immunoglobulins (RabIg)

• IMOGAM^® Rabies Pasteurized (rabies immunoglobulin [human]), Sanofi Pasteur Ltd.
• HYPERRAB^® (150 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.
• HyperRAB^® (300 IU/mL, rabies immunoglobulin [human]), Grifols Therapeutics LLC.*

KamRAB^TM (rabies immunoglobulin [human]), Kamada Ltd.*

Tetanus (Lockjaw)

Percutaneous – infection with Clostridium tetani introduced into the body through a scratch or wound that is contaminated with soil, animal or human feces or dust

Since tetanus is caused by a neurotoxin, it is not transmitted person-to-person

Cases – more than 10,000 reported cases worldwide in 2015 with more than 72,000 estimated deaths worldwide in <5 years reported in 2011

Symptoms – Stiffness in the jaw muscles (lockjaw), painful muscle spasms (affecting swallowing and breathing), fever, sweating, rapid heartbeat

Severe cases – suffocation, cardiac arrest, death          

The case-fatality ratio varies between 10-80% in unvaccinated cases, and its highest among infants and the elderly

Precautions against tetanus, including learning about appropriate wound care and vaccination, should be considered

Fact: Tetanus is caused by a neurotoxin produced by the bacterium Clostridium tetani. Clostridium tetani spores are widely distributed in soil worldwide and in animal intestinal tracts. Many Canadians, especially those who are older or were born outside of Canada, do not have protective concentrations of Tetanus anti-toxin

Vaccine:

Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off.

For clean, minor wounds, people who have been vaccinated in the last 10 years don’t need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot.

Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin.

Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib (Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheria-tetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

Tick-borne Encephalitis (TBE)

Vector – bite from an infected tick, belonging to the family Ixodes species, particularly, Ixodes recinus and Ixodes persulcatus

Most cases occur in April through November, with peaks in early and later summer when ticks are active

Most TBE viral infections result from tick bites acquired in forested areas through activities, such as camping, hiking, fishing, bicycling and outdoor occupations

Cases – 5-13,000 cases worldwide annually. Actual number is thought to be much higher

Symptoms – fever, headache muscle pain, fatigue. Approximately 2/3 of infections are asymptomatic

Severe case – infections of the CNS leading to meningitis encephalitis and myelitis. Disease severity increases with age

Precautions against TBE, including avoiding tick bites and vaccination, should be considered

• A vaccine exists but is only available in countries where the disease is present. No TBE vaccine currently exists in Canada
• Avoid tick habitats, such as long grass
• Use a recommended insect repellent containing either Icaridin (20%) or DEET
• Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, and closed shoes
• Carry a tick remover or find tooth tweezers
• Carefully check every day for attached ticks
• If found, remove the tick by gently gripping it as close to the skin as possible and pulling away steadily without twisting or crushing the tick. Ensure the entire tick – including head and mouthparts – is removed
• The date of the tick bite should be documented
• Wash your skin with water and soap afterwards, and apply antiseptic cream around the bite

Fact: TBE is a viral disease affecting the central nervous system

Vaccine:

A vaccine against TBE does exist but is only available in countries where the disease is present. Travelers at high risk can consult a health care provider at their destination to discuss the benefits of getting vaccinated.

Traveller’s Diarrhea

Currently there is no information available. We will add it as soon as possible.

Tuberculosis (TB)

Respiratory – person-to-person close contact with someone infected with Mycobacterium tuberculosis

Cases – 10.4 million worldwide cases in 2015

Symptoms – generally mild including persistent cough with sputum and blood, fever, chest pains, night sweats, weight loss

The majority of people infected never become symptomatic or ill and are said to have a latent tuberculosis infection. Overall, approximately 10% of those infected will ultimately develop active tuberculosis

Sever cases – if untreated, slow disease progressions, death

Precautions against TB, including avoiding people infected with TB and vaccination, should be considered:

• Discuss preventative options with a doctor for those with an immunocompromising condition
• Avoid exposure to potential TB sufferers in crowded or enclosed environments. Among specific facilities, working in hospitals in high incidence countries is associated with a particularly high risk
• Canadian travellers visiting friends and family are likely to represent a group at higher risk, perhaps due to their closer contact with the local population
• Vaccination may be considered for certain long-term travellers to high-prevalence countries in exceptional circumstances

Fact: 1 in 3 of the world’s population have been infected with the TB bacteria but have not (yet) become ill as a result (known as latent TB)

Typhoid

Fecal Oral – consumption of food or water contaminated with feces from an infected individual or chronic carrier

Cases – 21 million worldwide cases annually (estimated)

            Several studies have identified travelling children, those visiting friends and relatives, achlorhydria or use of acid suppression therapy, and longer duration of travel to be factors that increase the risk of travel associated typhoid

Symptoms – fever, fatigue, headache, abdominal pain, constipation or diarrhea (depending on age)

Severe cases – brain dysfunction, delirium, intestinal perforation, death

            The case fatality ratio is approximately 10% for untreated cases in low income setting and less than 1% for patients receiving care in high income countries

Precautions against typhoid fever, including good hygiene measures, safe eating and drinking habits and vaccination, should be considered  

• Eat food that been thoroughly cooked and that are still hot
• Avoid raw/undercooked fruit or vegetables that cannot be peeled
• Avoid drinking tap water (including fruit drinks), as well as drinks containing ice
• Frequent hand washing

Fact: Typhoid fever is caused by Salmonella enterica serovar, which only lives in humans

Vaccine:

In Canada there are two types of vaccines recommended to prevent typhoid fever. One is an oral vaccine called Vivotif which involves capsule pills taken over the course of four doses. The other option is through injectable typhoid vaccines.