(This advisory has been produced by
the Public Health Agency of Canada. Further information on travel to
South East Asia can be found by contacting the Department of Foreign
Affairs at http://www.voyage.gc.ca  )
General Health Precautions Following
Earthquake and Tsunami Activity in Southeast Asia
Released: December 31,
2004
The Public Health Agency of Canada is closely monitoring the potential
for diarrheal diseases and other communicable disease outbreaks in the
aftermath of the recent earthquake and tsunami activity affecting Sri
Lanka, southern India, Indonesia, Thailand, Malaysia, and the Maldives.
Coastal areas of Bangladesh, Burma (Myanmar), Mauritius and Somalia,
Kenya, the Seychelles and Tanzania have also been affected. The effects
of the earthquake have caused sewage systems to overflow, and rivers
or open well waters to become contaminated. Drinkable water is unavailable
in many areas.
At this time, Canadians travelling to the affected areas listed above
should expect that the risks of exposure to water-borne diseases such
as traveller's diarrhea, typhoid, and cholera,
and to food-borne diseases is increased at this time.
Intestinal infections caused by bacteria, parasites, or viruses transmitted
from contaminated food or water can cause travellers diarrhea. Bacteria
are the most common cause of gastrointestinal illness. The most common
causes include Escherichia coli, Campylobacter jejuni, Salmonella
species and Shigella species. Less common bacteria include the Aeromonas,
Plesiomonas and Yersinia species and non-cholera vibrio species
and rarely the Vibrio cholerae species.
Parasites that cause acute diarrhea in travellers include Giardia lamblia,
Entamoeba histolytica and cryptosporidium among others. Norwalk virus
(NV) and Norwalk-like viruses (NLV) are common causes of viral gastroenteritis
with outbreaks generally occurring where people congregate in close quarters
for extended periods.
There may also be an increased risk of insect-borne diseases such as
malaria, dengue fever and japanese encephalitis in the post-flooding
period. Dengue occurs in all countries affected by the earthquake and
is found predominately in urban and surrounding areas. Except for the
Maldives, Malaria is known to occur in the following either all regions
or some regions within the affected countries of India, Sri Lanka, Indonesia,
Thailand, Malaysia, Bangladesh, Burma (Myanmar), Mauritius, and Somalia.
Outbreaks of leptospirosis, a communicable disease acquired through
contact with the urine of infected animals, may also occur. Contact may
occur through swimming, accidental or occupational immersion, or through
direct contact with urine or tissues of infected animals.
Recommendations
The Public Health Agency of Canada strongly recommends that Canadian
international travellers seek the advice of their personal physician
or travel clinic prior to travel for an individual risk assessment to
determine their individual health risks and their need for vaccination,
preventative medication and personal protective measures.
Travellers should ensure that their routine (childhood) immunizations
- including diphtheria, whooping cough (pertussis), tetanus, polio, measles,
mumps and rubella - are up to date. Vaccination against influenza should
be considered for travellers at high risk for influenza complications
and for those traveling to Thailand where human cases of avian influenza
have occurred.
Immunizations to prevent typhoid and hepatitis A are recommended for
travellers to areas affected by the earthquake as a result of the current
poor sanitary conditions. The risk of acquiring cholera is very low if
food and water precautions are observed. Cholera vaccines are available
but they are not recommended for the prevention of cholera in the majority
of travellers to endemic areas.
Preventing malaria in travellers includes personal protective measures
to reduce the risk of mosquito bites, as well as the appropriate use
of antimalarial medications.
Given the magnitude of this natural disaster and the anticipated potential
adverse health affects, travellers should be especially diligent with
food and water precautions. For regions with increased mosquito activity,
insect precautions should be taken as well.
General Food and Water Precautions:
- Eat only food that has been well-cooked and is still hot when served.
- Drink only purified water that has been boiled or disinfected with
chlorine or iodine, or commercially bottled water in sealed containers.
- Avoid ice, unless it has been made with purified water.
- Avoid uncooked foods. Fruit and vegetables that can be peeled are
usually safe.
- Wash hands before eating or drinking!!
IF YOU GET DIARRHEA
Should you develop nausea, stomach cramps, diarrhea or vomiting during
travel or after returning, you should seek medical attention if the symptoms
persist longer than 48 hours, or if there is bloody diarrhea. Be sure
to tell the physician where you were travelling and the foods/beverages
that you consumed.
Most cases of traveller's diarrhea are self-limiting and clear up in
a few days. Be sure to drink more fluids (bottled water or boiled water,
or weak tea if still travelling) as soon as diarrhea starts. The antidiarrheal
drug, Imodium (loperamide HCL), may be used BY ADULTS for short
term relief of symptoms. It is not recommended for use in children under
12 years of age.
Use of antibiotics (such as ciprofloxacin, cotrimoxazole, doxycycline,
or tetracycline) as a preventative measure is not recommended; however,
they may be prescribed by a travel medicine clinic for use should diarrhea
develop in a location where medical help is not available .
Personal Measures to Avoid Mosquitoes
Female Anopheles mosquitoes bite mainly during the evening
and night. Using personal insect protective measures will reduce your
risk of being bitten by these mosquitoes.
- stay in well-screened or completely enclosed, air-conditioned accommodation;
- sleep under insecticide-treated bed nets;
- wear clothing that reduces the amount of exposed skin; wear long-sleeved
shirts (tightly weaved material, sleeves down, buttoned/zipped up,
tucked into pants) and long pants (tucked into socks or footwear);
light-coloured clothing may be less attractive to some mosquitoes and
make mosquitoes more noticeable;
- use DEET-based products as repellents on exposed skin.
The higher the concentration of DEET in the repellent formulation,
the longer the duration of protection. However, this relation reaches
a plateau at about 30% to 35%. DEET formulations that are "extended
duration" (ED), such as polymers, are generally considered to
provide longer protection times, and may be associated with less DEET
absorption. Formulations over 30% are not currently available in Canada,
although they are available internationally, including in the United
States. It should be noted, however, that products sold outside Canada
have not been evaluated by Health Canada. Most repellents containing "natural" products
are effective for shorter durations than DEET and for this reason are
not considered the preferred products for protecting against mosquito
bites.
Regulatory agencies in western nations may differ regarding the recommended
maximum concentration and application rates of DEET, especially for children.
The Committee to Advise on Tropical Medicine and Travel (CATMAT) is satisfied
that, for travel outside of Canada where the risk of malaria outweighs
the risk of any important adverse reaction to DEET, the threshold for
use of DEET should be low.
CATMAT recommends that concentrations of DEET up to 35% can be used
by any age group.
For children, alternative personal protective measures,
such as mosquito nets treated with insecticide, should be the first line
of defense, especially for infants less than 6 months of age. Portable
mosquito nets, including self-standing nets, placed over a car seat,
a crib, playpen, or stroller help protect against mosquitoes. However,
as a complement to the other methods of protection, the judicious use
of DEET should be considered for children of any age. Recent medical
literature from Canada suggests that DEET does not pose a significant
or substantial extra risk to infants and children. DEET/sunscreen combination
products are not generally recommended, because DEET can decrease the
efficacy of sunscreens. As well, sunscreens should be used liberally
and often while DEET should be used sparingly and only as often as required.
If application of both is necessary, the Canadian Dermatology Association
recommends that the sunscreen be applied first and allowed to penetrate
the skin for 20 minutes, prior to applying DEET.
Prevention of leptospirosis is best achieved by avoiding contact with
potentially contaminated water. Canadian travellers who may be at high
risk because of their activities at the site of the earthquake should
discuss with a physician the appropriate preventative medication should
this be a risk.
Canadian travellers are reminded to practice heightened personal hygiene
including good hand-washing practices. Using soap and hot water and lathering
for at least 20 seconds is the single most important procedure for preventing
infections. This is because disease-causing micro-organisms can frequently
be found on the hands. Alternatively, travellers can use waterless, alcohol-based
antiseptic hand rinses.
Canadian travellers should also be aware of the increased potential
for injury at sites affected by natural disasters. Debris, downed power
lines, structural and electrical damage to buildings, gas leaks, and
damage to infrastructure contain many hazards. The most common injury
following disasters is cut feet. Travellers should wear protective clothing
and sturdy shoes. Travellers who do become injured should seek prompt
medical attention as injuries are prone to infection in such conditions.
Travellers are advised that health care services may be limited in
affected areas due to disaster relief efforts. Hospitals and outpatient
clinics may have been destroyed or severely damaged; facilities that
are operational may be overwhelmed and medical supplies depleted. Evacuation
for travellers requiring medical attention may be required. Canadian
travellers with pre-existing medical conditions should consult with their
physicians as they may not be able to access medical care at this time.
The Public Health Agency of Canada recommends as well that travellers
who become sick or feel unwell on their return to Canada should seek
a medical assessment with their personal physician. Travellers should
inform their physician, without being asked, that they have been travelling
or living outside of Canada, and where they have been.
For More Information on:
General Travel Health
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