1. POLICY FOR TRAVELLER

3. World Flight Tracking (08/06/2015)

4. Indonesia Flight Tracking (08/06/2015)

5. 2014 Ebola Outbreak Reported Cases (Suspected, Probable, and Confirmed) in Guinea, Liberia, and Sierra Leone
This graph shows the total reported cases (suspected, probable, and confirmed) in Guinea, Liberia, and Sierra Leone provided in WHO situation reports beginning on March 25, 2014, through the most recent situation report on June 3, 2015. 5

6. Total Cases (Suspected, Probable, and Confirmed)
EVD Cases and Deaths*
Reporting Date
Total Cases (Suspected, Probable, and Confirmed)
Confirmed Cases
Total Deaths
Guinea
4 June 15
3,657
3,227
2,431
Liberia**
9 May 15
10,666
3,151
4,806
Sierra Leone
12,850
8,623
3,912
Italy
20 May 15 1
United Kingdom***
29 Dec 14
Nigeria***
15 Oct 14 20 19 8
Spain***
27 Oct 14
Senegal***
United States***
24 Oct 14 4
Mali***
23 Nov 14 7 6
TOTAL
27,076
15,010
11,155
Updated case counts available at
* Total cases include probable, suspected, and confirmed cases. Reported by WHO using data from ministries of health
**One case of Ebola was confirmed on March 20, No cases of Ebola were identified during 21 days of monitoring of contacts of this case. WHO declared the end of the Ebola outbreak in Liberia on May 9, 2015, after 42 days (two incubation periods) had passed since the last Ebola patient was buried. Public health authorities are maintaining active surveillance so that any new cases of Ebola are rapidly identified.
***There are currently no Ebola cases in Senegal, Nigeria, Spain, the United States, the United Kingdom, and Mali. 6

8. What Is Middle East Respiratory Syndrome (MERS)?
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness.
MERS is caused by a coronavirus called Middle East Respiratory Syndrome Coronavirus.
MERS-CoV was first reported in 2012 in Saudi Arabia.
Source: NBC News

9. Where Did MERS - CoV Come From…
At this time, it is unclear where the virus developed.
MERS-CoV most likely came from an animal
source.
In addition to humans, it has been found in camels in Qatar, Egypt and Saudi Arabia, and in a bat in Saudi Arabia. (CDC)
Camels in a few other countries have also tested positive for antibodies to MERS-CoV which means they were previously infected with MERS-CoV or a closely related virus.

10. How Is MERS-CoV Transmitted…
MERS-CoV is transmitted by water droplets that are expelled from the lungs when a person breathes, coughs or sneezes.
MERS-CoV has been shown to be transmitted by close contact with a person who is infected with the virus.
A close contact to the ill person includes:
Health care provider providing care to an ill patient.
Family member who is taking care of the ill person at home.
Anyone who visited the person when the person was ill.
A person who has traveled with the ill person within the past 14 days.

11. Am I At Risk For Developing MERS-CoV...
The groups at highest risk for developing MERS-CoV are:
Infants/Children
Elderly
People with immune system problems
Chronic Heart, Lung and Kidney problems
Pregnant women
People with Diabetes
A person who has traveled to one of the locations that has had confirmed lab tests that are positive for MERS-CoV.

12. What Are The Symptoms…
Most people with MERS-CoV develop respiratory illness with these symptoms:
Fever above 100.4ºF
Cough/ Runny nose
Shortness of breath
Pneumonia
Chills/ Body Aches
Sore Throat
Headache
Nausea/Vomiting
Diarrhea
Symptoms usually develop 2-14 days after exposure to a person infected with MERS-CoV
Or following travel from countries in or near the Arabian Peninsula within 14 days before onset of symptoms.

13. Travelers’ Health Risks
Of 100,000 travelers to a developing country for 1 month:
50,000 will develop some health problem
8,000 will see a physician
5,000 will be confined to bed
1,100 will be incapacitated in their work
300 will be admitted to hospital
50 will be air evacuated
1 will die
Steffen R et al. J Infect Dis 1987; 156:84-91

14. The Patient: Medical Issues
Age-specific issues
Underlying illness, immunosuppression
Systems review
Medical history
Medication use
Vaccination history
Allergies
Contraindications to vaccines and medications

15. The Patient: Other Issues
Reproductive
Pregnant
Breastfeeding
Preconception
Risk-taking behaviors

16. Travel Itinerary Full itinerary Styles of travel Accommodation
Dates, duration, stopovers
Seasonal considerations
Styles of travel
Rural vs. urban
Budget vs. luxury
Accommodation
Hotel vs. camping
Activities
Business vs. tourism
Adventure, safari
Missionary/Humanitarian/NGO

17. Travel Health Resources
CDC Travelers’ Health Website
World Health Organization
State Department
travel.state.gov
International Society of Travel Medicine
Health Information for International Travel
CDC “Yellow Book”
International Travel and Health
WHO “Green Book”

18. Deaths Related to International Travel
Hargarten S et al, Ann Emerg Med, :

19. Infectious Disease Risks to the Traveler
Schistosomiasis
Tuberculosis
Leptospirosis
Polio
Yellow Fever
Measles
JEV
Malaria
Diarrhea
Leishmaniasis
Rabies
Dengue
Meningococcal Meningitis
ETC.

20. Other Risks to the Traveler
Accidental injury
Environmental hazards
Crime and assault
Psychiatric problems
Animal bites, stings and envenomations
Dermatologic disorders
Altitude
…….

21. Immunizations to Consider for Adult Travelers
Routine
Diphtheria*
Tetanus*
Pertussis*
Measles +
Mumps+
Rubella +
Varicella
Pneumococcus
Influenza
Travel related
Hepatitis A
Hepatitis B
Typhoid
Rabies
Meningococcal disease
Polio
Japanese encephalitis
Yellow Fever
VZV (no mention of upper age limit; approved for >=12 months)
>= 13 Years of Age
After the first and second doses, 10.2% and 9.5% of vaccinees, respectively, developed fever (i.e., oral temperature greater than or equal to 100 F {37.7 C}); these febrile episodes occurred throughout the 42-day period and were usually associated with intercurrent illness.
After one and two doses, 24.4% and 32.5% of vaccinees, respectively, had complaints regarding the injection site; rash at the injection site at a peak of 6-20 days and 0-6 days postvaccination, respectively, developed in 3% and 1% of vaccinees, respectively; and a nonlocalized rash consisting of a median number of five lesions developed in 5.5% and 0.9% of vaccinees, respectively, and occurred at a peak of 7-21 days and 0-23 days postvaccination, respectively.

22. Travel Medications: Prophylaxis & Self Treatment
Malaria
chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine
Diarrhea
quinolone, azithromycin
Altitude
acetazolamide
Motion sickness
scopolamine, dimenhydrinate (Dramamine)

23. Patient Counseling Sufficient time for patient education
Tailored to suit traveler
Fitness for travel
Understanding impact on existing conditions
Advisability of destinations

24. Travel Preparation Travel health insurance
Medical care
Hospitalization
Evacuation
Obtaining medical care abroad
Awareness of travel notices
Hand washing and hygiene

25. Environmental Precautions
Air Travel
Jet Lag
Sun Protection
Extreme Heat and Cold
dehydration, heat stroke
hypothermia, frostbite
Altitude
Water recreation
Drowning, boating & diving accidents
Risk of schistosomiasis or leptospirosis
Biological and chemical contamination

26. Food and Water Precautions
Bottled water
Selection of foods
well-cooked and hot
Avoidance of
salads, raw vegetables
unpasteurized dairy products
street vendors
ice

27. Vector Precautions Covering exposed skin
Insect repellent containing DEET 25 – 50%
Treatment of outer clothing with permethrin
Use of permethrin-impregnated bed net
Use of insect screens over open windows
Air conditioned rooms
Use of aerosol insecticide indoors
Use of pyrethroid coils outdoors
Inspection for ticks

28. Bloodborne and STD Precautions
Prevalence of
STDs
Hepatitis B
Hepatitis C
HIV
Unprotected sexual activity
Commercial sex workers
Tattooing and body piercing
Auto accidents
Blood products
Dental and surgical procedures

29. Animal Precautions Animal avoidance Rabies Envenomations
Specific animal threats
Medical evaluation of bites/scratches
Post exposure immunization and immunoglobulin
Envenomations
Snakes, scorpions, spiders
Maritime animals

30. Injury and Crime Vehicles Use of drugs and alcohol
Risk of road and pedestrian accidents
Night travel
Seat belts and car seats
Use of drugs and alcohol
Understanding local crime risks
Scam awareness
Situational awareness
Location avoidance

31. Travel Emergency Kit Copy of medical records and extra pair of glasses
Prescription medications
Over-the counter medicines and supplies
Analgesics
Decongestant, cold medicine, cough suppressant
Antibiotic/antifungal/hydrocortisone creams
Pepto-Bismol tablets, antacid
Band-Aids, gauze bandages, tape, Ace wraps
Insect repellant, sunscreen, lip balm
Tweezers, scissors, thermometer

32. Post-Travel Care Post-travel checkup Post-travel care
Long term travelers
Adventure travelers
Expatriates in developing world
Post-travel care
Fever, chills, sweats
Persistent diarrhea
Weight loss

33. Thank You