Kenyan Mission Trip Travel Information (As of April 18, 2004) Vaccinations Needed These vaccinations are recommended by the Centers for Disease Control and Prevention (CDC) for all travelers to East Africa (for more information, please see http://www.cdc.gov/travel/eafrica.htm). Please see your doctor (or immunization clinic) at least 4-6 weeks before our trip to allow time for your shots to take affect. • Hepatitis A: Hepatitis A is a viral infection of the liver caused by hepatitis A virus (HAV). Hepatitis A vaccine, immune globulin (IG), or both, are recommended for all susceptible persons traveling to or working in countries with an intermediate or high endemicity of HAV infection. The first dose of hepatitis A vaccine should be administered as soon as travel to countries with high or intermediate endemicity is considered. One month after receiving the first dose of monovalent hepatitis A vaccine, 94%–100% of adults and children will have protective concentrations of antibody. The final dose in the hepatitis A vaccine series is necessary to promote long-term protection. • Hepatitis B: Hepatitis B is caused by the hepatitis B virus (HBV). HBV is transmitted through activities that involve contact with blood or blood-derived fluids. The risk of HBV infection for international travelers is generally low, except for certain travelers in countries where the prevalence of chronic HBV infection is high or intermediate. Modes of HBV transmission in areas with high or intermediate prevalence of chronic HBV infection that are important for travelers to consider are contaminated injection and other equipment used for health care-related procedures and blood transfusions from unscreened donors. However, unprotected sex and sharing illegal drug injection equipment are also risks for HBV infection in these areas. The usual schedule of primary vaccination consists of three intramuscular doses of vaccine. The vaccine is usually administered as a three-dose series on a 0, 1, and 6 month schedule. The second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose and at least 4 months after the first dose. • Rabies: Rabies, an acute, fatal encephalomyelitis caused by neurotropic viruses in the family Rhabdoviridae, genus Lyssavirus, is almost always transmitted by an animal bite that inoculates the virus into wounds. Although dogs are the main reservoir in resource-poor countries, the epidemiology of the disease differs sufficiently from one region or country to another to warrant the medical evaluation of all mammal bites. Travelers to rabies-endemic countries should be warned about the risk of acquiring rabies, although rabies vaccination is not a requirement for entry into any country. Travelers with extensive unprotected outdoor, evening, and nighttime exposure in rural areas, such as might be experienced while bicycling, camping, or engaging in certain occupational activities, might be at high risk even if their trip is brief. Pre-exposure vaccination with human diploid cell rabies vaccine (HDCV), purified chick embryo cell (PCEC) vaccine, or rabies vaccine adsorbed (RVA) may be recommended for international travelers based on the local incidence of rabies in the country to be visited, the availability of appropriate antirabies biologicals, and the intended activity and duration of stay of the traveler. Preexposure vaccination may be recommended for veterinarians, animal handlers, field biologists, spelunkers, missionaries, and certain laboratory workers. • Typhoid: Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella enterica Typhi. Typhoid vaccination is not required for international travel, but it is recommended for travelers to areas where there is a recognized risk of exposure to S. Typhi. Risk is greatest for travelers to the Indian subcontinent and other low-income countries who will have prolonged exposure to potentially contaminated food and drink. Vaccination is particularly recommended for those who will be traveling in smaller cities, villages, and rural areas off the usual tourist itineraries. Travelers should be cautioned that typhoid vaccination is not 100% effective and is not a substitute for careful selection of food and drink. Two typhoid vaccines are currently available for use in the United States: an oral, live, attenuated vaccine and a Vi capsular polysaccharide vaccine (ViCPS) for intramuscular use. The oral vaccination lasts 5 years, with a dosage of four pills, taken every other day. The one- shot, intramuscular vaccination lasts 2 years. • Yellow Fever: Yellow fever is a mosquito-borne viral disease. The disease occurs only in sub-Saharan Africa and tropical South America, where it is endemic and intermittently epidemic. In Africa, a variety of vectors are responsible for the disease, and it is in Africa where most cases are reported. The risk of a traveler's acquiring yellow fever is determined by immunization status, geographic location, season, duration of exposure, occupational and recreational activities while traveling, and the rate of yellow fever virus transmission at the time. In addition to vaccination, travelers should be advised to take precautions against exposure to mosquitoes when traveling in areas with yellow fever transmission. Staying in air- conditioned or well-screened quarters and wearing long-sleeved shirts and long pants will help to prevent mosquito bites. Insect repellents containing DEET should be used on exposed skin only. Permethrin-containing repellents should be applied to clothing. Travelers to rural areas should bring mosquito nets and aerosol insecticides or mosquito coils. Yellow fever is preventable by a relatively safe, effective vaccine. International regulations require proof of vaccination for travel to and from certain countries. For purposes of international travel, vaccines produced by different manufacturers worldwide must be approved by the World Health Organization and administered at an approved yellow fever vaccination center. State and territorial health departments have authority to designate nonfederal vaccination centers; these can be identified by contacting state or local health departments. Vaccinees should receive a completed International Certificate of Vaccination, signed and validated with the center's stamp where the vaccine was given. This certificate is valid 10 days after vaccination and for a subsequent period of 10 years. • As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults. Passport Information All participants of the Kenyan Mission Trip will need to have a current U.S. Passport. To get a U.S. Passport, you will need to present the following to an authorized passport agency: • Fill out US Passport application (form DS-11) • Proof of US Citizenship (ex: certified birth certificate) • Proof of Identity (ex: driver’s license) • Two recent, identical color photographs on a plain background • Fees (for passport and execution) You can get your passport at the Post Office. For people age 16 and over, the total cost of getting a passport at the Post Office is $85, and will last 10 years. For people under the age 16, the total cost of getting a passport at the Post Office is $70. The Post Office is also able to take the two identical color photographs for your registration form. NOTE: Be prepared to allow the Passport Agency to take your birth certificate and mail it in with your passport registration form. The US Government will return your birth certificate and passport to you in the mail in approximately six weeks. Visa Information A Kenyan visa in a valid passport are required documents for entering the country. If you arrive without a valid travel visa, you will not be allowed to enter, may be fined and will be immediately deported at your own expense. A single entry Kenya tourist visa is valid for up to 30 days from the day of entry. A multiple entry visa is valid for six months with each stay being up to 30 days. To get a tourist visa, you will need to: • Completed Kenya visa application form • A valid US passport with six months validity remaining • Two recent passport photos • A valid round trip ticket or letter from your travel agent verifying your travel plans • Payment (money order) • A self-addressed prepaid return envelope with postage (Priority Mail, Express Mail, FedEx, UPS, Airborne Express, or DHL only) Kenya travel visas are affixed in your passport on the pages specifically marked for them. Countries require that visa stamps be placed on those pages that do not contain any other stamps Travel Advisory Americans planning travel to Kenya should read the Travel Warning for Kenya, the Kenya Public Announcement and the East Africa Public Announcement, available on the Department of State web site at http://travel.state.gov/kenya.html. Travelers should also read the Worldwide Caution Public Announcement, available on the same web site.