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Afghanistan Islamic Republic of

VIEWS: 23 PAGES: 425

									Afghanistan, Islamic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is from May through November. Malaria may be
encountered throughout the country below 2000 meters, to include
urban areas. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus, the routine and
special immunizations required or recommended below, and malaria
as indicated above, the traveler should be aware that risk of
exposure to the following diseases exists in this country.

                                    DISEASE RISK PROFILE

 Afghanistan
         Disease          Endemic         Risk       Hazard
 Avian Influenza (H5N1)      X
 Brucellosis                               X
 Cholera                                   X
 Echinaococcosis                           X
 Giardiasis                                X
 Diarrheal Diseases                        X
 Helminthic Infections                     X
 Hepatitis, Viral                          X
 Leishmaniasis                                         X
 Sandfly Fever                                         X
 Tapeworms                                 X
 Trachoma                                  X
 Trichinosis                               X
 Tuberculosis               X
 Typhoid Fever                             X

Food/Water Safety

Water, milk products, and cold food unsafe.



VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under one year of age should
not be vaccinated due to health considerations. Please refer to
the discussion in Chapter 6.63 on avoiding yellow fever
vaccination in this age group.
Routine immunizations should be current. A rubeola
(measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but this should be considered for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended for all
travelers for their protection.

Typhoid Fever - Vaccination is recommended for all
travelers for their protection.

Viral Hepatitis B - Because of the high rate of healthy
carriers of hepatitis B in this country, vaccination is
recommended for persons on working assignments in the health care
field (dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Georgraphical distribution of the area of risk
for this country is a small region in the extreme northeastern
part of the country.

Typhus - Louse-borne typhus is cosmopolitan in distribution
and is present wherever groups of persons are crowded together
under conditions of poor sanitation and malnutrition. Risk
exists for persons living or working in remote areas of the
country (anthropologists, archeologists, geologists, medical
personnel, missionaries, etc.). Freedom from louse infestation
is the most effective protection against typhus.

Albania, Republic of

INFECTIOUS DISEASE RISK

Diseases of Special Risk

In addition to the worldwide hazard of tetanus, the traveler
should be aware that risk of exposure to the following diseases
exists in this country.

                              DISEASE RISK PROFILE
 Albania
            Disease           Endemic      Risk    Hazard
 Avian Influenza (H5N1)          X
 Brucellosis                     X
 Echinaococcosis                 X
 Encephalitis, Tick-Borne        X
 Leishmaniasis                   X
 Rabies                          X
 Sandfly Fever                   X
 Typhus, Endemic Flea-Borne      X
 West Nile Fever                 X

Food/Water Safety

Water probably safe, although not recommended. Milk and food
safe. Dysentery, other diarrheas and typhoid fever are more
common in the summer and autumn in southeastern and southwestern
areas.




VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but this should be considered for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Algeria, People’s Democratic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Risk is present in the southeastern parts of the Sahara regions:
Ain-Defla and Illizi departments. Risk period: March to October.
Centers for Disease Control does not currently recommend
preventative medication.

Falciparum malaria represents <1% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home only if considerable mosquito
exposure and bites have been encountered.
Diseases of Special Risk

Infection is present in the Mediterranean coastal area east of
Alger in the following villages: El Harrach, Reghaia, Khemis el
Khechna, Gue de Constantine; foci of infection are present in the
village of Jdiouia (southwest of El Asnam in the Tell mountain
region); at Biskra; the oases of Djanet and near the border with
Libya and at Aguedal-Anafid in the Wadi Saoura area (Beni Abbes
region).

Diarrheal diseases, to include helminthic infections and
dysentery are common in this country. Hepatitis A and typhoid
fever are common.

In addition to the worldwide hazard of tetanus, the routine
and special immunizations required or recommended below, and
specific diseases indicated above, the traveler should be aware
that risk of exposure to the following diseases exists in this
country.

                           DISEASE RISK PROFILE

 Algeria
             Disease            Endemic      Risk    Hazard
 Brucellosis                                  X
 Dengue Fever                     X
 Echinococcosis                   X
 Giardiasis                                   X
 Lassa Fever                      X
 Leishmaniasis                    X
 Rabies                           X
 Relapsing Fever                  X
 Sandfly Fever                    X
 Trachoma                         X
 Tuberculosis                     X
 Tungiasis                                    X
 Typhoid Fever                                X
 Typhus, Endemic Flea-Borne       X
 Typhus, Endemic Louse-Borne      X

Food/Water Safety

Water, milk products and cold food are not safe in this county.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but this should be considered for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be cautioned not to pet
dogs, cats, or other mammals.

American Samoa, Territory of

INFECTIOUS DISEASE RISK

Malaria Risk

None.


Diseases of Special Risk

      This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

      In addition to the worldwide hazard of tetanus and the
routine and special immunizations required and recommended below,
the traveler should be aware that risk of exposure to the
following diseases exists in this country.

                                DISEASE RISK PROFILE

 American Samoa
         Disease           Endemic      Risk      Hazard
 Dengue Fever                   X
 Encephalitis, Japanese         X
 Filariasis                                                X
 Tuberculosis                   X

Food/Water Safety

Water is safe, but is not recommended without treatment.
Milk products and food safe.


VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Viral Hepatitis A - Vaccination is recommended for all
travelers for their protection.

Typhoid fever - Vaccination is recommended for all
travelers for their protection.

Selective vaccinations - These apply only to specific
groups of travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy
carriers of hepatitis B in this country, vaccination is
recommended for persons on working assignments in the health care
field (dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Andorra, Principality of

INFECTIOUS DISEASE RISK

                                    DISEASE RISK PROFILE

 Andorra
    Disease           Endemic        Risk      Hazard

Food/Water Safety
Water is probably safe, but due to local variations in
bacterial counts, using bottled water for the first few weeks
will help the traveler adjust and decrease the chance of
traveler's diarrhea. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Angola, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. Resistance has developed in
this country to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore
there is a slight risk of p. vivax malaria exposure. Consider
use of primaquine upon return home.

Diseases of Special Risk

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Infection
with both S.haematobium and S.mansoni is endemic throughout
Angola. S.haematobium is predominant in the western half of the
country while S.mansoni is more prevalent in eastern regions.

In addition to the worldwide hazard of tetanus, the routine
and special immunizations required or recommended below, and
specific diseases indicated above, the traveler should be aware
that risk of exposure to the following diseases exists in this
country.

                              DISEASE RISK PROFILE
 Angola
             Disease            Endemic   Risk       Hazard
 Cholera                                               X
 Dysentery                                             X
 Dracunculiasis/Guinea Worm       X
 Filariasis                                            X
 Giardiasis                                            X
 Hepatitis A                               X
 Helminthic Infections                                 X
 Leishmaniasis                    X
 Onchocerciasis                                        X
 Relapsing Fever                  X
 Tapeworms                        X
 Trachoma                                              X
 Trypanosomiasis, African         X
 Sleeping Sickness
 Tuberculosis                     X
 Typhoid Fever                             X
 Typhus, Endemic Flea-Borne       X
 Typhus, Epidemic Louse-Borne     X
 Typhus, Scrub                    X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making
ice cubes should be boiled prior to use. Insure that bottled
water is uncapped in your presence. Milk should be boiled to
insure safety. Powdered and evaporated milk are available and
safe. Avoid butter and other dairy products. All meat, poultry
and seafood must be well cooked and served while hot. Pork is
best avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.


VACCINATIONS

Cholera - A cholera vaccination certificate is not required for
entry to this country. The disease is active in this country,
but the vaccine is not recommended for travelers protection.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age. CDC recommends a
yellow fever vaccination for all travelers over 9 months of age
who will travel outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the southern part of the country along the
border with Nambia (middle third).

Anguilla

INFECTIOUS DISEASE RISK

Malaria

No malaria risk is present in this country.

                                 DISEASE RISK PROFILE

 Anguilla
        Disease        Endemic       Risk       Hazard
 Ciguatera Poisoning      X

Food/Water Safety

No reliable information exists with regard to safety of
water, food, or dairy products. Discretion is advised.


VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Antigua and Barbuda

INFECTIOUS DISEASE RISK

Malaria Risk

No malaria risk is present in this country.


Diseases of Special Risk

Schistosomiasis is present in this country. Antigua has only
seasonal streams; however, the intermediate host is present in
man-made pools, canals and reservoirs. No recent cases have been
reported from the formerly infected areas of Sweet's, Liberta and
Bendals. Currently only the area surrounding the settlement of
John Hughs is infected with S.mansoni.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Antigua and Barbuda
            Disease           Endemic      Risk    Hazard
 Dengue Fever                    X
 Hepatitis, Viral                X
 Rabies                          X

Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are generally safe to eat, however, bacillary and
amoebic dysentary are encountered .




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

AIDS Information

Aids testing is required for university students, persons
intending on immigrating, those wishing to work, and those
suspected of having the HIV virus. Contact Antigua's embassy for
details.

Argentina, Argentine Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is from October through May, only below 1200 meters.
There is no risk of malaria in urban areas. Risk exists only in
the rural areas of the extreme northwestern corner of the country
bordering Bolivia: Province of Salta (northwestern corner of
province): Departments of Santa Victoria, Iruya, Oran. Province
of Jujuy (southeastern part of province): Departments of San
Martin, Ledesma, Santa Barbara and San Pedro. Prevent malaria with treatment of
clothing with permethrin and use a topical insect repellent on skin. Several
oral medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

IAMAT reports Chagas' disease is highly endemic in rural and
suburban areas below 3600 meters in the following provinces:
Catamarca, Chaco, Cordoba, Formosa, Jujuy, La Pampa, La Rioja,
Mendoza, Salta, Santa Fe, San Juan, San Luis, Santiago del
Estero, and Tucuman. Risk is also present in rural areas (below
3600 meters) of the provinces of Buenos Aires, Corrientes, Chubut
(northern half), Entre Rios, Misiones, Neuquan, and Rio Negro.
The main vectors in this country are Triatoma infestans and
Triatoma sordida.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                          DISEASE RISK PROFILE

 Argentina
      Disease       Endemic        Risk      Hazard
 Anthrax                            X
 Giardiasis                         X
 Hepatitis, Viral     X
 Rabies                                          X
 Tapeworms                          X
 Tuberculosis         X
 Trachoma             X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

Salmonellosis is relatively common in suburban areas and is a
particular risk in children below 5 years of age.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be

considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country. The
vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Yellow fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas. CDC recommends vaccination
for all persons over 9 months of age planning to visit the
northeastern forest areas.

Armenia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                              DISEASE RISK PROFILE

 Armenia
             Disease          Endemic      Risk         Hazard
 Brucellosis                     X
 Leishamaniasis (Cutaneous)      X
 Leishamaniasis (Visceral)       X
 Tuberculosis                    X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Australia, Commonwealth of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.
Areas of greatest risk are along the coast from Cornavon to Port
Darwin to Townsville and occasionally northern New South Wales.

Lyme arthritis is present.    Avoid ticks.

Viral encephalitis may occur in some rural areas.       Avoid
mosquitoes.

                                DISEASE RISK PROFILE


 Australia
     Disease        Endemic       Risk       Hazard

Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is considered infected.
A vaccination certificate is required for children over one year
of age. Vaccination certificate is required for travelers who
have been in or passed through an infected yellow fever area
within six days prior to arrival. Australia is not bound by
International Health Regulations. Australian officials currently
have added Cameroon, Ecuador, Ivory Coast, Senegal, Togo,
Trinidad and Tobago, and Venezuela to the infected country list.
Any country is considered infected when it has been so listed in
the Weekly Epidemiological Record.

Routine immunizations should be current. A
rubeola (measles) booster should be considered.       Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B among the local Aboriginal population in the
interior (mainly in the Warburton Creek area of Central
Australia), vaccination is recommended for persons working in
health care, education, or in close contact with them.

AIDS Information

Testing is required for all applicants for permanent residence
who are age 15 and over. All applicants who require a medical
examination are tested if there is a clinical indication.
Contact the Australian embassy for further details.

Austria, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 Austria
     Disease        Endemic    Risk         Hazard
 Tuberculosis          X


Food/Water Safety

Water is probably safe, but due to local variations in
bacterial counts, using bottled water for the first few weeks
will help the traveler adjust and decrease the chance of
traveler's diarrhea. Milk is pasteurized and safe to drink.
Butter, cheese, yogurt and ice-cream are safe. Local meat,
poultry, seafood, vegetables, and fruits are safe to eat.


VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered.      Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in all forested areas of southern, eastern, and northern
Austria (areas around Klagenfurt, Graz, Wiener Neustadt, Vienna,
and Linz, extending to the border with Germany along the Danube).

Azerbaijan, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Prevent malaria with treatment of clothing with permethrin and use of topical
insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks
before exposure, weekly while in the risk area, and continuing for 4 weeks post
exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

Hemorrhagic fever is encountered in southern Siberia.

                              DISEASE RISK PROFILE
 Azerbaijan
         Disease          Endemic   Risk       Hazard
 Avian Influenza (H5N1)      X
      Leishmaniasis
       (Cutaneous)          X
      Leishmaniasis
        (Visceral)          X
       Tuberculosis         X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Azores, Autonomous Region of the

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 Azores
    Disease         Endemic    Risk         Hazard
  Tuberculosis         X


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Some milk is pasteurized and safe to drink, but caution is
advised. Pasteurized butter, cheese, yogurt and ice-cream are
safe. Local meat, poultry, seafood, vegetables, and fruits are
generally safe to eat.

VACCINATIONS


Required immunizations

Yellow fever vaccination is required for all travelers over 1
year of age arriving from areas infected with this disease. This
certificate is not required for travelers in transit at Santa
Maria.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Viral Hepatitis A - Vaccination with gamma globulin is
recommended when traveling outside the areas usually visited by
tourists, traveling extensively in the interior of the country
and for persons on working assignments in remote areas.

Bahamas, Commonwealth of The

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Bahamas
      Disease       Endemic         Risk      Hazard
 Dengue Fever          X
 Dysentery                           X
 Hepatitis, Viral     X
 Rabies               X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.
Ciguatera fish poisoning may prove to be a hazard.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in which this disease is active. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Bahrain, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Bahrain
            Disease              Endemic      Risk   Hazard
 Brucellosis                                           X
 Cholera                            X
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                     X
 Hepatitis, Viral                              X
 Leishmaniasis (cutaneous)          X
 Leishmaniasis (visceral)           X
 Rabies                             X
 Relapsing Fever                    X
 Tapeworms                          X
 Trachoma                           X
 Tuberculosis                       X
 Typhoid Fever                           X
 Typhus, Endemic Flea-Borne   X
 Typhus, Scrub                X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

AIDS Information

Foreign workers in specific job categories are screened for HIV
after entry. Jobs such as hotel staff and hair dressers are
included. Contact Bahrain's embassy for details.

Bangladesh, People’s Republic of

INFECTIOUS DISEASE RISK

Malaria Risk
The malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention. Malaria is present in all parts
of this country, including urban areas, with the exception of
Dhaka City, where there is no risk. The risk in the remainder of
this country exists all year.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it
is a caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

It should be noted that 58% of the country's 103 million people
are infected with tuberculosis, causing 500,000 positive cases
annually.

                            DISEASE RISK PROFILE

 Bangladesh
            Disease         Endemic       Risk     Hazard
 Avian Influenza (H5N1)        X
 Brucellosis                               X
 Cholera                                   X
 Dysenteries                               X
 Echinococcosis                            X
 Encephalitis, Japenese        X
 Filariasis                                X
 Helminthic Diseases                       X
 Hepatitis A                               X
 Leishmaniasis (Visceral)                            X
 Rabies                                              X
 Sandfly Fever                                       X
 Tuberculosis                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making
ice cubes should be boiled prior to use. Insure that bottled
water is uncapped in your presence. Milk should be boiled to
insure safety. Powdered and evaporated milk are available and
safe. Avoid butter and other dairy products. All meat, poultry
and seafood must be well cooked and served while hot. Pork is
best avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is infected. A yellow fever
vaccination is also required from all countries the yellow fever
endemic zones in South and Central America and Central Africa. It is also
required from all persons
arriving from Botswana, Malawi, Mauritania, Belize, Costa Rica,
Guatemala, Honduras, and Nicaragua. When required, this
vaccination must be obtained by persons of all ages (including
infants) or they will face isolation up to 6 days. This vaccine
should not be given to infants younger than 6 months.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.
Cholera immunization is only REQUIRED of Bangladesh nationals on
leaving the country.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.


Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific
groups of travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy
carriers of hepatitis B in this country, vaccination is
recommended for persons on working assignments in the health care
field (dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throughout the country. Period of
transmission is all year, but greatest risk is June through
October. You may obtain information about a vaccine for this
disease from the CDC at (303) 221-6429.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Barbados

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Viral hepatitis occurs on this island.

Animal rabies is present, particularly in the mongoose.

                              DISEASE RISK PROFILE

 Barbados
      Disease       Endemic         Risk    Hazard


Food/Water Safety

First class hotels and restaurants serve purified drinking water
and reliable food. However, the hazard is left to your
judgement. Amoebic and bacillary dysenteries are common.


VACCINATIONS
Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is infected. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Belarus, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.


                              DISEASE RISK PROFILE

 Belarus
     Disease     Endemic       Risk      Hazard
  Tuberculosis      X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Belgium, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it
is a caution concerning the more likely endemic disease risks.

Heavy concentrations of bacterial contamination (salmonella)
have caused authorities to warn against swimming in the Ourthe
and Semois Rivers in the Ardennes. Officials report that 75% of
the waterways in northern Belgium are heavily polluted.

                              DISEASE RISK PROFILE

 Belgium
      Disease       Endemic     Risk        Hazard


Food/Water Safety

Local water is considered safe without further treatment.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Belize

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is year round. Malaria may be encountered
throughout the country below 400 meters, except urban areas.
There is no risk of malaria in in Belize City and the district of
Belize. Prevent malaria with treatment of clothing with permethrin and use of
topical insect repellent on skin. Take chloroquine 500 mg weekly, starting two
weeks before exposure, weekly while in the risk area, and continuing for 4 weeks
post exposure.

Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease is present in the sylvatic ecosystem, with
sporadic cases of human infection being reported. The main
vector is Triatoma dimidiata.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis has been reported in this country. Avoid
swimming or wading in fresh water lakes or rivers unless an
authoritative local source can assure you that the water is safe.

                              DISEASE RISK PROFILE

 Belize
                Disease              Endemic         Risk   Hazard
 Brucellosis                            X
 Dysentery (amoebic and Bacillary)                    X
 Encephalitis, Venezuelan Equine        X
 Helminthic Diseases                                  X
 Hepatitis, Viral                       X
 Leishmaniasis                          X
 Rabies                                                       X
 Trypanosomiasis, American              X
 Chaga's Disease
 Tuberculosis                           X
 Typhoid Fever                                        X
AIDS Information

Persons staying longer than three monthss require HIV antibody

testing. Foreign tests are acceptable only if done within the
preceding three months. Contact the Belize embassy for further
details.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active yellow fever. A vaccination is
required for children of all ages. Children under nine months of
age should not be vaccinated due to health considerations.
Although yellow fever is not active at this time, this country is in the endemic
zone.
Other countries may require a yellow fever certificate after
visiting this country.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - as above.
Benin, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 87% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk is
present in the entire country, to include urban areas.
S.haematobium is endemic throughout Benin. S.mansoni has been
reported from Benassi and Parakou (Bourgou region); from
Natitingou (Atakora region); from Savalou (Zou region) and from
Cotonou on the Atlantic coast.

Parasitic worm infections are common. Dysentery and diarrheal
diseases, including giardiasis, typhoid fevers, and viral
hepatitis, are widespread.


                              DISEASE RISK PROFILE

 Benin
            Disease                Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm           X
 Echinococcosis                                  X
 Filariasis                                              X
 Lassa Fever                         X
 Leishmaniasis (Cutaneous)           X
 Leishmaniasis (Visceral)            X
 Onchoceriasis                                           X
 Rabies                              X
 Relapsing Fever                     X
 Tapeworms                                               X
 Trachoma                                                X
 Trypanosomiasis, African            X
 Sleeping Sickness
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                             X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk may be unsafe due to poor
refrigeration, but other dairy products may be safe. All meat,
poultry and seafood must be well cooked and served while hot.
Pork is best avoided. Vegetables should be well cooked and
served hot. Salads and mayonnaise are best avoided. Fruits with
intact skins should be peeled by you just prior to consumption.
Avoid cold buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age, but the CDC
recommends vaccinations for everyone over 9 months of age who
will be traveling outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:
Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. The entire country is in this zone.

Bermuda

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

The is a very low incidence of communicable disease on this
island. Rocky Mountain spotted fever, encephalitis, and
tularemia all occur in low frequency. Snake bites and Portuguese
man-of-war injuries occur.

                              DISEASE RISK PROFILE


 Bermuda
     Disease        Endemic     Risk        Hazard


Food/Water Safety

Local water is considered safe without further treatment.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Bhutan, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is year around. Malaria may be encountered in the
southern districts bordering India and only below 1600 meters.
Risk is present in the southern half of the country, in the
following districts: Chirang, Gaylegphug, Samchi, Samdrupjongkhar
and Shemgang. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 10% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                           DISEASE RISK PROFILE

 Bhutan
          Disease          Endemic      Risk      Hazard
 Brucellosis                             X
 Cholera                     X
 Echinococcosis                          X
 Encephalitis, Japanese      X
 Giardiasis                  X
 Helminthic Infections       X
 Hepatitis, Viral            X
 Leishmaniasis                                      X
 Sandfly Fever                                      X
 Tapeworms                   X
 Tuberculosis                X
 Typhoid Fever               X
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Bolivia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present below 2500 meters. The highlands of La Paz,
the two southwestern provinces of Oruro and Potosi are risk free.
Where found, the risk exists all year. Multi-drug-resistant
P.falciparum malaria has been reported from the Guayaramerin area
and the northeastern border areas with Brazil (Beni and Pando).
Persons travelling into the Amazone basin and overland into
Brazil should follow a suppressive regimen with Lariam because of
the high incidence of multi-drug-resistant P. falciparum in that
country. While chloroquine is the drug of choice of many experts
for travel to most parts of Bolivia, the CDC recommends the use
of mefloquine (Lariam), particularly when traveling in the above
areas.

Falciparum malaria represents 13% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chaga's Disease risk is present in rural and suburban areas below
3600 meters with very high human infection rates reported from
the departments (including towns) of Cochabamba (including the
city of Cochabamba), Sucre, Tarija, and Santa Cruz. The main
vectors are the triatoma species infestans and sordida which are
known locally as "vinchuca."

Cholera has spread to Bolivia.     Immunization with cholera vaccine
is not recommended.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                           DISEASE RISK PROFILE

 Bolivia
             Disease             Endemic      Risk       Hazard
 Brucellosis                                   X
 Dysentery                                     X
 Echinococcosis                    X
 Hepatitis, Viral                           X
 Helminthic Infections                      X
 Leishmaniasis (Cutaneous)       X
 Leishmaniasis (Mucocutaneous)   X
 Leishmaniasis (Visceral)        X
 Plague                          X
 Rabies                          X
 Trypanosomiasis, American       X
 Chaga's Disease
 Tuberculosis                    X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.

Travelers' diarrhea is common. Also common are parasitic worm
infections and viral hepatitis.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. CDC recommends vaccination
of all persons over 9 months of age who go outside of urban
areas. Yellow fever is currently active in this country and is
present in the departments of Beni, Cochabamba, La Paz, Pando,
Tarija, and Santa Cruz. Bolivia recommends obtaining yellow
fever vaccination when visiting these areas.


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:
Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups
of travelers or persons on specific working assignments:

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is: along the border with Peru (middle third) north
of Lake Titicac (province of La Paz) and the Cordillera Oriental
between the provinces of Cochabama and Santa Cruz.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

AIDS Information

All applicants for residency are tested. Foreign tests are
accepted under certain conditions. Contact the Bolivian embassy
for details.

Bosnia and Herzegovina

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                          DISEASE RISK PROFILE

 Bosnia and Herzegovina
            Disease          Endemic      Risk     Hazard
 Avian Influenza (H5N1)         X
 Diarrheal Diseases             X
 Dysentery, Bacillary         X
 Encephalitis                 X
 Leishmaniasis (Cutaneous)    X
 Leishmaniasis (Visceral)     X
 Rabies                       X
 Sandfly Fever                X
 Tuberculosis                 X
 Typhoid Fever                X
 Typhus, Endemic Flea-Borne   X
 Typhus, Scrub                X
 West Nile Fever              X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas bordering Austria extending south to
the areas around Ljubljana and Zagreb.
Botswana, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is from November through May in the northern part of
the country above 21 degrees south, including urban areas. The
following districts and subdistricts are affected: Boteti, Chobe,
Ngamiland, Okavango and Tutume. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 95% of malaria, therefore
there is a slight risk of p. vivax malaria exposure. Consider
use of primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The districts
of Kgalagadi, Ghanzi and Central-Serowe (Kalahari Desert) are
risk free. Infection with S.haematobium is present along the
Limpopo river valley and its tributaries. Foci of infection with
S.haematobium have also been reported from Mabule (on the Molopo
river, Southern disrict), Francistown (North-East district).
Xhumo and Nata (Letlhakane district), Pandamatenga, Kasane and
Kavimba (Chobe district), Maun and Tsao (Ngamiland). Infection
with S.mansoni is endemic in the northern districts of Okavango
and Chobe, particulary along the Okavango river and marshlands
and in the villages along the Chobe river.

                            DISEASE RISK PROFILE

 Botswana
           Disease          Endemic       Risk     Hazard
 Plague                        X
 Rabies                        X
 Relapsing Fever               X
 Rift Valley Fever             X
 Trypanosomiasis, African      X
 Sleeping Sickness
 Tuberculosis                  X
 Typhus, Scrub                 X

Food/Water Safety

      All tap water used for drinking, brushing teeth, and making
ice cubes should be boiled prior to use. Insure that bottled
water is uncapped in your presence. Milk should be boiled to
insure safety. Powdered and evaporated milk are available and
safe. Avoid butter and other dairy products. All meat, poultry
and seafood must be well cooked and served while hot. Pork is
best avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Water, dairy products
and food products are considered safe in Gaborone.

      Amoeba and typhoid fever are common problems associated with
food ingestion in this country.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country. The
vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.
Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk is
scattered throughout this country.

Brazil, Federative Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is found below 900 meters in Acre, Amazonas, Goias,
Maranhao, Mato Grosso, and Para States; Territories of Amapa,
Rondonia, and Roraima. There is generally no risk in urban
areas, except in the urban areas of the Amazon region. The
following states are risk free (main cities in brackets): Alagoas
(Maceio), Ceara (Fortalezza), Distrito Federal (Brasilia),
Espirito Santo (Victoria), Paraiba (Joao Pessoa), Parana
(Curitiba), Pernambuco (Recife), Rio Grande do Norte (Natal), Rio
Grande do Sul (Porto Alegre), Rio de Janeiro (Rio de Janeiro),
Santo Caterina (Florianopolis), Sao Paulo (Sao Paulo, Santos),
Sergipe (Aracaju), and the Fernando de Noronha Archipelago. The
urban centers of the following states are risk free (main
cities): Amazonas (Manaus), Goias (Goiania), Maranhao (Sao Luis),
Mato Grosso (Cuiaba), Mato Grosso do Sul (Campo Grande), Para
(Santarem, Belem), Tocantins (Tocantina). Risk is also present
in the following rural areas: Bahia (Salvador): areas bordering
the states of Tocatins and Goias; Minas Gerais (Belo Horizonte):
areas bordering state of Goias; Parana (Curitiba): areas
bordering the state of Mato Grosso do Sul and Paraguay. High
risk of multi-drug-resistant P.falciparum malaria is present in
the following states and territories (main cities): Acre (Rio
Branco); Amapa (Macapa), Rondonia (Porto Velho), Roraima (Boa
Vista). The risk exists all year. The malaria in this country
is resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 40% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Cholera has entered Brazil in the Solimoes River drainage.
Jungle areas along the borders with Colombia and Peru are at
greatest risk for this disease. Active disease has been reported
in Amazonas State and Matto Grosso State. Immunization with
cholera vaccine is not indicated for any traveler, but food and
water safety precautions are urged.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible. Risk is limited to the
coastal areas of the following states: Amapa, Para, Maranhao,
Piaui.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Endemic areas
of S.mansoni infection are present in the densely populated
coastal regions, especilly around the numerous man-made water
bodies and irrigation systems. Infection has been reported from
all states except the following Amazonas, Mato Grosso do Sul, Rio
Grande do Sul, Rondonia, Roraima.
Areas of infection are present in:
Acre: Recent indigenous cases of infection have been reported,
put specific areas of risk are undetermined.
Alagoas: the entire state is infected.
Amapa: the state is free of risk except for the area of Macapa on
the Canal do Norte.
Bahia: the entire state is infected especially the coastal areas
and all major river basins.
Brasilia, D.F.: The federal district is infected.
Ceara: Risk of infection is present in the area of Fortaleza and
along the Choro River as far south as Quixada. Foci are also
present in the southeastern part of the state in the areas of
Iguatu and Juazeiro do Norte.
Espirito Santo: the entire state is infected.
Goias: Scattered areas of infection have been reported from all
parts of the state except from the northwest. Travellers should
consider the entire state as infected.
Maranhao: Infection is present along the coastal regions from the
border with Para State to Sao Luis (Bahia de Sao Marcos) and
along the lower part of the Pindare river. There are additional
foci present in the area of Pedreiras (Mearim river).
Mato Grosso: a few scattered foci of infection are present in teh
southern part of the state, the most significant at Caceres.
Minas Gerais: the eastern half of the state is heavily infected.
Foci of infection have been reported from all partes, therefore
travellers should consider the entire state as infected.
Para: infection is present in coastal areas around Braganca,
Capanema and Primavera.
Paraiba: The entire coastal area including Joao Pessoa, and as
far west as Campina Grande is infected. There are a few scattered
foci of risk present in the interior around Souza.
Parana: Foci of infection are scattered throughout the state with
heaviest concentration along the Paranapanema river valley. A
foci of infection is present at Iguacu Falls.
Pernambucco: The eastern half of the state is infected especially
along the coastal areas including Recife and as fas west as
Arcoverde, Buique and Bom Conselho. Scattered foci are present in
the northwest of the state including the area of Afogados do
Ingazeira, and along the Sao Francisco river.
Piaui: Foci of infection are present in the area of Teresina and
Barao de Grajau (on the Parnaiba river); in Campo Maior and Picos.
Rio Grande Do Norte: The coastal areas from Macau to the border
with Paraiba state including the area of Natal is infected. In
the interior, there are scattered foci of low infection present.
Rio De Janeiro: Foci of infection have been reported from all
parts including Rio de Janeiro city. The entire state should be
considered infected.
Santa Catarina: recent reports indicate indigenous foci of
infection, but no details are available.
Sao Paulo: the eastern coastal regions along the Paraiba do Sul
river, the Tiete Delta including Sao Paulo and Santos are
infected. Infection is present along the Paranapanema river
valley and in the area of Americana and Campianas.
Sergipe: the entire state is infected.
Tocantins: isolated foci of infection have been reported. Details
are not available.

Chaga's Disease risk is present in the rural areas of Alagoas,

Bahia, Ceara, Espirito Santo, Goias, Maranhao, Mato Grosso do
Sul, Minas Gerais, Paraiba, Parana, Pernambuco, Piaui, Rio de
Janeiro, Rio Grande do Norte, Rio Grande do Sul, Sao Oaulo,
Sergipe, and the Federal District. New foci of human infection
have recently been reported from the state of Para. Vectors and
wild animal reservoirs are present throughout Brazil. Several
insects are vectors, but all are known locally as "barbeiros."

                             DISEASE RISK PROFILE

 Brazil
               Disease             Endemic     Risk   Hazard
 Brazilian Purpuric Fever             X
 Brucellosis                                    X
 Dengue Fever                        X
 Echinococcosis                      X
 Encephalitis, Venezuelan Equine     X
 Hepatitis, Viral                               X
 Leishmaniasis (Cutaneous)           X
 Leishmaniasis (Mucocutaneous)       X
 Meningitis                          X
 Onchocerciasis                      X
 Plague                              X
 Rabies                              X
 Tapeworm                                       X
 Tuberculosis                        X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.
Amoebic dysentery, diarrheal diseases, parasitic worms, and viral
hepatitis associated with water and food supplies are common in
this country.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone, see page HHH.
A vaccination certificate is required for children over six
months of age, however vaccination is not advised for children
under nine months of age due to medical complications frequently
encountered in the younger age group. CDC recommends vaccination
of all persons over 9 months of age. Vaccination is recommended for travelers
to the
following states: Acre, Amazonas, Goias, Maranhao, Mato Grosso,
Mato Grosso do Sul, Para, Rondonia, and the Territories of Amap
and Roraima.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups
of travelers or persons on specific working assignments:

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is the northwestern part of the country in the
provinces of Bahia and Ceara. A small focus is present in the
area of Redonda (southern part of Minas Gerais).

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Brunei Darussalam

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                           DISEASE RISK PROFILE

 Brunei Darussalam
            Disease          Endemic       Risk    Hazard
 Cholera                        X
 Dengue Fever                   X
 Encephalitis, Japanese         X
 Fasciolopsiasis                X
 Filariasis                                          X
 Hepatitis, Viral               X
 Melioidosis                    X
 Rabies                         X
 Tuberculosis                   X
 Typhoid Fever                  X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Amoebic and bacillary
dysentery occurs in this country.




VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over one
year of age. Vaccination certificate is required for travelers
who have been in or passed through an infected yellow fever area
within six days prior to arrival.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following immunizations are not required but are recommended
for persons visitng this country.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

The following immunization is recommended for persons traveling
on special assignments or engaged in certain activities:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Bulgaria, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to tick-borne encephalitis,
rabies, and a viral hemorrhagic fever exists in this country.

Hepatitis A is endemic in this country, with cases reported from
all areas, but particularly from the districts of Varna and
Burgas. Immunization with gamma globulin for protection against
Hepatitis A is recommended for all travelers.

                              DISEASE RISK PROFILE

 Bulgaria
     Disease        Endemic     Risk      Hazard
 Tuberculosis          X


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

AIDS Information

All foreigners staying for more than 1 month for purposes of
study or work are tested. Contact the Bulgarian embassy for full
details.

Burkina Faso

INFECTIOUS DISEASE RISK
Malaria Risk

Malaria risk is all year in all sections of this country, to
include urban areas. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a 15% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.haematobium
infection is endemic throughtout the country. S.mansoni is
present in the southwestern regions of Hauts-Bassin and Sud-Ouest
and in isolated foci of Volta Noire, Centre-Ouest and Est.

                            DISEASE RISK PROFILE

 Burkina Faso
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Dracunculiasis/Guinea Worm         X
 Dysentery, Amoebic                            X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                           X
 Hepatitis, Viral                              X
 Meningitis                                    X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Sandfly Fever                     X
 Tapeworms                                             X
 Trachoma                                              X
 Trypanosomiasis, African          X
 Sleeping Sickness
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.

Amoebic dysentery, diarrheal diseases, parasitic worms, and viral
hepatitis associated with water and food supplies are common in
this country.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age who will be
traveling outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required. Avoid uncooked
foods and untreated water. Vaccination is advised only for
persons living or working under inadequate sanitary conditions
and for those with impaired defense mechanisms.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - - Vaccination is recommended for all travelers
for their protection.

Selective vaccinations - These apply only to specific groups
of travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. The disease is currently active in this country.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Burundi, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 80% of malaria, therefore there is
a 20% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis is present in this country. Avoid contact with
contaminated fresh water. S.mansoni is endemic along Lake
Tanganyika and the plain of Rusizi, including the capital
Bujumbura. Infection is also present in all villages situated
around Lake Cyohoha and Lake Rwihinda. The highlands of central,
eastern and southern Burundi are risk free. Additional snail
intermediate hosts: Biomphalaria choanomphalia and Biomphalaria
stanleyi.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                            DISEASE RISK PROFILE

 Burunda
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Dysentery, Amoebic                                    X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African          X
 Sleeping Sickness
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age. Vaccination is
recommended for travelers over 9 months of age for their
protection.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningitis - Vaccination for all travlers is recommended due to
the increased incidence of this disease.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups
of travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.


Cambodia, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The city of Phnom Penh is risk
free. The malaria in this couyntry is resistant to chloroquine
and mefloquine. Use doxycycline for malaria prevention.

Falciparum malaria represents 71% of malaria, therefore there is
a 29% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

Schistoaomiasis is present in this country.   Avoid contact with
contaminated water systems. Known endemic areas are present in
the eastern part of the country in the area of the provincial
capital of Kratie and the surrounding villages on the Mekong
river. The district of Stung Treng on the Mekong (north of
Kratie) is also infected. The full extent of the infection is not
known, but there are indications that the disease may be more
widespread that previously believed.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                          DISEASE RISK PROFILE

 Cambodia
           Disease        Endemic      Risk      Hazard
 Chikungunya Fever           X
 Cholera                     X
 Dengue Fever                X
 Diarrheal Disease Risk                 X
 Dysentery, Amoebic         X
 Encephalitis, Japanese     X
 Fasciolopsiasis            X
 Filariasis                                        X
 Hepatitis, Viral           X
 Melioidosis                X
 Rabies                     X
 Tuberculosis               X
 Typhoid Fever              X
 Typhus, Scrub              X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is scattered throughout the country.

Cameroon, Republic of
INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a 15% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found throughout this country, including
urban areas. Avoid contact with contaminated fresh water lakes,
ponds, or streams. S.haematobium is highly endemic in the two
northern Provinces (Sahel regions) with foci of infection
reported from all other provinces except North-West Province.
S.mansoni follows a similar pattern: it is highly endemic in the
northern provinces. Foci of infection with low incidence rates of
S.intercalatum have been reported from the Provinces of Centre
and Littoral.

Typhus - Louse-borne typhus is cosmopolitan in distribution and
is present wherever groups of persons are crowded together under
conditions of poor sanitation and malnutrition. Risk exists for
persons living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

Lake Nyos contains large amounts of dissolved carbon dioxide gas
which represents a potential threat for the release of another
cloud of asphyxiating gas. Caution is advised.


                              DISEASE RISK PROFILE

 Cameroon
             Disease               Endemic      Risk   Hazard
 Avian Influenza (H5N1)               X
 Dracunculiasis/Guinea Worm           X
 Diarrheal Disease Risk                                  X
 Dysentery, Amoebic                                      X
 Echinococcosis                                  X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Loiasis                                               X
 Onchocerciasis                                        X
 Relapsing Fever                X
 Trachoma                                              X
 Trypanosomiasis, African       X
 Sleeping Sickness
 Tuberculosis                   X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. CDC recommends
vaccination for all children over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is the northern third of
the country.

Canada

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 Canada
             Disease             Endemic      Risk   Hazard
 Encephalitis                       X
 Lyme Disease                       X
 Rabies                             X
 Rocky Mountain Spotted Fever       X
 Tularemia                          X
Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those

with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B among the local Inuit (Eskimo) population of
northern Canada, vaccination is recommended for persons working
in health care, education, or in close contact with them.

Canary Islands

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Food/Water Safety

                                    DISEASE RISK PROFILE

 Canary Islands
        Disease           Endemic         Risk       Hazard
 Tuberculosis                X


Water is probably safe, but due to local variations in
bacterial counts, using bottled water for the first few weeks
will help the traveler adjust and decrease the chance of
traveler's diarrhea. Milk is pasteurized and safe to drink.
Butter, cheese, yogurt and ice-cream are safe. Local meat,
poultry, seafood, vegetables, and fruits are safe to eat.


VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Cape Verde, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is all year in the rural areas of Concelho de
Santa Cruz (Sao Tiago Island). Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                             DISEASE RISK PROFILE

 Cape Verde
              Disease             Endemic      Risk   Hazard
 Diarrheal Disease Risk                                 X
 Dysentery, Amoebic                                     X
 Echinococcosis                                 X
 Filariasis                                             X
 Giardiasis                                             X
 Helminthic Diseases                                    X
 Hepatitis, Viral                                       X
 Lassa Fever                        X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Relapsing Fever                    X
 Trachoma                                               X
 Tungiasis                          X
 Tuberculosis                   X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age. The requirement
does not apply to travelers arriving in Sao Vincente, Sal, Maio,
Boa Vista, and Santiago. Vaccination is recommended for all
travelers for their protection. Vaccination is not advised for
children under nine months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Cayman Islands

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Cayman Islands
          Disease          Endemic      Risk      Hazard
 Dengue Fever                 X
 Diarrheal Disease Risk                  X
 Dysentery, Amoebic                      X
 Hepatitis, Viral            X
 Rabies                      X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Central African Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a 15% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis is found throughout this country, including urban
areas. Avoid contact with contaminated fresh water lakes, ponds,
or streams.

Tuberculosis, venereal disease, yaws, and leprosy are prevalent
amongst the local population, but travelers are at very low risk
in contracting these diseases.

                              DISEASE RISK PROFILE

 Central African Republic
               Disease              Endemic      Risk    Hazard
 Dracunculiasis/Guinea Worm            X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic                                        X
 Echinococcosis                                      X
 Filariasis                                                X
 Giardiasis                                                X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Leishmaniasis (Cutaneous)            X
 Leishmaniasis (Visceral)             X
 Loiasis                                                   X
 Onchocerciasis                                            X
 Relapsing Fever                      X
 Trachoma                                            X
 Trypanosomiasis, African             X
 Sleeping Sickness
 Tuberculosis                   X
 Typhoid Fever                                          X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

Food/Water Safety


All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April, but the danger extends from December through June. Local
area of greatest danger is the northern third of the country.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Chad, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in the entire country, all year long,
including urban areas. The malaria in this country is resistant
to chloroquine. Prevent malaria with treatment of clothing with permethrin and
use a topical insect repellent on skin. Several oral medications are available
to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 78% of the malaria present in this
country, therefore there is a risk of vivax exposure. Consider
the use of primaquine upon your return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.haematobium
and S.mansoni are endemic throughout the southern half of the
country. In the arid north, S.mansoni infection is present in and
around the oasis of Faya-Largeau. High prevalence of infection is
present in all highly populated areas of the south and
southwestern district. The status of Schistosomiasis infection in
many areas of the east and north of the country is unknown;
therefore, travellers should consider as infected all oases,
temporary and permanent water bodies.

The local population suffers from leprosy, tuberculosis,
influenza, tropical ulcers, eye diseases, pneumonia, measles,
cholera, polio, and fungal infections. Travelers are low risk in
contracting these illnesses.


                            DISEASE RISK PROFILE

 Chad
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic                                    X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African          X
 Sleeping Sickness
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - Vaccination is recommended for all travelers
for their protection. Vaccination is advised for all travelers
over 9 months of age who will be traveling outside of urban
areas.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April, but danger extends from December trough June. Local area
of greatest danger is the southern half of this country.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Chile, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Cholera has spread into this country from Peru. Immunization
with cholera vaccine is not indicated for any traveler, but food
and water precautions are urged.

Chagas' Disease is   present in rural and suburban areas in the
following northern   and central provinces: Tarapaca, Antofagasta,
Atacama, Coquimbo,   Valparaiso, Santiago, and O'Higgins. The main
vector is Triatoma   infestans.

                           DISEASE RISK PROFILE

 Chile
     Disease        Endemic       Risk      Hazard
 Anthrax                           X
 Echinococcosis       X
 Hepatitis, Viral     X
 Tapeworms            X
 Typhoid Fever        X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

China, (Hong Kong) People’s Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

The urban areas of Hong Kong are risk free and there is no risk
for travelers. Sporadic malaria cases have been reported from
the northern rural border areas.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Hong Kong
          Disease          Endemic      Risk      Hazard
 Avian Influenza (H5N1)       X
 Dengue Fever                 X
 Diarrheal Diseases           X
 Encephalitis, Japanese       X
 Hepatitis, Viral             X
 Tuberculosis                 X

AIDS Information

Government sources report 110 people have tested positive for HIV
antibody and that 10 persons have died of this disease as of
March 1988.

Food/Water Safety

First class hotels and restaurants serve purified drinking water
and reliable food.
VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported, with period of transmission all year.

China, (Macao) People’s Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Macao
        Disease            Endemic      Risk      Hazard
 Dengue Fever                 X
 Diarrheal Diseases                      X
 Encephalitis, Japanese   X
 Helminthic Diseases      X
 Hepatitis, Viral                        X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

First class hotels and restaurants serve purified drinking water
and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

China, (Mainland) People’s Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

In China malaria risk is present from June - November north of 33
degress North latitude; from May - December at 25 - 33 degrees
North latitude; and all year south of 25 degrees North latitude.
Malaria is found in parts of Anhui, Fujian, Guandong, Guangxi,

There is no malaria risk in the following municipalities and
provinces (main cities are listed in brackets): Beijing Shi
(Beijing), Tianjin Shi (Tianjin), Gansu (Lanzhou), Heilongjiang
(Harbin), Jilin (Changchun), Nei Mongol (Hohhot), Ningxia
(Yinchuan), Qinghai (Xining). Malaria risk is present from July
to November in the following rural areas: Hebei (Shigiazhuang):
the southern parts of the province including the areas along the
Bo Hai (Bo Sea); Liaoning (Shenyang, Luda): the entire southern
peninsula (Liadong Bandao); Shandong (Jinan): the entire
province; Xinjiang (Shihezi): risk is present in the Lli valley
on the northwestern border with the USSR. In Northern China only
vivax malaria infections are present. Take chloroquine as a
suppressive medication regimen in these areas. Main vector: A.
sinensis.

Central China: Malaria risk exists throughout central China from
May to December in rural areas of the following municipalities
and provinces: Shanghai Shi (Shanghai); Anhui (Hefei), Henan
(Zhengzhou), Hubei (Wuhan); in Shaanxi (Xi'an) the risk is
present in the southern half of the province; in Sichuan
(Chengdu, Chongqing) the eastern half of the province is infected
with malaria. In central China vivax malaria infections are
predominant. Take chloroquine 500 mg weekly for suppression, but
carry a three tablet treatment dose of Fansidar since some
chloroquine resistance has developed in this area. Main vectors:
A. sinensis, A. minimus minimus.

Southern China (including the southeastern tip of Tibet): Malaria
risk is present throughout the year in rural areas of the
following provinces: Fujian (Fuzhou), Guangdong (Guangzhou)
including Hainan Island (Haikou), Guangxi (Nanning, Gueilin),
Guizhou (Guiyang), Hunan (Changsha), Jiangxi (Nanchang), Zhejiang
(Hangzhou), Yunnan (Kunming); and the extreme southeastern part
of Tibet in the area bordering India (Arunachal Pradesh) and
Burma. In southern China P. falciparum malaria is predominant.
Chloroquine resistant P. falciparum malaria is present in parts
of the provinces of Yunnan, Gungxi and Guangdong (including the
island of Hainan). When travelling through the rural areas of

Yunnan province bordering Burma, Laos and Vietnam; the southern
parts of Guangxi province bordering Vietnam and the Gulf of
Tonkin; the areas of Guangdong province southwest of Guangzhou
(Canton) including the island of Hainan take Lariam for
suppressive medication. Main vectors: A. minimus minimus, A.
balabacensis balabacensis. Note: Persons flying into major
cities and making only daytime excursions into the countryside do
not need to take malaria suppressive medication, as all the
malaria-carrying mosquitoes breed in the countryside. Persons
travelling by car, train or extensively throughout the country
must follow a suppressive medication regimen. This also applies
to persons contemplating cruises on rivers, lakes or along the
coast of China.


Diseases of Special Risk
This country must be considered receptive to dengue fever. Intermittent
epidemics in the past make renewed
activity or reintroduction of the virus possible. Risk is
limited to the southern provinces of Yunnan, Guangxi, and
Guangdong.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Extensive
control programs have successfully eradicated S.japonicum from
many previously endemic areas. Today, the infection is present in
the following areas: In the central and lower Chang (Yangtze)
river valley including its tributaries and adjacent lakes. The
area extends from the city of Yicheng in Hubei Province to the
rural areas surrounding Shanghai in the east on the mouth of the
river. To the north this endemic area extends in Jiangsu Province
to the area of Lake Gaoyou, in Anhui Province to the area of Lake
Chao (south of Hefei); in Hubei Province the area surrounding
Wuhan, including all lakes and rivers are infected as far north
as Xiangfan. In the south, Lake Dongting and the area of Changsha
in Hunan Province are affected; in Jiangxi Province the infection
is present around Lake Poyang, along the valleys of the Gan river
and extending as far south as Fengcheng and Fuzhou. In Zhejiang
Province the infection is present in the northern three quarters
of the province including the area of the Bay of Hangshou. In
Fujian Province a foci of infection exists in the area of the

coastal town of Xiapu (Sandu Bay). In Sichuan Province the
infection is present in a large area surrounding Chengdu (approx.
200 km radius), and along the lower Yalong river valley in the
areas surrounding Zhaojue, Xichand and Hexi. In Yunnan province

the risk of infection is present in the northwestern corner of
the Province including the Jinsha (Yangtze) and the Lancang
(Mekong) River Valleys, including the area of Er Lake and as far
south as the area of Weishan.

Polio epidemics occur sporadically in China.         Tuberculosis occurs
at 55 times the United States rate.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 People's Republic of China
               Disease               Endemic         Risk     Hazard
 Avian Influenza (H5N1)                 X
 Brucellosis                            X
 Clonorchiasis                          X
 Dengue Fever                           X
 Diarrheal Disease Risk                               X
 Dysentery, Amoebic                                   X
 Encephalitis, Japanese                 X
 Encephalitis, Tick-Borne               X
 Fasciolopsiasis                  X
 Filariasis                       X
 Helminthic Diseases              X
 Hepatitis, Viral                             X
 Leishmaniasis (Visceral)         X
 Leptospirosis                    X
 Paragonimiasis                   X
 Plague                           X
 Trachoma                         X
 Tuberculosis                     X
 Typhus, Scrub                    X

AIDS Information

Antibody testing is required for all persons staying longer than
six months. Foreign tests are acceptable under certain
circumstances. Contact the China embassy for further details.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants in Beijing (Peking), Guangzhou (Canton), Nanjing
(Nanking), Tianjin (Tientsin), and Xi'in (Sian) serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:
Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Cases have
been reported from all provinces except Xinzang (Tibet), Xinjiang
(Sinkiang) and Qinghai. Disease is most prevalent in central and
eastern China. Period of transmission: June to October. High
risk group: children under 15 years of age.

Plague - Vaccination is recommended only for persons who
may be occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area.

Rabies - This disease kills 5,000 persons yearly in mainland
China. As many as 1 million yearly are bitten by possibly rapid
dogs. Rabies vaccine in China is in short supply.

Taiwan - Republic of China

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 Taiwan-Republic of China
              Disease          Endemic      Risk       Hazard
 Avian Influenza (H5N1)           X
 Tuberculosis                     X


Food/Water Safety
All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Taipei serve purified drinking water and reliable
food. However, the hazard is left to your judgement.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Occasional
outbreaks occur throughout the country. Period of transmission
June to October.

AIDS Information

Tests are required for all persons staying for more than three
months. Contact the Taiwan embassy for details.

Christmas Island, Territory of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                                   DISEASE RISK PROFILE

 Christmas Island - Indian Ocean
                 Disease                 Endemic      Risk   Hazard


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk and food products probably safe.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is infected with this
disease. A vaccination certificate is required for children over
one year of age. Vaccination certificate is required for
travelers who have been in or passed through an infected yellow
fever area within six days prior to arrival.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Colombia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present only below 800 meters in rural areas of Uraba
(Antioquia), Bajo Cauca-Nechi (Cauca and Antioquia), Magdelana
Medio, Caqueta (Caqueta), Sarare (Arauca), Catatumbo (Norte de
Santander, Pacifico Central and Sur, Putumayo (Putumayo), Ariari
(Meta), Alto Vaupes (Vaupes), and Amazonas. The risk exists all
year. There is no malaria risk in Bogota and vacinity. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

The department of Bogota and the Caribbean islands of San Andres
and Providencia are risk free. Note: The cities of Bogota, Cali,
Manizales, Medellin and other cities and villages in the Andean
highlands are risk free. On the Caribbean coast, the sea resort
of Santa Marta and the cities of Barranquilla and Cartagena are
risk free. Persons making excursions on the Magdalena River
(south of Barranquilla), travelling along the Pacific coast, or
travelling east of the Cordillera Oriental must take mefloquine
(Lariam) for suppressive medication.

Falciparum malaria represents 48% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Cholera has entered this country from Peru. Immunizations are
not required for any traveler, but water and food precautions are
urged.

Chagas' Disease risk is present below 2500 meters in the
following provinces: Boyaca, Caqueta, Cesar, Cundinamarca,
Guajira, Huila, Magdalena, Meta, Santander del Norte, Santander
del Sur, Tolima, and Valle del Cauca. The main vectors are
Rhodnius prolixus and Triatoma dimidiata.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.
Bartonellosis exists on the western slopes of the Andes,
primarily in river valleys, up to 3000 meters.

                            DISEASE RISK PROFILE

 Colombia
               Disease            Endemic      Risk    Hazard
 Brucellosis                                    X
 Diarrheal Disease Risk                         X
 Dysentery, Amoebic                             X
 Echinococcosis                     X
 Helminthic Diseases                               X
 Hepatitis, Viral                                  X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Mucocutaneous)      X
 Leishmaniasis (Visceral)           X
 Onchocerciasis                     X
 Trypanosomiasis, American          X
 Chagas' Disease
 Tuberculosis                       X
 Typhus, Scrub                      X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Bogota serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.
The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Yellow fever - Vaccination is recommended for all travelers for
their protection. Vaccination is advised for all persons
traveling outside of urban areas who are nine months or older.
Yellow fever is frequently active in this country in Arauca,
Caqueta, Casanare. Cucuta, Meta and Putumayo Intendencias; and
Antioquia, Boyaca, Cundinamarca, Cesar, Guaviare, Santander and
Norte de Santander Departments.

Comoros, Union of the

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The malaria in this country is resistant to chloroquine.
Prevent malaria with treatment of clothing with permethrin and use a topical
insect repellent on skin. Several oral medications are available to prevent
malaria in the country. See malaria prevention.

Falciparum malaria represents 88% of malaria, therefore there is
a 12% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                             DISEASE RISK PROFILE

 Comoros
              Disease               Endemic         Risk   Hazard
 Dracunculiasis/Guinea Worm            X
 Diarrheal Disease Risk
 Dysentery, Amoebic and Bacillary                            X
 Echinococcosis                                      X
 Filariasis                                                  X
 Giardiasis                                                  X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Leishmaniasis (Cutaneous)       X
 Leishmaniasis (Visceral)        X
 Onchocerciasis                                            X
 Rabies                          X
 Relapsing Fever                 X
 Trachoma                                                  X
 Trypanosomiasis, African
 Sleeping Sickness               X
 Tuberculosis                    X
 Typhoid Fever                                             X
 Typhus, Endemic Flea-Borne      X
 Typhus, Epidemic Louse-Borne    X
 Typhus, Scrub                   X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.
Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Congo, Democratic Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 94% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Bandundu and
Kasai Oriental provinces do not report any infection. All other
provinces report high incidence rates of infection, with S.
mansoni being the prevalent species. Additional snail
intermediate host for S. mansoni: Biomphalaria choanomphala,
Biomphalaria smithi and Biophalaria stanleyi.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.
                            DISEASE RISK PROFILE

 Dem. Rep. of Congo
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm                    X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Plague                            X
 Polio                                                 X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

The health minister reports an AIDS exposure rate of 12%
in Kinshasa and a 5% exposure rate in the rural towns in Shaba
Province, including Lumbumbashi and Kolwezi.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Kinshasa (Leopoldville) and Lubumbashi
(Elisabethville) serve purified drinking water and reliable food.
However, the hazard is left to your judgement.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age. The reqirement
applies to travelers arriving in or destined for that part of the
country south of 10 degrees south latitude. CDC recommends
vaccination for all travelers over 9 months of age who will be
traveling outside of urban areas. The Embassy of Zaire reports
that a yellow fever vaccination is rquired for all travelers over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.
Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are present in the notheastern corner of the
country bordering Uganda and Sudan.

Congo, Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore there is
a 10% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.haematobium
and S.mansoni are endemic throughout the country, with
S.haematobium being predominant. Snail intermediate host for
S.mansoni: Biomphalaria camerunensis.

Onchocerciasis is encountered in the south of the country with
the major concentration along the Djoue River and the bank
regions of the River Congo downstream from Brazzaville.

Typhus - Louse-borne typhus is cosmopolitan in distribution
and is present wherever groups of persons are crowded together
under conditions of poor sanitation and malnutrition. Risk
exists for persons living or working in remote areas of the
country (anthropologists, archeologists, geologists, medical
personnel, missionaries, etc.). Freedom from louse infestation
is the most effective protection against typhus.


                           DISEASE RISK PROFILE
 Republic of the Congo
              Disease           Endemic   Risk      Hazard
 Dracunculiasis/Guinea Worm        X
 Diarrheal Disease Risk                               X
 Dysentery, Amoebic                                   X
 Echinococcosis                            X
 Filariasis                                           X
 Giardiasis                                           X
 Helminthic Diseases                                  X
 Hepatitis, Viral                                     X
 Leishmaniasis (Cutaneous)        X
 Leishmaniasis (Visceral)         X
 Loiasis                                              X
 Onchocerciasis                                       X
 Relapsing Fever                  X
 Trachoma                                             X
 Trypanosomiasis, African
 Sleeping Sickness                X
 Tuberculosis                     X
 Typhoid Fever                                        X
 Typhus, Endemic Flea-Borne       X
 Typhus, Epidemic Louse-Borne     X
 Typhus, Scrub                    X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. Vaccination is
recommended for all travelers for their protection.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Cook Islands

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                           DISEASE RISK PROFILE

 Cook Islands
           Disease         Endemic      Risk      Hazard
 Diarrheal Disease Risk                  X
 Dysentery, Amoebic                      X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Typhoid Fever                           X
Food/Water Safety

Caution should be used with regard to water supplies.   Food and
milk products probably safe, but caution advised.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.


The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Costa Rica, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

San Jose and the central highlands are risk free. Malaria risk
exists only below 500 meters, where it is present all year. It is
present in the rural areas of Limon province (Caribbean coast)
and in the northern provinces of Alajuela, Guanacaste and
Puntarenas. Chloroquine is suggested for malaria prophylaxis in
these areas.

Falciparum malaria represents 27% of malaria, therefore there is
an increased risk of p. vivax malaria exposure. Consider the use
of primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease risk is present in rural areas below 1300 meters
along the Pacific coast and in the central plain. Guanacaste
province reports the highest incidence rates. The main vector is
Triatoma dimidiata.

This country must be considered receptive to dengue fever. Intermittent
epidemics in the past make renewed
activity or reintroduction of the virus possible.

                             DISEASE RISK PROFILE

 Costa Rica
               Disease              Endemic         Risk   Hazard
 Dengue Fever                          X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                                 X
 Hepatitis, Viral                     X
 Leishmaniasis                        X
 Paragonimiasis                       X
 Rabies                                                      X
 Trypanosomiasis, American
 Chaga's Disease                      X
 Typhoid Fever                                       X

AIDS Information

Costa Rica has officially reported 39 AIDS cases through September
1987.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Cote D' Ivoire

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in this entire country, all year, to include
urban areas. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 88% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
Primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis is present in the whole country, including urban
areas. Avoid contact with fresh water lakes, ponds, or streams.

Meningococcal meningitis may occur in the Sahelian savannah areas
during the dry season from December until June.


                            DISEASE RISK PROFILE

 Ivory Coast
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Cholera                            X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Abidjan serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required on arrival
from all countries. A vaccination certificate is required for
children over one year of age. CDC recommends vaccination for
all travelers over 9 months of age who will travel outside of
urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Croatia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Croatia
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Diarrheal Diseases                 X
 Dysentery, Bacillary               X
 Encephalitis                       X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Sandfly Fever                      X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas bordering Austria extending south to
the areas around Ljubljana and Zagreb.

Cuba, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue.     Intermittent epidemics in
the past make renewed
activity or reintroduction of the virus possible.

                                DISEASE RISK PROFILE

 Cuba
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                X
 Dysentary, Amoebic/Bacillary          X
 Hepatitis, Viral                      X
 Rabies                                X
 Typhoid Fever                         X

AIDS Information
AIDS antibody testing is required for all foreigners, excluding
diplomats, staying in Cuba for 90 days or longer. Over
one-fourth of the entire population has been screened for the HIV
virus, with 248 persons having HIV positive tests and 28 persons
ill with the disease. All donated blood in Cuba is screened for
the HIV antibody.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making
ice cubes should be boiled prior to use. Insure that bottled
water is uncapped in your presence. Milk should be boiled to
insure safety. Powdered and evaporated milk are available and
safe. Avoid butter and other dairy products. All meat, poultry
and seafood must be well cooked and served while hot. Pork is
best avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Cyprus, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.


Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE
 Cyprus
            Disease           Endemic   Risk          Hazard
 Avian Influenza (H5N1)          X
 Brucellosis                     X
 Cholera                         X
 Dracunculiasis/Guinea Worm      X
 Diarrheal Disease Risk          X
 Echinococcosis                  X
 Helminthic Diseases             X
 Hepatitis, Viral                X
 Leishmaniasis (Cutaneous)       X
 Leishmaniasis (Visceral)        X
 Rabies                          X
 Tapeworms                       X
 Trachoma                        X
 Typhoid Fever                   X
 Typhus, Endemic Flea-Borne      X
 Typhus, Scrub                   X

AIDS Information

HIV testing is performed upon arrival on all students
and foreign nationals working Cyprus.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe. At times refrigeration of dairy
products during transport is unsatisfactory.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Czech Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 Czech Republic
              Disease            Endemic      Risk    Hazard
 Avian Influenza (H5N1)             X
 Hepatitis, Viral                   X
 Rabies                                        X
 Rocky Mountain Spotted Fever                           X

AIDS Information

All persons entering the country from areas of high risk are
being tested for HIV antibody, including citizens returning from
those areas. Areas considered high risk include all countries in
Western Europe, North and South America, and Africa. All blood
donors are being screened with HIV testing. This country reports
11 AIDS cases and 66 known carriers.

Single use syringes and needles may be unavailable.   Medical
treatment should be deferred until reaching a facility where
adequate safeguards can be assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Water should be boiled in summer months and at other times when
the water table falls to low levels. Local meat, poultry,
seafood, vegetables, and fruits are safe to eat. Milk is
pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Gamma globulin is recommended for all
travelers.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas south of Prague, north of Brno, and the
areas west of Plzin (Pilsen).


Denmark, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

Rabies is prevalent in wild animals, especially foxes.
Diphyllobothrias (infection with fish tapeworm) is a risk in the
Baltic Sea area.

                              DISEASE RISK PROFILE

 Denmark
     Disease        Endemic     Risk        Hazard
 Avian Influenza
 (H5N1)                 X


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Djibouti, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria may be encountered throughout the country, to include
urban areas. Risk is year around. Prevent malaria with treatment of clothing
with permethrin and use of topical insect repellent on skin. Take chloroquine
500 mg weekly, starting two weeks before exposure, weekly while in the risk
area, and continuing for 4 weeks post exposure.

Falciparum malaria represents 80% of malaria, therefore there is
a 20% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk
In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Meningococcal meningitis may occur during the dry season
(December through June) in the savannah areas.

                            DISEASE RISK PROFILE

 Djibouti
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk             X
 Dysentery, Amoebic/Bacillary                  X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                                   X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk should be boiled to insure safety. Powdered and evaporated
milk are available and safe. Avoid butter and other dairy
products. All meat, poultry and seafood must be well cooked and
served while hot. Pork is best avoided. Vegetables should be
well cooked and served hot. Salads and mayonnaise are best
avoided. Fruits with intact skins should be peeled by you just
prior to consumption. Avoid cold buffets, custards, and any
frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Dominica, Commonwealth of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                                DISEASE RISK PROFILE

 Dominica
             Disease                Endemic      Risk   Hazard
 Dengue                                X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                                 X
 Rabies                                           X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
No vaccinations are required to enter this country.

Dominican Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is all year long. Malaria may be encountered
throughout the country below 400 meters, but not in urban areas.
Risk exists only along the border with Haiti in the following
urban and rural areas: entire Province of Monte Cristi; entire
Province of Dajabon; Province of Elias Pina: municipality of
Banica, Comendador and El Llano; Province of Independencia:
municipality of Jimani; Province of Barahona: municipalities of
Barahona and Cabral; Province of Pedernales: municipality of
Pedernales. There is no malaria risk in the resort areas of
Puerta Plata, Punta Cana, San Pedro de Macoris, etc. Falciparum
malaria represents 100% of malaria. Prevent malaria with treatment of clothing
with permethrin and use of topical insect repellent on skin. Take chloroquine
500 mg weekly, starting two weeks before exposure, weekly while in the risk
area, and continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is limited to the area of Hato Mayor and the
surrounding villages in the interior of the eastern part of the
country. Other known foci of infection are present at El Seibo,
Higuey and Nisibon.

                                DISEASE RISK PROFILE

 Dominican Republic
             Disease                Endemic      Risk   Hazard
 Dengue                                X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                      X
 Tuberculosis                          X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety
All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Santo Domingo serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals. This disease
is especially prevlent in the mongoose in this country.

AIDS Information

Testing is required for all foreigners applying for residency.
Contact the Dominican Republic's embassy for full details.

East Timor

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

No specific information is available.

                              DISEASE RISK PROFILE

 East Timor
       Disease      Endemic         Risk    Hazard
 Tuberculosis          X


Food/Water Safety

No specific information is available.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.
Ecuador, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is all year, only below 1500 meters, with minimal
risk in urban areas. There is little or no risk in Quito
vicinity and the Galapagos Islands. Malria risk is present in
Esmeraldas, Guayas (including Guayaquil), Manabi, and El Oro; and
rural areas of Los Rios, Morona Santiago, Napo, Pastaza,
Pichincha, and Zamora Chinchipe. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Persons travelling to Coca or Lago Agrio for cruises on the Napo
River and its tributaries in the upper Amazon jungle or
travelling along the Pacific coast (including the city of
Guyaquil) must follow these guidelines for suppressive
medication.

Falciparum malaria represents 22% of malaria, therefore there is
a 78% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' Disease is present in rural areas throughout Ecuador.
Risk is highest in the coastal provinces, including urban areas,
of Esmeraldes, Guayas, El Oro, Los Rios, and Manabi. The vector,
Triatoma dimidiata, is locally known as chinchorro.

Cholera has appeared in this country, spreading from the epidemic
in nearby Peru in March 1991. In May it had spread to the
Galapagos Islands. Food and water precautions are advised as
indicated below. The cholera vaccine is not required, nor
recommended for travelers.

Typhus - Louse-borne typhus is cosmopolitan in distribution and
is present wherever groups of persons are crowded together under
conditions of poor sanitation and malnutrition. Risk exists for
persons living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                           DISEASE RISK PROFILE

 Ecuador
              Disease            Endemic      Risk    Hazard
 Bartonellosis                      X
 Brucellosis                                X
 Diarrheal Disease Risk                                 X
 Dysentery, Amoebic/Bacillary                           X
 Echinococcosis                  X
 Helminthic Diseases                                    X
 Hepatitis, Viral                                       X
 Leishmaniasis (Cutaneous)       X
 Leishmaniasis (Mucocutaneous)   X
 Onchocerciasis                  X
 Paragonimiasis                  X
 Plague                                                 X
 Tuberculosis                    X

AIDS Information

All foreign visitors intending to stay longer than 60 days will
be tested for HIV virus antibody, but the starting date of this
testing period has not been announced.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making
ice cubes should be boiled prior to use. Insure that bottled
water is uncapped in your presence. Milk should be boiled to
insure safety. Powdered and evaporated milk are available and
safe. Avoid butter and other dairy products. All meat, poultry
and seafood must be well cooked and served while hot. Pork is
best avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Quito and Guayaquil serve purified drinking water
and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for
this country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Yellow fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas. The Centers for Disease
control recommend vaccination for all travelers over 9 months of
age who plan travel outside of urban areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is the southern part of the country in Loya
Province.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Egypt, Arab Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is from June through October in the Nile Delta, El
Faiyum area, the Oases and part of Southern (Upper) Egypt. Risk
exists in the following areas, excluding urban centers: Nile
Delta, the El Faiyum area, the oases, and part of Upper Egypt
(southern Egypt). Note: The cities of Alexandria and Cairo
inlcuding the archeological sites of Ghiza are risk free. As the
risk of malaria infections is limited for persons visiting the
archeological sites of Upper Egypt (Luxor, Karnak, etc.) there is
no need for suppressant medication when not venturing to rural
areas after sunset. However, persons contemplating Nile cruises
(during June to October) should follow a chloroquine regimen
since the boats pass through areas where malaria transmission can
occur.

Falciparum malaria represents 4% of malaria, therefore there is a
96% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Infection
with S. haematobium is endemic throughout the entire length of
the Nile valley including the El Faiyum area and along the Suez
Canal. It is one of the world's most highly infected countries.
Control measures have reduced the incidence rates in some areas,
but the infection is spreading around Lake Nasser. In addition,
S. mansoni infection is also endemic throughout the Nile Delta
but does not extend further south than El Giza.

                                DISEASE RISK PROFILE

 Egypt
             Disease                Endemic      Risk   Hazard
 Avian Influenza (H5N1)                X
 Brucellosis                                      X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                        X
 Filariasis                            X
 Giardiasis                                       X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Leishmaniasis                         X
 Rabies                                X
 Relapsing Fever                       X
 Rift Valley Fever                     X
 Sandfly Fever                         X
 Trachoma                              X
 Tuberculosis                          X
 Typhoid Fever                                    X
 Typhus                                X

AIDS Information

All foreigners living in Egypt longer than one month will be
tested for HIV antibodies. All tests must be done by Egyptian
authorities. In the case of families, only the head of the
household will be tested - although it is possible that spouses
may also be tested. An HIV antibody test will be required for
all foreign contractors entering Egyptian military facilities.
American organizations with qualified health personnel can
collect their own blood samples which are then to be turned over
to Egyptian authorities for testing.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water in first class hotels is probably safe, but due to local
variations in bacterial counts, using bottled water for the first
few weeks will help the traveler adjust and decrease the chance
of traveler's diarrhea. Treat all other sources of water or use
bottled water. Milk products should be considered unsafe, other
than canned, evaporated or dehydrated milk. Cold food is unsafe.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over
one year of age.

Cholera - This vaccne is not required officially, but the
U.S. Embassy reports that border officials may require this
immunization if travelers arrive from cholera-infected areas.

Special required immunizations - Visitors arriving from the Sudan
have recently been required to have immunization against cholera,
meningitis, and typhoid. This requirement was no longer official
as of Jan 1990. Visitors from the Sudan are required to be on
malaria prophylaxis and might be given anti-malria tablets to
swallow before being admitted to Egypt. Visitors from all
regions of the Sudan are required to have their yellow fever
vaccination.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.

The vaccinations listed are recommended for the traveler's
protection.

Meningitis - The Department of State recommends this vaccine for
all persons posted to Egypt, but the CDC does not currently
recommend this vaccine for travelers.
Poliomyelitis - A poliomyelitis booster is indicated for this
country. There are 300 cases of polio in this country yearly
amongst the native population.

Viral Hepatitis A - Vaccination is recommended for all
travelers for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

El Salvador, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria exists in rural areas this country throughout the
year, only below 1000 meters. There is no risk in urban areas.
Prevent malaria with treatment of clothing with permethrin and use of topical
insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks
before exposure, weekly while in the risk area, and continuing for 4 weeks post
exposure.

Falciparum malaria represents 9% of malaria, therefore there is a
91% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Cholera is present throughout this country. Vaccination is not
necessary or advised. Food and water precautions are important.
This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Chagas' disease is endemic throughout this country. Risk is
present in rural areas, small and medium sized towns and suburbs.
The main vectors are Triatoma dimidiata and Rhodnius prolixus.

                             DISEASE RISK PROFILE

 El Salvador
               Disease              Endemic         Risk   Hazard
 Brucellosis                           X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                                 X
 Hepatitis, Viral                     X
 Leishmaniasis                        X
 Tuberculosis                         X
 Typhoid Fever                                       X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over six months of age. Children under
nine months of age should generally not be vaccinated due to
health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals. Rabies is
especially found in dogs and bats.

Equatorial Guinea, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a 15% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis is endemic in this country. Avoid swimming or
wading in fresh water sources such as lakes, rivers, or ponds.
S. intercalatum has been reported from the area of Bata. Extent
of infection is undetermined. The entire country should be
considered infected.

                            DISEASE RISK PROFILE

 Equatorial Guinea
              Disease            Endemic      Risk   Hazard
 Dengue Fever                       X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                                   X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from countries with
current infection. A vaccination is required for children of all
ages.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to
western travelers is low. Immunization is not required or
recommended for travel to this country due to its low
effectiveness. Avoid uncooked foods and untreated water.
Vaccination is advised only for persons living or working under
inadequate sanitary conditions and for those with impaired
defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Areas of risk are scattered throughout the
country.

Eritrea, State of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is found throughout the country, including urban areas,
but excluding Addis Ababa, in all regions below 2000 meters. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 80% of malaria, therefore there is
a 20% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The city of
Addis Ababa is risk free. Foci of infection are scattered
throughout the country. Well documented areas of infection are
in the areas of Adwa and Adi Abun (along the Mai Assem and Mai
Guagua streams), in the Upper and Lower Awash valley. Foci of
infection are also present in Eritrea. More than 2.5 million
natives are infected with this disease.


There is a risk of meningococcal meningitis in the Sahelian
savannah areas from December through June.

Onchocerciasis (river blindness) affects more than 1.3 million
natives. These disease is endemic in the western part of the
country.

There are 10,000 cases of relapsing fever in this country
annually which is the highest rate of anywhere in the world.
Travelers are at low risk from this louse borne disease.

Louse-borne typhus is cosmopolitan in distribution
and is present wherever groups of persons are crowded together
under conditions of poor sanitation and malnutrition. Risk
exists for persons living or working in remote areas of the
country (anthropologists, archeologists, geologists, medical
personnel, missionaries, etc.). Freedom from louse infestation
is the most effective protection against typhus.

                            DISEASE RISK PROFILE

 Ethiopia
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                        X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                                   X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)                     X
 Leishmaniasis (Visceral)                              X
 Rabies                            X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                             X
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                                 X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Addis Ababa, Asmara, and Massawa serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.


Estonia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

Hemorrhagic fever is encountered in southern Siberia.

AIDS Information

Beginning Feb 1989, all persons staying longer than 3 months
in the Soviet Union will be required to undergo HIV antibody
testing. This includes diplomats, journalists, students, and
businessmen. Reports from countries that have a "mutually
accepted agreement" will be honored, but there is no list of
which countries were included in this arrangement. Previously
U.S. tests were not accepted. Any person who knowingly infects
another with AIDS can be jailed up to 8 years. Conditions which
contribute to the spread of AIDS in this country include improper
sterilization of dental instruments, reuse of syringes and other
medical supplies, lack of an adequate supply of condoms, and low
reliability of the HIV screening tests being used.

                              DISEASE RISK PROFILE

 Estonia
     Disease        Endemic    Risk      Hazard
 Tuberculosis          X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.
VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Ethiopia, Federal Democratic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is found throughout the country, including urban areas,
but excluding Addis Ababa, in all regions below 2000 meters. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 80% of malaria, therefore there is
a 20% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The city of
Addis Ababa is risk free. Foci of infection are scattered
throughout the country. Well documented areas of infection are
in the areas of Adwa and Adi Abun (along the Mai Assem and Mai
Guagua streams), in the Upper and Lower Awash valley. Foci of
infection are also present in Eritrea. More than 2.5 million
natives are infected with this disease.


There is a risk of meningococcal meningitis in the Sahelian
savannah areas from December through June.

Onchocerciasis (river blindness) affects more than 1.3 million
natives. These disease is endemic in the western part of the
country.

There are 10,000 cases of relapsing fever in this country
annually which is the highest rate of anywhere in the world.
Travelers are at low risk from this louse borne disease.

Louse-borne typhus is cosmopolitan in distribution
and is present wherever groups of persons are crowded together
under conditions of poor sanitation and malnutrition. Risk
exists for persons living or working in remote areas of the
country (anthropologists, archeologists, geologists, medical
personnel, missionaries, etc.). Freedom from louse infestation
is the most effective protection against typhus.

                            DISEASE RISK PROFILE

 Ethiopia
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                        X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                                   X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)                     X
 Leishmaniasis (Visceral)                              X
 Rabies                            X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                             X
 Tuberculosis
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                                 X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Addis Ababa, Asmara, and Massawa serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Falkland Islands

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Falkland Islands
          Disease          Endemic       Risk     Hazard
 Echinococcosis               X
 Hepatitis, Viral             X
 Tapeworms                    X
 Typhoid Fever                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Faroe Islands

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

                                DISEASE RISK PROFILE

 Faroe Islands
        Disease       Endemic        Risk       Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Fiji Islands, Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

      This country must be considered receptive to dengue fever.
Active cases of dengue fever and dengue hemorrhagic fever have
been reported from Fiji's central and western divisions.
                          DISEASE RISK PROFILE

 Fiji
           Disease        Endemic      Risk      Hazard
 Diarrheal Disease Risk      X
 Encephalitis, Japanese      X
 Filariasis                                        X
 Helminthic Diseases        X
 Hepatitis, Viral           X
 Tuberculosis               X
 Typhoid Fever              X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Finland, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the
routine immunizations recommended above, the traveler should be
aware that rabies is prevalent in wild animals, especially foxes.

                              DISEASE RISK PROFILE

 Finland
     Disease        Endemic    Risk         Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat. There is concern amongst some
authorities that radioactive fallout from Chernobyl has
contaminated northern reindeer herds.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas along the coast of the Gulf of Finland
from Kotka to the border with the USSR, and all the islands south
of Turku including the Aland islands.

France, French Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country, primarily in the Mediterranean costal
areas. This list is not all inclusive, but it is a caution
concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 France
            Disease              Endemic      Risk    Hazard
 Avian Influenza                    X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Sandfly Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

AIDS Information

3,073 cases of AIDS have been reported, the highest level in
Europe, with 40% of these cases being located in Paris. No
testing of foreign travelers is required. Blood donors are being
checked. Premarital HIV antibody testing is performed. Prenatal
exams include HIV antibody testing.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

French Guiana

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention


Falciparum malaria represents 70% of malaria, therefore there is
a 30% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease is present in all rural areas.       The main vector
is Rhodnius prolixus.

                           DISEASE RISK PROFILE

 French Guiana
            Disease              Endemic      Risk         Hazard
 Brucellosis                                X
 Chikungunya Fever               X
 Dengue Fever                    X
 Diarrheal Disease Risk          X
 Dysentery, Amoebic              X
 Echinococcosis                  X
 Encephalitis                    X
 Filariasis                                             X
 Helminthic Diseases             X
 Hepatitis, Viral                X
 Leishmaniasis (Cutaneous)       X
 Leishmaniasis (Mucocutaneous)   X
 Rabies                          X
 Tuberculosis
 Trypanosomiasis, American       X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk should be boiled to insure safety. Powdered and evaporated
milk are available and safe. Avoid butter and other dairy
products. Local meat, poultry, seafood, vegetables, and fruits
are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required on arrival
from all countries. A vaccination certificate is required for
children over one year of age. CDC recommends vaccination for
all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

French Polynesia, Overseas Lands of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present
in this country at all times and may give rise to major
outbreaks. An active epidemic of dengue and dengue hemorrhagic
fever is present in this country at this time.

                           DISEASE RISK PROFILE

 French Polynesia
            Disease        Endemic       Risk     Hazard
 Diarrheal Disease Risk                   X
 Encephalitis, Japanese       X
 Filariasis                                         X
 Helminthic Diseases                      X
 Tuberculosis                 X
 Typhoid Fever                            X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe.    Local meat, poultry, seafood,

vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Gabon, Gabonese Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria exists all year, in all parts of the country below 1000
meters, including urban areas. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 95% of malaria, therefore there is
a 5% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.


Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis is present in this country. Avoid contact with
fresh water lakes, pounds, or rivers. Infection with S.
haematobium and/or S. intercalatum has been reported from all
populated regions of Gabon. S. haematobium is more prevalent in
the western half of the country, while S. intercalatum is
predominant in the eastern half. No research data is available
from the northeastern interior.

                            DISEASE RISK PROFILE

 Gabon
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm                    X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                    X
 Helminthic Diseases                                   X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)                     X
 Leishmaniasis (Visceral)                      X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                          X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information
AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from all countries. A vaccination certificate
is required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age who go outside
of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country. Polio is prevalent in this country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Gambia, Republic of The

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in this entire country all year around.
The malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a 15% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.
haematobium is endemic along the Gambie valley. The snail
intermediate host for S. haematobium: Bulinus jousseaumei and
Bulinus guernei. S.mansoni is present in some villages south of
Banjul along the border with Senegal.


                                DISEASE RISK PROFILE

 Gambia
             Disease                 Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm             X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic/Bacillary                      X
 Echinococcosis                                    X
 Filariasis                                                X
 Giardiasis                                        X
 Helminthic Diseases                               X
 Hepatitis, Viral                          X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Rabies                         X
 Relapsing Fever                X
 Rift Valley Fever              X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                             X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on arrival
from all countries. A vaccination certificate is required for
children over one year of age. CDC recommends vaccination for all
travelers over 9 months of age. This disease is active presently
in the Upper River Division.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Meningococcal infection is present in this country.

Georgia

INFECTIOUS DISEASE RISK

Malaria Risk

Prevent malaria with treatment of clothing with permethrin and use of topical
insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks
before exposure, weekly while in the risk area, and continuing for 4 weeks post
exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.
                              DISEASE RISK PROFILE

 Georgia
     Disease        Endemic    Risk      Hazard
 Avian Influenza
 (H5N1)               X
 Tuberculosis         X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Germany, Federal Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following disease
exists in this country. This list is not all inclusive, but it is a
caution concerning the most likely endemic disease risk. Rabies
is prevalent in wild animals, especially foxes.

AIDS Information

1,760 cases of AIDS were reported through Jan 1988. No official
requirement exists for testing travelers, but travelers suspected
of carrying the HIV virus may be refused entry. The state of
Bavaria requires an HIV antibody test for persons planning on
staying there longer than 180 days. Results of US tests are not
accepted.

                               DISEASE RISK PROFILE

 Germany
      Disease       Endemic       Risk      Hazard
 Avian Influenza
 (H5N1)               X


Food/Water Safety

Local water is considered safe without further treatment.    Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the forested areas around Karlsruhe and Pforzheim,
Stuttgart and Tubingen, and in areas around Regensburg, extending
south to Landshut and to Passau on the border with Austria.

Ghana, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria exists in all parts of this country, all year long. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis is found throughout this country, including urban
areas. Avoid contact with contaminated fresh water lakes, ponds,
or streams.

Amoebic and bacillary dysentery, diarrheal diseases, helminthic
diseases, and viral hepatitis associated with water and food
supplies are particularly common in this country.


                            DISEASE RISK PROFILE

 Ghana
             Disease             Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                                X
 Filariasis                                            X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over
one year of age. Vaccination certificate is required for
travelers who have been in or passed through an infected yellow
fever area within six days prior to arrival. Vaccination is
recommended for all travelers for their protection. The Centers
for Disease Control recommends immunization for all travelers 9
months and over.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Local officials may demand a cholera
vaccination, therefore it is advisable to obtain one prior to
arrival in this country.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is in the region bordering
Burkina Faso.
Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Gibraltar

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                                DISEASE RISK PROFILE

 Gibraltar
             Disease                Endemic      Risk   Hazard
 Brucellosis                           X
 Diarrheal Disease Risk                X
 Dysentery, Amoebic/Bacillary          X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)              X
 Sandfly Fever                         X
 Typhoid Fever                         X
 Typhus, Endemic Flea-Borne            X
 Typhus, Scrub                         X
 West Nile Fever                       X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Greece, Hellenic Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Greece
            Disease              Endemic      Risk    Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                        X
 Diarrheal Disease Risk             X
 Dysentery, Bacillary               X
 Echinococcosis                     X
 Encephalitis, Tick-Borne           X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Sandfly Fever                      X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

Special Note: Most medications with codeine have been banned in
Greece. Obtain a physician's letter explaining the need for
medications containing codeine (caution - many cough preparations
contain codeine). Fines of $850 to $85,000 or prison terms of up
to ten years can be levied on anyone attempting to bring codeine
into the country without a doctor's justification.

AIDS Information

Foreign students receiving Greek government scholarships and
performing artists must produce evidence of a negative HIV
antibody test result.

Food/Water Safety
Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over 6 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Greenland

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Rabies ocurs in this country in wildlife, especially bats.

Tularemia is also endemic in Greenland.
                                 DISEASE RISK PROFILE

 Greenland
     Disease        Endemic         Risk      Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of   the high rate of healthy carriers
of hepatitis B among the local   Inuit (Eskimo) population,
vaccination is recommended for   persons working in health care,
education, or in close contact   with them.

Grenada

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.
Amoebic and bacillary dysentery, diarrheal diseases, and viral
hepatitis associated with water and food supplies are
particularly common in this country.

Rabies is prevalent in this country, especially in the mongoose.

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

                              DISEASE RISK PROFILE


 Grenada
     Disease        Endemic     Risk      Hazard

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Guadeloupe

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The entire
island of Grande Terre is infected. All densely populated coastal
areas of Basse Terr are infected, with only the interior highland
forest areas free of risk. No data is available from the islands
of Marie-Galante and La Desirade.

Rabies has been reported, especially in the mongoose, in this
country.

Amoebic and bacillary dysentery, diarrheal diseases, and viral
hepatitis associated with water and food supplies are
particularly common in this country.

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

                               DISEASE RISK PROFILE


 Guadeloupe
      Disease        Endemic       Risk       Hazard

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Guam, Territory of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Guam
           Disease         Endemic      Risk      Hazard
 Dengue Fever                 X
 Diarrheal Disease Risk                  X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever               X

Food/Water Safety

First class hotels and restaurants serve purified drinking water
and reliable food. However, the hazard is left to your
judgement.
VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Guatemala, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk


Malaria risk exists all year only below 1500 meters. The city of
Guatemala and the high altitude areas of the central highland are
risk free. It is found (a) (excluding urban areas) in Baja
Verapaz, Chiquimula, Escuintla, Jalapa, El Peten, El Progreso, El
Quiche, Santa Rosa, Suchitpequez, Zacapa; (b) Alta Verapaz,
Huehuetenago, Izabal, Jutiapa, Retalhuleu; and in the Municipios
of Coatepeque (Quetzaltenango Dep.) and Ocos (San Marcos Dept.)
Note: Persons vacationing on the Pacific or Caribbean coasts, or
contemplating trips to the archaeological sites of Sayache and
Tikal and the jungle of Peten, or traveling throughout the
interior should follow an antimalarial regimen. Prevent malaria with treatment
of clothing with permethrin and use of topical insect repellent on skin. Take
chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in
the risk area, and continuing for 4 weeks post exposure.

Falciparum malaria represents 6% of malaria, therefore there is a
risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk


There has been a significant spread of cholera into much of this
country. Cholera vaccination is not required or advised. Food
and water precautions are essential.

Chagas' disease risk is present in all rural areas below 1500
meters of the following departments: Alta Verapaz, Baja Verapaz,
Chiquimula, El Progreso, Escuintla, Guatemala, Huehuetenango,
Jalapa, Jutiapa, Sa, Marcos, Santa Rosa, and Zacapa. The main
vectors are Triatoma dimidiata and Rhodnius prolixus.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                             DISEASE RISK PROFILE

 Guatemala
               Disease              Endemic         Risk         Hazard
 Brucellosis                           X
 Dengue Fever                          X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                  X
 Hepatitis, Viral                     X
 Leishmaniasis                        X
 Onchocerciasis                       X
 Trypanosomiasis, American
 Chaga's Disease                      X
 Tuberculosis                         X
 Typhoid Fever                                       X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Guatemala City serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is infected with yellow
fever. A vaccination certificate is required for children over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered.            Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals. Rabies is
most commonly found in this country in dogs and bats.


AIDS Information

Testing is required for all applicants for residence permits.
Foreign tests are acceptable under certain circumstances. but
contact the Guatemalan embasy for details.

Guinea, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in this entire country, all year long. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 92% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.
haematobium and S. mansoni are endemic throughout Guinea, except
for the administrative regions of Conakry, Boffa, Dubreka,
Telimele and Pita (coastal and western part of the country).

Amoebic and bacillary dysentery, diarrheal diseases, helminthic
diseases, and viral hepatitis associated with water and food
supplies are particularly common in this country.


                            DISEASE RISK PROFILE

 Guinea
            Disease              Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                                X
 Filariasis                                            X
 Lassa Fever                       X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                                        X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Tungiasis                                             X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety
All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Yellow fever is
active in this country at this time. CDC recommends vaccination
for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:
Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be cautioned not to pet
dogs, cats, or other mammals.

Guinea-Bissau, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in this entire country, all year long. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.haematobium
is highly endemic throughout the northern half of the country,
particulary in the valleys of the Cacheu and Geba rivers, and
along the border with Guinea. Infection is not present along the
saltwater marsh and mangrove areas of southwestern Guinea-Bissau
and the outlying islands.

Amoebic and bacillary dysentery, diarrheal diseases, helminthic
diseases, and viral hepatitis associated with water and food

supplies are particularly common in this country.
                            DISEASE RISK PROFILE

 Guinea-Bissau
            Disease              Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                                X
 Filariasis                                            X
 Lassa Fever                       X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Tungiasis                                             X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone, see page HHH.
A vaccination certificate is required for children over one year
of age. CDC recommends vaccination for all travelers over 9
months of age.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Guyana, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk
Malaria is present in North West Region and Rupununi Region of
this country below 900 meters, excluding urban areas. The risk
exists all year. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 41% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present
in this country at all times and may give rise to major
outbreaks.

Amoebic and bacillary dysentery, diarrheal diseases, helminthic
diseases, and viral hepatitis associated with water and food
supplies are particularly common in this country.

The vector for Chagas' disease, Rhodnius prolixus, is present in
rural areas, but due to the lack of investigations on Chagas'
disease the extent of human infection cannot be determined.

                             DISEASE RISK PROFILE

 Guyana
            Disease            Endemic       Risk   Hazard
 Brucellosis                      X
 Echinococcosis                   X
 Encephalitis                     X
 Filariasis                       X
 Leishmaniasis (Cutaneous)        X
 Leishmaniasis (Visceral)         X
 Rabies                           X
 Tuberculosis                     X
 Trypanosomiasis, American        X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use.   Insure that bottled water

is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Georgetown serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination is required
for children of all ages. CDC
recommends vaccination for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.

Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Haiti, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in this country in all areas below 300
meters, including urban areas, all year long. Note: Persons
vacationing in sea resorts or stopping overnight on a cruise in
any port of the country must take malaria suppressant medication.
Prevent malaria with treatment of clothing with permethrin and use of topical
insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks
before exposure, weekly while in the risk area, and continuing for 4 weeks post
exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                                DISEASE RISK PROFILE

 Haiti
             Disease                Endemic      Risk     Hazard
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                               X
 Filariasis                            X
 Hepatitis, Viral                      X
 Rabies                                X
 Tuberculosis                          X
 Tularemia                             X

AIDS Information

Researchers report 1,000 to 2,000 cases of AIDS have been
diagnosed, with between 100,000 to 200,000 persons estimated to
be infected with the virus. Projections are that 1 million of the
country's 6 million inhabitants will become infected with the
virus within the next 5 years.

50% of Haitian prostitutes carry the AIDS virus.        Four out of
every 10 AIDS patients are female.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure

safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with current infection. A vaccination is
required for children of all ages. Children under nine months of
age should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.
Honduras, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no risk of malaria in the urban areas of the Central
highlands. Malaria is found below 1000 meters from May through
December in rural areas of Intibuca, La Paz, Lempira, and Olancho
Departments. The city of Tegucigalpa is risk free. Note:
Persons vactioning in the sea resorts of Ceiba and Tela or the
Bay Islands (Islas de la Bahia), or travelling along the Pacific
coast or extensively in the interior should take malaria
suppressant medication. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Falciparum malaria represents 3% of malaria, therefore there is
risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Cholera has appeared in this country along the Pacific coast.
Vaccination is not required or recommended. Food and water
precautions are urged.

Chaga's Disease is present in rural areas below 1500 meters in
the following departments: Choletucaca, Comayagua, Copan, El
Paraiso, Francisco Morazan, Intibuca, La Paz, Lempira,
Ocotepeque, Olancho, Santa Barbara, and Yoro. The main vectors
are Triatoma dimidiata and Rhodnius prolixus.


                             DISEASE RISK PROFILE

 Honduras
               Disease              Endemic         Risk   Hazard
 Brucellosis                           X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                                 X
 Hepatitis, Viral                     X
 Leishmaniasis                        X
 Tuberculosis                         X
 Typhoid Fever                               X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Tegucigalpa serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. Children under nine months
of age should generally not be vaccinated with yellow fever
vaccine due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals. Rabies
frequently occurs in dogs and bats in this country.

Hungary, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                          DISEASE RISK PROFILE

 Hungary
         Disease          Endemic     Risk       Hazard
 Avian Influenza (H5N1)      X
 Diarrheal Disease Risk      X
 Dysentery, Bacillary        X
 Rabies                      X
 Tuberculosis                X
 Typhoid Fever               X

AIDS Information

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas extending from the Austrian border east
to the outskirts of Budapest.

Iceland, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 Iceland
      Disease       Endemic    Risk         Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

India, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas, except the following northern states which are risk free:
Himachal Pradesh, Jammu, Kashmir and Sikkim. Main vectors:
northern India; A. minimus minimus; Ganges plane: A. stephensi
stephensi and A. culicifacies; peninsular India: A culcifacies.
The malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 19% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Meningococcal meningitis - There have been outbreaks in the New
Delhi area. Consider vaccination for travel to this area.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk is
limited to the area of the Gimvi village in Ratnagiri District,
State of Maharashtra, in the hills along the Konkan coast, south
of Bombay (approximately 16km from shore). Risk of transmission
in other areas of India have not been confirmed. Snail
intermediate host: Ferrissia tenuis.
                                DISEASE RISK PROFILE

 India
             Disease                Endemic      Risk   Hazard
 Avian Influenza (H5N1)                X
 Brucellosis                                      X
 Chikungunya Fever                     X
 Cholera                                          X
 Dengue Fever                          X
 Dracunculiasis/Guinea Worm                       X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                                   X
 Encephalitis, Japanese                X
 Filariasis                                       X
 Helminthic Diseases                              X
 Hemorrhagic Fevers                    X
 Hepatitis, Viral                                 X
 Leishmaniasis (Visceral)                                 X
 Rabies                                           X
 Relapsing Fever                                  X
 Sandfly Fever                                            X
 Trachoma                                         X
 Tuberculosis                          X
 Typhoid Fever                                    X
 Typhus                                           X

AIDS Information

Proof of a negative HIV antibody test is required by all students
over the age of 18 and other persons between 18 and 70 planning
to stay for more than 1 year, excluding accredited journalists
and those working in foreign missions. U.S. test results are
accepted. These test results should be validated with the
uniform stamp used to certify yellow fever and cholera
vaccinations. Testing must be performed within
30 daysd of arrival.

Health officials in Bombay have indicated that the number of AIDS
carriers doubles in that city every six months. A survey of the
country's blood supply in 1989 indicated that more than 1% of the
country's blood supply is contaminated with the AIDS virus.
There is a very poor blood donor screening program.
Approximately 10,000 prostitutes in Bombay are believed to carry
the AIDS virus.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants in Agra, Ahmadabad, Bangalore, Bombay, Calcutta,
cochin, Darjeeling, Jaipur, madras, New Delhi, Simla, Srinagar,
Udaipur, and Varanasi (Benaress) serve purified drinking water
and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.
Travelers leaving this country are required to possess a
vaccination certificate on their departure to countries which
still demand such a certificate.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone but to include all portions
of the Sudan - not just that
area south of 15 degrees north latitude. A vaccination is
required for children up to six months of age. CDC recommends
vaccination for all travelers over 9 months of age.
Vaccination certificate is required for travelers who have been
in or passed through an infected yellow fever area within six
days prior to arrival.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. The disease
is most prevalent in the north, northeast, and south. Period of
transmission is all year, with the high risk group being children
under 15 years of age. Time of greatest risk is June through
October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the north: Himachal Pradesh and the northern
part of Uttar Pradesh; in the south: the northwestern part of
Tamil Nadu.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Indonesia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria exists in the rural areas only, and below 1200 meters.
Risk is all year. There may be urban exposure in Irian Jaya.
Jagkarta, Surabaya, Denpasar (Bali) and other large cities are
risk free. Note: Persons travelling through rural areas, or
making cruises between the islands should be aware of
multi-drug-resistant P. falciparum malaria and should follow an
antimalarial regimen. The malaria in this country is resistant
to chloroquine. Prevent malaria with treatment of clothing with permethrin and
use a topical insect repellent on skin. Several oral medications are available
to prevent malaria in the country. See malaria prevention.

IAMAT has found evidence of malaria in Bali. Exposure to
mosquitoes at night should be minimized with the use of insect
repellant and/or netting.

Falciparum malaria represents 40% of malaria, therefore
there is a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Only the
centre of Sulawesi is considered endemic. Risk is present in the
Lindu valley and localized around Lake Lindu (villages of Anca,
Langko, Tomado and Puroo); and in the Napu valley (about 50 km
southeast of Lindu valley) affecting the villages of Wuasa,
Maholo, Winowanga, Alitupu and Watumaeta. Snail intermediate
host is a subspecies: Oncomelania hupensis lindoensis.

Amoebic and bacillary dysentery, diarrheal diseases, helminthic
diseases, and viral hepatitis associated with water and food
supplies are particularly common in this country.


                           DISEASE RISK PROFILE

 Indonesia
           Disease         Endemic      Risk      Hazard
 Avian Influenza (H5N1)       X
 Chikungunya Fever            X
 Encephalitis, Japanese       X
 Fasciolopsiasis              X
 Filariasis                                         X
 Melioidosis                             X
 Rabies                                  X
 Tuberculosis                X
 Trachoma                    X
 Typhus, Scrub               X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Denpasar, Jakarta, Surabaya, and Yogyakarta serve
purified drinking water and reliable food. However, the hazard
is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination is required
for children of all ages.
Children under nine months of age should generally not be
vaccinated due to health considerations. Please refer to the
discussion on page III on avoiding yellow fever vaccination in
this age group.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.


Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throughout the country all year long (highest
instance in June through October), with the highest risk being in
children younger than 15 years of age.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is on the island of Java south of Surakarta.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Iran, Islamic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Risk is present in rural areas throughout Iran, except the
central and northern high altitude areas (above 1500 m).
Chloroquine is the drug of choice for Iran in these areas.
Chloroquine resistant P. falciparum malaria has been reported
from Baluchistan (area bordering Pakistan) and Sistan (area
bordering Afghanistan). Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 21% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of primaquine
upon return home.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.
haematobium is present only in the plains of the province of
Khuzestan on the southwestern border with Iraq. The following
areas are affected: Dasht Mishan, Khorramshahr, Hamidieh, Ahwaz
and the extensively irrigated areas of Dezful, Shushtar, Mian Ab,
Haft Tappeh, including the area of Sardasht. The infection does
not extend beyond the Zagros Mountains to the east.

Amoebic and bacillary dysentery, diarrheal diseases, giardiasis,
helminthic diseases, and viral hepatitis associated with water
and food supplies are particularly common in this country.

                           DISEASE RISK PROFILE

 Iran
      Disease       Endemic        Risk      Hazard
 Avian Influenza
 (H5N1)               X
 Brucellosis                        X
 Echinococcosis                     X
 Leishmaniasis                      X
 Relapsing Fever                    X
 Sandfly Fever                                    X
 Trachoma                           X
 Tuberculosis         X
 Typhoid Fever                      X
 Typhus                             X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Abadan, Esfahan, Mashhad (Meshed), Shiraz, and
Tehran serve purified drinking water and reliable food.   However,
the hazard is left to your judgement.




VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
one year of age.


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to
western travelers is low. Immunization is not required or
recommended for travel to this country due to its low
effectiveness. Avoid uncooked foods and untreated water.
Vaccination is advised only for persons living or working under
inadequate sanitary conditions and for those with impaired
defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of risk for this
country are present in the northwest portion of the country in
the areas around Manjil where the Talish Mountains meet the
Elburz Mountains.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

AIDS Information

AIDS testing is required for all persons staying longer than
three months. Further information is available from the Iranian
embassy.

Iraq

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is found below 1500 meters in the northern part of the
country, including urban areas, in the Provinces of Duhok, Erbil,
Kirkuk, Mawsil, Ninawa, and Sulaimaniya. Risk is also present in
rural areas in the eastern half of the country along the border
with Iran. Note: the city of Baghdad is risk free. Prevent malaria with
treatment of clothing with permethrin and use of topical insect repellent on
skin. Take chloroquine 500 mg weekly, starting two weeks before exposure, weekly
while in the risk area, and continuing for 4 weeks post exposure.

Falciparum malaria represents <1% of malaria, therefore there is
a significant risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The
mountainous regions of the northeastern part of the country
bordering Iran, namely the provinces of Irbil, Kirkuk and
Sulaymaniyah are risk free. S. haematobium is endemic along the
entire Euprhates and Tigris (as far north as Samarra) river
systems, their tributaries, irrigation canals and marsh areas
including urban areas. As isolated focus exists in the northern
Province of Mawsil (Mosul) in the area of Tall Kayft.

                              DISEASE RISK PROFILE

 Iraq
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                                           X
 Cholera                            X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                        X
 Echinococcosis                     X
 Hepatitis, Viral                              X
 Hemorrhagic Fever                  X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Relapsing Fever                    X
 Tapeworms                          X
 Trachoma                           X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X

AIDS Information

Travelers planning on staying longer than 5 days must be tested
for HIV antibody. Failure to have this test performed will
result in a fine of $1,600 US. Foreign tests are acceptable
under certain circumstances and can result in avoiding the $330
test fee. Conact the Iraqi embassy for further details.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Baghdad serve purified drinking water and reliable
food. However, the hazard is left to your judgement.
VACCINATIONS

Yellow fever - A vaccination certificate is required for all
travelers coming from infected areas and from or in transit
through countries with active infection.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Known areas of risk are present in the eastern
part of the country, with a major focus of activity around
Khanaqin.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Ireland

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 Ireland
      Disease       Endemic    Risk         Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.


VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those

with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Israel, State of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

A recent polio epidemic makes it advisable for everyone traveling
to Israel to be current on polio immunization.

                              DISEASE RISK PROFILE

 Israel
            Disease              Endemic      Risk     Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                                             X
 Cholera                            X
 Diarrheal Diseases                            X
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                     X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)                     X
 Leishmaniasis (Visceral)                      X
 Rabies                             X
 Relapsing Fever                    X
 Tapeworms                          X
 Trachoma                           X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X

AIDS Information

The government is debating the testing for HIV antibody
in all foreign volunteers coming to work at kibbutzim, or
communal farms. Some kibbutzim are currently conducting tests.
Blood donors have been screened since 1986. The number of
persons infected with the virus is known to be 237; persons with
active AIDS disease 45; and deaths from AIDS, 33 through July
1987.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
There has been a steady increase in infectious hepatitis in
recent years. Milk is pasteurized and safe to drink. Butter,
cheese, yogurt and ice-cream are generally safe. Local meat,
poultry, seafood, vegetables, and fruits are safe to eat with
caution as to the source.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered.      Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Italy, Italian Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Italy
            Disease              Endemic      Risk    Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                        X
 Diarrheal Diseases                 X
 Dysentery, Bacillary               X
 Echinococcosis                     X
 Hepatitis, Viral                   X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Sandfly Fever                      X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
This problem is more common in the summer months in the southern
portion of the country. Water in the Adige River in northeastern
Italy is contaminated with toxic chemicals and should not be
drunk. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Hepatitis A is found with increasing risk in this country,
therefore gamma globulin injection is recommended.

Jamaica

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Scabies and head lice are frequent problems amongst the lower
class native population.

Dumping of raw sewage into the ocean at major resort areas and in
Kingston Bay are potential health problems that may grow as the
tourist business increases.

                           DISEASE RISK PROFILE

 Jamaica
           Disease             Endemic      Risk      Hazard
 Diarrheal Disease Risk                   X
 Dysentery, Amoebic/Bacillary             X
 Hepatitis, Viral               X
 Leptospirosis                  X
 Rabies                         X
 Typhoid Fever                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

A typhoid fever outbreak in the western regions of this country
underscores the requirement for obtaining a safe water supply.
The thyphoid fever area is not frequented by tourists. Sewage
treatment is very poor and even many first class hotels dump
waste directly into the ocean. Medical waste can be found on the
south shore beaches.


VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Japan

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

In this country Schistosomiasis has been brought under control
due to improved sanitation and irrigation systems, and widespread
destruction of the snail intermediate host. No human cases have
been reported sine 1978. Today, S. japonicum in Japan is a
zoonsis (infection of animals) limited to the Kofu Basin, with
cattle and rodents being the major parasite reservoirs.

                           DISEASE RISK PROFILE

 Japan
          Disease          Endemic       Risk     Hazard
 Avian Influenza (H5N1)       X
 Clonorchiasis                X
 Dengue Fever                 X
 Paragonimiasis               X
 Tuberculosis                 X
 Typhoid Fever (Okinawa)      X
 Typhus, Scrub                X

Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.



VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccination listed is recommended for the traveler's
protection.
Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur in western and southern Japan, especially on the islands of
Kyushu and Okinawa. Period of transmission is June through
October, with the elederly being at the highest risk.

Jordan, Hashemite Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

The Department of State recommends meningococcal meningitis
immunization for travel to this country, but the CDC does not.

                              DISEASE RISK PROFILE

 Jordan
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                                           X
 Cholera                            X
 Diarrheal Diseases                            X
 Dracunculiasis/Guinea Worm         X
 Dysentery, Amoebic                 X
 Echinococcosis                     X
 Giardiasis                         X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Relapsing Fever                    X
 Tapeworms                          X
 Trachoma                           X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Amman serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Kazakhstan, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                                    DISEASE RISK PROFILE

 Kazakhstan
         Disease          Endemic          Risk            Hazard
 Avian Influenza (H5N1)      X
 Tuberculosis                X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).
Kenya, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year, but only below 2500 meters.
There is no risk of malaria in Nairobi and the highlands above
2500 meters of the central, Rift Valley, Eastern, Nyanza and
Western provinces. Persons contemplating safaris or vacationing
in Mombasa and the sea resorts along the coast must take
suppressive medication. The malaria in this country is resistant
to chloroquine. Prevent malaria with treatment of clothing with permethrin and
use a topical insect repellent on skin. Several oral medications are available
to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Both S.
haematobium and S. mansoni are endemic in Kenya, especially in
irrigated agricultural zones and the densely populated rural and
suburban areas around Lake Victoria (Kavirondo Gulf and Nyakach
Bay), the islands of Mfangano and Rusinga, Kisumu and Kano Plain;
on the Plateaux to the east, northeast and north of Nairobi,
expecially in the districts of Kitui and Machakos; in the lower
valley of the Tana river in the southeastern part of the country
extending from the towns of Garissa to Galole; the Indian ocean
coastal from Lamu to the border with Tanzania including the areas
of Mombasa; Lake Jipe and surrounding areas including the areas
of Taveta, Wundanyi and Voi. Foci of infection have also been
reported from Wajir and W.Bor in North Eastern Province, and from
Kimilili, Western Province. The full extent of the infection is
not yet determined. Additional snail intermediate hosts; Bulinus
ugandae, Bulinus tropicus, Bulinus nasutus for S. haematobium;
Biophalaria choanomphala for S. mansoni.


Meningococcal meningitis is at times epidemic in the savannah
during the dry season from December until June.


                           DISEASE RISK PROFILE

 Kenya
              Disease           Endemic   Risk       Hazard
 Dracunculiasis/Guinea Worm        X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                            X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)        X
 Leishmaniasis (Visceral)         X
 Hemorrhagic Fever (Marburg)      X
 Plague                           X
 Polio                                                 X
 Rabies                           X
 Relapsing Fever                  X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                X
 Tuberculosis                     X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne       X
 Typhus, Epidemic Louse-Borne     X
 Typhus, Scrub                    X

AIDS Information

Government researchers randomly tested 200 Nairobi prostitutes
and indicated that 85% were HIV antibody positive.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. All meat,
poultry and seafood must be well cooked and served while hot.
Pork is best avoided. Vegetables should be well cooked and
served hot. Salads and mayonnaise are best avoided. Fruits with
intact skins should be peeled by you just prior to consumption.
Avoid cold buffets, custards, and any frozen dessert. First class
hotels and restaurants in Malindi, Mombasa, Nanyuki, and Tsavo
serve purified drinking water and reliable food. However, the
hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
one year of age. Vaccination is recommended for all travelers
for their protection. CDC recommends vaccination for all
travelers over 9 months of age who will travel outside of urban
areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal menigitis - Vaccination is recommended for all
travelers to this country who might visit rural areas or areas
with possible refugee activity. In general, this vaccination
should be given to all travelers to this country.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the areas around Nairobi and along the border
with Tanzania (eastern part).

Kiribati, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Kiribati
           Disease         Endemic      Risk      Hazard
 Dengue Fever                 X
 Diarrheal Diseases                      X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever                           X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Korea, Democratic People’s Republic of (North Korea)

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 North Korea
          Disease           Endemic       Risk     Hazard
 Dengue Fever                  X
 Diarrheal Diseases                        X
 Encephalitis, Japanese        X
 Encephalitis, Tick-Borne                  X
 Hepatitis, Viral                          X
 Tuberculosis                  X
AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Pyongyang serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:
Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occasionally, with the period of transmission from June to
October.

Korea, Republic of (South Korea)

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 South Korea
            Disease         Endemic       Risk     Hazard
 Avian Influenza (H5N1)        X
 Clonorchiasis                 X
 Dengue Fever                  X
 Diarrheal Diseases                        X
 Encephalitis, Japanese        X
 Encephalitis, Tick-Borne      X
 Filariasis                    X
 Hepatitis, Viral                          X
 Paragonimiasis                X
 Tuberculosis                  X
 Typhus, Scrub                 X

AIDS Information

AIDS antibody testing is required for foreigners working as
entertainers who are staying longer than 90 days. Contact the
South Korean embassy for further details.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Pusan and Soul (Seoul) serve purified drinking
water and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.
Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
reported from all provinces, especially the southwest, with the
period of transmission from June to October. High risk groups are
children and young adults.

Kuwait, State of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Kuwait
             Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)              X
 Brucellosis                                            X
 Cholera                             X
 Diarrheal Diseases                                     X
 Dracunculiasis/Guinea Worm          X
 Echinococcosis                      X
 Hepatitis, Viral                               X
 Leishmaniasis (Cutaneous)           X
 Leishmaniasis (Visceral)            X
 Rabies                              X
 Relapsing Fever                     X
 Tapeworms                           X
 Trachoma                            X
 Tuberculosis                        X
 Typhoid Fever                                  X
 Typhus, Endemic Flea-Borne          X
 Typhus, Scrub                       X

AIDS Information

AIDS antibody testing is required for persons applying for
residence permits for periods longer than six months. U.S. test
results are accepted. Conact the Kuwait embassy for further
details.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Kyrgyzstan, Kyrgyz Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.
Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                                DISEASE RISK PROFILE

 Kyrgyzstan
       Disease        Endemic           Risk           Hazard
 Tuberculosis            X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Laos, Lao People's Democratic Republic

INFECTIOUS DISEASE RISK

Malaria Risk

The city of Viangchan (Vientiane) is risk free. Falciparum
malaria consitutes 93 percent of the malaria in this country.
This malaria is resistant to chloroquine and the CDC recommends
the use of weekly Lariam (mefloquine) for prophylaxis.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Known areas
of infection are present on Khong Island in the Mekong river in
the southwest of the country on the border with Cambodia. Risk
exists also further north on the Mekong in the districts of Pakxe
and Bassac.


                           DISEASE RISK PROFILE
 Laos
             Disease             Endemic   Risk     Hazard
 Avian Influenza (H5N1)             X
 Chikungunya Fever                  X
 Cholera                            X
 Clonorchiasis/Opisthorchiasis      X
 Dengue Fever                       X
 Diarrheal Disease Risk                               X
 Dysentery, Amoebic/Bacillary               X
 Encephalitis, Japanese            X
 Fasciolopsiasis                   X
 Filariasis                                           X
 Helminthic Diseases               X
 Hepatitis, Viral                  X
 Melioidosis                       X
 Rabies                            X
 Tuberculosis                      X
 Typhoid Fever                     X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Vientiane serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. The disease
is endemic throughout the year. Period of transmission is all
year.

Latvia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                              DISEASE RISK PROFILE

 Latvia
     Disease        Endemic    Risk      Hazard
 Tuberculosis          X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Lebanon, Lebanese Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk is
limited to the Litani River delta near As Sarafand between Sur
(Tyre) and Sayda (Sidon). The infection has been brought under
control as no cases of locally acquired human Schistosomiasis
have been reported since 1969.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE
 Lebanon
            Disease           Endemic   Risk      Hazard
 Brucellosis                                        X
 Cholera                        X
 Diarrheal Diseases                                 X
 Dracunculiasis/Guinea Worm     X
 Echinococcosis                 X
 Hepatitis, Viral               X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Polio                                              X
 Rabies                         X
 Relapsing Fever                X
 Tapeworms                      X
 Trachoma                       X
 Typhoid Fever                           X
 Typhus, Endemic Flea-Borne     X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. Children under nine months
of age should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

AIDS Information

AIDS testing is required for all persons planning to live or work
in Lebanon. Contact Lebanon's embassy for full details.

Lesotho, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Locations of
infection are not confirmed.

                           DISEASE RISK PROFILE

 Lesotho
          Disease          Endemic       Risk     Hazard
 Diarrheal Disease Risk                   X
 Dysentery, Amoebic                       X
 Plague                     X
 Rabies                                   X
 Relapsing Fever            X
 Rift Valley Fever          X
 Trypanosomiasis, African   X
 Sleeping Sickness
 Tuberculosis               X
 Typhoid Fever                            X
 Typhus, Scrub              X

Food/Water Safety

Water, milk, and food is safe in Maseru, but precautions should

be taken in other areas of the country.

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be

assured.



VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. Children under nine months
of age should not be vaccinated due to health considerations.
The U. S. Embassy reports that the yellow fever certificate is
generally not checked by officials upon entry to this countyr.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.
Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is the western half of the country.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Liberia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including
urban areas. The risk exists all year. The malaria in this
country is resistant to chloroquine. Prevent malaria with treatment of clothing
with permethrin and use a topical insect repellent on skin. Several oral
medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents 90% of malaria, therefore there is
a 10% risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The coastal
regions of Liberia are risk free, specifically the countries of
Grand Cape Mount, Montserrado, Grand Bassa, Sinoe, Maryland and
Grand Gedeh. The interior regions are heavily infected with both
S. haematobium and S. mansoni.

                                DISEASE RISK PROFILE

 Liberia
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                                   X
 Dysentery, Amoebic/Bacillary                             X
 Echinococcosis                                   X
 Filariasis                                               X
 Helminthic Diseases                                      X
 Hepatitis, Viral                                         X
 Lassa Fever                           X
 Loiasis                                                  X
 Onchocerciasis                                           X
 Polio                                                    X
 Rabies                                X
 Relapsing Fever                       X
 Trachoma                                                 X
 Trypanosomiasis, African
 Sleeping Sickness                     X
 Tuberculosis                          X
 Tungiasis                                                X
 Typhoid Fever                                            X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot. Salads
and mayonnaise are best avoided. Fruits with intact skins should
be peeled by you just prior to consumption. Avoid cold buffets,
custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from all countries. A vaccination certificate
is required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Libya, Great Socialist People’s Libyan Aran Jamahiriya

INFECTIOUS DISEASE RISK
Malaria Risk

There is no malaria risk in this country exceot in two small
areas in the southwest corner of the country in the region of
Fezzan. The CDC does not recommend taking any preventative
medication for travel to this country.

Falciparum malaria represents <1% of malaria, therefore the risk
of exposure is limited to p. vivax malaria in the infected areas.
Consider use of Primaquine upon return home,
if travel and exposure in southwest Libia has occurred.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Triolitania
and Cyrenaica are free from schistosomiasis, except for two
isolated foci near the Mediterranean coast, one at Darnah (S.
haematobium) located halfway between Benghazi and the Egyptian
border, and the other at Tawurgha (S. mansoni), an oasis located
south of Misratah. S. haematobium is highly endemic in the
central part of Fezzan around Sabha, mainly in the villages along
the wadis of Buanis, Shati, Ajal and Hufra. Risk is also present
in the oases of Ghat, El Feuet and Al Birkah on the southwestern
border with Algeria.

                           DISEASE RISK PROFILE

 Libya
          Disease         Endemic      Risk       Hazard
 Brucellosis                            X
 Dengue Fever               X
 Diarrheal Disease Risk                 X
 Echinococcosis             X
 Giardiasis                             X
 Helminthic Diseases                    X
 Hepatitis, Viral                       X
 Leishmaniasis              X
 Polio                      X
 Rabies                     X
 Relapsing Fever            X
 Rift Valley Fever          X
 Sandfly Fever              X
 Trachoma                   X
 Typhoid Fever                          X
 Typhus                     X

AIDS Information

Proof of a negative HIV antibody test is required from persons
seeking residence visas for work or study. Other visitors and
official delegation members are reportedly exempt.
AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Al Jaghbub, Banghazi (Benghazi), and Tarabulus
(Tripoli) serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's

protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is around Tobruk (northeastern part of the country)
and the areas around Sidra.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Liechtenstein, Principality of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

The traveler should be aware that risk of exposure to rabies
occus in wild animals in this country.


                                 DISEASE RISK PROFILE

 Liechtenstein
        Disease       Endemic         Risk       Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Lithuania, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                              DISEASE RISK PROFILE


 Lithuania
      Disease       Endemic     Risk           Hazard
 Tuberculosis          X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current.   A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rural areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the western part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).
Luxembourg, Grand Duchy of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

The traveler should be aware that risk of exposure to rabies
occus in wild animals, especially foxes, in this country.

                               DISEASE RISK PROFILE

 Luxembourg
      Disease        Endemic       Risk       Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Macedonia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
                              DISEASE RISK PROFILE

 Macedonia
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                        X
 Diarrheal Disease Risk             X
 Dysentery, Bacillary               X
 Echinococcosis                     X
 Encephalitis, Tick-Borne           X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Sandfly Fever                      X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

Special Note: Most medications with codeine have been banned in
Greece. Obtain a physician's letter explaining the need for
medications containing codeine (caution - many cough preparations
contain codeine). Fines of $850 to $85,000 or prison terms of up
to ten years can be levied on anyone attempting to bring codeine
into the country without a doctor's justification.

AIDS Information

Foreign students receiving Greek government scholarships and
performing artists must produce evidence of a negative HIV
antibody test result.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS


Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over 6 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Madagascar, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, below 1700
meters, including most urban areas. The risk exists all year.
There is almost no risk of malaria in the town of Antananarivo
and minimal risk in the outskirts. There is minimal risk in the
towns of Antsirabe, Manjakandriana, and Anramasina. The malaria
in this country is resistant to chloroquine. Prevent malaria with treatment of
clothing with permethrin and use a topical insect repellent on skin. Several
oral medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams.
Shistosomiasis is highly endemic in most areas of the country,
except for the most northern tip of the Island (canton of
Antsiranana) and the following cantons of the northeastern coast:
Maroantsetra, Mananara, Soanierana-Ivongo, Andilamena,
Ambatondrazaka, Manjakandriana; in the interior of the country
the cantons of Anjozorobe, Amdramasina, Abatolampy, Betafo and
Antsirabe are also risk free. S. haematobium is prevalent in the
northern and western parts of the island, while S. mansoni is
predominant in the eastern and southern parts. Madagascar has a
high incidence of internal migration which facilitates the
spreading of Shistosomiasis. Travellers should consider the
entire country as infected. Additional snail intermediate host
for S. haematobium: Bulinus obtusispira.

                            DISEASE RISK PROFILE

 Madagascar
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Plague                            X
 Polio                             X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Antananarivo (Tananarive) and Tamatave serve
purified drinking water and reliable food. However, the hazard
is left to your judgement.




VACCINATIONS

Cholera - A cholera vaccination certificate is recommended for
travelers coming from or having been in transit through areas
considered infected. Local officials frequently demand, however,
that travelers show proof of cholera immunization, even though
they have not been in infected areas.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and sometimes from or in
transit through countries in the endemic yellow fever zone. A vaccination is
required for children of all
ages. Children under 9 months of age should not be vaccinated
due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the central highlands (Antananarivo and
Fianarantsoa provinces).

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Country number 121

Madeira Islands

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                               DISEASE RISK PROFILE

 Madeira
     Disease         Endemic     Risk       Hazard
 Tuberculosis           X


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over one year of age. The
requirement applies only to travelers arriving in or destined for
the Azores and Madeira. No certificate is, however, required
from transit passengers at Funchal, Porto Santo, and Santa Maria.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Malawi, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk
Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country in all areas,
including urban settlements. Avoid contact with fresh water
lakes, ponds, or streams.

                            DISEASE RISK PROFILE

 Malawi
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Meningitis                        X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                                        X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Blantyre serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination is required
for children of all ages.
Children under nine months of age should not be vaccinated due to
health considerations.
Vaccination is recommended for all travelers for their
protection. Vaccination is not advised for children under nine
months of age.

Although not officially required for travel to this country,
officials sometimes demand that a cholera certificate of
immunization be presented. This vaccine is not recommended, but
the travel clinic may wish to stamp the immunization record on
the cholera page indicating that the vaccine is not medically
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is the southern half of the country.


Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Malaysia

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present only below 1700 meters this country, in rural
areas only. The risk exists all year. Urban and coastal areas of
peninsular Malaysia including the Island of Pinang are risk free.
Island of Borneo: Sarawak: Coastal and urban areas are risk free.
Sabah: Risk is present in urban and rural areas throughout the
year. The malaria in this country is resistant to chloroquine.
Prevent malaria with treatment of clothing with permethrin and use a topical
insect repellent on skin. Several oral medications are available to prevent
malaria in the country. See malaria prevention.

Falciparum malaria represents 22% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of Primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country.         This list is not all inclusive, but it is a

caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.
Dengue fever is on an increase in this country and may be a
particular hazard during 1990 and 1991.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Known foci of
risk are present in the area of Fort Betau, (Pahang State) along
the Kapor River (tributary to the Pahang) in central Malaysia,
east of Kuala Lumpur, and in two camps of Orang Asli
tribespeople: Pos Iskandar and Bukit Lanjan, east of Kuala
Lumpur. Snail intermediate host: Robertsiella kaporensis.

Due to the high incidence of tuberculosis in this country, and
pre- travel and post-travel TB test is recommended when traveling
to this country.


                                DISEASE RISK PROFILE

 Malaysia
             Disease                Endemic      Risk      Hazard
 Avian Influenza (H5N1)                X
 Cholera                                          X
 Opisthorchiasis                       X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                                  X
 Hepatitis, Viral                      X
 Melioidosis                           X
 Polio                                 X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety


All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Kuala Lumpur and Pinang (George Town) serve
purified drinking water and reliable food. However, the hazard
is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throughout the country, throughout the year.

AIDS Information

AIDS testing is required for foreign workers seeking employment
such as construction, domestic, or plantation workers. Foreign
test results are accepted under certain conditions. Contact the
Malaysian embassy for full details.

Maldives, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no risk of malaria in Male Island, Kaafu Atoll and
resort areas. The CDC recommends a weekly dose of chloroquine
when traveling to areas of risk in this country. Malaria in other
areas is only 1% falciparum. Malaria risk is disappearing; the
last indigenous cases have been reported in 1983. Note: There is
no risk for persons vacationing in the resort areas.Consider use
of Primaquine therapy upon return home if heavy exposure occurs.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                           DISEASE RISK PROFILE

 Maldives
                Disease            Endemic        Risk   Hazard
 Brucellosis                                       X
 Cholera                                           X
 Diarrheal Disease Risk                            X
 Dysentery, Amoebic/Bacillary                      X
 Echinococcosis                                    X
 Helminthic Diseases                               X
 Hemorrhagic Fever, Crimea-Congo     X
 Hepatitis, Viral                                  X
 Leishmaniasis (Visceral)                                  X
 Polio                                                     X
 Rabies                                            X
 Sandfly Fever                                               X
 Typhoid Fever                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold

buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's

protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Mali, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found throughout this country, including
urban areas. Avoid contact with contaminated fresh water lakes,
ponds, or streams. The entire southern half of Mali (south of
Lake Faguibine) is endemic for both S. haematobium and S. mansoni
especially in the highly populated areas of the Niger and Senegal
river basins and their tributaries. High incidence rates of
infection have been reported from the urban areas of Bamako,
Segou and Mopti regions. No information is available from the
Gao area and the northern desert regions. Travellers should
consider the entire country as infected.

Cholera is present in this country. Risk to western travelers is
low. Immunization is not required or recommended for travel to
this country due to its low effectiveness. Avoid uncooked foods
and untreated water.

                                DISEASE RISK PROFILE

 Mali
              Disease                Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm             X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic/Bacillary                              X
 Echinococcosis                                    X
 Filariasis                                                X
 Giardiasis                                                X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Lassa Fever                           X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Loiasis                                               X
 Onchocerciasis                                        X
 Rabies                         X
 Relapsing Fever                X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.

Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on arrival
from all countries. Except: travelers arriving from a
non-infected area and staying less than two weeks in the country.
Vaccination is recommended for all travelers for their
protection, including those visiting the capital Bamako. This
disease is active in this country at this time. CDC recommends
vaccination for all travelers over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger in the southern half of the
country.

Rabies - In this country, where rabies is a constant
threat, a pre-exposure rabies vaccination is advised for persons
planning an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Malta, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Malta
            Disease              Endemic      Risk   Hazard
 Brucellosis                        X
 Diarrheal Diseases                 X
 Dysentery, Bacillary               X
 Echinococcosis                     X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Sandfly Fever                      X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over six months of age. Children under
nine months of age should not be vaccinated due to health
considerations. If
indicated on epidemiological grounds, infants under six months of
age are subject to isolation or surveillance if coming from an
infected area.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Marianas, Commonwealth of Northern

INFECTIOUS DISEASE RISK
Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).


Penicillin resistant gonorrhea is common in the Phillipines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                           DISEASE RISK PROFILE
 Mariana Islands
             Disease            Endemic   Risk      Hazard
 Chikungunya Fever                 X
 Cholera                           X
 Dengue Fever                      X
 Diarrheal Disease Risk                    X
 Dysentery, Amoebic/Bacillary              X
 Encephalitis, Japanese           X
 Fasciolopsiasis                  X
 Filariasis                                           X
 Helminthic Diseases                       X
 Hepatitis, Viral                          X
 Melioidosis                      X
 Opisthorchiasis                  X
 Paragonimiasis                   X
 Polio                            X
 Rabies                           X
 Tuberculosis                     X
 Typhoid Fever                    X
 Typhus, Scrub                    X

AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Marshall Islands, Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).
Penicillin resistant gonorrhea is common in the Phillipines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                                DISEASE RISK PROFILE

 Marshall Islands
             Disease                Endemic      Risk   Hazard
 Chikungunya Fever                     X
 Cholera                               X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Melioidosis                           X
 Opisthorchiasis                       X
 Paragonimiasis                        X
 Polio                                 X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.
Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Martinique, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found throughout this country, including
urban areas. Avoid contact with fresh water lakes, ponds, or
streams.

                                DISEASE RISK PROFILE

 Martinique
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                      X
 Typhoid Fever                         X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Water, milk, and food
in Forte-de-France are considered safe, however, the hazard is
left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Mauritania, Islamic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no risk of malaria in the following areas north of 20
degrees north: Dakhlet-Nouadhibou, Inchiri, Adrar, and
Tiris-Zemour. Malaria is present all year, throughout the
country, except as noted. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 8% of malaria, therefore there is a
significant risk of p. vivax malaria exposure. Consider use of
Primaquine upon return home.


Diseases of Special Risk
In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection with S. haematobium has been reported from all regions
including the capital of Nouakchott, except from Dakhlet
Nouadhibou. The highest infection rates are reported from the
populated areas along the Senegal river, the Karakoro river
valley including the settlements along their tributaries and
diversion canals, and from the Adrar mountain region in the
center of the country. The nomadic life of Mauritanian herdsmen
facilitates the spread of the infection. Travellers should
consider all oases and settlements as infected. Additional snail
intermediate host: Bulinus truncatus rohlfsi.

Rift Valley fever is a risk to persons working with domestic
animals and livestock, and from mosquito exposure, in the Tarza
Region, especially in the Departments of Rosso and Keur Macene.


                            DISEASE RISK PROFILE

 Mauritania
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Lassa Fever                       X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Rabies                            X
 Relapsing Fever                   X
 Rift Valley Fever                 X
 Trachoma                                              X
 Tuberculosis                      X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. Except: travelers
arriving from a non-infected area and staying less than two weeks
in the country. CDC recommends vaccination for all travelers
over 9 months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Hepatitis A - Vaccination is recommended for all travelers for
their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.
Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger in the southern third of
the country.


Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague

infested area. Geographical distribution of the area of risk for
this country is the northwestern corner of the country along the
border with Morocco.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Mauritius, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in the country in rural areas only in the
following disticts: Pamplemousses, Plaines Wilhelms, Riviere du
Rampart, Grand Port and Port Louis.. No malaria is found on
Rodiguez Island. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.
Falciparum malaria represents 0% of malaria, therefore there is a
risk of p. vivax malaria exposure. Consider use of Primaquine
upon return home.

Diseases of Special Risk
In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found throughout this country. Avoid
contact with contaminated fresh water lakes, ponds, or streams.
Snail intermediate host for S. haematobium: Bulinus cernicus.

Tuberculosis would be a risk if the traveler is in intimate
contact with the native population over a period of time. Pre-
and post-trip tuberculosis skin tests are advised under the above
circu,stance.


                            DISEASE RISK PROFILE

 Mauritius
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

AIDS Information

Testing is required for all foreigners planning to work or to
seek residency. Foreign tests are accepted under some
circumstances. Contact this country's embassy for full details.

Mayotte, Territorial Collectivity of

INFECTIOUS DISEASE RISK

Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).


Penicillin resistant gonorrhea is common in the Phillipines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                                DISEASE RISK PROFILE

 Mayotte
             Disease                Endemic      Risk   Hazard
 Chikungunya Fever                     X
 Cholera                               X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Melioidosis                           X
 Opisthorchiasis                       X
 Paragonimiasis                        X
 Polio                                 X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X
AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Mexico, United Mexican States

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk in Mexico has been increasing in recent years,
doubling from 42,104 in 1980 to 85,501 in 1984 (the last year of
current statistics). There is only limited risk of malaria in
the major tourist developments of the Pacific and Gulf coasts.
There is no risk of malaria in urban areas. It is only found in
rural areas below 1000 meters in the following locations: the
Pacific coastal areas from Guaymas to the southern border with
Guatemala; months of risk: all, except for the states of Sonora
and Sinaloa where the risk is present from May to October; the
valleys fo central Mexico below 1000 m; months of risk: May to
October.; the coastal areas along the Gulf of Mexico from Tampico
to and including the Yucatan Peninsula; months of risk: all.
Plasmodium vivax is predominant, Plasmodium falciparum malaria is
present in small foci of Chiapas and Tabasco.

Note: Visitors to the major resorts along both coasts (Acapulco,
Puerto Vallarta, etc.) residing in hotels should use mosquito
repellents (containing DEET) after sunset. They do not require an
antimalarial regimen. Persons camping and hiking along the coasts
should take a full course of suppressive medication.

Archeological sites: Daytime excursions from cities to the
following archeological sites do not require an antimalarial
regimen. However, persons staying overnight in the vicinity or in
nearby villages should take a full course of suppressive medication:
Bonampak, El Cayo, La Mar, Palenque, Tonina, etc. in the state of
Chiapas. (There is no risk in the cities of Villahermosa and
Tuxtla Gutierrez);
Becan, Calakmul, Edzna, Hochob, Xpuhil, etc. in the state of
Campeche. (There is no risk in the city of Campeche);
Coba, Muyil, Tulum, Xelha, etc. in the state of Quintana Roo.
(There is no risk on Cozumel and Cancun.);
Balahkanche Cave, Chichen Itza, Kabah, Labna, Mayapan, Sayil,
Uxmal, etc. (There is no risk in the cities of Merida and Valladolid).

Prevent malaria with treatment of clothing with permethrin and use of topical
insect repellent on skin. Take chloroquine 500 mg weekly, starting two weeks
before exposure, weekly while in the risk area, and continuing for 4 weeks post
exposure.

Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of Primaquine
upon return home if significant exposure in the areas at risk has
been encountered.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease risk is present below 1500 meters in the
following states: Ðáãéæéã Ãïáóô: Sonora, Sinaloa, Nayarit,
Jalisco, Colima, Michoacan, Guerrero, Oaxaca, Chiapas; Çõìæ ïæ
Íåøéãï áîä Ãáòéââåáî ãïáóô: Veracruz, Tabasco, Campeche, Yucatan,
Quintana Roo; Ãåîôòáì Íåøéãï: Durango, Guanajuata, Hidalgo,
Zacatecas, San Luis Potosi, Mexico, Morelos, and Puebla. The
main vectors Triatoma dimidiata is present in all infected areas
and Rhodnius prolixus is present in Oaxaca and Chiapas.

Cholera is now present throughout most of Mexico. Cholera
vaccination is not recommended, but food and water precautions
are important.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

During 1990 a measles epidemic in Juarez resulted in hundreds of
cases and 9 deaths.      Case frequency has probably been
under-reported.

Ozone levels have reached highly dangerous levels in Mexico City
according to a World Health Organization news report in January
1991. The rodent problem in Mexico City is considered a serious
health hazard.

                             DISEASE RISK PROFILE

 Mexico
               Disease              Endemic         Risk    Hazard
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                                 X
 Hepatitis, Viral                                    X
 Leishmaniasis                        X
 Onchocerciasis                       X
 Rabies                                                       X
 Trypanosomiasis, American            X
 Chaga's Disease
 Tuberculosis                         X

AIDS Information

As of 31 March 1991 a total of 6,510 AIDS cases have been
reported. AIDS is spreading fastest amongst heterosexual women.
One-third of the blood supply in Mexico comes from 25,000
professional donors who are running 10% HIV virus positive. The
general population is running 0.8% positive. There is no
requirement for HIV antibody test by travelers or those applying
for work visas, but it is possible that those applying to
immigrate must present proof of a negative HIV antibody test.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels
and restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.


VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over six months of age. Children under
nine months of age should not be vaccinated due to health
considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling

outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

AIDS Information

Testing is required for permanent residence visas. US test
results are accepted under some circumstances. Contact the
Mexican embassy for full details.

Micronesia, Federated States of

formerly Pacific Island Trust Territory, Truk Islands
INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Micronesia
           Disease         Endemic      Risk      Hazard
 Dengue Fever                 X
 Diarrheal Diseases                      X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever                           X

Food/Water Safety

On main islands: Local water is considered safe without further
treatment. Milk is pasteurized and safe to drink. Butter,
cheese, yogurt and ice-cream are safe. Local meat, poultry,
seafood, vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

AIDS Information

Testing is required for persons staying over one year.
Moldava, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

Hemorrhagic fever is encountered in southern Siberia.

AIDS Information

Beginning Feb 1989, all persons staying longer than 3 months
in the Soviet Union will be required to undergo HIV antibody
testing. This includes diplomats, journalists, students, and
businessmen. Reports from countries that have a "mutually
accepted agreement" will be honored, but there is no list of
which countries were included in this arrangement. Previously
U.S. tests were not accepted. Any person who knowingly infects
another with AIDS can be jailed up to 8 years. Conditions which
contribute to the spread of AIDS in this country include improper
sterilization of dental instruments, reuse of syringes and other
medical supplies, lack of an adequate supply of condoms, and low
reliability of the HIV screening tests being used.

                              DISEASE RISK PROFILE

 Moldava
     Disease       Endemic        Risk        Hazard
 Tuberculosis         X
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the wetsern part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Monaco, Principality of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Monaco
            Disease              Endemic      Risk   Hazard
 Diarrheal Diseases                 X
 Dysentery, Bacillary               X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Sandfly Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Mongolia

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 Mongolia
          Disease          Endemic      Risk      Hazard
 Avian Influenza (H5N1)       X
 Dengue Fever                 X
 Diarrheal Diseases                      X
 Encephalitis, Japanese      X
 Hemorrhagic Fever           X
 Hepatitis, Viral                        X
 Tuberculosis                X

AIDS Information

All foreign students and anyone staying longer than three months
must show proof of negative HIV antibody tests. Results from the
U.S. are acceptable. Contact the Mongolian embassy for further
details.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.
VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk is
scattered throughout the country.

Montserrat

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present on the east coast in the areas of Trants,
Farms, Behtel, Bramble and Tuitts.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                                DISEASE RISK PROFILE

 Montserrat
             Disease                Endemic      Risk   Hazard
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                      X
 Rabies                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

AIDS Information

Testing is required for university students and for work or
residency applicants. Foreign tests are accepted under some
circumstances. Contact Montserrat's embassy for details.

Morocco, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present from May through October in the rural
areas of northern and central Morocco, mainly in the provinces of
Chefchaouen, Beni Mellal, El Kelaa, Fes Khemisset, Khenifra,
Khouribga, Meknes, Settat, Tanger, Taounate and Taza. There is
no risk in urban areas. CDC recommends mosquito protection for
prevention of malaria in this country.

Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home only if considerable mosquito exposure has
occurred.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. An
approximately 100 km deep coastal strip from Kenitra to Essaouira
is risk free, as are the central areas of Meknes, Fez, Taza and
the Middle Atlas. S. haematobium is endemic throughout the
southern half of Morocco, with high incidence rates of infection
expecially in the irrigated agricultural areas of Beni-Mellal, El
Kelaa des Srarhna, Marrakech, Agadir, Taroudant, and Tiznit, the
Anti Atlas and Haut Atlas regions of Ouarzazate and Er Rachidia.
Travellers should consider all oases, settlements and temporary
water bodies in southern Morocco as infected. In the north the
infection is present in the Province of Tetouan affecting the
areas of Dar Chaoui, Souk Tnine de Sidi el Yamani, Larache, Tleta
Rissana, El Rhedira and Souk Tolba; in the Province of Kenitra
the areas of Arbaoua, Lalla, Mimouna, Karia Aouda, Moulay
Bousselham and Gnafda; in the Province of Nador the areas of
Nador town, Segangane, Mont Arouia, Zaio, Hassi Berkane and Ras
el Ma; in the Province of Oujda in the areas of Aklim, El Aioun,
Jerada and Ain Benimathar.
                                DISEASE RISK PROFILE

 Morocco
             Disease                Endemic      Risk   Hazard
 Brucellosis                                      X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                        X
 Giardiasis                                       X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Lassa Fever                           X
 Leishmaniasis                         X
 Rabies                                X
 Relapsing Fever                       X
 Trachoma                              X
 Tuberculosis                          X
 Tungiasis                                                X
 Typhoid Fever                                    X
 Typhus                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Agadir, Al Hoceima, Casablanca, Essaouira
(Mogador), Fes (Fez), Ketama, Marrakech, Meknes, Rabat, Safi,
Tanger (Tangier) serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the southern part of the country (areas of
former Spanish Sahara).

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Mozambique, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 95% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis is found throughout this country, including urban
areas. Avoid contact with fresh water lakes, ponds, or streams.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                            DISEASE RISK PROFILE

 Mozambique
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Plague                            X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Beira and Maputo (Lourenco Marques) serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:
Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is in the north of the country (all of Niassa
province and the western part of Tete province).

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Myanmar, Union

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present only below 1000 meters in rural areas as
noted: April - December in Tenasserim; May - December in
Irrawaddy and Mandalay Division; June - December in Pegu and
Rangoon Divisions, Arakan, Chin, Hachin, Karen, Mon and Shan
States; June - October in Magwe and Sagaing Division. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention. Some authorities suggest the use
of doxycycline 100 mg, taken 1 tablet daily as an alternate drug
for malaria prophylaxis for this country, due to probable
malaria resistance to mefloquine in this country.

Falciparum malaria represents 88% of the malaria strains,
therefore there is a risk of exposure to vivax malaria.
Travelers may wish to consider the use of primaquine upon their
return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists.   The virus is present
in this country at all times and may give rise to major
outbreaks.

                            DISEASE RISK PROFILE

 Myanmar
            Disease          Endemic       Risk     Hazard
 Avian Influenza (H5N1)         X
 Chikungunya Fever              X
 Cholera                        X
 Dengue Fever                   X
 Diarrheal Disease Risk         X
 Dysentery, Amoebic             X
 Encephalitis, Japanese         X
 Fasciolopsiasis                X
 Filariasis                                           X
 Hepatitis, Viral               X
 Leishmaniasis (Visceral)                   X
 Melioidosis                    X
 Plague                                     X
 Rabies                         X
 Trachoma                       X
 Tuberculosis                   X
 Typhoid Fever                  X
 Typhus, Scrub                  X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A
vaccination is required for children of all ages. Children under
nine months of age should not be vaccinated due to health
considerations. Travelers leaving this country are required to possess a
vaccination certificate on their departure to an infected area or
to countries which still demand such a certificate. Burmese
nationals are required to possess certificates of vaccination on
their departure from an infected area.

Routine immunizations should be current.        A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The following vaccinations listed for this country are listed for
the traveler's protection, but they are not required for entry:

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases occur throughout the year, with all ages being considered
equally at high risk.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is west of Mandalay.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.
Namibia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk exists in the northern part of the country in the
area bordering Angola (Ovamboland), Zambia and Botswana (Caprivi
Strip) from November through May. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore there is
only a slight risk of p. vivax malaria exposure. Consider use of
Primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present only in the north of the country along the
border with Angola, Zambia and Botswana (Kavango and Caprivi
Strip), affecting the villages along the Okavango, Chobe and
Zambezi rivers.

                            DISEASE RISK PROFILE

 Namibia
           Disease          Endemic       Risk     Hazard
 Diarrheal Disease Risk        X
 Dysentery, Amoebic            X
 Plague                        X
 Relapsing Fever               X
 Rift Valley Fever             X
 Trypanosomiasis, African
 Sleeping Sickness             X
 Tuberculosis                  X
 Typhoid Fever                 X
 Typhus, Scrub                 X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water, milk, and food is considered safe in Swakopmund, Walvis
Bay, and Windhoek. Elsewhere all tap water used for drinking,
brushing teeth, and making ice cubes should be boiled prior to
use. Insure that bottled water is uncapped in your presence.
Milk should be boiled to insure safety. Powdered and evaporated
milk are available and safe. Avoid butter and other dairy
products. All meat, poultry and seafood must be well cooked and
served while hot. Pork is best avoided. Vegetables should be
well cooked and served hot. Salads and mayonnaise are best
avoided. Fruits with intact skins should be peeled by you just
prior to consumption. Avoid cold buffets, custards, and any
frozen dessert.

Nauru, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.


Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                           DISEASE RISK PROFILE

 Nauru
           Disease         Endemic      Risk      Hazard
 Diarrheal Disease Risk                  X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever                           X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Nepal

INFECTIOUS DISEASE RISK

Malaria Risk
Malaria risk is primarily in Terai district and hill districts
below 1200 meters. The risk exists all year. There is no risk
of malaria in urban areas. Kathmandu and the northern high
altitude areas of the country are risk free.
Chloroquine-resistant P.falciparum malaria (15% of total cases)
has been reported from the malarious areas in the southern part
of the country: the districts of Dhanukha, Mahotari, Sarlahi,
Rautahat, Bara, Parsa, Rupendehi, Kapilvastu (Terai districts)
and all areas along the border with India. Persons flying into
Kathmandu and visiting the northern Himalayan districts do not
need to take malaria suppressive medication. Persons travelling
from India overland into Nepal and throughout the southern parts
of the country must follow CDC guidelines for suppressive
medication. The malaria in this country is resistant to
chloroquine. Prevent malaria with treatment of clothing with permethrin and use
a topical insect repellent on skin. Several oral medications are available to
prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 15% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of Primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                                DISEASE RISK PROFILE

 Nepal
             Disease                Endemic      Risk   Hazard
 Brucellosis                                      X
 Diarrheal Diseases                               X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                                   X
 Encephalitis, Japanese                X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Leishmaniasis (Visceral)                                 X
 Meningococcus                                    X
 Polio                                                    X
 Sandfly Fever                                            X
 Tapeworms                                        X
 Trachoma                                         X
 Tuberculosis                          X
 Typhoid Fever                                    X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Kathmandu serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is recommended when
traveling outside the areas usually visited by tourists,
traveling extensively in the interior of the country (trekkers,
hikers) and for persons on working assignments in remote areas.
All persons planning treks outside the Kathmandu Valley should
receive the vaccine.
Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occasionally in the southern plains bordering India (Terai
Districts). Period of transmission is June to October. High
risk groups are all ages.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is the western half of the country.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post

exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Netherlands Antilles

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists.   The virus is present in
this country at all times and may give rise to major outbreaks.

                                DISEASE RISK PROFILE

 Netherlands Antilles
             Disease                Endemic      Risk   Hazard
 Dysentery, Amoebic/Bacillary          X
 Hepatitis, Viral                      X
 Rabies                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Netherlands, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the other
routine immunizations recommended above, the traveler should be
aware that risk of exposure to rabies, primarily found in foxes,
exists in this country.

                               DISEASE RISK PROFILE

 Netherlands
       Disease       Endemic       Risk        Hazard


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every

ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

New Caledonia and Dependencies, Territory of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.
Take precautions to avoid mosquito bites.


                           DISEASE RISK PROFILE

 New Caledonia and Dependencies
                  Disease               Endemic   Risk       Hazard
 Diarrheal Disease Risk                    X
 Encephalitis, Japanese                    X
 Filariasis                                                       X
 Helminthic Diseases                      X
 Tuberculosis                             X
 Typhoid Fever                            X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS


Cholera - Travelers from infected areas must complete a
form for the Health Service. No immunization required.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

New Zealand

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                                DISEASE RISK PROFILE

 New Zealand
       Disease        Endemic        Risk       Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat. Hydatid tapeworm infections can
occur, but likelihood of infection is low.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B among Maori, vaccination is recommended for
persons working in health care, education, or in close contact
with them.

Nicaragua, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria exists in rural areas below 1000 meters from May through
December. There is some risk in the outskirt towns of
Chinandega, Leon, Granada, Managua, Nandaime, and Tipitapa. The
city of Managua is risk free. Only the centers of the cities of
Bluefields, Bonanza, Chinandega, Granada, Leon, Puerto Cabeza,
Rosita are risk free. Prophylaxis may not be needed if trips are
restricted to urban areas. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Falciparum malaria represents 14% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home if heavy mosquito exposure was encountered.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease is present in rural areas below 1500 meters in
the following departments: Chinandega, Esteli, Jinotega, Leon,
Madriz, Managua, Masaya, Matagalpa, Nueva Segovia, and Rivas.
The main vectors are Triatoma dimidiata and Rhodnius prolixus.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.
                             DISEASE RISK PROFILE

 Nicaragua
               Disease              Endemic         Risk   Hazard
 Brucellosis                           X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Venezuelan Equine      X
 Helminthic Diseases                                 X
 Hepatitis, Viral                     X
 Leishmaniasis                        X
 Polio                                               X
 Rabies                                                      X
 Trypanosomiasis, American
 Chaga's Disease                      X
 Tuberculosis                         X
 Typhoid Fever                                       X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Managua serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever vaccination is required of any traveler older than 1
year of age arriving from areas infected with this disease.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Niger, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 82% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. High
incidence rates of infection with S. haematobium rates of
infection with S. haematobium have been reported from all
populated areas in the southern part of the country, especially
from the Niger river basin and surrounding areas, including the
capital of Niamey; and from the departments of Niamey; and from
the departments of Niamey, Dosso, Tahoua, Maradi, Zinder and
Diffa. The infection has not been reported from the northern
desert area of Agadez. S. mansoni is present in a foci in the
area of Gaya in the southeast corner of Dosso on the border with
Benin.

                              DISEASE RISK PROFILE

 Niger
             Disease               Endemic      Risk   Hazard
 Avian Influenza (H5N1)               X
 Dracunculiasis/Guinea Worm           X
 Diarrheal Disease Risk                                  X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                            X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Lassa Fever                    X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                         X
 Relapsing Fever                X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.


VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age who will be
traveling outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is in the southern third of
the country.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Nigeria, Federal Republic of

INFECTIOUS DISEASE RISK
Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 83% of malaria, therefore
there is a risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found throughout this country, including
urban areas. Avoid contact with fresh water lakes, ponds, or
streams.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                                DISEASE RISK PROFILE

 Nigeria
              Disease                Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm             X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic/Bacillary                              X
 Echinococcosis                                    X
 Filariasis                                                X
 Giardiasis                                                X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Lassa Fever                           X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)              X
 Loiasis                                                   X
 Onchocerciasis                                            X
 Polio                                                     X
 Rabies                                X
 Relapsing Fever                       X
 Trachoma                                                  X
 Trypanosomiasis, African
 Sleeping Sickness              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

AIDS Information

From 8% to 85% of the blood supply is screened at the nation's
nine blood banks as of February 1988. The Minister of Health has
announced that Nigeria will reciprocate against any country that
introduces mandatory testing for Nigerian travelers.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Enugu, Ibadan, Kano, and Lagos serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.




VACCINATIONS


Cholera - Cholera is present in this country. Risk to
western travelers is low. Immunization is not required or
recommended for travel to this country due to its low
effectiveness. Avoid uncooked foods and untreated water.
Vaccination is advised only for persons living or working under
inadequate sanitary conditions and for those with impaired
defense mechanisms. Travelers leaving this country are required
to possess a vaccination certificate on their departure to an
infected area or to countries which still demand such a
certificate.

Yellow fever - A vaccination certificate is required on arrival
from all countries. A vaccination certificate is required for
children over one year of age. The CDC recommends vaccination of
all travelers older than 9 months of age who will be traveling
outside of urban areas. Yellow fever is currently active in this
country in Benue, Cross River, Kaduna, Kwara, Ogum, Ondo, Dyo,
and Lagos States. 1,320 deaths from yellow fever were reported in
1987. In 1989 49 deaths were reported from Imo State.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is the northern half of the
country.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Niue

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                           DISEASE RISK PROFILE

 Niue
           Disease         Endemic      Risk      Hazard
 Diarrheal Disease Risk                  X
 Encephalitis, Japanese      X
 Filariasis                                          X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever                           X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are usually safe. Local meat, poultry, seafood,
vegetables, and fruits are generally safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Norway, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

Rabies is a risk in rural areas in wild animals, especially
foxes.

                              DISEASE RISK PROFILE

 Norway
    Disease         Endemic    Risk         Hazard


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in scattered areas around Bergen.

Rabies - This disease is common in wild animals, primarily foxes,
in rural areas.

Oman, Sultanate of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present throughout the country including urban
areas. Risk is present at all altitudes. The falciparum malaria
is resistant to chloroquine in this country. It is recommended
that Lariam (mefloquine) be used for prophylaxis.

Falciparum malaria represents 86% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection has been reported from the region of the Dhorfar
affecting the areas of Salalah, Arazat, Mirbat, and Taqah.

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Oman
            Disease              Endemic      Risk    Hazard
 Brucellosis                                            X
 Cholera                            X
 Dracunculiasis/Guinea Worm         X
 Echinococcosis                     X
 Hepatitis, Viral                              X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Polio                                                  X
 Rabies                             X
 Relapsing Fever                    X
 Tapeworms                          X
 Trachoma                           X
 Typhoid Fever                           X
 Typhus, Endemic Flea-Borne   X
 Typhus, Scrub                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country. In 1988 an outbreak of polio resulted in at least 80
cases centered around the western towns of Rostaq and Jalan on
the Batinah coast.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

AIDS Information

Testing is required for some job and lenght of stay applicants.
The blood supply in this county is not adequately screened.

Pacific Islands Trust Territory of the U.S.A.

INFECTIOUS DISEASE RISK

Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).


Penicillin resistant gonorrhea is common in the Phillipines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                                   DISEASE RISK PROFILE

 Pacific Islands Trust Territory
             Disease                   Endemic      Risk   Hazard
 Chikungunya Fever                        X
 Cholera                                  X
 Dengue Fever                             X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic/Bacillary                        X
 Encephalitis, Japanese                   X
 Fasciolopsiasis                          X
 Filariasis                                                  X
 Helminthic Diseases                                 X
 Hepatitis, Viral                                    X
 Melioidosis                              X
 Opisthorchiasis                          X
 Paragonimiasis                           X
 Polio                                    X
 Rabies                                   X
 Typhoid Fever                            X
 Typhus, Scrub                            X

AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Pakistan, Islamic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 23% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Leprosy and tuberculosis are present in this country. Risk to
travelers is quite low, but pre- and post-trip TB tests are
recommended if contact with the local population has been
extensive.

                           DISEASE RISK PROFILE
    Pakistan
                Disease            Endemic   Risk   Hazard
    Avian Influenza (H5N1)            X
    Brucellosis                               X
    Diarrheal Diseases                                X
    Dysentery, Amoebic/Bacillary                      X
    Echinococcosis                            X
    Giardiasis                                        X
    Helminthic Diseases                               X
    Hepatitis, Viral                                  X
    Polio                                             X
    Rabies                                    X
    Trachoma                                  X
    Tuberculosis                     X
    Typhoid Fever                             X

AIDS Information

AIDS antibody testing is required for persons staying longer than
one year. Foreign tests may be acceptable. Contact the
Pakistani embassy for further details.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.


-    Æïïä/×áôåò Óáæåôù

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Karachi, Lahore, and Rawalpindi serve purified
drinking water and reliable food. However, the hazard is left to
your judgement.




VACCINATIONS

Cholera - A cholera vaccination certificate is required when
coming from an infected area.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
six months of age. However, children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current.   A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is northern Kashmir.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Palau, Republic of
INFECTIOUS DISEASE RISK

Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).


Penicillin resistant gonorrhea is common in the Phillipines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                                DISEASE RISK PROFILE

 Palau
             Disease                Endemic      Risk   Hazard
 Chikungunya Fever                     X
 Cholera                               X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Melioidosis                           X
 Opisthorchiasis                       X
 Paragonimiasis                        X
 Polio                                 X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Panama, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in rural areas of the eastern provinces
(Darien and San Blas) and the northwestern provinces (Bocas Del
Toro and Veraguas). The risk exists all year. Chloroquine
resistant malaria has developed in all malarious areas east of
the Canal Zone, including the San Blas Islands. The malaria in
this country is resistant to chloroquine. There is no risk along
the Panama Canal Zone, the cities of Panama and Colon and the
central highlands above 800 meters. Prevent malaria with treatment of clothing
with permethrin and use a topical insect repellent on skin. Several oral
medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents 16% of the malaria encountered,
therefore there is a risk of vivax exposure. Consider the use of
primaquine upon return home if prolonged mosquito exposure was
encountered.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease is present in the rural areas of the provinces of
Chiriqui, Bocas del Toro, Cocle, Colon, Darien, and Panama. The
highest incidence has been reported from the province of Chiriqui
(bordering Costa Rica) and in the valley of the Rio Chagres (in
central Panama) and the areas of the Canal Zone adjacent to Rio
Chagres. The main vectors are Triatoma dimidiata and Rhodnius
pallescens.

Tuberculosis is endemic in this country. If the travekler will
experience close contact with the native population, a pre- and
post-trip TB skin test is advised.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.


                           DISEASE RISK PROFILE

 Panama
           Disease                Endemic         Risk   Hazard
 Diarrheal Disease Risk                      X
 Dysentery, Amoebic                          X
 Encephalitis, Venezuelan Equine   X
 Helminthic Diseases                         X
 Hepatitis, Viral                  X
 Leishmaniasis                     X
 Paragonimiasis                    X
 Rabies (esp dogs and bats)                              X
 Trypanosomiasis, American
 Chaga's Disease                   X
 Tuberculosis                      X
 Typhoid Fever                               X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Water, milk, and food
in Panama City is safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.
Yellow fever - A yellow fever vaccination certificate is
recommended for all travelers going to the provinces of Bocas del
Toro and Darien. Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Papua New Guinea, Independent State of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 73% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                           DISEASE RISK PROFILE

 Papau New Guinea
            Disease          Endemic       Risk   Hazard
 Diarrheal Disease Risk                     X
 Encephalitis, Japanese         X
 Filariasis                                         X
 Helminthic Diseases                        X
 Tuberculosis                   X
 Typhoid Fever                           X
 Typhus, Scrub               X

AIDS Information


Foreign workers and those seeking residency will be required to
show proof of a negative HIV antibody test. Results from the
U.S. will be accepted. Spread of AIDS in this country is
following the African pattern, primarily via heterosexual
contact.


AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. All meat, poultry and seafood must
be well cooked and served while hot. Pork is best avoided.
Vegetables should be well cooked and served hot. Salads and
mayonnaise are best avoided. Fruits with intact skins should be
peeled by you just prior to consumption. Avoid cold buffets,
custards, and any frozen dessert. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.
Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Paraguay, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present from October through May in areas
bordering Brazil, rural parts of Amambay, Canendiyu and Alto
Parana Departments. There is no risk of malaria in urban areas.
Caaguazu and San Pedro. Note: There is no malaria risk at
Iguassu Falls reported by the government. Prevent malaria with treatment of
clothing with permethrin and use of topical insect repellent on skin. Take
chloroquine 500 mg weekly, starting two weeks before exposure, weekly while in
the risk area, and continuing for 4 weeks post exposure.

Falciparum malaria represents 6% of malaria, therefore there is a
risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease is highly endemic in all rural areas, with
particularly high human incidence rates in the Chaco regions.
The main vectors are Triatoma infestans and Triatoma sordida,
know locally as "chincha timbuku" or "chincha guasu."

                           DISEASE RISK PROFILE

 Paraguay
            Disease              Endemic      Risk    Hazard
 Brucellosis                                X
 Diarrheal Disease Risk                     X
 Dysentery, Amoebic                         X
 Echinococcosis                  X
 Helminthic Diseases                        X
 Hepatitis, Viral                X
 Leishmaniasis (Cutaneous)                  X
 Leishmaniasis (Mucocutaneous)              X
 Leishmaniasis (Visceral)                   X
 Polio                           X
 Rabies                          X
 Trypanosomiasis, American
 Chaga's Disease                 X
 Tuberculosis                    X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Asuncion serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

AIDS Information


Tests are required for temporary or permanent residence status.
Foreign tests are accepted under certain circumstances. Contact
the Paraguay embassy for full details.

Peru, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Risk exists in rural areas below 1500 m in the following parts of
the country:

Northwest Peru: along the coast in the Departments of Tumbes,
Piura, Lambayeque, and La Libertad, Ancash and the Departments of
Cajamarca, Amazonas, San Martin.

Northeastern and Eastern Peru: the Departments of Loreto and Ucayali.

Central and Southern Peru: Departments of Madre de Dios, Huanuco,
Ayacuho, Apurimac and the following areas fo the Department of
Cusco: La Convencion province; Department of Junin: Satipo and
Chanchamayo provinces.
Note: There is no malaria risk in Lima, and the Andean highlands
(Cuzco, Machu Picchu, Puno, Ayacucho, Huancayo and other
high-altitude areas). Peru reports almost exclusively P.vivax malaria
infections and chloroquine is the drug of choice for travel
within Peru.
Sporadic cases of multi-drug-resistant P.falciparum malaria have
been reported from the following border areas: Tumbes Department
bordering Ecuador, Napo and Putumayo river valleys bordering
Colombia; Yavari, Acre and Madre de Dios river valleys bordering
Brazil and Bolivia. Persons travelling into the Amazone basin
and overland into the neighboring countries of Ecuador, Colombia
and Brazil must follow a mefloquine (Lariam) suppressive
medication regimen because of the high incidence of multi-drug
resistant P.falciparum malaria in these countries.

Falciparum malaria represents 1% of malaria, therefore there is a
risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Peruvian health officials have confirmed over 300,000 cases of
Cholera with over 2,000 deaths. Risk is considered as low to a
traveler, but food and water precautions are urged. Immunization
is not recommended.

Chagas' disease is present in two seperate geographical areas: 1)
Rural and suburban areas of the departments of Tumbes, Piura,
Cajamarca, Loreto and Amazonas in the northern part of the
country bordering Ecuador, with a foci in eastern Loreto in the
areas of Javary and Amasonas rivers bordering Brazil (main
vector: Triatoma dimidiata); 2) Rural and suburban areas under
3500 meters of the coastal departments of Tacna, Moquegua,
Arequipa, and Ica. The main vector here is Triatoma infestans,
locally known as "vinchuca" or "chirimacha."

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

                            DISEASE RISK PROFILE

 Peru
               Disease            Endemic      Risk    Hazard
 Bartonellosis                       X
 Diarrheal Disease Risk                            X
 Dysentery, Amoebic                                X
 Echinococcosis                     X
 Helminthic Diseases                               X
 Hepatitis, Viral                                  X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Mucocutaneous)      X
 Leishmaniasis (Visceral)       X
 Polio                                      X
 Rabies                                                 X
 Trypanosomiasis, American
 Chaga's Disease                X
 Tuberculosis                   X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Cuzco, Iquitos, and Lima serve purified drinking
water and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A

vaccination certificate is required for children over six months
of age. CDC recommends vaccination for all travelers over 9
months of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the area of risk for
this country is: the north of thr country; western part of Piura
Department (Huancabama provine), all of Cajamarca Department, and
the southern part of Ancash Department.

Philippines, Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

The islands of Bohol, Catanduanes, Cebu and Leyte and the plains
of the islands of Negros and Panay (above 600 m) are risk free.
Note: There is no risk in the city of Manila and other urban
centres. Use of Chloroquine is recommended only for those
travelers who will have outdoor exposure in rural areas during
evening and nightime hours. Prevent malaria with treatment of clothing with
permethrin and use of topical insect repellent on skin. Take chloroquine 500 mg
weekly, starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Chloroquine resistant malaria is found on the islands of Luzon,
Basilan, Mindoro, Palawan, Mindano and the Sulu Archipelago.

Falciparum malaria represents 69% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in Luzon: in the areas of Sorsogon in the
Irosin-Juban valley on the southern tip of the island. Mindoro:
in the area surrounding Lake Naujan, including the villages of
Pola, Victoria and Naujan. Samar: along the entire western
coastal area from Allen to Basey and along the northern coast
from Lavezares to Palapag, extending south to Las Navas. Leyte:
the entire island is infected except the southern quarter (the
area south of Julita and Mac Arthur). Bohol:in the northern
coastal areas of Talibon and Trinidad. Mindanao:in all villages
along the Bay of Panquil from Dipolog to Lala (provinces of
Misamis Occidental and Lanao del Norte); in all villages in the
Agusan river valley from Butuan to Compostela; in the northern
coastal peninsular area from Butuan to Tago including the area
around Lake Maninit; in the area Davao and the Penal Colony on
the Bay of Davao. Additional foci are present at Malaybalay,
Maramag (Province of Misamis Oriental) and Pikit (Province of
Cotabato).


Penicillin resistant gonorrhea is common in the Philippines.

The local population has a high incidence of tuberculosis.
Persons in close contact with the native population should
consider a pre- and post-trip TB skin test.

                                DISEASE RISK PROFILE

 Phillippine Islands
              Disease               Endemic      Risk   Hazard
 Chikungunya Fever                     X
 Cholera                               X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Melioidosis                           X
 Opisthorchiasis                       X
 Paragonimiasis                        X
 Polio                                 X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

All applicants for permanent resident visas are required to show
proof of a negative HIV antibody test. Results from a U.S.
laboratory are accepted.
AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants serve purified drinking water and reliable food.
However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Children under
one year of age are subject to isolation or surveillance, if
indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases are reported throuhgout the country. Period of
transmission is all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Pitcairn Island

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                                    DISEASE RISK PROFILE

 Pitcairn Island
         Disease          Endemic         Risk       Hazard
 Tuberculosis                X


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Safety of milk and dairy products unknown. Local meat, poultry,
seafood, vegetables, and fruits are safe to eat.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Poland, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.


Diseases of Special Risk

Rabies is frequent in wild animals in rural areas, especially in
foxes.

For those traveling into rural areas, there is risk of typhoid
and hepatitis A from contaminate water supplies. Immunizations
against these diseases is advisable.

The fish tapeworm (diphyllobothriasis) is found in the Baltic Sea
area.

AIDS Information

Blood donor screening has been started, but lack of funds has
prevented full implementation of this program. Thirty seven
cases have been reported. There are plans to broaden the extent
of HIV antibody testing to persons arriving from countries "known
for their bad epidemiological situation." Currently, proof of a
negative HIV antibody test is required by all foreign students.
Results of tests performed in the United States are accepted.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

                              DISEASE RISK PROFILE
 Poland
     Disease        Endemic    Risk      Hazard
 Avian Influenza
 (H5N1)               X
 Tuberculosis         X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the northern part of the country extending from the
forested areas around Gdansk south and eastward to the Russian
border, including the areas around Bialystock. Other areas of
risk are forested lands around Warsaw, Lodz and Lukow, and along
the border with Czechoslovakia south of Wroclaw.

AIDS Information

Testing is required for students, although results are not needed
to gain entry. Contact the Polish embassy for details.

Portugal, Portugese Republic
INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Due to a high incidence of tuberculosis amongst the local
population, the traveler may need to consider a pre- and post-trip
TB skin test.

                          DISEASE RISK PROFILE

 Portugal
       Disease          Endemic     Risk         Hazard
 Brucellosis               X
 Diarrheal Diseases        X
 Dysentery, Bacillary      X
 Tuberculosis              X
 Typhoid Fever             X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Yellow fever - A vaccination certificate is required only for
travelers coming from infected areas and from or in transit
through countries with active infection arriving in or destined
for the Azores and Madeira. A vaccination certificate is
required for children over one year of age. No certificate is,
however, required from transit passengers at Funchal, Porto
Santo, and Santa Maria.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Puerto Rico, Commonwealth of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Low infection
rates have been reported from all parts of the island. Infection
also occurs on the islands of Vieques and Culebra, both located
off the eastern coast of Puerto Rico.


                                DISEASE RISK PROFILE

 Puerto Rico
              Disease               Endemic      Risk   Hazard
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Filariasis (Bancroftian)              X
 Hepatitis                             X
 Rabies                             X

Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Qatar, State of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                             DISEASE RISK PROFILE

 Qatar
            Disease             Endemic      Risk     Hazard
 Brucellosis                                            X
 Cholera                           X
 Diarrheal Diseases                           X
 Echinococcosis                    X
 Hepatitis, Viral                             X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Rabies                            X
 Relapsing Fever                   X
 Tapeworms                    X
 Trachoma                     X
 Tuberculosis                 X
 Typhoid Fever                           X
 Typhus, Endemic Flea-Borne   X
 Typhus, Scrub                X

AIDS Information

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Ad Dawhah (Doha) serve purified drinking water and
reliable food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infections. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Reunion

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 Reunion
              Disease            Endemic      Risk   Hazard
 Diarrheal Diseases                                    X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information
AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice

cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Romania

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
                         DISEASE RISK PROFILE

 Romania
       Disease        Endemic     Risk          Hazard
 Avian Influenza
 (H5N1)                 X
 Brucellosis            X
 Diarrheal Diseases     X
 Hepatitis, Viral       X
 Rabies                 X
 Tuberculosis           X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the forested areas in the western part of the country.

Russia, Russian Federation

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

Hemorrhagic fever is encountered in southern Siberia.

AIDS Information

Beginning Feb 1989, all persons staying longer than 3 months
in the Soviet Union will be required to undergo HIV antibody
testing. This includes diplomats, journalists, students, and
businessmen. Reports from countries that have a "mutually
accepted agreement" will be honored, but there is no list of
which countries were included in this arrangement. Previously
U.S. tests were not accepted. Any person who knowingly infects
another with AIDS can be jailed up to 8 years. Conditions which
contribute to the spread of AIDS in this country include improper
sterilization of dental instruments, reuse of syringes and other
medical supplies, lack of an adequate supply of condoms, and low
reliability of the HIV screening tests being used.

                              DISEASE RISK PROFILE

 Russia
     Disease        Endemic    Risk      Hazard
 Avian Influenza
 (H5N1)               X
 Tuberculosis         X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the wetsern part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Rwanda, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 90% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Louse-borne typhus is cosmopolitan in distribution and is present
wherever groups of persons are crowded together under conditions
of poor sanitation and malnutrition. Risk exists for persons
living or working in remote areas of the country
(anthropologists, archeologists, geologists, medical personnel,
missionaries, etc.). Freedom from louse infestation is the most
effective protection against typhus.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of S.
mansoni is present in the western half of the country including
the Kigali area, Lake Kivu, Lake Ruhondo, Lake Bulera and Lake
Cyohoha areas. The eastern highland areas including lakes
Bugesera, Mugesera, Muhazi, Kagera and the valleys of Akagera and
Kagitumba are free of Sshistosomiasis. Additional snail
intermediate hosts: Biomphalaria choanomphala, Biomphalaria and
Biomphalaria smithi.

                            DISEASE RISK PROFILE

 Rwanda
              Disease            Endemic      Risk   Hazard
 Diarrheal Diseases                                    X
 Dracunculiasis/Guinea Worm        X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

Approximately 30% of the adults between the ages of 18
and 45 in the capital city of Kigali are infected with the HIV

virus. The countryside rate is between 2% and 3%, but increasing.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Kigali serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Cholera - Risk to western travelers is low. Avoid uncooked foods
and untreated water. WHILE CHOLERA VACCINE IS NOT OFFICIALLY
REQUIRED FOR ENTRY TO THIS COUNTRY, ACCORDING TO RECENT REPORTS
BORDER OFFICIALS ARE INSISTING ON CHOLERA VACCINATION FOR ENTRY.
Travelers arriving without a current cholera vaccination are
having tickets for forward travel impounded until they obtain
vaccination in country. This means that they must buy their own
needle and syringe and report to a local hospital for
vaccination.

Yellow fever - A vaccination certificate is required on
arrival from all countries, except passengers in transit who do
not leave the airport. A vaccination certificate is required for
children over one year of age. CDC recommends vaccination for
all travelers over 9 months of age who will travel outside of
urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for

persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Saint Helena

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                           DISEASE RISK PROFILE

 St. Helena
        Disease       Endemic         Risk        Hazard
 Diarrheal Diseases                    X
 Dysentery, Amoebic                    X
 Typhoid                               X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat.
VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Saint Kitts and Nevis

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                                DISEASE RISK PROFILE

 St. Kitts and Nevis
               Disease                 Endemic         Risk   Hazard
 Diarrheal Disease Risk                                 X
 Dysentery, Amoebic/Bacillary                           X
 Hepatitis, Viral                        X
 Rabies                                  X


AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety
Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active infection. A vaccination
certificate is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

AIDS Information

Tests are required for students, residency applicants, and those
seeking employment. Contact the St Christopher embassy for
details.

Saint Lucia

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.


Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

Projects for total eradication of Schistosomiasis are in progress
and risk of infection is low. However, travellers should still
consider all fresh water bodies as infected.

                                DISEASE RISK PROFILE

 St. Lucia
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                      X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Saint Pierre and Miquelon

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk
In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.


                            DISEASE RISK PROFILE

 St. Pierre and Miquelon
              Disease            Endemic      Risk    Hazard
 Encephalitis                       X
 Plague                             X
 Rabies                             X
 Rocky Mountain Spotted Fever       X
 Tularemia                          X

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Saint Vincent and the Grenadines

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                              DISEASE RISK PROFILE

 St. Vincent and the Grenadines
                 Disease                 Endemic     Risk   Hazard
 Encephalitis                                         X
 Plague                                               X
 Rabies                                     X
 Rocky Mountain Spotted Fever               X
 Tuberculosis                               X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.




Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
Samoa, Independent State of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                           DISEASE RISK PROFILE

 Samoa
           Disease         Endemic      Risk      Hazard
 Diarrheal Disease Risk                  X
 Encephalitis, Japanese      X
 Filariasis                                         X
 Helminthic Diseases                     X
 Tuberculosis                X
 Typhoid Fever                           X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

San Marino, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

                              DISEASE RISK PROFILE

 San Marino
      Disease       Endemic      Risk       Hazard


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Sao Tome and Principe, Democratic Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. Prevent malaria with treatment of clothing
with permethrin and use a topical insect repellent on skin. Several oral
medications are available to prevent malaria in the country. See malaria
prevention.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Through the
construction of a major irrigation project by workers from the
African continent, S. haematobium has recently been introduced on
the island of Sao Tome. The infection seems to be localized
around the capital Sao Tome, but the extent of the infection has
not been determined. The snail intermediate host has not been
identified.

                              DISEASE RISK PROFILE

 Sao Tome and Principe
             Disease               Endemic      Risk   Hazard
 Diarrheal Diseases                                      X
 Dracunculiasis/Guinea Worm          X
 Dysentery, Amoebic                                      X
 Echinococcosis                                  X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Lassa Fever                    X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Polio                                                 X
 Rabies                         X
 Relapsing Fever                X
 Trachoma                                              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.

VACCINATIONS

Yellow fever - A vaccination certificate is required on arrival
from all countries. A vaccination certificate is required for
children over one year of age. Except: travelers arriving from a
non-infected area and staying less than two weeks in the country.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Saudi Arabia, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

The Eastern, Northern and Central Provinces and the high altitude
areas of Asir Province (southwest) are risk free: Ad Dammam, Al
Quatif, Al Jawf, Tabuk, Ar Riyad, etc. The urban areas of Western
Province-Jiddah, Al Madinah, Makkah, Ta'if -are risk free. In
other areas, including urban regions, malaria exists all year.
Prevent malaria with treatment of clothing with permethrin and use a topical
insect repellent on skin. Several oral medications are available to prevent
malaria in the country. See malaria prevention.

Falciparum malaria represents 51% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.


Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in   this country. Avoid contact with
contaminated fresh water lakes,   ponds, or streams. S.
haematobium and S. mansoni (the   latter predominant) are highly
endemic throughout the country,   except for the Al Ahsa Plain on
the Persian Gulf, the An Nafud desert (north) and the southern
no-mans-land of Ar Rub'al Khali. Travellers should condider all
oases, watering holes, irrigation canals and open wells as
infected. Additional snail intermediate hosts for S. haematobium:
Bulinus beccarrii, Bulinus reticulatus wrighti.

                            DISEASE RISK PROFILE

 Saudi Arabia
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                                           X
 Cholera                           X
 Dracunculiasis/Guinea Worm        X
 Diarrheal Disease Risk                        X
 Echinococcosis                    X
 Hepatitis, Viral                  X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Polio                                                 X
 Rabies                            X
 Relapsing Fever                   X
 Tapeworms                         X
 Trachoma                          X
 Tuberculosis                      X
 Typhoid Fever                                 X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

Of the 4 different classifications of visas (work, business,
visitor, and resident), only the application for a work visa
requires accompanying proof of a negative HIV antibody test.
Foreign workers will be re-tested for HIV antibody three months
after their arrival. Blood transfusions are routinely tested for
AIDS.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Ar Riyad (Riyadh), Az Zahran (Dhahran), and Juddah
(Jidda) serve purified drinking water and reliable food.
However, the hazard is left to your judgement.


VACCINATIONS
Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries any part of which is infected. A vaccination
is required for children of all ages. Children under nine months
of age should not be vaccinated due to health considerations.

Meningococcal meningitis - CDC and State Depertment confirmed
active cases of meningococcal meningitis in Aug 1987 in this
country. Active strains of menigitis serogroup A are most likely
circulating among the population of this country. According to
CDC comments "it would be prudent for future travelers to Saudi
Arabia to receive meningococcal vaccine at least 10 days prior to
departure." Vaccination may not be received more than 2 years
prior to the arrival. Receipt of this vaccine is mandatory if
arriving from Benin, Burkina Faso, Cameroon, Chad, Cote d'
Ivoire, Egypt, Mautitania, Niger, Nigeria, Pakistan, Senegal,
Sudan, Togo, Yemen, Ethiopia, India, Morocco, and the Syrian Arab
Republic.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to ensure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.


Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Senegal, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home only if considerable mosquito exposure has
occurred.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.
haematobium is endemic along the entire Senegal River valley
including the area of Lake Guiers; in the western regions of Cape
Vert (including Dakar) Thies, Diourbel and Sine Saloum; in the
two southern provinces of Senegal Oriental and Casamance. S.

mansoni is endemic in areas along the border with Guinea
(Province of Senegal Oriental), in two foci at Kolda and Bigona
(Casamance Province) and in two foci in the north: at Fatich
(Sine Saloum) and at Fandene-St Marcel (Thies). Additional snail
intermediate host for S. haematobium: Bulinus jousseaumei,
Bulinus guernei.

                                DISEASE RISK PROFILE

 Senegal
              Disease                Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm             X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic/Bacillary                              X
 Echinococcosis                                    X
 Filariasis                                                X
 Giardiasis                                                X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Lassa Fever                    X
 Leishmaniasis (Cutaneous)      X
 Leishmaniasis (Visceral)       X
 Loiasis                                               X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                         X
 Relapsing Fever                X
 Rift Valley Fever              X
 Tapeworms                                             X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness              X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                  X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X
 Yellow Fever                   X

AIDS Information

Donated blood is currently screened for HIV antibodies at Dakar's
principal hospital and the National Transfusion Center. Plans to
test the entire country's blood supply have been announced, but
the date of starting this screening was not set.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Dakar and St Louis serve purified drinking water
and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Yellow fever - Vaccination is required for all travelers over 1
year of age coming from the endemic zones or infected areas. CDC
recommends vaccination for all travelers over 9 months of age who
will travel outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April, with risk being possible from December until June. Local
area of greatest danger in in the northern third of the country.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Serbia and Montenergro

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk
In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                              DISEASE RISK PROFILE

 Serbia and Montenegro
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Diarrheal Diseases                 X
 Dysentery, Bacillary               X
 Encephalitis                       X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Rabies                             X
 Sandfly Fever                      X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.
No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas bordering Austria extending south to
the areas around Ljubljana and Zagreb.

Seychelles, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                            DISEASE RISK PROFILE

 Seychelles
              Disease            Endemic      Risk    Hazard
 Diarrheal Disease Risk                                 X
 Dysentery, Amoebic/Bacillary                           X
 Echinococcosis                                X
 Filariasis                                             X
 Giardiasis                                             X
 Helminthic Diseases                                    X
 Hepatitis, Viral                                       X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Rabies                            X
 Relapsing Fever                   X
 Tapeworms                                              X
 Trachoma                                               X
 Tuberculosis                      X
 Typhoid Fever                                          X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information
AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Sierra Leone, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.
Falciparum malaria represents 80% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. An
approximate 100 km deep coastal strip is free of infection. Both
S. haematobium and S. mansoni are highly endemic in the interior
of the country.


                            DISEASE RISK PROFILE

 Sierra Leone
              Disease            Endemic      Risk   Hazard
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Lassa Fever                       X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Loiasis                                               X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                                                X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. CDC recommends vaccination for all
travelers over 9 months of age who will be traveling outside of
urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.
Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Singapore, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                                DISEASE RISK PROFILE

 Singapore
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                X
 Dysentery, Amoebic/Bacillary          X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Hepatitis, Viral                      X
 Rabies                                X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

Foreigners without "permanent residence" status found to be
carrying the HIV virus antibodies will be expelled. No
compulsory testing guidelines were announced, however, except
that all new foreign housemaids entering the city must present
proof of a negative HIV antibody test. Blood donations have been
tested since 1985.
Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Milk is pasteurized and safe to drink. Butter, cheese, yogurt
and ice-cream are safe. Local meat, poultry, seafood,
vegetables, and fruits are safe to eat. Sinapore has been rated
as one of the cleanest cities in Asia.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis B - Because of the high rate of healthy
carriers of hepatitis B in this country, vaccination is
recommended for persons on working assignments in the health care
field (dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases occur on the island, all year.

Slovakia, Slovak Republic

INFECTIOUS DISEASE RISK

Malaria Risk
There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 Slovakia
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Hepatitis, Viral                   X
 Rabies                                        X
 Rocky Mountain Spotted Fever                          X

AIDS Information

All persons entering the country from areas of high risk are
being tested for HIV antibody, including citizens returning from
those areas. Areas considered high risk include all countries in
Western Europe, North and South America, and Africa. All blood
donors are being screened with HIV testing. This country reports
11 AIDS cases and 66 known carriers.

Single use syringes and needles may be unavailable. Medical
treatment should be deferred until reaching a facility where
adequate safeguards can be assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Water should be boiled in summer months and at other times when
the water table falls to low levels. Local meat, poultry,
seafood, vegetables, and fruits are safe to eat. Milk is
pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Gamma globulin is recommended for all
travelers.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas south of Prague, north of Brno, and the
areas west of Plzin (Pilsen).

Slovenia, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

                            DISEASE RISK PROFILE

 Slovenia
              Disease            Endemic      Risk    Hazard
 Avian Influenza (H5N1)             X
 Hepatitis, Viral                   X
 Rabies                                        X
 Rocky Mountain Spotted Fever                           X

AIDS Information

All persons entering the country from areas of high risk are
being tested for HIV antibody, including citizens returning from
those areas. Areas considered high risk include all countries in
Western Europe, North and South America, and Africa. All blood
donors are being screened with HIV testing. This country reports
11 AIDS cases and 66 known carriers.

Single use syringes and needles may be unavailable. Medical
treatment should be deferred until reaching a facility where
adequate safeguards can be assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Water should be boiled in summer months and at other times when
the water table falls to low levels. Local meat, poultry,
seafood, vegetables, and fruits are safe to eat. Milk is
pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.

Viral Hepatitis A - Gamma globulin is recommended for all
travelers.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in forested areas south of Prague, north of Brno, and the
areas west of Plzin (Pilsen).

Solomon Islands

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country below 400 meters,
including urban areas. The risk exists all year. The malaria in
this country is resistant to chloroquine. Prevent malaria with treatment of
clothing with permethrin and use a topical insect repellent on skin. Several
oral medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents 30% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                           DISEASE RISK PROFILE

 Solomon Islands
            Disease        Endemic       Risk     Hazard
 Diarrheal Disease Risk       X
 Encephalitis, Japanese       X
 Filariasis                                         X
 Helminthic Diseases                      X
 Tuberculosis                 X
 Typhoid Fever                            X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are
generally safe to eat. Milk is pasteurized and safe to drink.
Butter, cheese, yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.
Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Somalia

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 94% of malaria, therefore there is
a 6% risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home only if considerable exposure to
mosquitos has occurred.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. The northern
provinces of North West, North East, Migiurtinia and Mudugh are
free of infection. S. haematobium is highly endemic in the
southern provinces of Hiran, Benadir, Lower Jubba and Upper
Jubba, especially in the irrigated agricultual areas of the
Shabeelle and Giuba (Jubba) river valleys. Snail intermediate
host: Bulinus abyssinicus.

Meningitis is a risk during the dry season in the Savannah
protion of this country, from December through March.


                            DISEASE RISK PROFILE

 Somolia
              Disease            Endemic      Risk   Hazard
 Cholera                            X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Echinococcosis                                X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Polio                                                 X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Mogadishu (Mogadiscio) serve purified drinking
water and reliable food. However, the hazard is left to your
judgement.




VACCINATIONS

Yellow fever A vaccination certificate is required for all
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations. Vaccination is
recommended for
all travelers for their protection.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Cholera - Cholera is possible in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Meningitis - Due to the current famine and unrest, this disease
has become a hazard in the country and vaccination for all
travelers is recommended.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

South Africa, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk exists throughout the year in rural areas (including
game parks) in the north, east, and western low altitude areas of
Transvaal and in the Natal coastal areas north of 28 degrees
south latitude. The malaria in this country is resistant to
chloroquine. More specifically, risk is present in the
northeastern part of the country in the areas of Transvaal
bordering Botswana, Zimbabwe and Mozambique including the Kruger
National Park, and along the coast of Natal north of Tugela
river. Note: Persons visiting the Kruger National Park must take
malaria suppressive medication. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 99% of malaria, therefore there is
only a slight risk of p. vivax malaria exposure. There is little
need to consider using primaquine upon returning home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. S.
haematobium and S. mansoni (the first predominant) are highly
endemic in the northeastern part of the country, particularly in
Northern Transvaal (including Bophuthatswana, Venda and the
Kruger National Park) extending from the Limpopo river basin and
it tributaries south to the northern part of the Witwatershed
Mountain Chain. In the Southern Transvaal the infection is
present in the northwest: Marico, Swartruggens and Rustenburg
districts with foci in the southwest at Koster, Wolmaransstad and
Bloemhof on the Vaal river; and the Piet-Retief district in the
eastern part of the State (on the border with Swaziland). High
rates of infection are present in Kwa Zulu and the entire plain
and coastal areas of Natal (limited to the west by the
Drakensberg mountain chain). This endemic area extends south into
Transkei to the area of Port St. Johns. Foci of infection are
present in Ciskel in the area of East London, and in Eastern Cape
in the area of Utterhage, north of Port Elizabeth. Recently, foci
of infection have been reported from the lower Orange River in
northern Cape Province along the border with Namibia. Note: S.
matthei is mainly an infection of animals and rarely transmitted
to humans.



                            DISEASE RISK PROFILE

 South Africa
           Disease          Endemic       Risk     Hazard
 Diarrheal Disease Risk                    X
 Dysentery, Amoebic                        X
 Plague                        X
 Relapsing Fever               X
 Rift Valley Fever             X
 Trypanosomiasis, African
 Sleeping Sickness             X
 Tuberculosis                  X
 Typhoid Fever                             X
 Typhus, Scrub                 X
 West Nile Fever               X

Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone in Africa. A vaccination
certificate is required for children
over one year of age. Travelers on scheduled airlines, whose
flights have originated outside the areas regarded as infected
and who are in transit through these areas, are not required to
possess a certificate provided they have remained at the
scheduled airport or in the adjacent town during transit.
Children under one year of age are subject to isolation or
surveillance, if indicated.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are present along the northern and western
border with Lesotho and in Mountain Zebra National Park north of
Port Elizabeth.

Spain, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Due to a high incidence of tuberculosis in the native population,
persons with prolonged contact with local individuals should
consider a pre- and post-trip tuberculosis skin tets.

                              DISEASE RISK PROFILE

 Spain
            Disease              Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Brucellosis                        X
 Diarrheal Diseases                 X
 Dysentery, Amoebic                 X
 Leishmaniasis (Cutaneous)          X
 Leishmaniasis (Visceral)           X
 Sandfly Fever                      X
 Tuberculosis                       X
 Typhoid Fever                      X
 Typhus, Endemic Flea-Borne         X
 Typhus, Scrub                      X
 West Nile Fever                    X

AIDS Information

Authorities report 624 persons with AIDS through September
1987. Deaths from the disease total 322, with Madrid reporting
195 cases and 102 deaths and Catalonia reporting 127 cases and 61
deaths. No updated information has been received as of January
1993. .

Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those with
chronic medical conditions. Influenza vaccine may be considered
for those providing essential community services, health care
workers, and those wishing to reduce the likelihood of becoming
ill with influenza. Adults over 65 years of age are urged to
obtain yearly influenza immunization and to insure that their
tetanus and diphtheria immunizations are current. Pneumococcal
vaccination is also suggested for this age group.
No vaccinations are required to enter this country.

Sri Lanka, Democratic Socialist Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country below 800 meters,
including urban areas, but excluding Colombo and the District of
Nuwara Eliya (180 m). The risk exists all year. The malaria in
this country is resistant to chloroquine. Prevent malaria with treatment of
clothing with permethrin and use a topical insect repellent on skin. Several
oral medications are available to prevent malaria in the country. See malaria
prevention.

Falciparum malaria represents 27% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Potential risk of dengue fever exists. The virus is present in
this country at all times and may give rise to major outbreaks.

                                DISEASE RISK PROFILE

 Sri Lanka
             Disease                Endemic      Risk   Hazard
 Brucellosis                                      X
 Chikungunya Fever                     X
 Cholera                                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                                   X
 Encephalitis, Japanese                X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Leishmaniasis (Visceral)              X
 Polio                                                    X
 Rabies                                           X
 Sandfly Fever                                            X
 Tuberculosis                          X
 Typhoid Fever                                    X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.
Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins

should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Anuradhapura, Colombo, Kandy, Nuwara Eliya, and
Trincomalee serve purified drinking water and reliable food.

However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Risk to western travelers is low. Immunization is not
required or recommended for travel to this country due to its low
effectiveness. Avoid uncooked foods and untreated water.
Vaccination is advised only for persons living or working under
inadequate sanitary conditions and for those with impaired
defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Sporadic
cases occur throughout the country with prevalence in the west.
Period of transmission all yaer. High risk group is children
under 15 years of age.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Sudan, Republic of the

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 99% of malaria, therefore there is
only a slight risk of p. vivax malaria exposure. There is little
need to consider use of primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
Schistosomiasis may be found throughout this country. Avoid
contact with contaminated fresh water lakes, ponds, or streams.
S. haematobium and S. mansoni are endemic throughout all
populated areas of Sudan except for the Province of Red Sea. S.
haematobium is predominant in the north and west, while S.
mansoni is prevalent in the east and south of the country.

                            DISEASE RISK PROFILE

 Sudan
              Disease            Endemic      Risk   Hazard
 Avian Influenza (H5N1)             X
 Dracunculiasis/Guinea Worm         X
 Diarrheal Disease Risk                                X
 Dysentery, Amoebic/Bacillary                          X
 Filariasis                                            X
 Giardiasis                                            X
 Helminthic Diseases                                   X
 Hepatitis, Viral                                      X
 Leishmaniasis (Cutaneous)         X
 Leishmaniasis (Visceral)          X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                            X
 Relapsing Fever                   X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                 X
 Tuberculosis                      X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne        X
 Typhus, Epidemic Louse-Borne      X
 Typhus, Scrub                     X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.



Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Khartoum serve purified drinking water and
reliable food. However, the hazard is left to your judgement.
VACCINATIONS

Cholera - A cholera vaccination certificate is required when
coming from an infected area. Cholera is present in this
country. Risk to western travelers is low. Immunization is not
required or recommended for travel to this country due to its low
effectiveness. Avoid uncooked foods and untreated water.
Vaccination is advised only for persons living or working under
inadequate sanitary conditions and for those with impaired
defense mechanisms.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
one year of age. Travelers leaving this country are required to
possess a vaccination certificate on their departure to an
infected area or to countries which still demand such a
certificate. Vaccination is recommended for all travelers for
their protection. CDC recommends vaccination for all travelers
over 9 months of age who will travel outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.



The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is the southern two thirds
of the country.
Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of areas of risk for
this country are present in the southern part along the border
with Zaire and Uganda.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Suriname, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas, except Paramaribo district and coastal areas north of 5
degrees North latitude. The risk exists all year. The cities of
Paramaribo, Commewijine, Totness, Nieuw Amsterdam north are risk
free. The malaria in this country is resistant to chloroquine.
Prevent malaria with treatment of clothing with permethrin and use a topical
insect repellent on skin. Several oral medications are available to prevent
malaria in the country. See malaria prevention.

Falciparum malaria represents 95% of malaria, therefore there is
a slight risk of p. vivax malaria exposure. Consider use of
primaquine upon return home only if considerable mosquito
exposure has been experienced.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Chagas' disease vector is present in rural areas, but the exact
extent of the infectionis unknown. The vector is Rhodnius
prolixus.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of
infection is present in the central part of the coastal region in
the cultivated swamp and shell sand bar areas surrounding
Paramaribo. This endemic areas extends from the delta area of
the Commewijne river to the marsh areas north of Wageningen
(Nickerie district).


                             DISEASE RISK PROFILE

 Suriname
               Disease              Endemic         Risk   Hazard
 Dengue Fever                          X
 Diarrheal Disease Risk                              X
 Dysentery, Amoebic                                  X
 Echinococcosis                       X
 Encephalitis, Venezuelan Equine      X
 Filariasis (Bancroftian)                                    X
 Helminthic Diseases                                 X
 Hepatitis, Viral                                    X
 Leishmaniasis (Cutaneous)            X
 Leishmaniasis (Mucocutaneous)        X
 Polio                                                       X
 Rabies                               X
 Trypanosomiasis, American
 Chaga's Disease                      X
 Tuberculosis                         X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Water is safe to
drink, food safe, but milk not safe without the above precautions
in Paramaribo.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. CDC recommends vaccination for all
travelers over 9 months of age, who may travel beyond urban
areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Swaziland, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present from December through March in the northern
border areas of Bordergate, Lomahasha, Mhlume, and Tshaneni. The
malaria in this country is resistant to chloroquine. Prevent malaria with
treatment of clothing with permethrin and use a topical insect repellent on
skin. Several oral medications are available to prevent malaria in the country.
See malaria prevention.

Falciparum malaria represents 99% of malaria, therefore there is
very little risk of p. vivax malaria exposure. The traveler
should probably not need to consider the use of primaquine upon
return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis is present in the whole country, including urban
areas. Avoid contact with fresh water lakes, ponds, or streams.


                          DISEASE RISK PROFILE

 Swaziland
          Disease         Endemic     Risk       Hazard
 Diarrheal Disease Risk                X
 Dysentery, Amoebic                    X
 Hepatitis, Viral                      X
 Plague                     X
 Rabies                                            X
 Relapsing Fever            X
 Rift Valley Fever          X
 Tuberculosis               X
 Typhoid Fever                         X
 Typhus, Scrub              X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Water, dairy products,
and foods are safe in the city of Mbabane.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Cholera - Cholera is present in this country. Risk to western
travelers is low. Immunization is not required or recommended
for travel to this country due to its low effectiveness. Avoid
uncooked foods and untreated water. Vaccination is advised only
for persons living or working under inadequate sanitary
conditions and for those with impaired defense mechanisms.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Sweden, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Fishing has been banned in Lake Opptjarn in central Sweden,
due to high radiation levels detected in fish caught there,
presumed to be due to the Chernobyl nuclear accident.

Diphyllobothrium, fish tapeworm, may contaminate the waters of
the Baltic Sea area and caution is advised.

                              DISEASE RISK PROFILE

 Sweden
     Disease        Endemic        Risk     Hazard
 Avian Influenza
 (H5N1)               X


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS


Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the forested areas around Uppsala down to
Krisitanstad, including the islands of Gotland and Oland, and in
the wooded areas around Goteborg.

Switzerland, Swiss Confederation

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.
Diseases of Special Risk

                               DISEASE RISK PROFILE

 Switzerland
        Disease      Endemic       Risk       Hazard
 Avian Influenza
 (H5N1)                    X


Food/Water Safety

Local water is considered safe without further treatment. Milk
is pasteurized and safe to drink. Butter, cheese, yogurt and
ice-cream are safe. Local meat, poultry, seafood, vegetables,
and fruits are safe to eat.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are

urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the wooded areas around Schaffhausen and north of
Winterhur, and around the western shore of Lake Thun.

Syria, Syrian Arab Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present from May through October in this country below
600 meters, except Deir-es-Zor and As Suwayda. There is no risk
of malaria in urban areas. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.
Falciparum malaria represents <1% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home if heavy exposure to mosquitos has
been encountered.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Risk of S.
haematobium is present in the northeastern part of the ocuntry of
the country along the Belikh and lower Euphrates river basins. In
Ar Raqqah sector the infection extends from Tall al Abyad along
Wadi Belikh and Euphrates to Khamisia, continuing in Dayr az Zawr
sector along the Euprates to Abu Kamai on the border with Iraq.
In Al Hasakah sector the infection is limited to a foci around
Khatuniyah (close to the Iraqi border).

Meningitis is a potential threat to travelers in this country.
The CDC does not recommend this vaccine for travelers here at
this time. The Department of State recommends that its personnel
receive meningococcal meningitis vaccine. The WHO reports active
disease.

                                DISEASE RISK PROFILE

 Syrian Arab Republic
             Disease                Endemic      Risk   Hazard
 Brucellosis                                              X
 Cholera                               X
 Dracunculiasis/Guinea Worm            X
 Diarrheal Disease Risk                                   X
 Dysentery, Amoebic/Bacillary                             X
 Echinococcosis                        X
 Hepatitis, Viral                                 X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)              X
 Polio                                                    X
 Rabies                                X
 Relapsing Fever                       X
 Tapeworms                             X
 Trachoma                                         X
 Tuberculosis                          X
 Typhoid Fever                                    X
 Typhus, Endemic Flea-Borne            X
 Typhus, Scrub                         X

AIDS Information

All persons applying for foreign work permits and all foreign
students must undergo HIV antibody testing at official government
approved laboratories upon their arrival in Syria. Contact the
Syrian embassy for further details.

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Dimashq (Damascus) and Halab (Aleppo) serve
purified drinking water and reliable food. However, the hazard
is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination is required
for children of all ages. Children under nine months of age
should not be vaccinated due to health considerations.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are present in the northern and eastern parts of
the country bordering Iraq.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Tajikistan, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria risk is present in a few scattered border areas with Iran
and Afghanistan. Prevent malaria with treatment of clothing with permethrin and
use of topical insect repellent on skin. Take chloroquine 500 mg weekly,
starting two weeks before exposure, weekly while in the risk area, and
continuing for 4 weeks post exposure.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Giardia is a problem in the western portions of the country,
especially in Leningrad.

Cutaneous leishmaniasis is encountered in southern sections of
the country.

Scrub (tick borne) typhus is found in eastern and central
Siberia.

Rabies is prevalent in many rural areas, especially in foxes.

The fish tape worm, diphyllobothrium, is common in the Baltic Sea
area.

                              DISEASE RISK PROFILE

 Tajikistan
       Disease      Endemic       Risk        Hazard
 Tuberculosis          X


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk is pasteurized and safe to
drink. Butter, cheese, yogurt and ice-cream are safe. Cold
foods may be safe, but are not recommended.

VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization, and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended when traveling
outside the areas usually visited by tourists, traveling
extensively in the interior of the country (trekkers, hikers) and
for persons on working assignments in remote areas.

Typhoid fever - Vaccination is recommended when traveling outside
the areas usually visited by tourists, traveling extensively in
the interior of the country (trekkers, hikers) and for persons on
working assignments in remote areas.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur occassionally in the southeast between the border with
China and the Sea of Japan, with prevalence in the area of
Vladivostok. Period of transmission is June to October.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are in Azerbaijan, Armenia and Georgia; in the
Kazakh SSR; on the northern shores of the Caspian Sea, the
northeastern shores of the Aral Sea and the southern shores of
Lake Balkash. In Turkmen SSR a large focus of activity is
present east of the Caspian Sea.

Tick-borne encephalitis - (Central European encephalitis)
Vaccination is recommended for persons involved in recreational
activities in forested areas (camping, hiking) or working in
forestry occupations. Risk season: March to November. Risk is
present in the wetsern part of the country and in eastern Siberia
(Russian Far Eastern encephalitis).

Tanzania, United Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider use of primaquine
upon return home if an unusual amount of mosquito exposure was
encountered.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Known areas of
infection are present in the northern part of the country along
the eastern and southern shore of Lake Victoria including the
islands; and in the Tanga District in the northeastern part of
the country. Infection has also been reported from the area of
Kasulu, Kigoma District near the northern shore of Lake
Tanganyika; the area of Lake Rukwa and the area of Songea in
southwestern Tanzania; foci are present in Kidodi, Kitatu and
Ruaha, northeast of Iringa. The islands of Zanzibar and Pemba
are infected.

The Centers for Disease Control recommends travelers to the
northern portions of this country receive meningococcal vaccine
as an epidemic of meningitis occurred during late 1989 in the
Arusha area. No cases of meningitis has been reported in
travelers, but this area includes the most popular tourist
destinations in the country.

                            DISEASE RISK PROFILE

 Tanzania
                Disease             Endemic        Risk   Hazard
 Dracunculiasis/Guinea Worm            X
 Diarrheal Disease Risk                                     X
 Dysentery, Amoebic/Bacillary                               X
 Echinococcosis                                     X
 Filariasis                                                 X
 Giardiasis                                                 X
 Helminthic Diseases                                        X
 Hepatitis, Viral                                           X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)              X
 Onchocerciasis                                             X
 Plague                                X
 Polio                                                      X
 Rabies                                X
 Relapsing Fever                       X
 Trachoma                                                   X
 Trypanosomiasis, African
 Sleeping Sickness                     X
 Tuberculosis                          X
 Typhoid Fever                                              X
 Typhus, Endemic Flea-Borne            X
 Typhus, Epidemic Louse-Borne          X
 Typhus, Scrub                         X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Arusha, Dar Es Salaam, Moshi, and Zanzibar serve
purified drinking water and reliable food. However, the hazard
is left to your judgement.




VACCINATIONS

Cholera - A cholera vaccination certificate is required for
travelers intending to enter the islands of Pemba and Zanzibar.
Although cholera vaccination certificate is not officially
required for entering Tanzania, travelers may be asked to show
proof of cholera vaccination upon arrival. (Complaints to that
effect have been lodged by tourists.) To avoid harassment IAMAT
suggests vaccination. One injection is sufficient to satisfy
health officials, but it must be obtained 10 days prior to
arrival.

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate
is required for children over
one year of age. Vaccination is recommended for all travelers
for their protection. CDC recommends vaccination for all
travelers over 9 months of age who are going to northwestern
forest regions.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.

Meningitis - Due to the local epidemic of meningococcal disease,
vaccination is recommended by the CDC for all travelers to this
country.

Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.
Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Plague - Vaccination is recommended only for persons who may be
occupationally exposed to wild rodents (anthropologists,
geologists, medical personnel, missionaries, etc). The standard
vaccination course must be completed before entering the plague
infested area. Geographical distribution of the areas of risk
for this country are present south of Lake Victoria and along the
eastern part of the border with Kenya (Tanga Province).

Thailand, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. Resistance has developed in
this country to chloroquine, Fansidar, and mefloquine -
particularly in refugee camp areas. There is no risk of malaria
in urban areas. Prophylaxis in not necessary if your trip is
confined to these areas. Note: There is no malaria risk in the
cities of Bangkok, Chiang Mai, Songhkla and the resort areas of
Pattaya and Phuket. Persons flying into cities and making only
daytime excursions to rural areas do not need to take malaria
suppressive medication. Persons travelling by car, boat or train
through rural areas of the interior, forested and hilly areas,
and to mining and refugee camps should be aware of the presence
of multi-drug resistant malaria. Current prophylaxis
recommendations can be obtained from Malaria Branch, Centers for
Disease Control by your physician. Doxycycline 100 mg taken once
daily has been a recent recommendation for prophylaxis in this
area.

Falciparum malaria represents 70% of malaria, therefore there is
a 30% risk of p. vivax malaria exposure. Consider use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it
is a caution concerning the more likely endemic disease risks.

Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Infection
with S. mekongi is limited to two foci. The first is present in
the area of Chongmek (near the confluence of the Mae Nam Mun and
the Mekong) on the border with Laos. Ubon Province, and the
second in the southern province of Nakhon Si Thammarat in a few
villages of the Chawang, Chang Klang and Toong Song cantons.

                                DISEASE RISK PROFILE

 Thailand
             Disease                Endemic      Risk   Hazard
 Avian Influenza (H5N1)                X
 Chikungunya Fever                     X
 Cholera                               X
 Opisthorchiasis                       X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary          X
 Encephalitis, Japanese                X
 Fasciolopsiasis                       X
 Filariasis                                               X
 Hepatitis, Viral                      X
 Polio                                 X
 Rabies                                X
 Trachoma                              X
 Tuberculosis                          X
 Typhoid Fever                         X
 Typhus, Scrub                         X

AIDS Information

There are 10,000 cases of HIV antibody positive

carriers and known cases amongst drug users in Thailand. The
virus is spreading rapidly amongst female prostitutes.
Heterosexual women now make up the second largest group of
persons infected with the virus.

AIDS is of concern in the blood supply. Single use
syringes and needles may be unavailable. Medical treatment
should be deferred until reaching a facility where adequate
safeguards can be assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Bangkok (Krung Thep), Chiang Mai, and Sattahip
serve purified drinking water and reliable food. However, the
hazard is left to your judgement.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries in the endemic yellow fever zone. A vaccination certificate is
required for children over
one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Japanese encephalitis - Vaccination is indicated for persons
traveling extensively in rual areas or living and working near
rice growing rural and suburban areas and other irrigated land,
when exposure to the disease carrying mosquitoes is high.
Children are especially susceptible to the infection. Outbreaks
occur mostly in the northern region (Chiang Mai valley), with
sporadic cases reported from the areas of Sukhothai and
Phitsanulok and the southern region. Period of transmission in
the north: June to October; in the south: all year.

Rabies - In this country, where rabies is a constant threat, a
pre-exposure rabies vaccination is advised for persons planning
an extended stay or on working assignments (naturalists,
agricultural advisors, archeologists, geologists, etc.).
Although this provides adequate initial protection, a person
bitten by a potentially rabid animal would still require post
exposure immunization. Children should be
cautioned not to pet dogs, cats, or other mammals.

Togo, Togolese Republic

INFECTIOUS DISEASE RISK

Malaria Risk

Malaria is present in all parts of this country, including urban
areas. The risk exists all year. The malaria in this country is
resistant to chloroquine. Prevent malaria with treatment of clothing with
permethrin and use a topical insect repellent on skin. Several oral medications
are available to prevent malaria in the country. See malaria prevention.

Falciparum malaria represents 85% of malaria, therefore there is
a risk of p. vivax malaria exposure. Consider the use of
primaquine upon return home.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

Schistosomiasis is present in the whole country, including urban
areas. Avoid contact with fresh water lakes, ponds, or streams.


                                DISEASE RISK PROFILE

 Togo
              Disease                Endemic      Risk   Hazard
 Avian Influenza (H5N1)                 X
 Dracunculiasis/Guinea Worm                                X
 Diarrheal Disease Risk                                    X
 Dysentery, Amoebic/Bacillary                              X
 Echinococcosis                                    X
 Filariasis                                                X
 Giardiasis                                                X
 Helminthic Diseases                                       X
 Hepatitis, Viral                                          X
 Lassa Fever                           X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)       X
 Onchocerciasis                                        X
 Polio                                                 X
 Rabies                         X
 Relapsing Fever                X
 Trachoma                                              X
 Trypanosomiasis, African
 Sleeping Sickness                                     X
 Tuberculosis                   X
 Tungiasis                                             X
 Typhoid Fever                                         X
 Typhus, Endemic Flea-Borne     X
 Typhus, Epidemic Louse-Borne   X
 Typhus, Scrub                  X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Lome serve purified drinking water and reliable
food. However, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required on
arrival from all countries. A vaccination certificate is
required for children over one year of age. CDC recommends
vaccination for all travelers over 9 months of age who plan to go
outside of urban areas.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Poliomyelitis - A poliomyelitis booster is indicated for this
country.

Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Meningococcal meningitis - Vaccination is advised for persons
traveling extensively or on working assignements in the
meningitis belt of Africa's northern savannah, which stretches
from the Red Sea to the Atlantic Ocean. Peak season is March and
April. Local area of greatest danger is in the northern third of
the country.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Tokelau

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                           DISEASE RISK PROFILE
 Tokelau Islands
           Disease         Endemic   Risk       Hazard
 Diarrheal Disease Risk               X
 Encephalitis, Japanese      X
 Filariasis                                       X
 Helminthic Diseases                  X
 Typhoid Fever                        X

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water

is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert.




VACCINATIONS

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

No vaccinations are required to enter this country.

Tonga, Kingdom of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
This country must be considered receptive to dengue fever.
Intermittent epidemics in the past make renewed activity or
reintroduction of the virus possible.

                          DISEASE RISK PROFILE

 Tonga
           Disease        Endemic      Risk      Hazard
 Diarrheal Disease Risk                 X
 Encephalitis, Japanese     X
 Filariasis                                        X
 Helminthic Diseases                    X
 Tuberculosis               X
 Typhoid Fever                          X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. Food, water, and milk
products in Nuku'alofa on Togatapu Island are considered safe,
however, the hazard is left to your judgement.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.


The vaccinations listed are recommended for the traveler's
protection.


Viral Hepatitis A - Vaccination is recommended for all travelers
for their protection.

Typhoid fever - Vaccination is recommended for all travelers for
their protection.

Selective vaccinations - These apply only to specific groups of
travelers or persons on specific working assignments:


Viral Hepatitis B - Because of the high rate of healthy carriers
of hepatitis B in this country, vaccination is recommended for
persons on working assignments in the health care field
(dentists, physicians, nurses, laboratory technicians), or
working in close contact with the local population (teachers,
missionaries, Peace Corps), or persons foreseeing sexual
relations with local inhabitants.

Trinidad and Tobago, Republic of

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.

Dengue fever is active in this country. The World Health
Organization reported 1,200 cases through mid-February 1990.     No
deaths were reported. Mosquito protection is important.

                                DISEASE RISK PROFILE

 Trinidad and Tobago
             Disease                Endemic      Risk   Hazard
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Hepatitis, Viral                      X
 Rabies                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.


Food/Water Safety

Water is probably safe, but due to local variations in bacterial
counts, using bottled water for the first few weeks will help the
traveler adjust and decrease the chance of traveler's diarrhea.
Local meat, poultry, seafood, vegetables, and fruits are safe to
eat. Milk is pasteurized and safe to drink. Butter, cheese,
yogurt and ice-cream are safe.




VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas and from or in transit
through countries with active disease. A vaccination certificate
is required for children over one year of age. Vaccination is
recommended when traveling outside the areas usually visited by
tourists, traveling extensively in the interior of the country
(trekkers, hikers) and for persons on working assignments in
remote areas. CDC recommends vaccination for all travelers over
9 months of age who may travel outside of urban areas. Some
countries will require a yellow fever vaccination to enter their
country after visiting this country.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providing essential community services,
health care workers, and those wishing to reduce the likelihood
of becoming ill with influenza. Adults over 65 years of age are
urged to obtain yearly influenza immunization and to insure
that their tetanus and diphtheria immunizations are current.
Pneumococcal vaccination is also suggested for this age group.

Tunisia, Tunisian Republic

INFECTIOUS DISEASE RISK

Malaria Risk

There is no malaria risk in this country.

Diseases of Special Risk

In addition to the worldwide hazard of tetanus and the routine
and any special immunizations recommended below, the traveler
should be aware that risk of exposure to the following diseases
exists in this country. This list is not all inclusive, but it is a
caution concerning the more likely endemic disease risks.
Schistosomiasis may be found in this country. Avoid contact with
contaminated fresh water lakes, ponds, or streams. Extensive
control measures have reduced the once extensive endemic area to
the following foci of low risk: Governate of Gabes: El Hamma,
Zarat, Matamta; Governate of Gafsa: Ouled Tlijane and Ouled
Majed.

                                DISEASE RISK PROFILE

 Tunisia
             Disease                Endemic      Risk   Hazard
 Brucellosis                                      X
 Dengue Fever                          X
 Diarrheal Disease Risk                           X
 Dysentery, Amoebic/Bacillary                     X
 Echinococcosis                        X
 Giardiasis                                       X
 Helminthic Diseases                              X
 Hepatitis, Viral                                 X
 Lassa Fever                           X
 Leishmaniasis (Cutaneous)             X
 Leishmaniasis (Visceral)              X
 Polio                                 X
 Rabies                                X
 Relapsing Fever                       X
 Sandfly Fever                         X
 Trachoma                              X
 Tungiasis                                                X
 Typhoid Fever                                    X
 Typhus                                X

AIDS Information

AIDS is of concern in the blood supply. Single use syringes and
needles may be unavailable. Medical treatment should be deferred
until reaching a facility where adequate safeguards can be
assured.

Food/Water Safety

All tap water used for drinking, brushing teeth, and making ice
cubes should be boiled prior to use. Insure that bottled water
is uncapped in your presence. Milk should be boiled to insure
safety. Powdered and evaporated milk are available and safe.
Avoid butter and other dairy products. All meat, poultry and
seafood must be well cooked and served while hot. Pork is best
avoided. Vegetables should be well cooked and served hot.
Salads and mayonnaise are best avoided. Fruits with intact skins
should be peeled by you just prior to consumption. Avoid cold
buffets, custards, and any frozen dessert. First class hotels and
restaurants in Bizerte, Hamamet, Jerba (Djerba), Sfax, Sousse,
and Tunis serve purified drinking water and reliable food.
However, the hazard is left to your judgement. The water, food,
and dairy products in the city of Quairouan are considered safe.
VACCINATIONS

Yellow fever - A vaccination certificate is required for
travelers coming from infected areas. A vaccination certificate
is required for children over one year of age.

Routine immunizations should be current. A
rubeola (measles) booster should be considered. Persons age 16
to 65 should receive a booster of tetanus and diphtheria every
ten years. Healthy adults under age 65 do not require
pneumococcal vaccine, but it is appropriate for those
with chronic medical conditions. Influenza vaccine may be
considered for those providin