The CDC recommends that travellers avoid all nonessential travel to Venezuela. There are outbreaks of infectious diseases, and adequate health care is not available in most of the country. There has been a breakdown of the medical infrastructure in Venezuela. There are shortages of food, water, electricity, medicine, and medical supplies creating a crisis in many parts of the country. Adequate health care is currently not available through the public health system in Venezuela. Infectious diseases are on the rise, and several large outbreaks are occurring of measles, diphtheria and malaria

There are increasingly large numbers of polio cases in various parts to the world. If you are travelling to any of the following countries you should get a booster Polio vaccine even if you were vaccinated several time as a child. The following countries have outbreaks of Polio.

• Pakistan
• Philippines
• Nigeria
• Ghana
• Benin
• Niger
• Angola
• Central African Republic
• Somalia
• Burma (Myanmar)
• Papua New Guinea
• DR Congo
• Mozambique
• Indonesia
• Ethiopia

EBOLA in Democratic Republic of Congo (DRC)

Ebola fever is a deadly disease that causes outbreaks in several African countries. It is spread by direct contact with blood or body fluids of a person infected with Ebola virus. It is also spread by contact with contaminated objects or infected animals.
Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

An outbreak of Ebola is occurring in the North Kivu (Kivu Nord) and Ituri provinces of the DRC, including the cities of Beni and Butembo. The provinces have been experiencing a prolonged humanitarian crisis and deteriorating security situation, which is limiting public health efforts to respond to this outbreak.
The risk to most travelers to DRC is low, with potential increased risk to those travelers going in or near the outbreak area and inadvertently coming in close contact with person infected with Ebola.

What can travelers do to protect themselves?

There is no FDA-approved or widely available vaccine or Ebola virus treatment, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola:

• Avoid contact with other people’s blood or body fluids. Do not handle items that may have come in contact with a person’s blood or body fluids (such as clothes, bedding, needles, or medical equipment).
• Avoid contact with wild animals and bush-meat.
• Avoid participating in burial rituals that require handling a dead body.
• Before you go to a doctor’s office or emergency room, tell the doctor about your recent travel and your symptoms.
• Advance notice will help the doctor care for you and protect other people who may be in the office or hospital.

Travelers who may have been exposed to Ebola or who become sick during travel should postpone further travel and get immediate medical attention. Any person with possible exposure or Ebola-like symptoms will not be allowed to travel unless the travel is part of an appropriate medical evacuation.

Five human rabies cases and almost 800 cases of people being bitten by rabid animals have been reported in the Malaysian state of Sarawak. All five people infected with rabies have died.

Rabies is a deadly disease found in the saliva of infected animals. All mammals can get rabies. People usually get rabies from licks, bites, or scratches from infected dogs or other animals.

Rabies affects the nervous system causing brain disease and death. Once symptoms of rabies appear, the disease is nearly always fatal, so prevention is especially important.

Avoid touching all animals, including wild animals and pets. Pets in other countries, such as Malaysia, may not be vaccinated against rabies.

See your local travel clinic to get vaccinated for Rabies before traveling to an area of risk.

Please note that there are currently severe shortages of inject able Typhoid vaccine and Yellow fever vaccine in the province in Ontario.

To ensure your best chances of receiving either of these vaccines if you need them , it is best to visit a travel clinic as early as possible. If the vaccine is not available at the time , your name can be put on a waiting list to receive the vaccine in priority.

Also note that Yellow Fever vaccine is a mandatory requirement for entry to certain countries

There is currently an outbreak of bubonic plague in widespread areas of Madagascar.

The Plague is a bacterial infection spread through bites by infected fleas. Plague causes high fever, swollen lymph glands and the infection can spread to the lungs

Plague pneumonia ( infection in the lungs) is the only way it that can be directly transmitted from one person to another. Plague can be treated with antibiotics. However, without prompt treatment, plague can cause serious illness or death.

No vaccine is available to prevent plague. But travelers can take steps to prevent plague, and complications of plague can be prevented with antibiotics.

Travelers to Madagascar should use insect repellent that lists protection against fleas on the label and contains at least 25% D.E.E.T. Avoid close contact with sick or dead animals. Avoid close contact with people who are coughing up blood.

Travelers who have had close contact with people with plague pneumonia should immediately contact a doctor. During or after travel to Madagascar, travelers should watch for symptoms of plague. If symptoms do appear, they should seek medical care and inform the provider about their travel to Madagascar. Antibiotics are available to treat the plague.

There have increased number of cases of Polio ( Poliomyelitis reported in the Democratic Republic of Congo, Syria and Nigeria.

Travelers to these areas are urged to receive a booster dose of Polio vaccine ( on top of your child hood doses) prior to departure to these countries. It is also advised that you carry some documentation of proof of vaccination as this may be required prior to your exit from certain countries.