Guest post by IAMAT Board member Shirley Cheng, MPH. Shirley has over 20 years of public health experience in both Canada and China. She holds a Master of Public Health from the University of Waterloo and a Bachelor of Medical Sciences from West China University of Medical Sciences.

Chest x-rays courtesy of Stock.XCHNG.

Today is World Tuberculosis Day. One hundred and thirty years ago, the German doctor Robert Koch discovered the bacteria Mycobacterium tuberculosis which causes tuberculosis (TB). TB continues to be a global health concern: In 2010, 9 million people suffered from TB, 1.4 million people died from this infection, and one-third of the world's population is at risk. The World Health Organization (WHO) has designated March 24 of every year as World Tuberculosis Day in order to raise public awareness of this infection (pulmonary TB being the most contagious). This year's slogan, "Stop TB in our lifetime", is a call to action for us to prevent the spread of TB, especially as we face challenges controlling multi-drug-resistant tuberculosis (MDR-TB) and extensive drug-resistant TB (XDR-TB).

Air travel and pulmonary tuberculosis
Travellers may recall the 2007 tuberculosis scare caused by a passenger who travelled by plane to various international destinations including the US, France, Greece, Italy, the Czech Republic, and Canada while he was suspected of having extensive drug-resistant tuberculosis. Some travellers who flew on the same planes accused him of selfishly putting their lives in danger. It was also the first case where the US Centers for Disease Control and Prevention (CDC) quarantined a person infected with TB. It raised many questions about the risk of contracting TB in an aircraft (as a result of travelling in a confined space for a prolonged period of time) and highlighted how easily infectious diseases can be potentially transmitted through international travel.

The airline industry follows the WHO Tuberculosis and Air Travel guidelines which indicate that people with infectious TB must postpone long distance travel while those with multiple drug-resistant tuberculosis must postpone all air travel. Some countries have their own DO NOT FLY list at their border services for public health reasons. Quarantine officers from the Public Health Agency of Canada, for example, work in major international airports to prevent infectious diseases and outbreaks. According to the WHO, no active TB case has been identified due to exposure on a commercial aircraft so far. This is because airplanes are built with HEPA (High-Efficiency Particulate Air) filter systems on board which kill germs when air is circulated in the aircraft. Travellers can rest assured that under normal conditions, cabin air is cleaner than the air in most buildings. Furthermore, aircraft ventilation systems are operating as long as the doors are closed even if the plane is on the tarmac. WHO advises ground delays should be kept to a maximum of 30 minutes.

So what are the risks of contracting TB when someone sitting beside you is coughing or sneezing? What precautions can you take to protect yourself?

Tuberculosis is an airborne disease. Symptoms include weight loss, fever, excessive coughing, loss of appetite, fatigue, and night sweats. Sometimes TB may be misdiagnosed as bronchitis or pneumonia. TB becomes infectious when a person with active TB releases the bacteria into the air through coughing or sneezing. Others nearby may breathe the air containing the bacteria into their lungs and become infected. TB is not spread by sharing cutlery, dinner plates, drinking cups, or toilet seats.

The critical steps for controlling and preventing TB is to make sure that persons with active TB get proper and timely treatment. If you have active TB, you'll need to be isolated until the culture test results are negative. Once you are no longer contagious, you can resume your normal activities and travel. To prevent drug resistance to the infection, you need to take the full course of medication for a minimum of 6 months which can take up to one year or more to complete.

As a frontline public health practitioner working directly with TB patients and their families, I often got questions asking: Why did I or a loved one get TB? Can I let my parents / grandparents / child fly back to visit relatives back home? What are the air travel restrictions for people affected by TB? The answer is that persons who have lived in or traveled to areas where TB is endemic, are at greater risk of developing tuberculosis. Persons can fly back to their home country after their sputum results turn up negative and they follow an established treatment regime. Income, housing conditions, lack of access to health services, social exclusion and other social determinants of health also play a role in TB infection. For example, data shows how healthy newcomers who have latent TB are at risk of becoming infectious within the first five years of immigrating. Unequal access to employment, education, and wealth distribution are all key factors contributing to physical and psychological stress.

If you are a TB carrier ask your local public health department official who is in charge of infection control, or your treating physician, to issue a letter explaining your health status and confirming that you are fit for travel in case you get asked at the border about your medications.

I hope this information reassures you that there is no need to panic about TB and instead, enjoy your vacation to the fullest.

Shirley discusses TB in the videos "Are you at risk?" and "The difference between TB infection and TB diseases" in Mandarin. If you have any questions for Shirley, please contact us.

You can find more information about TB from:

• STOP TB Partnership
  
• Bill & Melinda Gates Foundation
  
• World Health Organization
  
• Public Health Agency of Canada
  
• Centers for Disease Control and Prevention
  
  

Guest post by Caitlin Garlow, Communications Associate, Sabin Vaccine Institute.
Sabin is a non-profit organization working to eleminate neglected tropical diseases through innovative vaccine research and development, and advocating for improved access to vaccines and essential medicines for citizens around the globe.

Children getting medication to prevent NTDs in India. Photo by Esther Havens.	Schoolchildren in India. Photo by Esther Havens.

For health conscious individuals planning to visit other countries, there's a pre-travel checklist:
- Visit the travel clinic, check
- Catch up on necessary immunizations, check
- Research medical insurance, check

But even the savviest travellers may not know about all the diseases that are native to the countries they visit, how to avoid them or how they can help those affected by particularly devastating diseases that most people have never heard of.

Neglected tropical diseases (NTDs) are a group of diseases that are largely unknown to many people. Travellers probably won't find pamphlets about them in travel clinics and they may not be on the recommended shot list either. But these bacterial and parasitic infections are very common in countries in Africa, Asia and Latin America.

The seven most common NTDs - ascariasis (roundworm), hookworm, lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis, trachoma and trichuriasis (whipworm) - impact one in six people worldwide, including 500 million children. The symptoms are different for each disease and can include rashes, nausea and vomiting, fever and loss of blood. Left untreated, these diseases can eventually lead to blindness, huge swelling of the limbs, severe malnutrition and anemia. These long-lasting effects help to perpetuate poverty by preventing parents from working and keeping kids out of school.

NTDs can be transmitted through insect bites, contact with contaminated food, water or soil and direct human contact. Cautious travellers visiting endemic countries can take steps to avoid contracting these diseases (for a specific list of prevention tips related to the NTD schistosomiasis, visit this post on End the Neglect by IAMAT president Assunta Uffer-Marcolongo), but should also consider how they can be a part of the solution to the global health problems created by NTDs.

And the solution is simple. A rapid-impact package that contains four pills can treat and prevent all seven NTDs. Pharmaceutical companies donate a majority of the pills, so the costs are limited to distributing the medicine and setting up treatment programs that communities can run themselves. As a result, the total cost of treating and preventing seven NTDs is only 50 cents per person per year.

That's why this year the Global Network for Neglected Tropical Diseases launched END7 , an international advocacy campaign that encourages people to learn more about NTDs and take action to help those who are affected. To show your support for ending seven NTDs, we'd like to invite you to visit our web site, www.end7.org, join our Facebook or Twitter, join our Facebook communities, and consider donating 50 cents to give one person the chance to live a healthy and productive life. Travellers interested in learning more about the causes, symptoms and treatments for NTDs can also take a look at the series of interactive fact sheets on our the Global Network for Neglected Tropical Diseases web site.

Travellers have the opportunity to do more than just see the sights when they visit new places. Becoming knowledgeable about important health issues in the countries they visit and advocating for those with tangible solutions can help people connect with the cultures they visit. Don't forget next time you're planning a trip to add learning about NTDs to your travel checklist.

As a record number of travellers are booking cruise holidays – the latest numbers show that there were approximately 15 million cruise passengers worldwide in 2010 – the risk of getting ill on a cruise ship increases.

Illnesses on large ships have a ripple effect; living in close quarters with hundreds or thousands of other travellers for an extended period of time not only exposes you to infectious diseases, but can also have a negative health impact on host port communities where passengers disembark for sightseeing tours and on-land activities.

What are common illnesses found on cruise ships?
Gastro-intestinal illnesses (gastroenteritis) caused by norovirus, e. coli, and salmonella can be present on cruise ships. These highly contagious viral and bacterial infections are transmitted by:

- Ingesting contaminated food and fluids
- Improper hand and body hygiene (fecal-oral route)
- Touching infected surfaces and objects
- Coming into close contact with a sick person

Symptoms usually develop within 12 to 48 hours after exposure and can appear suddenly. They include vomiting, watery diarrhea, abdominal cramps, fever, headache, and nausea. The illness typically lasts 1 to 2 days, but you can be contagious anywhere from 3 days to 2 weeks after getting sick.

Respiratory illnesses such as influenza are also common on ships. The virus is transmitted among passengers through infected air droplets by sneezing or coughing. A person can be contagious 1 day before and up to 7 days after symptoms appear. Symptoms include high fever, sore throat, nasal congestion, high fever, muscle aches, headache, fatigue, and general weakness. Patients usually recover after 1 or 2 weeks, but the illness can cause complications in young children or persons with pre-existing health problems.

The hepatitis A virus is transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Hepatitis A symptoms can mimic the flu - fatigue, nausea, abdominal pain, fever, loss of appetite, and jaundice (skin and eyes). Symptoms appear anywhere from 2 to 6 weeks after being exposed. The illness can last up to 6 months. However, some people are long-term hepatitis A carriers and will not exhibit any symptoms during their lifetime.

Legionnaire's Disease is a lung infection caused by the Legionella bacteria. Passengers acquire the infection when breathing contaminated air droplets from water found in hot tubs, hot water tanks, building air conditioner and plumbing systems that are not properly cleaned and disinfected. Symptoms mimic pneumonia (cough, chills, high fever, muscle aches and headache) and usually appear 2 to 14 days after being exposed. If caught and treated early with antibiotics, patients can make a full recovery, however it is responsible for fatalities in up to 5% - 30% of cases. The bacteria does not spread from person to person.

Due to the different immunity status of passengers and being in a confined area, persons who are not vaccinated are also at higher risk of contracting vaccine preventable diseases.

What should I do before my trip?
1.Consult with your doctor to make sure your routine immunizations are up-to-date. We also recommend getting the hepatitis A and B vaccine.
2.If you have any chronic illnesses such as diabetes, heart disease, or a compromised immune system, ask your health practitioner if taking a cruise holiday is right for you. You may want to consider specialty cruises for passengers with chronic illnesses and disabilities.
3.If you are sick before your trip, advise the cruise company to see if there are alternatives or if you can postpone the trip. You don't want to be responsible for making other passengers sick.
4.Research your cruise line's reputation. Tour companies are required to report any illnesses and evaluations are publicly available through government websites. If the ship reported illnesses in the past, find out how they dealt with it and what measures they have taken since to prevent the spread of infectious diseases.
5.Check if your cruise trip is covered by your travel health insurance.

How do I protect myself and others?
1.Wash your hands often and thoroughly. We cannot emphasize this enough! Good hand hygiene is proven to reduce illness and the spread of infectious diseases. Wash your hands with soap and water for at least two minutes before eating, after using the toilet, touching publicly used surfaces such as door handles, hand rails, elevator buttons, and currency, or if they're dirty. Also remembers to keep your hands away from your mouth and face. If you don't have access to soap and water, an alcohol-based hand sanitizer is an alternative.
2.Stay healthy and hydrated. Drink lots of water, eat healthy foods, and get regular sleep. Check out your cruise ship's exercise room and wellness schedule. Book an aerobics, pilates or yoga class. Maintaining a healthy immune system and good mental health will decrease the risk of getting ill during travel.
3.Boil it, cook it, peel it, or forget it should be your mantra when travelling. Many cruise lines have a good reputation when it comes to food preparation and handling. However, when you get off the ship make sure to eat well cooked foods or fruits that you can peel. Avoid shellfish, meat, and dairy products that have been out for a long time.
4.Practice safe sex.

What to do if I or others around me get sick?
1.If you get sick, immediately report your illness to the cruise's medical staff. They will tell you what precautions you should take to improve your health and prevent further infection.
2.If someone gets sick in your vicinity (such as vomiting or diarrhea), leave the area and notify medical staff.
3.Avoid shaking hands or being in close contact with other passengers. Make sure to wash your hands frequently.
4.Stay well hydrated.

For more information on ship health go to:
Health Canada Cruise Ship Inspection Program
CDC Vessel Sanitation Program

When rabies comes up in conversations, it's often in veterinary clinics where our pets are vaccinated against infection. Rabies however, is also a major concern for travellers.

More than 150 countries report rabies in their animal population putting humans at risk. The majority of human rabies cases are reported from Asia and Africa and 99% of cases are from dog bites. The World Health Organization estimates that 55,000 people die annually, although the illness is often misdiagnosed or under-reported. On a positive note though, the WHO states that 15 million people worldwide receive the post-exposure vaccinations, preventing an estimated 327 000 deaths annually.

It's not only travellers going on eco-tourism or adventure expeditions that are at risk. In many cities, stray dogs, cats, monkeys, and bats come into contact with humans. They may seem cute and harmless, but it is imperative not to touch or feed mammals (or any other animals for that matter) during your trip.

The rabies virus belongs the Rhabdoviridae family and is transmitted to humans through bites or scratches by infected mammal saliva. If you do get exposed to the virus, symptoms will start appearing anywhere from less than 1 week to 3 months, and rarely, up to several years after being bitten. Symptoms include a tingling or burning sensation around the wound accompanied by fever. The illness progresses to the central nervous system culminating in the inflammation of the brain and spinal cord. If you are not vaccinated or treated immediately, rabies is fatal.

Here's how to prevent animal bites:

• Avoid approaching, feeding, or touching stray mammals.
• Try not to disturb, accidentally surprise or frighten an animal. Often, their instinct is to protect themselves by biting.
• If a dog is charging at you, picking up a rock (or pretending to) will often deter an attack.
• If visiting areas where monkeys run loose such as temples, ruins, or in the jungle, do not eat or carry food near them since they will jump on you.
• If you travel with children, consistently ask them if they have any scratches or bites. Sometimes they forget or are too shy to report them.

If you are bitten:

• Wash the bite with copious amounts of soap and water. If available, apply povidone iodine (brand name Betadine). In fact, this product should be included in your travel medicine first aid kit.
• Seek medical attention immediately.

Depending on the type of travel (aid work, missionary, nature field work, archeology, eco-tourism, cave exploring), length (long-term, repeat travel), destination (where rabies is endemic or where there is limited access to emergency medical care) you may want to get the rabies pre-exposure vaccination series - you get vaccinated three times prior to your trip and twice after, if you are bitten by a rabid animal.

If you do not get the rabies pre-exposure shots, you will need five injections of the rabies vaccine. In addition, rabies immune globulin (RIG) will need to be injected into your bite wound. Note however, that RIG is in short supply worldwide and is likely not available in remote regions. It is therefore highly recommended that you get the rabies pre-exposure vaccinations before leaving for a trip if you are going to high risk areas.

For a complete list of countries with rabies risk and protection recommendations, see IAMAT's World Immunization Chart or our online listing.

The recent dengue outbreaks, notably in the Philippines, USA (Key West), India (Delhi), and China (Guangdong province) got us thinking about why infection rates are on the increase and how the disease is spreading to areas previously believed safe from the virus.

The dengue virus is primarily spread by infected female Aëdes aegypti (urban domestic) mosquitoes that bite during the day (dawn to dusk) both indoors and outdoors. The disease has become a major economic burden and serious public health concern in tropical and sub-tropical areas. According to the World Health Organization, there are approximately 50 million infections worldwide each year and 2.5 billion people are at risk of contracting dengue. However, under-reporting (because the patient did not receive medical treatment) and misdiagnosis (the illness mimics the flu) make it difficult to monitor the spread of the disease.

Dengue can be asymptomatic, meaning that some people do not exhibit any symptoms and may unknowingly be carriers of the disease. If a person does get sick, the illness is characterized by flu-like symptoms generally occurring 4 to 7 days after the bite. High fever (usually lasting 2 to 7 days), pain behind the eyes, muscle and joint pain, severe headache, and a rash (bright red spots) are typical signs of the illness. While there are no permanent physiological effects from these symptoms, a person can be ill for up to six weeks. The infection may progress to a more severe illness called Dengue Hemorrhagic Fever (DHF). Symptoms include severe abdominal pain, vomiting, diarrhea, convulsions, bruising, and uncontrolled bleeding. It can lead to circulatory system failure and shock, and possibly death.

Transmission occurs when mosquitoes bite an infected person. The virus incubates in the mosquito for 8 to 10 days and can transmit the disease for the rest of her life. There are four distinct, but closely related dengue viruses (DENV) belonging to the Flavivirdae family that are responsible for the illness. Contracting one type of virus provides immunity for life for that specific dengue virus, but does not provide immunity to the other three types. If a person becomes ill with dengue more than once, they are at higher risk of developing Dengue Hemorrhagic Fever.

Dengue is now endemic – transmission occurs continuously – in 100 countries in the Caribbean, Central and South America, Southeast Asia, Oceania, Eastern Mediterranean, and Africa. In 2009, Argentina saw a major outbreak and so far this year, Brazil, Venezuela, Thailand, Malaysia, and the Philippines have reported the most cases. Since the risk of infection is based on cyclical weather patterns – higher transmission rates during rainy seasons – sudden infection of thousands of people overburdens the healthcare system and causes major work and school absenteeism.

Over the past couple of years, we've seen a drastic rise in dengue cases. Why the sudden increase?

Urbanization: As more people move to cities, high population density means that human-mosquito contact increases contributing to risk of infection. Also, deteriorating urban infrastructure (old plumbing and sewer systems), poor sanitary conditions (inadequate waste disposal, unattended water in artificial containers, old tires), and lack of adequate housing (broken or no door / window screens, little or no air circulation, no plumbing) are all responsible for the proliferation of mosquito breeding sites.

Lack of funding, interrupted fumigation campaigns, and poor management of mosquito eradication programs contribute to the mosquito resistance. Moreover, public health education programs do not always reach the people most at risk of contracting dengue and directives are not always carried out effectively and consistently.

International Travel: Globalization – mainly worldwide trade and international travel – is also a contributing factor to the rapid spread of dengue. People and goods (and mosquitoes) are now being transported within hours rather than days and weeks. We are now finding disease vectors in regions that did not previously have them. In fact, the jungle-dwelling A. albopictus mosquito which is also a dengue carrier, was originally found in Asia, but is now well established in the United States, Central and South America and Caribbean, Europe and Africa.

Global Warming: As global weather patterns are changing and some local temperatures get warmer, the Aëdes aegypti and A. albopictus mosquitoes adapt to higher altitudes and move to more northern latitudes where infection was previously unknown or rare (the Key West, Florida outbreak being an example).

If you are travelling to an area affected by dengue, take measures to prevent mosquito bites during the daytime. Insect-bite prevention includes wearing light coloured clothing, using a DEET-containing repellent on exposed skin, and applying a permethrin spray or solution to clothing and gear. Remove any artificial containers that can hold stagnant water from your living space. Proper solid waste disposal is also key to preventing mosquitoes from laying eggs. You may also want to apply insecticides inside the room or place where you are staying. There is currently no vaccine or medication to prevent dengue.

See the list of countries where dengue is present: IAMAT Dengue information.

The recent polio (poliomyelitis) outbreaks in Central Asia (Tajikistan, Uzbekistan, Russia) are reminders of how travel and migration can contribute to the re-emergence of a disease in a region previously declared free of infection.

In Tajikistan, for example, the country was declared polio free in 2002, but this year alone 239 children became paralyzed and 15 patients have died of the disease imported from India. The disturbing news is that since 2003 there have been 25 countries - originally declared polio free - that have been re-infected. (Kenya, Uganda, Burkina Faso, Benin, Togo, Cameroon, Burundi, Central African Republic, Cote d'Ivoire, and Guinea are some of the countries that have since taken steps to control the reappearance of polio).

Travellers who are un-vaccinated or under-vaccinated (did not complete the vaccination series) are at risk of infection where polio is still a threat.

Polio is well on its way to being eradicated around the world - since 1988 there has been a 99% decrease in the number of reported polio cases worldwide. Still, parts of Nigeria, India, Pakistan, and Afghanistan remain polio endemic. This year, there is encouraging news from Nigeria where only 3 cases have been reported so far in 2010 compared to 312 cases in 2009 during the same time period.

Polio's continuing presence and re-emergence is largely due to a lack of funding and access to vaccines (the World Health Organization expects a $1.3 billion shortfall over the next 3 years in funding for polio research and vaccination programs). Systemic poverty - crowded living conditions, poor sanitation, high birth rates, malnutrition, little or no access to healthcare - and armed conflicts make it even harder to eradicate the disease, not to mention travel. Unvaccinated Hajj pilgrims, for example, were one of the sources for spreading polio around world; either having contracted the infection in Saudi Arabia and importing it back home or vice versa. However, by implementing strict travel health entry requirements (travellers who are not vaccinated or cannot provide proof of vaccination, get inoculated at the border), Saudi Arabia has been a key player in helping to eradicate the disease.

Polio is a highly contagious childhood disease, mainly affecting children under 5 years of age, although it has repercussions throughout a person's adult life. The poliovirus spreads from person to person through the fecal-oral route (ingestion of contaminated water and food) or through the respiratory system (infected air droplets and saliva). The incubation period (before symptoms show up) can be anywhere from 3 to 35 days, but a person is usually infectious between 7 days before and 10 days after the appearance of symptoms.

The difficulty with diagnosing polio is that some people do not exhibit symptoms or mild cases where patients suffer from headaches, fever, vomiting, neck and back pain, and extremities, including lethargy, are misdiagnosed for another illness. In severe cases (1 in 200 people), the virus attacks the central nervous system and patients see their muscles weakening, have difficulty controlling their movements, and become paralyzed.

The best prevention is to get vaccinated (routinely given as a series of childhood vaccinations, so you may already be protected). However, if you are travelling to endemic areas or where polio is still a risk, you may need additional protection (one booster as an adult). Other prevention methods include washing your hands, eating well cooked foods and drinking bottled water or purifying your water (tablets, purifier). Avoid crowded areas and places with poor sanitation.

See IAMAT's World Immunization Chart or our online Disease List where a polio booster is recommended.

For more information see the Global Polio Eradication Initiative website. GPEI is an initiative by national governments, the World Health Organization, Rotary International, UNICEF, and the Centers for Disease Control and Prevention that funds and coordinates polio eradication programs worldwide.

Measles continues to be a threat all over the world, even making resurgences close to home. During the last decade we have seen measles outbreaks in places where this disease is considered a rare occurrence. The most recent cases were reported in Vancouver, British Columbia, and San Francisco and Amador Counties in California.

Two factors explain the resurgence of measles in our communities: International travel and lack of immunization. The cases in Vancouver show that people who contracted the infection were not vaccinated or did not follow-up with the second dose required for effective protection. Add travel to the mix and you have the recipe for spreading this highly contagious disease.

Here at home, even if you are not vaccinated you may not be exposed to vaccine preventable infectious diseases because people around you are vaccinated (herd immunity). If you are not vaccinated or only partially vaccinated and are travelling to endemic areas where immunization rates in the local population are low, you are at high risk of getting infected. Since the incubation period (time before symptoms appear) for measles is approximately 8-12 days you may unwittingly bring it back home and spread it to unvaccinated or under vaccinated people in your community.

Measles is a respiratory infection caused by the paramyxovirus and spread through infected air droplets and saliva. Symptoms include fever, cough, runny nose, red eyes, followed by a rash spreading all over the body. Complications may lead to death. Children, teenagers and young adults are at higher risk of contracting the disease.

Before you travel, find out about the health risks at your destination. The latest outbreaks in February and March 2010 were reported from South Africa (Western Cape province), Zimbabwe (Bulawayo), the Philippines (throughout the country), Nigeria (Bayelsa State), Malawi (Blantyre and Lilongwe), New Zealand (Hokianga region), and Afghanistan (North Waziristan).

IAMAT recommends that you consult your doctor to determine your immunization status and update your routine immunizations if needed before travel.

For more information: World Health Organization: Measles

We've been getting many online inquiries from people who are getting ready for aid missions in Haiti. Emergency relief efforts are underway to help Haitians recover from the devastating earthquake of January 12.

Prior to the earthquake, Haitians were already struggling with access to health care, clean water, and proper sanitation. Only 11 percent of the population had access to water in their homes and the median life expectancy is 60 years. While the death toll continues to mount and survivors have to rebuild their lives, there is hope that reconstruction efforts can be done in such a way that Haitians affected by the earthquake will have universal access to proper shelter, food, and clean water.

So what do you need to look for if you are going to Haiti?
Malaria: Falciparum malaria (the deadly type) is endemic in Haiti. Malaria is present throughout the country, including urban areas. IAMAT recommends a Chloroquine (ARALEN) regimen in weekly doses of 500mg (300mg base). Start one week before entering the malarious area, continue weekly during your stay, and continue for four weeks after leaving the country. See the IAMAT World Malaria Risk Chart and How to Protect Yourself Against Malaria Chart for prevention and treatment information.

Typhoid, Hepatitis A, Diarrhea: These gastro-intestinal infections thrive in areas with poor sanitary and hygienic conditions. Prevention includes drinking purified water, eating well cooked foods, and peeling your own fruits. Vaccination against typhoid and hepatitis A is also highly recommended. Based on your current health status, consult your healthcare practitioner to see if you need a prescription for medication to prevent diarrhea. Click here for a full list of Food and Water safety risks in Haiti.

Hepatitis B: This viral infection is transmitted through infected blood products, sexual intercourse, or infected items such as needles or razor blades, and may cause severe liver damage. IAMAT recommends this vaccine for your protection. It is usually combined with the hepatitis A vaccine.

Tuberculosis: This air-borne infection caused by mycrobacteria is endemic in Haiti. IAMAT recommends getting a pre-departure TB skin test and to get re-tested upon your return home.

Dengue Fever: This parasitic infection is transmitted by the daytime biting Aëdes aegypti mosquito. IAMAT recommends taking anti-mosquito bite measures, including applying repellent containing DEET on exposed skin and applying permethrin spray or solution to clothing. Risk is present year-round in Haiti, although outbreaks usually occur from April to September.

Post-Traumatic Stress Disorder: Witnessing the devastation may have an impact on your mental health. Burn-out, stress, and trauma is common among aid workers. Click here for information and useful links on this issue.

Rabies: This viral infection is transmitted through the saliva of infected animal bites which affects the brain and the spinal cord, and may be fatal. IAMAT recommends getting the pre-exposure rabies vaccination (three shots).

See IAMAT's complete list of disease risks in Haiti. Unfortunately, we do not have medical contacts in this country at the moment. Your consulate or embassy should be able to help you find appropriate medical care.

If you are looking to donate to, or volunteer for, medical charities operating in Haiti, here is a list to get you started:

Doctors Without Borders | MSF USA

International Committee of the Red Cross

Médecins sans frontières | Canada

Médecins du Monde | Canada

Project Medishare

Partners in Health

For a list of reputable charities:

Information on donating to US groups

Information on donating to Canadian groups