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Vaccines for an african trip

TRNR at ccdxxxx.em.cdc.gov TRNR at ccdxxxx.em.cdc.gov
Mon Jul 10 13:14:07 EST 1995

In article <616095230.3729442 at horus.fdn.fr> malek at horus.fdn.fr (Karim Abdelmalek) writes:

>Two young people I know, 14 and 11-y-old (70kgs and 45 kgs), are planning for
>a 3-week trip to Benin, Africa.
>Can you please help me to know which kind of vaccination they should have?
>My e-mail is:malek at horus.fdn.fr,Internet.
>Thank you.


I found this info from the U. S. State Department and the CDC in Atlanta, GA.

Benin - Consular Information Sheet
 April 28, 1995

Country Description:  Benin is a developing west African country.  
Its capital city is Porto Novo; however, the city of Cotonou is the 
main port and largest city.  It is the site of the international 
airport and most government, commercial, and tourist activity.  
Tourist facilities in Cotonou are available, but are not fully 
developed elsewhere.

Entry Requirements:  A passport and a visa are required for entry 
into Benin.  Visa applications and further information on entry 
requirements may be obtained from the Embassy of the Republic of 
Benin, 2737 Cathedral Avenue, N.W., Washington, D.C. 20008, 
telephone (202) 232-6656.

Areas of Instability:  Travel at night, outside of population 
centers, poses a risk principally because of poor road conditions.  
Travelers may wish to contact the U.S. Embassy for the latest 
security information.

Medical Facilities:  Medical facilities in Benin are limited.  Not 
all medicines are available, and doctors and hospitals often expect 
immediate cash payment for health services.  U.S. medical insurance 
is not always valid or accepted outside the United States.  The 
Medicare/Medicaid program does not provide for payment of medical 
services outside the United States.  Travelers have found 
supplemental medical insurance with specific overseas and medical 
evacuation coverage to be useful.  For additional health 
information, travelers can contact the Centers for Disease Control's 
international travelers hotline (404) 332-4559.

Information on Crime:  Street crime, especially within Cotonou, 
continues to rise.  Most robberies and muggings occur along the 
Marina Boulevard and the beach near the hotels frequented by 
international visitors.  Some of the incidents reported involve the 
use of force, often by armed persons, with occasional minor injury 
to the victim.  Visitors should exercise caution and avoid isolated 
areas.  The loss or theft of a U.S. passport should be reported 
immediately to the local police and to the nearest U.S. embassy or 
consulate.  The pamphlets "A Safe Trip Abroad" and "Tips for 
Travelers to Sub-Saharan Africa" provide useful information on 
protecting personal security while traveling abroad and on travel in 
the region in general.  Both are available from the Superintendent 
of Documents, U.S. Government Printing Office, Washington, D.C. 

Drug Penalties:  U.S. citizens are subject to the laws of the 
country in which they are traveling.  Penalties for possession, use 
or trafficking in illegal drugs are strict and convicted offenders 
can expect jail sentences and fines.

Embassy Location/Registration:  U.S. citizens who register with the 
U.S. Embassy in Cotonou at Rue Caporal Anani Bernard, may obtain 
updated information on travel and security in Benin.  The Embassy's 
mailing address is B.P. 2012, Cotonou, Benin.  The telephone numbers 
are (229) 30-06-50, 30-05-13, and 30-17-92.  The fax numbers are 
(229) 30-14-39 and 30-19-74.

 No. 95-059

This replaces the Consular Information Sheet dated April 22, 1994, 
to update information on Country Description, Areas of Instability, 
Crime and Medical Information.

CDC information follows:
March 20, 1995                                              Document # 220110

Date Last Rev'd: March 9, 1995



Countries in this region: Benin, Burkina Faso, Cape Verde Islands, Cote
d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania,
Niger, Nigeria, Sao Tome & Principe, Senegal, Sierra Leone, Togo.
Other topical documents for travelers, including pregnant travelers and
travelers with children, may be found in the travel directory.
Travelers to West Africa may be exposed to potential diseases from a
number of sources. The most frequently reported illness is traveler's diarrhea,
but there are other diseases which are unique to Africa or the tropics. These
diseases are transmitted by insects, contaminated food and water, or close
contact with infected people. Specific diseases are discussed under each of
these topical headings. In order to reduce the risk of infection travelers
must (1) protect themselves from insects, (2) ensure the quality of their
food and drinking water, and (3) be knowledgeable about potential diseases
in the region to be visited. Finally, diseases are not restricted to cleanly
defined geographical areas, i.e. mosquitoes can fly over city or country
borders, therefore, all travelers should protect themselves by taking the
basic preventive precautions.

Many diseases are transmitted through the bite of infected insects such as
mosquitoes, flies, fleas, ticks, and lice. In general, travelers must protect
themselves from insect bites by wearing proper clothing, using bednets,
applying an insect repellent to exposed skin and clothing, and if possible,
avoiding high risk situations, i.e. outdoor activities during night time
hours from dusk to dawn when mosquitoes bite, unscreened living
accommodations, etc. If a mosquito net is unlikely to be available,
consideration should be given to purchasing a portable mosquito net.

MALARIA: Malaria is a serious parasitic infection transmitted to humans by
a mosquito. These mosquitoes bite at night from dusk to dawn. Symptoms
range from: fever and flu-like symptoms, to chills, general achiness, and
tiredness. If left untreated, malaria can cause anemia, kidney failure, coma,
and death. Drugs are available to help prevent a malaria infection. However,
in spite of all protective measures, travelers occasionally develop malaria.
Therefore, while traveling and up to one year after returning home, travelers
should seek medical evaluation for any flu-like illness .

Risk:  In Benin, Burkina Faso, Cote d'Ivoire, Gambia, Ghana, Guinea,
Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Sao Tome &
Principe, Senegal, Sierra Leone, and Togo, a high risk for malaria exists
throughout the year in all parts of these countries including the urban areas.
The dominant form is P. falciparum (the most dangerous type), which has
been reported to be resistant to the drug chloroquine. Cape Verde Islands:
No risk of malaria, except on Sáo Tiago.

Prevention:  Travelers at risk for malaria should take MEFLOQUINE to
prevent malaria. This drug is marketed in the United States under the name
LariamÔ.  The adult dosage is 250 mg (one tablet) once a week.
MEFLOQUINE should be taken one week before leaving, weekly while in
the malarious area, and weekly for 4 weeks after leaving the malarious area.
Minor side effects one may experience while taking MEFLOQUINE include
gastrointestinal disturbances and dizziness. More serious side effects at the
recommended dosage have rarely occurred. Consult a physician for other
Mefloquine is not recommended for use by:
     - women in the first trimester of pregnancy,
     - children under 30 pounds,
     - travelers with a history of epilepsy or psychiatric disorder,
     - travelers with a known hypersensitivity to mefloquine,
     - travelers with cardiac arrhythmia or cardiac conduction problems.
Travelers who cannot take mefloquine should request and read the document
titled "Prescription Drugs for Malaria".
  Additional malaria information is found in other CDC Fax documents:
  "Malaria General Information", and "Malaria Info: Pregnancy and
In addition to using drugs to prevent malaria, travelers should use measures
to reduce exposure to malaria-carrying mosquitoes, and protect themselves
from mosquito bites. These mosquitoes bite mainly during the evening and
night, from dusk to dawn. See the section "Preventing Insect Bites" below.
YELLOW FEVER: Yellow fever is a viral disease transmitted to humans by
a mosquito bite. The mosquitoes are most active during the evening hours.
Symptoms range from fever, chills, headache, and vomiting to jaundice,
internal bleeding, and kidney failure. Death occurs in about 5% of those
infected. There is no specific drug to treat an infection of yellow fever,
therefore prevention of infection is important.
Risk:  Outbreaks of yellow fever have occurred in Burkina Faso, Cote
d'Ivoire, Gambia, Ghana, Mali, Mauritania, Nigeria, Senegal, Sierra Leone,
and Togo. Yellow fever is not always active in all countries of this region,
but there is a significant risk to all travelers throughout the year,
especially in travel or visits to rural settings. For the current list of
yellow fever infected countries, request "Summary of Health Information for
International Travel. (The Blue Sheet)".
(See "REQUIREMENTS" below.) In general, if you are traveling to a West
African country, the easiest and safest thing to do is to get a yellow fever
vaccination and a signed certificate. Yellow fever vaccination, a one dose
shot, may be administered to adults and children over 9 months of age. This
vaccine is only administered at designated yellow fever centers, usually your
local health department. If at continued risk, a booster is needed every 10
years. Infants under 4 months must not be immunized.  Also, persons
severely allergic to eggs should not be given the vaccine.  Generally, persons
able to eat eggs or egg products can safely receive the vaccine. The vaccine
is not recommended for persons who are pregnant or whose immune systems
are not functioning normally.
In addition to the vaccine, travelers should use measures to reduce exposure
to mosquitoes and protect themselves from mosquito bites. These
mosquitoes bite mainly during the evening and morning hours. See the
section "Preventing Insect Bites" below.

REQUIREMENTS: PLEASE NOTE: If you are traveling to any country in
(Yellow fever vaccine is the ONLY vaccine that may be officially required
for entry into certain countries.)

  Benin            Gabon              Mauritania         Sao Tome and
  Burkina Faso     Ghana              Niger              Principe
  Cameroon         Liberia            Senegal            Togo
  Cote d'Ivoire,   Mali
  (Ivory Coast)

In addition if you are traveling from a country listed in the left two
columns of the following table to a West African country in the right hand
column, you are required to have a yellow fever vaccination.
  TRAVELING FROM "ENDEMIC"                        TRAVELING TO
Africa:                 South America:                Cape Verde Islands
 Angola                   Bolivia                     Equatorial Guinea
 Benin                    Brazil                      Gambia
 Burundi                  Colombia                    Guinea
 Burkina Faso             Ecuador                     Guinea-Bissau
 Cameroon                 French Guiana               Nigeria
 Central African          Guyana                      Sierra Leone
Republic                  Panama
 Chad                     Peru
 Congo                    Suriname
 Cote d'Ivoire, (Ivory    Venezuela
 Equatorial Guinea
 Guinea Bissau
 Sao Tome and Principe
 Sierra Leone

Yellow Fever Certificate:
After immunization an International Certificate of Vaccination is issued and
is valid 10 days after vaccination to meet entry and exit requirements for
all countries. The Certificate is good for 10 years. You must take the
Certificate with you. Travelers who have a medical reason not to receive the
yellow fever vaccine should obtain a medical waiver. Most countries will
accept a medical waiver for persons with a medical reason not to receive the
vaccine (e.g. infants less than 4 months old, pregnant women, persons
hypersensitive to eggs, or those with an immunosuppressed condition.)
When required, CDC recommends obtaining written waivers from consular
or embassy officials before departure. A physician's letter clearly stating the
medical reason not to receive the vaccine might be acceptable to some
It should be written on letterhead stationery and bear the stamp used by a
health department or official immunization center to validate the
International Certificate of Vaccination. Check embassies or consulates for
specific waiver requirements.

  For comprehensive country-by-country yellow fever vaccine requirements,
  request   "Comprehensive Yellow Fever Vaccination Requirements".
DENGUE FEVER  : Dengue Fever is primarily an urban viral infection
transmitted by mosquito bites. The mosquitoes are most active during the
day, especially around dawn and dusk,  and are frequently found in or
around human habitations. The illness is flu-like and characterized by sudden
onset, high fever, severe headaches, joint and muscle pain, and rash. The
rash appears 3-4 days after the onset of fever. Since there is no vaccine or
specific treatment available, prevention is important.

Risk:  Dengue fever occurs sporadically in epidemics most recently in
Burkina Faso, Cote d'Ivoire, Guinea, Nigeria, and Senegal. The risk of
infection is small for most travelers except during periods of epidemic

Prevention:  There is no vaccine for dengue fever therefore the traveler
should avoid mosquito bites. These mosquitoes bite mainly in the daytime.
See the section "Preventing Insect Bites" listed below.

OTHER INSECT DISEASES: Risks: Other diseases spread by mosquitoes,
sand flies, black flies, or other insects are prevalent, especially in rural
areas. These diseases include: Filariasis and Chikungunya (mosquito),
leishmaniasis (sandfly), Onchocerciasis (blackflies), Trypanosomiasis
(flies), Congo-Crimean Hemorrhagic Fever (ticks), typhus (lice), and Plague
(fleas). Details of these and other insect diseases can be found in the
document titled "Other Insect Diseases". Also, read the next section
"Preventing Insect Bites".

PREVENTING INSECT BITES: To reduce mosquito bites travelers should
remain in well-screened areas, use mosquito nets, and wear clothes that
cover most of the body. Travelers should also take insect repellent with them
to use on any exposed areas of the skin. The most effective repellent is
DEET (N,N-diethyl meta-toluamide) an ingredient in most insect repellents. 
However, DEET containing insect repellents should always be used
according to label directions and sparingly on children. Avoid applying
high-concentration (greater than 35%) products to the skin, particularly on
children, and refrain from applying repellent to portions of the hands that are
likely to come in contact with the eyes and mouth. Rarely toxic reactions or
other problems have developed after contact with DEET. Travelers should
also purchase a flying insect-killing spray to use in living and sleeping areas
during the evening and night. For greater protection clothing and bednets
can be soaked in or sprayed with PERMETHRIN, which is an insect
repellent licensed for use on clothing. If applied according to the directions,
permethrin will repel insects from clothing for several weeks. Portable
mosquito bednets, DEET containing repellents, and permethrin can be
purchased in hardware, back-packing, and military surplus stores.

Food and waterborne diseases are the number one cause of illness to
travelers and are very common in West Africa. Traveler's diarrhea is the
most frequent health problem for travelers. It can be caused by viruses,
bacteria, or parasites which are found universally throughout the region.
Transmission is most often through contaminated food or water. Infections
cause diarrhea and vomiting (typhoid fever, cholera, and parasites), liver
damage (hepatitis), or muscle paralysis (polio). For additional detailed
precautions, be sure to read the document "Traveler's Diarrhea & Food and
Water Precautions".

TYPHOID FEVER: Typhoid Fever is a bacterial infection transmitted
through contaminated food and/or water, or directly between people.
Symptoms of typhoid include fever, headaches, tiredness, loss of appetite,
and constipation more often than diarrhea. Typhoid fever can be treated
effectively with antibiotics.

Risk:  Travelers to West Africa are at risk for typhoid fever, especially
when traveling to smaller cities, villages, or rural areas.

Prevention:  By drinking only bottled or boiled water and eating only
thoroughly cooked food, a traveler lowers the risk of infection. Currently
available vaccines have been shown to protect 70- 90% of the recipients.
Therefore, even vaccinated travelers should be cautious in selecting their
food and water. Two available vaccines provide equivalent protection
against typhoid fever. The oral vaccine consists of 4 capsules taken every
other day over a seven day period. The other vaccine has a primary series of
two injections, spaced at least 4 weeks apart.

Recommendations:  CDC recommends a typhoid vaccination for those
travelers who are going off the usual tourist itineraries, traveling to smaller
cities and rural areas, or staying long term, that is, a traveler for six weeks or
more. Typhoid vaccination is not required for international travel.

CHOLERA: Cholera is an acute intestinal infection caused by a bacterium.
Infection is acquired by ingesting contaminated water or food. Symptoms
include an abrupt onset of voluminous watery diarrhea, dehydration,
vomiting, and muscle cramps.

Risk:  Cholera cases have been reported from most of the countries of West
Africa. The risk of infection to the U. S. traveler is low, especially those
that are following the usual tourist itineraries and staying in standard
accommodations. Travelers should consider the vaccine if they have stomach
ulcers, use anti-acid therapy, or if they will be living in less than
sanitary conditions in areas of high cholera activity.  For the current list
of cholera infected countries, request "Summary of Health Information for
International Travel. (The Blue Sheet)".

Prevention:  Travelers to cholera infected areas should follow the standard
food and water precautions of eating only thoroughly cooked food, peeling
their own fruit, and drinking either boiled water, bottled carbonated water,
or bottled carbonated soft drinks. Persons with severe cases respond well to
simple fluid and electrolyte-replacement therapy, but medical attention must
be sought quickly when cholera is suspected. The available vaccine is only
50% effective in reducing the illness, and is not recommended routinely for
travelers. The primary series is normally two injections with booster doses
given every 6 months for persons who remain at high risk. Cholera vaccine is
not recommended for infants under 6 months old, or for pregnant women.
  For additional information about cholera, read "Cholera Information".

HEPATITIS A: Hepatitis A is a viral infection of the liver transmitted by the
fecal oral route; through direct person to person contact; from contaminated
water, ice or shellfish; or from fruits or uncooked vegetables contaminated
through handling. Symptoms include fatigue, fever, loss of appetite, nausea,
dark urine, jaundice, vomiting, aches and pains, and light stools. No
specific therapy is available.

Risk: Travelers are at risk for Hepatitis A, especially if travel plans
include visiting rural areas and extensive travel in the countryside,
frequent close contact with local persons, or eating in settings of poor

Prevention:  The virus is inactivated by boiling or cooking to 85 degrees
centigrade for one minute, therefore eating thoroughly cooked foods and
drinking only treated water serve as general precautions. No vaccine is
licensed for use in the U.S. Immune globulin (IG) is recommended for
international travel. For those traveling for less than 3 months, a single
dose (0.02 ml/kg) of IG is recommended. For extended travel or residence in
developing countries, a repeat dose (0.06 ml/kg) should be given every 5
months. Screening for Hepatitis A antibodies via laboratory tests to
determine the traveler's immunity may save the long term traveler the need of
taking IG regularly. IG prepared by the Cohn-Oncley procedure (the
standard procedure in the U.S.) is safe from transmission of infectious
agents, such as hepatitis B virus, or HIV. Travelers should note that
preparations manufactured in foreign countries may or may not meet these
requirements  Recommendations:  CDC recommends an injection of immune
serum globulin (IG), formerly called gamma globulin, for protection against
Hepatitis A. 

PARASITES: Parasitic infections are acquired by eating or drinking
contaminated food or water, through direct contact with soil or water
containing parasites or their larva, or by contact with biting insects.
Symptoms and evidence of infection may include, but are not limited to
fever, swollen lymph nodes, rashes or itchy skin, digestive problems such as
abdominal pain or diarrhea, eye problems, and anemia.

Risk:  Travelers to West Africa are at risk of parasitic infections. There
are many types of parasites and infection may occur in several ways: by
eating undercooked meats infected with parasites or their larva; by eating
food or drinking water contaminated with parasites or their eggs; by contact
with soil or water infected with parasites; or through insect bites. Several
types of parasites can penetrate intact skin and travelers are advised to
wear shoes and avoid swimming, wading, or washing in fresh water (see

Prevention:  Travelers should eat only thoroughly cooked food, drink safe
water, wear shoes, refrain from swimming in fresh water, and avoid contact
with insects, particularly mosquitoes, biting flies, gnats, and midges.

PEOPLE HIV / AIDS: Human immunodeficiency virus (HIV) which causes
acquired immunodeficiency syndrome or AIDS is found primarily in blood,
semen, and vaginal secretions of an infected person. HIV is spread by sexual
contact with an infected person, by needle-sharing among injecting drug
users, and through transfusions of infected blood and blood clotting factors.
Babies born to HIV-infected women may become infected before, during, or
shortly after birth. In the United States blood is screened for HIV antibodies,
but this screening may not take place in all countries. Scientific studies have
revealed no evidence that HIV is transmitted by air, food, water, insects,
inanimate objects, or casual contact. Even though HIV antibodies are
normally detected on a test within 6 months after infection, the period
between infection and development of disease symptoms (incubation period)
may be 10 years or longer. Treatment has prolonged the survival of some
HIV infected persons, but there is no known cure or vaccine available. For
additional information request documents: HIV Transmission and Prevention
of HIV Infection.

Risk:  AIDS is found throughout the region. In West Africa, heterosexual
transmission accounts for the majority of the cases. The risk to a traveler
depends on whether the traveler will be involved in sexual or needle-sharing
contact with a person who is infected with HIV. Receipt of unscreened
blood for transfusion poses a risk for HIV infection.

Prevention:  No effective vaccine has been developed for HIV. Travelers
should avoid sexual or needle-sharing contact with a person who is infected
with HIV. If a blood transfusion is necessary, screened blood should be from
an HIV-negative blood donor.

Recommendations:  Travelers should avoid activities known to carry risks
for infection with HIV.

HEPATITIS B: Hepatitis B is a viral infection of the liver. Primarily,
Hepatitis B is transmitted through activities which result in the exchange of
blood or blood derived fluids and/or through sexual activity, either
heterosexual or homosexual, with an infected person. Any unscreened blood
or blood product, as well as unsterilized needles, or contact with potentially
infected people who have open skin lesions due to impetigo, scabies, and
scratched insect bites, heightens the potential for infection to the
traveler. An effective vaccine for prevention of hepatitis B is available.

Risk:  The risk of Hepatitis B virus infection is high for Africa.  The risk
to the individual international traveler is determined by the extent of: (1)
direct contact with blood or other body fluids, etc.; (2) intimate sexual
contact with an infected person; (3) the duration of travel.

Prevention:  The primary prevention consists of either vaccination and/or
reducing intimate contact with those suspected of being infected. For those
travelers expecting to reside in countries of high risk, as well as all
health workers, vaccination is strongly recommended. Vaccination should
ideally begin 6 months before travel, in order to complete the full series.
The three intramuscular doses of vaccine should be spaced with the second
dose given one month after the first. The final dose is given 6 months after
the first. The vaccination schedule should be initiated even if it will not
be completed before travel begins.

Recommendations:  CDC recommends vaccination for any of the following
people:  any health care worker (medical, dental, or laboratory) whose
activities might result in blood exposure; any traveler who may have intimate
sexual contact with the local population; any long-term (6 months or more)
traveler, e.g. teachers, who will reside in rural areas or have daily physical
contact with the local population; or any traveler who is likely to seek either
medical, dental, or other treatment in local facilities during their stay.
Hepatitis B vaccination is not required for travel to any country.

MENINGOCOCCAL DISEASE: Meningococcal disease (bacterial
meningitis) is a bacterial infection in the lining of the brain or spinal cord.
Early symptoms are headache, stiff neck, a rash, and fever. The bacteria is
transmitted through respiratory droplets when an infected person sneezes or
coughs on you.

Risk:  There is seasonal risk of meningococcal disease in parts of West
Africa, primarily during the dry season from December through June. When
a traveler lives and works around the local population, the risk increases.

Prevention:  A one dose vaccine called MenomuneÔ is available.

Recommendations: Vaccination is not required for entry into any country in
this region. CDC recommends vaccination with meningococcal vaccine for
travelers going to Mali and all countries directly eastward, including
Burkina Faso, Niger, Benin, and Nigeria, when travel occurs between
December and June.

SCHISTOSOMIASIS : Schistosomiasis is an infection that develops after
the larvae of a flatworm have penetrated the skin. These larvae can penetrate
unbroken skin. Water treated with chlorine or iodine is virtually safe, and
salt water poses no risk.
Risk:  Schistosomiasis infection is widespread in West Africa, especially in
the savannah regions of Burkina Faso, Mali, Niger, and Nigeria. The risk is a
function of the frequency and degree of contact with contaminated fresh
water for bathing, wading, or swimming.
Prevention:  The traveler cannot distinguish between infested and
non-infested water. Therefore, swimming in fresh water in rural areas should
be avoided. Bath water should either be heated to 50 degrees C (122 degrees
F) for five minutes or treated with chlorine or iodine as done for drinking
water. If exposed, immediate and vigorous towel drying or application of
rubbing alcohol to the exposed areas may reduce the risk of infection.
Screening procedures are available for those who suspect infection, and
schistosomiasis is treatable with drugs.
Recommendations:  Avoid contact with potentially contaminated water.

RABIES: Rabies is a viral infection that affects the central nervous system.
It is transmitted by animal bites which introduce the virus into the wound.
Although dogs are the main reservoir of the disease, all warm-blooded
animal bites should be suspect.
Risk:  For all countries in West Africa, there is a risk of rabies infection
particularly in rural areas, or in areas where large numbers of dogs are
found. Prevention:  Do not handle any animals! Any animal bite should
receive prompt attention. When wounds are thoroughly cleaned with large
amounts of soap and water, the risk of rabies infection is reduced. Exposed
individuals should receive prompt medical attention and advice on
post-exposure preventiv

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