NaTHNaC | Help Page: Country Information

This section provides links to Health Information Sheets on the NaTHNaC website for advice on health risks that may apply to all travellers. This advice should be an integral part of any pre-travel health consultation.

1.2 Vaccine preventable risks

This section provides information on vaccines routinely recommended according to United Kingdom (UK) immunisation schedules; vaccines recommended because of risk during travel; and yellow fever vaccine recommendations and requirements. Prior to giving any vaccine the practitioner should be familiar with the information in the Summary of Product Characteristics (SPC) and the Department of Health's Immunisation Against Infectious Disease (Green Book).

Yellow fever. Specific advice is provided on the risk of yellow fever at the destination, and any requirements for certification of vaccination against yellow fever as defined by the International Health Regulations.
Additional risks. This section provides advice on routine and recommended vaccinations.
- Routine vaccinations form part of the UK national vaccination programme. A pre-travel health consultation is an ideal opportunity to ensure that primary vaccination schedules are up to date. Further information on routine vaccination schedules is available on the NHS website at www.immunisation.nhs.uk and the Department of Health's Immunisation Against Infectious Disease (Green Book).
- Recommended vaccinations are those that may be recommended for travel depending on the destination, type of travel, planned activities and the health status of the traveller. A decision as to whether a vaccine is recommended will depend on a comprehensive risk assessment. To assist this process, each vaccine preventable disease has a section on risk assessment and risk management.
  - Risk assessment - provides information on the occurrence, mode of transmission, and factors that may increase the risk of disease transmission.
  - Risk management - provides information on methods that will reduce the risk of disease, and recommendations for vaccination.

Vaccine preventable risks are listed in alphabetical order; this does not imply order of importance.

In order to assist the health professional in making decisions about vaccine use, the recommendations for routine and recommended vaccinations have been graded using the following standard terms:

"should be given" indicating that all travellers who are in the risk categories should receive vaccine
"may be given" indicating that the risk is generally low for most travellers, but vaccination may be given to travellers in the higher risk categories.

1.3 Non-vaccine preventable risks

Malaria. This section provides information on the risk of malaria within the country, and recommendations for reducing the risk including the use of malaria prevention tablets (chemoprophylaxis). It follows guidelines written by the Health Protection Agency Advisory Committee on Malaria Prevention (ACMP).
- Risk assessment - provides information on where malaria is a risk. The level of risk has been graded for each country using the standard terms "no risk", "very low risk", "low risk" and "high risk".
- Risk management - for ease of use this has been divided into sections A, B, C & D: Awareness of the risk of malaria at the destination, Bite avoidance measures, Chemoprophylaxis (specific recommendations for malaria prevention tablets) and Diagnosis of malaria.
  The degree of drug resistance within a country is also described using standard terms to indicate whether resistance is "present" (resistance may be at a low level or not evenly distributed), or "widespread" (resistance is widely distributed throughout the country). Resistance in most cases refers to resistance of Plasmodium falciparum to chloroquine.
Additional risks. This section provides information on infectious disease risks for which there are no vaccines, e.g. dengue, as well as non-infectious disease risks such as altitude. This list is not comprehensive, and further information on infectious and non-infectious disease risks will be added in due course. Further information on country-specific risks can be found on the NaTHNaC Health Information Sheets and the Outbreak Surveillance search.

2. How to use the Country Information pages

The information contained within the country pages is intended for health professionals who are assessing a traveller's health risks. These pages can be used with a risk assessment that includes the traveller's itinerary, planned activities, and health status, to assess which prevention measures, vaccines and malaria prevention tablets are appropriate. Prior to giving any vaccine the practitioner should be familiar with the information in the Summary of Product Characteristics (SPC) and the Department of Health's Immunisation Against Infectious Disease (Green Book).

The malaria advice within the country information pages should be used in conjunction with the ACMP malaria prevention guidelines.

3. Limitations of the Country Information pages

The country information pages are not a complete guide and not all travel health risks are discussed. It is not a substitute for a pre-travel health consultation. Travellers who use this site should discuss the information with a health professional for specific guidance related to their travel and medical history.

Although the emphasis is on vaccine-preventable disease risks and malaria prevention, all travellers should receive advice on food and water hygiene, travellers' diarrhoea, insect bite avoidance, and where applicable, sun protection.

Safety and security issues are of great importance. Accidents and injuries are an important cause of serious illness during travel.

An adequate travel insurance policy is essential to cover any emergency that may occur overseas. Further information on travel health insurance may be found on the Foreign & Commonwealth Office website.

4. Navigating the Country Information pages

4.1 Navigating to a Country Information page

From the main country information page (http://www.nathnac.org/ds/map_world.aspx) you can access the pages in one of three ways.

Using the world and regional maps
Using the drop down menu - Typing in the first two or three letters of a country name into the drop down menu will pull up close matches. Some countries may be listed under more than one name where there are common alternatives. For example, Côte d'Ivoire can also be found under Ivory Coast.
Using the alphabetical listing presented on left hand panel of the page

4.2 Navigating a Country Information page

Once in an individual Country Information (CI) page you can navigate the page using hyperlinks.

The menu at the top of each CI page is split into two sections (Figure 1):

Contents: This menu provides links to the information within the CI page
Current Health and Security Information: This menu provides links to important resources not found on the CI pages.

Figure 1:

The contents are positioned directly above Current Health and Security information.

The three main section headings on risk (General, Vaccine Preventable and Non-Vaccine Preventable) (Figure 1) will direct you to these sections of the CI page.

Figure 2:

In each section there are links that allow you to navigate within the page.

Within each section, e.g. "Vaccine Preventable Risks", you can navigate to the other sections (Figure 2, Arrows 1). You can go also between the Yellow Fever and Additional Risks sub-sections (Figure 2, Arrows 2). Likewise within the "Non-vaccine Preventable Risks" section you can navigate between the Malaria and Additional Risks sub-sections.
When on a CI page, you can always return to the main menu using the "Back to Top" text located on the right hand corner of each of the section headings (Figure 2, Arrows 3).

Figure 3:

There are hyperlinks under the additional risks section that take you to disease information or offer navigation links.

Under the introduction to the "Additional Risks" section for both the "Vaccine Preventable" and the "Non-Vaccine Preventable" risks sections, there are hyperlinks to direct you to the diseases that will be covered under that section (Figure 3, Arrow 1). These are listed alphabetically.
On the right-hand side of each disease name there are hyperlinks directing you to the beginning of the sub-section or back to the top of the CI page (Figure 3, Arrows 2).

4.3 Other useful resources on the Country Information page

Under each disease there is a "Resources" box. The box is divided between resources for health professionals and resources for travellers. NaTHNaC resources open in the current browser window whereas external resources will open in new windows to allow the NaTHNaC site to remain open.

Other useful resources are presented in the left hand column of the page and in the menu at the top of the page:

Outbreak Surveillance search function: check for recent outbreaks of disease that may affect travellers (see Outbreak Surveillance section for further information).
NaTHNaC Clinical Updates: Timely information on health events that may affect travel advice.
NaTHNaC Health Information Sheets: Information on a range of topics related to travel health. There are two links, one to information sheets for health professionals and one for travellers.
Foreign & Commonwealth Office: Up to date information on safety, security and services provided to British citizens abroad.

4.4 Leaving the Country Information pages

Once you have read the page for an individual country you can do one of the following to carry on using the NaTHNaC website:

Click on one of the world regions listed on the left hand panel to take you back to a region map where you can select another country page.
Click on a letter of the alphabet on the left hand panel to take you to a list of countries.
Click on either the "Health Professionals" or "Travellers" links on the menu bar across the top of the page. These links will take you to the "Health Professionals" or "Travellers" home pages where you can access the full range of NaTHNaC information and resources.
Click on the "Outbreak Surveillance", "Clinical Updates", "Health Information Sheets", and "Foreign and Commonwealth Office" links on the left hand panel of the page.

5. Outbreak Surveillance

The Outbreak Surveillance (OS) search (Figure 4) allows you to search for information about disease outbreaks that may affect UK travellers. This is updated daily. You can search for all outbreaks which have occurred in a country, all outbreaks of one disease globally, or you can perform a specific search relating to a single disease in an individual country. The search is limited to outbreaks occurring up to one year from the date of the search. The information on the Outbreak Surveillance database is the property of NaTHNaC. If it is the intention to use the dataset for purposes other than to check for recent outbreaks (e.g. research or commercial purposes) please contact NaTHNaC.

Figure 4:

Iluustrating the outbreak search function.

5.1 Searching for outbreaks

Coming from a CI page, the name of that country will appear in the "Country" field, "All" diseases will be selected, and the search period will be set to six months. These are the default settings.

To find all recent outbreaks in a country, choose the desired country from the drop-down list, choose "All" from the drop-down list of diseases and choose either "Month", "6 months" or "Year" from the period drop-down list. To search for a particular disease globally, select that disease from the disease list and choose "All" in the country list.

Clicking "Go" will generate a report. This report will be in the same window as the search tool but you can easily navigate back to perform another search using the "back" button on the report or on your browser.

5.2 Producing a report

Once a report has appeared on your screen you may print it. To achieve the best results the report should be printed in landscape orientation.

5.3 Understanding the report

Information about disease outbreaks is grouped by an individual outbreak. The original report of an outbreak appears with grey shading and any updates (subsequent reports related to the original outbreak) are not shaded (i.e. white background). Updates appear above the original report.

The outbreaks are ordered alphabetically first by country and then by disease. Multiple outbreaks of one disease within a country are sorted with the most recently updated report on the outbreak at the top.

Where the original outbreak information occurred outside of the time period that has been searched, only updates within that time period will be displayed. To see all information about the outbreak, including information outside of the search parameters, click the link in the "All updates relevant to this outbreak" field (Figure 5).

The report (Figure 5) has the following fields:

Disease
Country
Reported date: The date the outbreak was reported.
Region: The region of the country where the outbreak occurred.
Location: The precise location of the outbreak
New / updated: This tells you whether this is the first report of an outbreak (new) or whether this outbreak has been reported previously and is now being updated (update).
Source: This shows the source of the report. Where possible there is a hyperlink which takes you to the actual report of the outbreak. See below for a full list of sources.
Verification: This shows the verification status of the outbreak. Reports that are "unverified" should be treated with caution as unverified reports may be subject to change, misreporting and prove to be unsubstantiated.
Details: This provides the details such as case numbers and duration.
Human: This is a Yes/No field. If a "No", the outbreak is occurring in animals. If "Yes", it is occurring in humans.
All updates relating to this outbreak: This links to all reports related to the outbreak. Clicking on this generates a second report detailing all previous reports of this outbreak.

Figure 5:

A thumbnail image of an example outbreak report, open to view a larger image (opens in new window).

5.4 Imported infections

When a disease is imported from one country to another (e.g. from Turkey to Germany), the outbreak will appear under both countries. The "Country" field will show both country names in the following format:

[Country in which the disease is reported] Ex [Country from which the disease originated]

5.5 List of sources for Outbreak Surveillance:

The following sources are used to compile the report:

Eurosurveillance: This is a weekly, on-line, peer-reviewed journal that publishes open-access articles concerning public health. These reports are a source of verified information, and are often written by state health departments.
Global Polio Eradication Initiative: The Global Polio Eradication Initiative website is a collaboration between the WHO, Rotary International, the U.S. Centers for Disease Control and Prevention (CDC) and UNICEF. It provides updates on the global situation of polio and is a source of verified information.
MMWR (Morbidity and Mortality Weekly Report): This is a CDC publication that focuses primarily on health issues in the USA and reports outbreaks of disease that may be relevant to UK travellers. It is a source of verified information.
NGO (Non Governmental Organisations): Health related NGOs, relief organisations and charities often report outbreaks of disease. Some of the reports will be unverified, while others will be verified.
ProMED (The International Society of Infectious Diseases Program for Monitoring Emerging Diseases): ProMED-mail is a reporting system dedicated to rapid global dissemination of information on outbreaks of infectious diseases and exposures to agents that affect human health. Sources of information include media reports, official verified reports, on-line summaries, local observers, and others. Reports are often contributed by ProMED-mail subscribers. A team of expert human, plant, and animal disease moderators screens, reviews, and investigates reports before posting to the network. Reports based on information from ProMED-mail should be treated as unverified unless otherwise stated. These reports may subsequently become verified.
ReliefWeb: ReliefWeb provides information (documents and maps) on humanitarian emergencies and disasters. It is administered by the UN Office for the Coordination of Humanitarian Affairs (OCHA) and publishes both official and unofficial reports. Information from ReliefWeb should be treated as unverified unless otherwise stated.
Scientific literature: Occasionally outbreaks that are not reported elsewhere are reported in scientific literature. This is verified information.
State: Information from state authorities (i.e. countries) may come from Ministry of Health or Public Health body websites such as the CDC and the Public Health Agency of Canada. These website's provide a source of verified information. Since the CDC and Public Health Agency of Canada make up the majority of these reports they are listed separately as CDC and Health Canada.
World Health Organization (WHO) Disease Outbreak News (DON): The WHO DON provides information about officially confirmed outbreaks of international importance. These reports are a source of verified information.
WHO Other: This category contains other WHO resources not detailed above and provide verified information on disease outbreaks.
WHO regional offices: The regional offices of WHO provide local or regional information on disease outbreaks. These websites are a source of WHO-verified information.
World Organisation for Animal Health (OIE): The OIE is an intergovernmental organisation with 167 member countries. It collects, analyses and disseminates veterinary scientific information and provides expertise in the control of animal diseases. Member states report cases of listed diseases to the OIE who then disseminate the information via email, the website and periodicals. This information includes diseases transmissible to humans (e.g. avian influenza) and intentional introduction of pathogens. These reports are sources of verified information.

6 Disclaimers

6.1 Maps

The maps on the world and region pages are designed for navigation purposes only and are not to be considered an authority on the delimitation of boundaries, the spelling of place names or the geographical locations of countries and state entities.

For the purpose of these web pages the term "country" covers countries, territories and areas. Areas within a country may be shown separately where it is felt necessary in order to provide travel health information.

6.2 Country information

The travel health information contained in these pages is intended for health professionals who assess a patient's travel health needs. This document is not a complete medical guide for travellers nor are all travel risks discussed. Travellers using this site should consult with a health professional for specific information related to their travel and medical history. While every care has been taken to ensure the accuracy and timeliness of the travel health information, NaTHNaC cannot accept any liability for injury, loss or damage arising in any respect of any statement contained therein.

6.3 Outbreak surveillance

The outbreak search function is intended to inform about existing or emerging threats to the health of travellers from communicable diseases. NaTHNaC does not necessarily analyse, assess or investigate reports of disease outbreaks. As many disease outbreaks do not get reported, the absence of reports of a disease within an individual country should not be taken to mean an absence of risk. Likewise, if a disease outbreak is reported it does not necessarily imply a risk to the traveller.

The information presented in the disease surveillance reports is collated from a variety of sources, including government bodies, international organisations and the media. The verification status of each report is clearly indicated. Verified reports are confirmed by official sources. Some unverified reports are included to ensure timely dissemination of information and whilst every effort is made to substantiate these reports, confirmation of their detail may not always be possible. Unverified reports may be subject to change, misreporting and may later prove to be unsubstantiated. They should not therefore be regarded as official. Where available, a web link is provided to the original information source. NaTHNaC cannot accept responsibility for the sites to which it links, or for the information found on that site. Linking to outside sites does not imply endorsement by NaTHNaC.

7. Glossary of Terms Used

Acute:: of sudden onset and relatively short duration. Often used to describe a disease process.
Adverse event:: undesirable effects; usually associated with medication.
Chemoprophylaxis:: medication taken in order to prevent disease. Often used to describe malaria prevention tablets.
Chronic:: having a slow, progressive course. Often used to describe a disease process.
Contraindication:: a situation or condition which makes a particular drug or treatment inadvisable.
Crustaceous:: relating to or affecting the skin.
Encephalomyelitis:: inflammation of the brain and spinal cord.
Endemic:: regularly found in a certain area. Usually refers to a disease.
Endemicity:: being endemic.
Epidemiology:: the incidence and distribution of a disease.
Exudate:: discharge, usually from a wound or lesion.
Febrile:: having symptoms of a fever.
Flatworms:: soft-bodied parasitic worms with flattened, elongated bodies.
Immunoglobulin:: a blood product containing disease antibodies.
Incidence:: the occurrence, rate or frequency of an event. Often refers to a disease.
Indigenous:: occurring naturally in a specific area.
May be given:: the disease risk is low for most travellers and vaccination is not required as a condition of entry. Vaccination should be considered for those at higher risk as defined in the Risk Assessment section.
Pharyngeal:: relating to the pharynx, a section of the respiratory tract located at the back of the throat.
Pulmonary:: relating to the lungs.
Should be given:: Vaccination should be given to all travellers in risk categories as defined in the Risk Assessment section.
Systemic:: affecting the whole body.

Locate Country

Guidance

Outbreak Surveillance

Clinical Updates

Clinical update index

Health Information Sheets

Foreign and Commonwealth Office

Country Information Help Page

Contents

1. Aim of the Country Information pages.

1.1 General health risks