No 26 - 2012

Malaria prophylaxis & vaccination for foreign travel: updated recommendations
Counselling of private individuals
Free HPV vaccination to adult females

Malaria prophylaxis & vaccination for foreign travel: updated recommendations

A reference group has revised and updated the SSI's country-specific recommendations for malaria prophylaxis and vaccination in connection with travels abroad. In 2012 the following changes apply:

Malaria prophylaxis

Armenia: no mosquito prophylaxis
Azerbaijan: v (month 6/10) in groups 2-4 (only mosquito prophylaxis)
Belize: low risk in Corozal (lowered).
Bangladesh: in the majority of the country, there is no malaria risk, including Dhaka. The risk is high in Chittagong Hill Tract (the districts of Bandarban, Rangamati and Khagrachari) and in the districts of Chittagong and Cox Bazaar.
Bhutan: New risk areas in the south of the country (Dagana, Pemagatshel and Sarpang). The Geyleg-phug area is discontinued.
Bolivia: Cobija ceases to be risk area.
Botswana: Bobirwa is a new risk area.
India: High risk areas: Orissa, Chhattisgarh, Jharkhand and Assam (including surrounding states); here, the recommendation continues to be X in groups 2-4. In the remaining parts of India, the risk is estimated to be so low that mosquito prophylaxis will normally suffice. Please refer to (in Danish) for a map. A quality-assured level III drug may be brought for standby treatment, EPI-NEWS 24/10.
South Sudan: New country, X in groups 1-4.

In countries marked with a small letter, the malaria risk only applies in part of the territory. Description of the updated risk areas: (Danish language). Select ”sygdomsforekomst = malaria” and place the arrow above the red area. Long texts may be incomplete. Click country to see full text.
Mosquito bite prophylaxis and chemoprophylaxis to children and pregnants: EPI-NEWS 19/05 & 24/10.


Yellow fever:
Vaccination requirement:
The Central African Republic: All travellers >9 months of age (previously >1 year).
Myanmar (previously Burma): In connection with transit stays >12 hours in the yellow fever transmission zone.
Pakistan: All travellers >9 months of age from countries with yellow fever transmission risk, including transit stays >12 hours.
The Philippines: All travellers with transit stay in countries with yellow fever transmission risk, regardless of duration of stay.
Zanzibar (Tanzania): For some time, the island of Zanzibar has required yellow fever vaccination of travellers from Tanzania (and from countries with yellow fewer transmission risk). It has not been possible to achieve official disconfirm of this requirement. Until further notice, vaccination is therefore recommended.
Thailand: All travellers >1 year of age from countries with yellow fewer transmission risk, including all travellers in transit from such countries.
South Africa: All travellers >1 year of age from yellow fever transmission areas and from Eritrea, Sao Tomé and Principe, Somalia, Tanzania and Zambia, including transit stay.

Yellow fever vaccination recommendation:
Bolivia: small g (big G for the Amazonas)
Currently, no vaccination is required for travellers arriving directly from Denmark. Vaccination is recommended for all travellers >9 months of age for the regions of Beni, Pando and any low-lying areas in the regions of Chuquisaca, Cochabamba, La Paz and Tarija, see map in Danish at Vaccination is not recommended for stays exclusively above 2300 m and for travels to the cities of La Paz and Sucre.
South Sudan: New country, no yellow fever vaccination requirement, but vaccination is recommended.
It is important to remember that transit stays in countries may trigger a vaccination requirement when continuing to another country, including to countries outside of the yellow fever transmission zone. The WHO recommends that transit stays not exceeding 12 hours in countries with a risk of yellow fever transmission should not trigger a vaccination requirement from the final destination; nevertheless, many countries require travellers to have a valid yellow fever vaccination certificate. Link to such countries:

Japanese encephalitis
Bhutan: no data - transmission period assessed to equal that of Nepal.
China: transmission period June - October, excluding the Tibet.
Japan: transmission period July - October.
North Korea: no data. Transmission period assessed to equal that of South Korea (May - October).
Laos: transmission period June - September.
Nepal: transmission period June - October.
Pakistan: few data. Cases reported from the Karachi area. Transmission period is assessed to cover the period May - October.
Russia: transmission risk in the easternmost area to the south of Khabarovsk in July - September.
Taiwan: transmission period May - October.

The updated tables with vaccination recommendations for foreign travel will be published in No. 27.

(M. Buhl, Danish Society of Travel Medicine, S. Thybo, Danish Society for Infectious Disease, J. Kurtzhals, Danish Society for Clinical Microbiology, N.E. Møller, Danish College of General Practitioners, L.S. Vestergaard, Danish Society for Tropical Medicine and International Health, K. Gade, The Danish Paediatric Society, P.H. Andersen, Department of Infectious Disease Epidemiology)

Counselling of private individuals

Again, SSI is experiencing an increasing number of enquiries from private individuals stating that their general practitioners have referred them for advice about travel vaccination and the like.
SSI does not usually advise private citizens. The counselling should take place via the person’s own GP or other healthcare staff who, in case of doubt or for more detailed questions, may contact the Institute. Further, on the SSI website, answers to many questions may be found.

(Department of Infectious Disease Epidemiology)

Free HPV vaccination to adult females

The Danish parliament, Folketinget, has previously decided that the offer of free vaccination against cervical cancer (HPV vaccination) should include adult females born 1985-1992. The start and end dates of the offer will be published at and as soon as possible.

The offer and any details concerning its practical implementation will be detailed further in the first issue of EPI-NEWS after the summer break, which will be published on 15 August 2012.
(Department of Infectious Disease Epidemiology)

Summer holidays

Unless special circumstances arise, EPI-NEWS will not be published in Weeks 28-32. The editorial team wishes the readers of EPI-NEWS a pleasant summer.

27 June 2012