Recommended vaccination and preventive Medications .
The Following Vaccines may be recommended for you to travel .
Discuss your travel plans and personal health with health care provider to determine which vaccines you will need .

Hepatitis A or Immune globulin ( IG )
Hepatis A is an acute infectious disease of the liver caused by the hepatitis A virus (HAV), which is most commonly transmitted by the fecal-oral route via contaminated food or drinking water. virus spreads by the fecal-oral route and infections often occur in conditions of poor sanitation and overcrowding. ingestion of shellfish cultivated in polluted water is associated with a high risk of infection. Virus can survive for months in fresh and salt water. Common-source (e.g., water, restaurant) outbreaks are typical Heaptitis A can also be transmiteed from fruits , vegetables and other foods that are consumed / eaten uncooked and that were contaminated during harvesting or subsequent handling . Infection is common in children in developing countries.


Hepatitis B or Immune globulin ( IG )
Hepatitis B is an infectious illness caused by hepatitis B virus (HBV) which infects the liver and causes an inflammation called hepatitis. Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood. Possible forms of transmission include unprotected sexual contact, blood transfusions, re-use of contaminated needles & syringes, and vertical transmission from mother to child during childbirth. Without intervention, a mother who is positive for HBsAg confers a 20% risk of passing the infection to her offspring at the time of birth. This risk is as high as 90% if the mother is also positive for HBeAg. HBV can be transmitted between family members within households, possibly by contact of nonintact skin or mucous membrane with secretions or saliva containing HBV ( Hepatitis B Virus ) . A few patients may have more severe liver disease (fulminant hepatic failure), and may die as a result of it. The infection may be entirely asymptomatic and may go unrecognized.


Japanese encephalitis
Japanese encephalitis previously known as Japanese B encephalitis to distinguish it from von Economo's A encephalitis—is a disease caused by the mosquito-borne Japanese encephalitis virus.Domestic pigs and wild birds are reservoirs of the virus; transmission to humans may cause severe symptoms. One of the most important vectors of this disease is the mosquito Culex tritaeniorhynchus. This disease is most prevalent in Southeast Asia and the Far East. Rural areas in endemic locations are at highest risk; Japanese encephalitis does not usually occur in urban areas. Countries which have had major epidemics in the past, but which have controlled the disease primarily by vaccination.So If you Plan to visit rural farming area and under special circumstances such as known outbreak of Japenese Encephalitis , vaccination is recommended .

Malaria
Many travelers acquire malaria, a potentially life-threaten-ing disease, during travel to tropical and subtropical countries. If you are traveling to Mexico and Central America, Haiti, the Dominican Republic, South America, sub-Saharan Africa, the Indian subcontinent, Eastern Europe, Asia, the Middle East, Papua New Guinea, Vanuatu, or the Solomon Islands, you could be at risk for malaria. Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. You can usually prevent malaria by taking an antimalarial drug and by avoiding mosquito bites. ( refrence Health Web site at www.cdc.gov/travel)
Travelers to countries with malaria, including infants, children, and former residents of these countries, should visit their health care provider 4-6 weeks before travel, for vaccinations and a prescription for an antimalarial drug.
Antimalarial drugs are available by prescription only. Your health care provider will prescribe your antimalarial based on your travel itinerary and medical history.
Pregnant women should NOT take Malarone or doxycycline to prevent malaria.

Typhoid
Typhoid fever, also known as Salmonella typhi or commonly just typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person Transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Typhoid spreads through food or eating food ,drinking baverages that have been handled by person who is infected and such food sold by street vendors . Careful food preparation and washing of hands are crucial to prevent typhoid. With an estimated 16–33 million cases of annually resulting in 216,000 deaths in endemic areas, the World Health Organization identifies typhoid as a serious public health problem. Its incidence is highest in children and young adults between 5 and 19 years old. Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. Vaccination is Particularly important because of presence of S.Typhi strain resistant to multiple antibiotics ,There Have been recent reports of typhod drug resistant in India and Nepal

Meningococcal disease
Meningococcal disease (commonly referred to as meningitis or epidemic meningitis) is a serious, sometimes fatal bacterial infection. Meningococcal disease occurs worldwide, but the sub-Saharan African “meningitis belt” is an area at uniquely high risk for epidemic meningitis. The meningitis belt includes parts of the following countries: Senegal, Guinea, The Gambia, Guinea-Bissau, Mali, Burkina Faso, Cameroon, Côte d'Ivoire, Ghana, Benin, Togo, Nigeria, Niger, Chad, Sudan, Ethiopia, Uganda, Kenya, and Eritrea. Meningitis epidemics occur regularly in the meningitis belt during the dry season (December through June). However, during January 2010, Burkina Faso and Chad had more reported meningitis cases compared with the number of reported cases during the same time period in 2009 (refrence Health Web site at www.cdc.gov/travel) People traveling to the meningitis belt in sub-Saharan African during the remaining months of the dry season (December through June) should be aware of this season’s ongoing disease activity and get a meningococcal vaccine. Protection develops 7–10 days after receiving the vaccine, so if possible, travelers should get vaccinated at least 10 days before travel. Travelers leaving in less than 10 days should still get vaccinated before travel.

Rabies,
Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping. hiking, or bicycling, or engaging in certain occupational activities.

Recommendations for Travelers
Staying Healthy During Your trip
Travellers should take the following Precautions
Protect yourself from mosquito bites. Mosquitoes that transmit malaria bite between dusk and dawn. Prevent mosquito bites by staying indoors, if possible. If out-of-doors, wear long-sleeved shirts, long pants, and a hat. ,Apply insect repellent to exposed skin only; do not use under clothing. Use insect repellents containing DEET for the best protection.
When using repellent with DEET, follow these recommendations:

• Read and follow all directions and precautions on the product label.
• Use only when outdoors and wash skin with soap and water after coming indoors.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed.)
• Do not put repellent on wounds or broken skin.
• Higher concentrations of DEET may have a longer repellent effect; however, concentrations over 50% provide no added protection.
• Timed-release DEET products may have a longer repellent effect than liquid products.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years of age should not apply repellent themselves. Do not apply to young children’s hands or around eyes and mouth.

Take a flying-insect spray or mosquito coils on your trip to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide to quickly kill mosquitoes.

If you will not be staying in well-screened or air-conditioned rooms, take additional precautions, including sleeping under mosquito netting (bed nets). Bed nets sprayed with the insecticide permethrin are more effective. In the United States, permethrin is available as a spray or liquid to treat clothes and bed nets. You can purchase bed nets that have already been treated with permethrin. Permethrin or another insecticide, deltamethrin, may be purchased overseas to treat nets and clothes.

Prepared by the Malaria Branch, Division of Parasitic Diseases,National Center for Infectious Diseases, For details visit CDC’s Travelers’ Health Web site www.cdc.gov/travel