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Myanmar - MD Travel Health
If you are a physician or physician with information about the Myanmar region, why not submit an application for this site? The majority of travellers to Myanmar require hepatitis A, typhus and eradication of poliomyelitis, as well as medication for the prevention of tuberculosis and travel diarrhoea. Insecticides are advised in combination with other methods to avoid gnat sting.
Travellers should either go to a medical station or their family doctor 4-8 week before depart. Prophylaxis with lariam (mefloquin), Malarone (atovaquone/proguanil) or Doxycyclin is suggested for all areas below 1000 meters, except the regions of Bago, Kayah, Kachin, Kayin, Shan and Tanintharyi, where mefloquin should not be used due to the absence of mefloquine-resistant antimalaria.
GelbfieberRequired for all travellers over one year old from a region in Africa or America contaminated with the disease, and for travellers who have spent more than 12 hrs at an airfield in a nation at a time when there is a danger of transmitting it. For Myanmar citizens and inhabitants leaving for an affected area.
Otherwise not advisable. Diarrhoea is the most frequent travel-related disease. Travellers should all take an antimicrobial medication and an antidiarrhea medication, which, in the case of significant diarrhoea, defines as three or more loosened faeces within 8 hours or five or more loosened faeces within 24 hours, especially in the case of sickness, emesis, cramping, fever epilepsy or bleeding in the faeces.
Chinolones are generally well-tolerated but cause occasional sensitivities to sunlight and should not be administered to infants, pregant females or persons with a Quinolinone intolerance. RIPAXIMINE should not be used by persons with a high temperature or blood ied stool and is not intended for the use of a woman or person under 12 years of age. However, it is not intended for use by other people.
The majority of cases of travel diarrhoea are moderate and do not need either anti-diarrhoeal or antibiotic treatment. You should consult a doctor if diarrhoea is serious or rare, if you have a temperature with shivering, or if you have stomach ache, or if diarrhoea lasts longer than 72 h. Although efficacious, it is not advised as a prophylaxis (i.e. to avoid diarrhoea before it occurs), because of the risks of undesirable side effect, although this may be justified in specific circumstances, e.g. in immunosuppressed travellers.
Myanmar malaria: Prevention is recommended for all areas below 1000 meters, except the towns of Mandalay and Rangoon (Yangoon). Side affects that are usually moderate can be stomach ache, sickness, puke, sore throat, diarrhoea or vertigo. Long distance travellers who visit malarial areas and may not have direct health coverage should take medication for emergencies if they experience signs of the disease, such as temperature, shivering, headaches and muscular pains, and cannot receive health attention within 24hrs.
More information about the country can be found at Roll Back Myanmar or at the World Health Organization - South East Asia Region. Hepatitis A vaccines are suggested for all travellers over one year of travel. Elderly people, immunosuppressed people and people with either hepatic or other chronical diseases who should be given a lone intramuscular dosage of immunoglobulin (0,02 mL/kg) at a seperate anatomical site of administration in excess of the starting dosage of the immunoglobulin less than two week before depart.
Travellers less than one year old or those who react allergically to a particular part of the immunoglobulin should be given a simple injection of immunoglobulin intramuscularly (see hepatitis A dosage) instead of the inoculant. Typhus booster is advised for all travellers. Alternatively, an injectionable Polysaccharide/Typphim Vi (Aventis Pasteur Inc.) injection can be administered as a supplement (PDF).
Side effects that are unusual can be injections, fevers and headaches. Travellers over six years of age are eligible for the orally available immunization, while those over two years of age are eligible for the injected one. No information is available on the security of typhus vaccines during gestation.
Typhim Vi is probably preferred to vaccines for immunosuppressed mothers. Poliomyelitis vaccination is highly encouraged. In Myanmar, near the Bangladesh frontier, where poliomyelitis is still widespread, there are still outbreaks. Every grown-up who has been given the vaccinations as a child but never had a boost as an adulthood should receive a full dosage of an unactivated poliovaccine.
However, since the deactivated poliovaccine contains traces of streptomycin, neo-mycin and poly-myxin type A, people with an allergy to these drugs should not use it. Use of the Japan Encephalitis Immunization Formula is suggested for those wishing to stay in the countryside for a period of one or more months, for short-term travellers who are spending a lot of free travel or for extended extracurricular or farming activity, especially in the afternoons.
Transplanted by gnat stings, it seems to appear all over Myanmar, with a frequency from May to October. Recurrent eruptions have been recorded in Shan State in Chiang Mai Valley. IXIARO, given 0. 5 cc intramuscular followed by a second dosage 28 dagen later.
There was no evidence of pregnancy, breastfeeding or infants under two-month-olds. The Hepatitis B1 immunization is suggested for all travellers, if not inoculated. It is also authorised for use after 0, 1, 2 and 12 month, which may be suitable for travellers leaving in less than 6month.
The side affects are generally moderate and may involve site ailments and low temperature. Ragweed vaccines are suggested for travellers who spend a great deal of outdoor travelers, high-risk travellers for vet and keeper occasions, long-term travellers and expats, and travellers engaged in outdoor activity that could put them in close touch with a bat.
Most cases in Myanmar are caused by the bite of dogs. Pre-exposure therapy comprises three injections into the delta muscles on day 0, 7 and 21 or 28. Advisable tetanus-diphtheria inoculant for all travellers who have not been vaccinated against tetanus-diphtheria in the last 10 years.
Measles mumps rublla vaccine: For all travellers newborn after 1956, two dosages are suggested (if not previously given), unless the test shows resistance. Do not administer MMR vaccines to people who are either pregant or highly immunosuppressed. The use of inoculant is generally not advised, although Myanmar has a low incidence of the disease, as most travellers have a low incidence of it.
Where available, these inoculants are only suggested for high-risk persons, such as auxiliaries, healthcare personnel and people travelling to isolated areas where cases of the epidemic of cholera occur and have restricted accessibility. Because of its low effectiveness and common side effect, the only U.S.-approved anticholera drug is no longer in use.
Gelbfieber vaccines are necessary for all travellers coming from a African or American risking the spread of gel fevers, for travellers who have travelled more than 12 hrs at an airfield in a foreign state risking the spread of gel fevers, and for Myanmar citizens and inhabitants leaving for a nonrecommended or mandatory state.
YF-VAX (Aventis Pasteur Inc.) vcc (PDF) must be given at an accredited YF centre that provides each of the vaccines with a fully valid international certificate of inoculation. Gelbfiebervaccstoff should not be generally given to persons who are younger than nine month old, impregnated, immunosuppressed or allergically against egg.
A pestilence eruption was announced from Yangon in July 2010. If you are in touch with any of the mammals or their flies, you should take a prophylactic dose of Doxycyclin with you when you are exposed. In order to minimise the risks, travellers should refrain from areas with small cavities or cavities, never deal with diseased or deceased pets and take mosquito repellent precautions as described below.
Eruptions of Dengue fevers in Myanmar appear yearly. In July 2010 the last ones were registered from Naypyidaw, in June 2010 from Yangon and in August 2009 from the state of Arakan (Rakhine) in the west of the state. There was an incident in June 2009 in Kalemyo, a city near the boundary of India in the north-west of the state. At least ten infants died.
About the same period, an eruption took place in Myitkyina, the capitol of the state of Kachin. In June 2009, an increasing number of cases were registered in Yangon (Rangooon) (see PerMED email, August 3 and 31, 2009). There is currently no inoculant available. Case reports of dementia among aid personnel from other nations who had voluntarily worked in Myanmar after Cyclone Nargis were received in July 2008.
About the same period, a dengue eruption was recorded from the Monywa Township in sagaing (see ProMED-Mail, August 6, 2008). In 2007, an exceptionally large eruption was recorded, probably due to strong rain. An eruption of dengue was recorded in September 2006 in Yangon (Rangoon). An eruption of dengue was announced in July 2006 in the community of Yezagyo, Magwe Divison in Cuba.
In 1998, an abnormally high number of cases were recorded, possibly due to climate change caused by El Nino. A chikkungunya virus infection, a mosquito-borne disease characterised by fevers and disabling pain in the joints, was recorded in Myanmar in August 2010, mainly affecting the Ayeyarwady Division, Yangon Division, Rakhine State and Shan State.
Chikungunyafever is characterized by fevers, pain ful joints, muscular pain, headaches and rashes. We strongly recommend the use of fly repellents as described below. Due to the risks of mother-to-child transfer, expectant mothers must be especially careful to avoid being bitten by mosquitoes. In May 2008, cases of the Irrawaddy delta were recorded after the hurricane, but the figure did not seem to be higher than in other years.
Where available, the use of the anticholera inoculant is only suggested for auxiliaries, healthcare personnel and persons travelling to isolated areas where healthcare is restricted, as mentioned above. H5N1 outbreak ( "avian flu") was first recorded in Myanmar in December 2007, when a seven-year-old female from the township of Kyaing Tone, Shan State (East) was involved.
Since March 2006, there have been reports of bird eruptions from Myanmar, affecting businesses in Mandalay province and Sagoing province. For almost a year, no new cases have been registered. From February 2007 and until June, however, a number of eruptions of bird ranches outside Yangon (Rangoon) were heralded. New eruptions were recorded in August 2007 from the Bago metropolitan area, Mon State and neighbouring Kayin State in the south.
Other eruptions were announced by Bago in October 2007 and by Oriental Shang State in November and December 2007. Recent chicken epidemic was announced in January 2011 in the state of Rakhine. The majority of travellers have an extreme low incidence of bird flu, as almost all cases have been recorded in other counties that have had face-to-face contacts with living, contaminated birds or continued close contacts with members of the families who suffer from the virus.
However, the Centers for Disease Control and the World Health Organisation discourage travelling to bird flu affected areas but suggest that travellers should stay away from living fowl, include visiting bird holdings and open bird market areas, not touching areas that could be affected by faeces from fowl or other livestock, and ensure that all fowl and ova are thoroughly boiled.
Vaccines against bird flue have recently been licensed by the U.S. Food and Drug Administration (FDA), but produce sufficient antibodies in less than half of the patients and are not available on a commercial basis. Everyone who has developed fevers and flu-like signs after a trip to Myanmar should see a doctor immediately, which can involve tests for bird flu.
In May 2007, a poliomyelitis eruption was recorded in the Maungdawownship in Rakhine state in the west of Myanmar, near the Bangladesh frontier. This unique eradication boost is highly recommendable for any mature traveller who has been vaccinated in infancy but has never had a vaccination against poliomyelitis as an AD. Pre-trip vaccinations against poliomyelitis are required for infants.
In August 2006, a viral parasite eruption was recorded in several communities in a secluded area of the community of Ponna Kyunt, 16 mi from Arakan' s capitol Akyab (see Romanian Ministry of Health, ProMED-Mail; August 30, 2006). Travellers to Myanmar's countryside should take prophylactic treatment for insect bite as described below.
Anti-HIV (Human Immune Deficiency Virus) disease reports, but travellers are not at risk unless they have exposed sex or are receiving an injection or hematology. Rickettsiosis, dementia and typhus were other frequent diagnosed cases. You can find a Myanmar healthcare history at the World Heath Organization. Travellers should all take an antimicrobial medication and an antidiarrhea medication, which, in the case of significant diarrhoea, is understood as three or more loosened faeces in a 24-hour interval of 8 hours or five or more loosened faeces, especially if it is associated with sickness, emesis, cramping, fever in the faeces or in the faeces.
You should take either Loperamid (Imodium) or Diphenoxylat (Lomotil) in combination with antibiotics to decrease diarrhoea and avoid it. You should consult a doctor if diarrhoea is serious or rare, if you have a temperature with shivering, or if you have stomach ache, or if diarrhoea lasts longer than 72 h.
When the disease strikes abroad, the cost of healthcare, which includes evacuating, can be as high as ten thousand US dollar. Generally, Myanmar's health services are bad. Travellers should take enough medication for their journey to Myanmar. Ensure before leaving that you have the addresses and contacts of doctors, medical centers and hospital where you can get urgent health assistance if necessary.
The American Academy of Pediatrics recommends that all infants should be kept informed of the latest inoculations. Childrens 12 month or older should be given a minimum of 2 dosages of MMR vaccines (Measles-Mumps-Rubella), divided by at least 28 nights before the trip. 6-11 month old infants should be given a simple dosage of the vaccine.
An MMR dose may be given if no measles dose is available, although vaccination against insomnia and German measles is not required before the first year of life, unless you visit a host state. If you travel with small infants, pay particular attention to what you allow them to consume (see nutrition and drinking precautions), as diarrhoea can be particularly hazardous in this group and because the hepatitis A and typhus virus serum, which is spread by infected foods and drinking waters, is not licensed for infants under two years of life.
It is important to avoid travelling internationally by expecting mothers with diseases such as diabetic or hypertensive diseases or early pregnancy related problems such as miscarriages or birth. The second term (18-24 weeks) is probably the best period for expectant mothers in good physical condition to go abroad, and the third term is the most uncertain, as it is much better not to have to ship to a different state.
Make sure you have the name of and the name and address of doctors, medical centres and hospital where you can get obstetrics if necessary. Generally speaking, expectant mothers should refrain from travelling to a country that does not have advanced equipment for the treatment of preterm births and other maternity problems.
In general, expectant mothers should not visit areas where the disease is present. Recommended DEET insecticides are the same for expecting mothers as for other people. Stringent observance of dietary and aquatic safety measures is particularly important for the expectant passenger, as some diseases, such as listeria, have serious effects on the foetus as it develops.
In addition, many of the drugs used to relieve traveler's diarrhoea cannot be administered during the course of gestation. Acithromycin and third-generation cyphalosporins are available as treatment for traveler's diarrhoea in expecting mothers. Consular Section is at 114 University Avenue, Rangoon; phone (95-1) 538-036, 538-037 or 538-038; e-mail consularrangoo@state. gov; or website: http://rangoon.usembassy.gov.
The Consular Section is not in the U.S. Embassy. Embassy is at 581 Merchant Street, Rangoon, 95-1) 379-880 and (95-1) 379-883; facsimile (95-1) 379-883. Have you been to Myanmar recently? Visit our Myanmar (Burma) page for travel, lodging, videos and ratings.
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