Travelers' Health
The Center for Disease Control and Prevention (CDC) uses Travel Health Notices (THNs) to inform travelers about global health risks during outbreaks, special events or gatherings, and natural disasters, and to provide advice about protective actions travelers can take to prevent infection or adverse health effects.
A THN can be posted for: 1) a disease outbreak (higher number of expected cases) in a country or region, 2) sporadic cases of a disease in an unusual or new geographic location, 3) natural and human-made disasters with severe environmental health risks, or infrastructure damage that would limit healthcare services availability, and 4) mass gathering events that can lead to disease outbreaks.
Types of notices
Level 4 – Avoid All Travel
Avoid travel to this destination unless traveling for humanitarian aid or emergency response; there is an extreme health risk for travelers and no available precautions.
Level 3 – Reconsider Nonessential Travel
Reconsider nonessential travel to this destination. The outbreak or event poses risk to travelers because limited precautions are available.
Level 2 – Practice Enhanced Precautions
Practice enhanced precautions for this destination. The Travel Health Notice describes additional precautions or defines a specific population at risk.
Level 1 – Practice Usual Precautions
Practice usual precautions for this destination, as described in the Travel Health Notice and/or on the destination page.
Yellow fever
The most recent and applicable news for international travelers, includes yellow fever in the African Region (Disease Outbreak News) and Nigeria (CDC Travel Health Notice). This travel notice for yellow fever is currently considered a Level 2– Practice Enhanced Precautions.
Current yellow fever key points:
- Yellow fever cases remain elevated in Nigeria, after an outbreak was first reported in November 2020.
- Yellow fever is caused by a virus transmitted through bites of infected mosquitoes.
- Travelers to Nigeria should take steps to prevent yellow fever by getting vaccinated at least 10 days before travel and taking steps to prevent mosquito bites.
- Since January 2023, several states in Nigeria have reported yellow fever cases (see map). Unless vaccinated, travelers should not visit these areas.
What does this mean for Michigan?
Multiple Michigan counties have a number of residences reporting an African birthplace, which may have a greater likelihood and interest in traveling to African nations. Correspondingly, the Michigan counties in Table 1 saw higher numbers of referrals during the recent Ebola outbreak in Uganda, as well as the Marburg outbreaks from United Republic of Tanzania and Equatorial Guinea. Healthcare providers are encouraged to discuss vaccine needs with residents planning travel to Nigeria and any other country with risk for Yellow Fever (see page).
Measles
Though currently only referenced as a Level 1, measles cases are continuing to increase globally, including in the United States. The majority of measles cases imported into the United States occur in unvaccinated U.S. residents who become infected during international travel. A list of countries with confirmed measles outbreaks can be found on the Global Measles Travel Health Notice (THN).
Recommendations for health professionals
Measles spreads rapidly in communities that are not fully vaccinated and may also pose a risk to international travelers in places not included in the THN. CDC recommends all travelers get fully vaccinated against measles before traveling to any international destination. Clinicians should vaccinate anyone 6 months or older traveling overseas who does not have written documentation of vaccination or other evidence of measles immunity. Local health departments may enhance outreach and communications to under-vaccinated communities through trusted messengers.
Recommendations for parents and international travelers
- Even if not traveling, ensure that children receive all recommended doses of MMR vaccine. Two doses of MMR vaccine provide better protection (97%) against measles than one dose (93%). Getting MMR vaccine is much safer than getting measles, mumps, or rubella.
- Anyone who is not protected against measles is at risk of getting infected when they travel internationally. Before international travel, check your destination and CDC’s Global Measles Travel Health Notice for more travel health advice, including where measles outbreaks have been reported.
- Parents traveling internationally with children should consult with their child’s healthcare provider to ensure that they are current with their MMR vaccinations at least 2 weeks before travel. Infants aged 6 to 11 months should have one documented dose and children aged 12 months and older should have two documented doses of MMR vaccine before international travel. Depending on where you are going and what activities you plan, other vaccines may be recommended too.
- After international travel, watch for signs and symptoms of measles for 3 weeks after returning to the United States. If you or your child gets sick with a rash and a high fever, call your healthcare provider. Tell them you traveled to another country and whether you or your child have received MMR vaccine.
Before you travel
Take steps to prepare so you can stay safe and healthy during your trip.
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Making sure you are up-to-date on all of your routine vaccines is important before traveling, especially internationally. Routine vaccinations protect you from infectious diseases, like measles, that can spread quickly in groups of unvaccinated people. Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries.
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Check the CDC’s destination pages for travel health information to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.
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Prepare a travel health kit with items you may need, especially those items that may be difficult to find at your destination. Include your prescriptions and over-the-counter medicines in your travel health kit and take enough to last your entire trip, plus extra in case of travel delays. Depending on your destination you may also want to pack a mask, insect repellent, sunscreen (SPF15 or higher), aloe, alcohol-based hand sanitizer, water disinfection tablets, and your health insurance card.
MDHHS Travelers Health team
The Michigan Department of Health and Human Services (MDHHS) Travelers Health (TH) Team organizes response and dissemination of information across the state for various travel-related diseases. Their subject matter expertise ensures prompt and thorough response to incidences of airline exposures as well as domestic and international exposures through coordination with the Detroit Port Health Station and Division of Global Migration Health. For further information or travel-related questions, please reach out to the TH Team at MDHHS-TravelersHealth@michigan.gov.
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