Health Information for Travelers to Mali Updated November 2012

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Health Information for Travelers to Mali

On this Page

• Travel Notices in Effect
• Safety and Security Abroad
• Preparing for Your Trip to Mali
• Other Diseases Found in West Africa
• Staying Healthy During Your Trip
• After You Return Home

Travel Notices in Effect

• Update: Dengue in Tropical and Subtropical RegionsNovember 27, 2012
• Update on the Global Status of PolioNovember 19, 2012
• Measles UpdateSeptember 21, 2012
• Meningococcal Disease and Travel to AfricaJuly 14, 2010

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Safety and Security Abroad

• Registration of Traveler Emergency Contact and Itinerary InformationJanuary 13, 2011
• Transportation Security Administration
• U.S. Department of State

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Preparing for Your Trip to Mali

Before visiting Mali, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)
To have the most benefit, see a health-care provider at least 4?6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.
Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.
CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.
If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.
Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.
Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.
Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.
Vaccine-Preventable Diseases

Vaccine recommendations are based on the best available risk information. Please note that the level of risk for vaccine-preventable diseases can change at any time.
<table><thead><tr> <th scope="col">Vaccination or Disease</th> <th scope="col">Recommendations or Requirements for Vaccine-Preventable Diseases</th> </tr></thead><tbody><tr><td scope="row">Routine </td><td> Recommended if you are not up-to-date with routine shots, such as measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc.
</td></tr><tr><td scope="row">Hepatitis A or immune globulin (IG)</td><td> Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors.
</td></tr><tr><td scope="row">Hepatitis B </td><td> Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map), especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
</td></tr><tr><td scope="row">Typhoid </td><td>Recommended for all unvaccinated people traveling to or working in West Africa, especially if staying with friends or relatives or visiting smaller cities, villages, or rural areas where exposure might occur through food or water.</td></tr><tr><td scope="row">Polio </td><td>Recommended for adult travelers who have received a primary series with either inactivated poliovirus vaccine (IPV) or oral polio vaccine (OPV). They should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.
</td></tr><tr><td scope="row">Yellow Fever </td><td> Requirements: Required upon arrival from all countries and ≥1 year of age.
Recommendations:
Recommended for all travelers ≥9 months of age going to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-18).
Vaccination should be given 10 days before travel and at 10-year intervals if there is on-going risk. Find an authorized U.S. yellow fever vaccination clinic.
</td></tr><tr><td scope="row">Meningococcal (meningitis) </td><td> Recommended if you plan to visit countries that experience epidemics of meningococcal disease during December through June (see map).
</td></tr><tr><td scope="row">Rabies </td><td>Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking. Also recommended for travelers with significant occupational risks (such as veterinarians), for long-term travelers and expatriates living in areas with a significant risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats, carnivores, and other mammals. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. </td></tr></tbody></table>
Malaria

Areas of Mali with Malaria: All (more information)
If you will be visiting an area of Mali with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:

• Taking a prescription antimalarial drug
• Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
• Sleeping in air-conditioned or well-screened rooms or using bednets

All of the following antimalarial drugs are equal options for preventing malaria in Mali: Atovaquone-proguanil, doxycycline, or mefloquine. For detailed information about each of these drugs, see Table 3-11: Drugs used in the prophylaxis of malaria. For information that can help you and your doctor decide which of these drugs would be best for you, please see Choosing a Drug to Prevent Malaria.
Note: Chloroquine is NOT an effective antimalarial drug in Mali and should not be taken to prevent malaria in this region.
To find out more information on malaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, cities, and place names for more specific malaria risk information and the recommended prevention medicines for that area.


Malaria Contact for Health-Care Providers
For assistance with the diagnosis or management of suspected cases of malaria, call the CDC Malaria Hotline: 770-488-7788 or toll-free 1-855-856-4713 (M-F, 9 am-5 pm, Eastern time). For clinicians needing emergency consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician.
A Special Note about Antimalarial Drugs
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.


More Information About 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. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).
Travelers to malaria risk-areas in Mali, including infants, children, and former residents of Mali, should take one of the antimalarial drugs listed in the box above.
Symptoms

Malaria symptoms may include

• fever
• chills
• sweats
• headache
• body aches
• nausea and vomiting
• fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
Items to Bring With You

Medicines you may need:

• The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
• Antimalarial drugs, if traveling to a malaria-risk area in Mali and prescribed by your doctor.
• Medicine for diarrhea, usually over-the-counter.

Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.
Other items you may need:

• Iodine tablets and portable water filters to purify water if bottled water is not available. See A Guide to Water Filters, A Guide to Commercially-Bottled Water and Other Beverages, and Safe Food and Water for more detailed information.
• Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Basic Information about Skin Cancer for more information.
• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
• To prevent insect/mosquito bites, bring:
  • Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
  
  

See other suggested over-the-counter medications and first aid items for a travelers' health kit.
Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.
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Other Diseases Found in West Africa
Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies.

The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available.
Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects that also occur in West Africa. African trypanosomiasis (African sleeping sickness) has increased in Africa (it is epidemic in Angola, Democratic Republic of the Congo, and the Sudan; and highly endemic in Cameroon, Central African Republic, Chad, Congo, C?te d'Ivoire, Guinea, Mozambique, Uganda, and Tanzania; low levels are found in most of the other countries), and an increase in travelers has been noted since 2000. Most had exposures in Tanzania and Kenya, reflecting common tourist routes. Protecting yourself against insect bites will help to prevent these diseases.
Schistosomiasis, a parasitic infection, can be contracted in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries.

Polio outbreaks were reported in several previously polio-free countries in Central, Eastern, and Western Africa beginning in 2003. Polio is still endemic in Nigeria.
Travelers to rural areas of West Africa may be exposed to Lassa virus, which is spread through contact with rat urine or droppings. People can be exposed to Lassa virus by inhaling tiny particles of these excretions in the air, especially if they stay in traditional dwellings. Travelers should avoid contact with rats and should not stay in dwellings that may be infested with rats. Human-to-human transmission of the disease has been described. Proper safety precautions should be followed to prevent human-to-human transmission from infected people.
Highly pathogenic avian influenza (H5N1) has been found in poultry populations in several countries in Africa. Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds, and avoid places such as poultry farms and bird markets where live birds are raised or kept. For a current list of countries reporting outbreaks of H5N1 among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE), and for total numbers of confirmed human cases of H5N1 virus by country see the World Health Organization (WHO) Avian Influenza website.
Many countries in this region have high incidence rates of tuberculosis and high HIV prevalence rates.

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Staying Healthy During Your Trip

Prevent Insect Bites

Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:

• Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
• Wearing long-sleeved shirts, long pants, and a hat outdoors.
• Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
• Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
• Spraying rooms with products effective against flying insects, such as those containing pyrethroid.

For detailed information about insect repellent use, see Insect and Arthropod Protection.
Prevent Animal Bites and Scratches

Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.

• Be sure you are up to date with tetanus vaccination.
• Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
• Help children stay safe by supervising them carefully around all animals.
• If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away.
• After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.

For more information about rabies and travel, see the Rabies chapter of the Yellow Book or CDC's Rabies homepage. For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards.
Be Careful about Food and Water

Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:

• Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
• Do not eat food purchased from street vendors.
• Make sure food is fully cooked.
• Avoid dairy products, unless you know they have been pasteurized.

Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.
Avoid Injuries

Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:

• Not drinking and driving.
• Wearing your seat belt and using car seats or booster seats in the backseat for children.
• Following local traffic laws.
• Wearing helmets when you ride bikes, motorcycles, and motor bikes.
• Not getting on an overloaded bus or mini-bus.
• Hiring a local driver, when possible.
• Avoiding night driving.

Other Health Tips

• To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections.
• To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, especially on beaches where animals may have defecated.

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After You Return Home

If you are not feeling well, you should see your doctor and mention that you have recently traveled. Also tell your doctor if you were bitten or scratched by an animal while traveling.
If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (doxycycline or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.
Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.
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Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.

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• Page created: September 21, 2012
• Page last updated: November 27, 2012

http://wwwnc.cdc.gov/travel/destinations/mali.htm

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Re: Health Information for Travelers to Mali Updated November 2012

Travel Warning
U.S. DEPARTMENT OF STATE
Bureau of Consular Affairs

Mali

January 18, 2013

The U.S. Department of State warns U.S. citizens against all travel to Mali because of ongoing fighting in northern and central Mali, fluid political conditions, the loss of government control of Mali?s Northern provinces, and continuing threats of attacks and kidnappings of westerners. While the security situation in Bamako remains relatively stable, the recent escalation of hostilities around Mopti in northern Mali has heightened tensions throughout the country. Mali continues to face challenges including food shortages, internally displaced persons, and the presence in northern Mali of factions linked to ******** in the Islamic Maghreb (AQIM). On January 18, the Department of State ordered the departure of all dependent family members who are not employed at the U.S. Embassy in Bamako, Mali, for a period of up to 30 days. This Travel Warning replaces the Travel Warning for Mali dated January 16, 2013.

The Malian government has banned all public demonstrations and Interim President Dioncounda Traore declared a State of Emergency effective January 12. The state of emergency, which will last for 10 days with a possibility for extension, enables the government to take extraordinary measures to deal with the crisis in the north. As a result of safety and security concerns, some organizations, including foreign companies, NGOs, and private aid organizations, have temporarily suspended operations in Mali or withdrawn some family members and/or staff. The U.S. Embassy will continue to monitor this situation closely and update U.S. citizens via Emergency Messages which it will post on the U.S. Embassy Bamako website.

Embassy Bamako instructed embassy employees to be cautious when traveling within Bamako, and encourages U.S. citizens to exercise caution, remain vigilant, maintain situational awareness at all times, and take appropriate security precautions to ensure personal safety. The Embassy strongly advises against any travel in the Segou region due to increased troop movement and the potential for checkpoints and military activity. U.S. citizens throughout Mali should develop personal contingency plans, avoid all unnecessary travel, and travel on main roads. Malian security forces are likely to increase their security safeguards, including checkpoints and other controls on movement in Bamako and around the country.

The Government of Mali may periodically impose or lift curfews as security needs may dictate. U.S. citizens should be mindful of such potential measures, stay attuned to local news announcing such curfews, and comply with such locally imposed curfews. The U.S. Embassy for internal safety and security reasons may also, without advanced notice, periodically impose temporary curfew on U.S. Embassy employees. Where possible such restrictions will be shared with the private U.S. citizen community and posted on the Embassy?s website. U.S. citizens should carefully consider adopting similar safety measures by limiting any unnecessary travel or movements during such periods of heightened tension.

Northern Mali remains under the control of Ansar al-Dine, the Movement for Oneness and Jihad in West Africa (MUJAO), and other groups. The National Movement for the Liberation of Azawad (MNLA) was allied with Ansar al-Dine and shared control over Gao, Timbuktu, and Kidal. During June and July of 2012, Ansar al-Dine and MUJAO, aided by AQIM, turned on the MNLA, ejecting it from major cities and seizing control over the north. Islamists destroyed ancient tombs in Timbuktu and implemented sharia law in the cities they hold. On November 20, 2012, a French citizen was kidnapped by MUJAO from Diema, Koulikoro region, and terrorist groups have stepped up their rhetoric calling for additional attacks or kidnapping attempts on Westerners, particularly those linked to support for international military intervention.

On January 10, Islamic extremist elements took the central town of Konna , but were driven out after French military intervention and heavy fighting. Supplies and troops are being continually transported via convoys on main roads throughout the country as the fighting continues. While the situation currently remains calm in Bamako, events in the north have heightened tensions throughout the country.

U.S. citizens should also note that the Embassy has forbidden all travel by U.S. government employees and their dependents to regions north of the city of Mopti. This designation is based on insecurity in areas adjacent to this area, including the presence of AQIM and the threat of kidnapping, as well as banditry in the region. U.S. citizens planning to travel to Mali, particularly to destinations outside of Bamako, should consult the Embassy or your host organization(s) for the most recent security assessment of the areas where you plan to travel.

Senou International Airport in Bamako is currently open for business and scheduled flights are proceeding normally. Some international flights have occasionally been canceled due to low travel volume, but travelers have been notified in advance. Persons wishing to depart the country should check with commercial airlines for the airport?s operational status, and flight and seat availability, before traveling to the airport.

In this period of heightened tension, the U.S. Embassy reminds all U.S. citizens of the risk of terrorist activity in Mali, including in Bamako. U.S. citizens are urged to exercise caution, to be particularly alert to their surroundings, and to avoid crowds, demonstrations, or any other form of public gathering. U.S. citizens are further encouraged to exercise prudence if choosing to visit locations frequented by Westerners in and around Bamako.

The U.S. Embassy in Bamako may close temporarily for non-emergency business from time to time to review its security posture. U.S. citizens currently in Mali, despite this Travel Warning, should enroll in the State Department?s Smart Traveler Enrollment Program (STEP). By enrolling, the U.S. embassy can contact you in case of emergency.

U.S. citizens should consult the Country Specific Information for Mali and the Worldwide Caution, both located on the Department of State?s Bureau of Consular Affairs website. Current information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or a regular toll line at 1-202-501-4444 from other countries. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

Stay up to date by bookmarking our Bureau of Consular Affairs website, which contains the current Travel Warnings and Travel Alerts as well as the Worldwide Caution. Follow us on Twitter and the Bureau of Consular Affairs page on Facebook as well. You can also download our free Smart Traveler App, available through iTunes and the Android market, to have travel information at your fingertips.

The U.S. Embassy in Bamako is located in ACI 2000 at Rue 243, Porte 297. The Embassy?s mailing address is B.P. 34, Bamako, Mali. The telephone number, including for after-hour emergencies, is 223 2070-2300. The consular fax number is 223 2070-2340.http://travel.state.gov/travel/cis_p...w/tw_5858.html