Anyone considering travel to tsunami-affected areas should first seek advice from a health care professional or travel clinic to determine individual health risks and to obtain information about vaccination, preventative medication and personal protective measures. Travel medicine services are not covered by OHIP.

The following information is based on Health Canada's Travel Medicine Web site, the National Immunization Guide, 2002 and U.S. Centers for Disease Control (CDC) Traveler's Health Web site.

Ensure vaccinations for young travelers are up-to-date, including :

• Diphtheria, polio, tetanus
• pertussis (whooping cough)
• measles, mumps, rubella (German measles)
• haemophilus b (for infants)
• hepatitis B (school age children in Grade 7 and high risk groups)
• influenza

For all of the above vaccinations, protective immunity develops within two to four weeks, except if the person needs a series of shots, for example, hepatitis B.

All travellers to South East Asia must ensure that their Diphtheria and Tetanus booster vaccinations are up-to-date. Booster vaccinations are needed every 10 years. Boosting of immunity takes maximum effect in two weeks.

For adults who have never received hepatitis B vaccine, vaccination is strongly recommended. For maximum protection three hepatitis B shots are required. After the first shot, protection is about 30-55 per cent. After full vaccination, following a recommended schedule, protection has been shown to last for at least 15 years.

Vaccination against influenza should be considered for travellers at high risk for influenza complications and for those traveling to Thailand where human cases of avian influenza have occurred. Protective immunity develops two weeks after influenza vaccine is given; efficacy is 70-90 per cent against strains included in the vaccine. Protection usually lasts less than one year, influenza vaccination is needed annually.

Typhoid and Hepatitis A vaccinations are a minimum requirement for all travellers to the tsunami-affected areas.

Immunization to prevent typhoid is recommended as a result of the current poor sanitary conditions. Typhoid vaccine does not necessarily grant complete protection against the disease  :

• injectable typhoid vaccine (preferred option) : 60-70%
• oral vaccine : 51%

Typhoid vaccine does not provide protection against all strains of typhoid. Protective immunity develops in about two weeks after a typhoid vaccine is given. Immunity is thought to last approximately two to three years.

Immunization to prevent Hepatitis A is recommended. To provide full immunity, a second dose is needed six to 12 months after the first vaccine is given. A single dose has a protective efficacy of about 95 per cent.

Protective immunity develops within three weeks after the Hepatitis A vaccine is given. The first dose of vaccine usually provides protection even when the exposure to the illness occurs right before (or immediately after) the shot was given. After full immunization, duration of protection is at least 20 years.

People who have not had Hepatitis B shots may be immunized with a combination vaccine that protects against both Hepatitis A and B (e.g., Twinrix).

For malaria in India, Indonesia and Sri Lanka the recommended preventative medication is (in alphabetical order) atovoquone/proguanil; doxycycline or mefloquine. These medications are for chloroquine-resistant areas.

In Thailand, travellers require Doxycycline or atovaquone/proguanil for overnight exposure in rural areas on the border with Myanmar and Cambodia. Protection is provided a couple of hours after medication has been started. Volunteers or people traveling to tsunami affected areas of Thailand should take malaria prophylaxis due to the risk of increased mosquito populations in the affected areas.

Taking Doxycycline for malaria will also protect against leptospirosis.

Mosquito protection is essential for travellers; include insect repellent containing DEET in your travel kit.

Based on your individual risk assessment, a health care professional can determine your need for any additional immunization and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease.

The actual immunizations you may require will vary according to your age, health, and any pre-existing medical conditions, as well as the nature of your travel, and whether you will be staying in urban or rural areas.

The risk of acquiring cholera is very low if food and water precautions are observed. Cholera vaccine is recommended only if cases or outbreaks are reported in your travel area.

Exposure to animal bites, especially dogs, pose a risk for rabies in all the tsunami-affected areas. Rabies pre-exposure vaccine is recommended if you might be exposed to animals. Rodents, snakes and other animals may also pose a greater risk in the aftermath of a tsunami and other natural disasters.

Japanese encephalitis vaccine could be considered if you will be in endemic areas or if cases are being reported from the area you are planning to visit.

Travelers should carry a travel health kit that includes any medications you are taking as well as additional supplies of these medications in case they are unavailable at the destination. Include anti-diarrheals for self-treatment of most causes of acute bacterial illness; insect repellent containing DEET; mosquito netting, and an ample supply of antimalarial medication along with additional emergency supplies. Carry a sufficient supply of food (canned and processed may be safest in some areas) and water, or means of water purification. Always carry a supply of alcohol-based hand rubs in case you do not have access to clean water and soap for hand washing.

Consult your health care provider or travel clinic for further advice.

Always carry passports and travel documents in a water-tight packet and ensure a family member/friend has copies of your passport and other travel documents, as well as details of your travel plans and how to contact you. Make arrangements to check in with family/friends at specific intervals.

Returning travellers should seek health care in the event of fever, rash, respiratory illness or any other unusual symptoms. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home ,(especially within the first two months of return), seek immediate medical attention and tell the physician your travel history.

Further travel health information is available at the Health Canada Travel Medicine Web site.

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