(Australia, Bermuda, Canada, Greenland, New Zealand, Saint Pierre and Miquelon and the United States of America (with Hawaii))

3.2.1  Disease risks

Communicable diseases are unlikely to prove a hazard greater than that found in the UK.

Malaria is not endemic in these areas.

Other arthropod-borne diseases (see Chapter 7) include various strains of viral encephalitis in some rural areas of Australia (eg Ross River fever) and USA (eg West Nile Virus, St Louis encephalitis).

•   Japanese encephalitis confined to islands of Torres Strait and sporadic cases at Cape York Peninsula.

•   Lyme disease is endemic in north-eastern, mid-Atlantic and upper Midwest USA, with occasional cases reported from the Pacific north-west.

•   Rocky Mountain spotted fever and tularaemia occur occasionally in N America.

•   Dengue fever has occurred in northern Australia in recent years; it is endemic in Hawaii and has occurred in South USA.

•   Plague in USA.

•   Tick-borne relapsing fever in west USA and west Canada.

•   Tick and scrub typhus in Queensland, Australia.

Diseases of close association:

•   Poliomyelitis has been eliminated in the Americas, Australia and New Zealand.

•   Tuberculosis predominantly in certain high risk groups (as in the UK).

Sexually transmitted and blood-borne infections:

•   Hepatitis B highly prevalent in certain indigenous groups in N. Canada, Alaska, Greenland, Australia and New Zealand.

•   HIV predominantly in high risk groups.

Other hazards could include:

In N. America - leptospirosis, hantavirus (mainly in the western states of the USA and SW provinces of Canada); rabies in wildlife (including bats); poisonous snakes; poison ivy, poison oak; very low temperatures in the north in winter.

In Australia and New Zealand - Corals and jelly fish and spines of poisonous fish during sea bathing; snakes and venomous spiders in Australia. Insectivorous and fruit-eating bats in Australia have been found to harbour a rabies-related virus. Heat in northern and central Australia.

3.2.2  Recommendations for immunisations and malaria chemoprophylaxis (see later chapters for general health precautions)

FOR ALL COUNTRIES Check routine immunisations including tetanus.

3.2.3  Country by country variations:

Australia

Yellow fever vaccination certificate required from travellers over one year of age entering Australia within six days of having stayed overnight or longer in an infected country, as listed in the WHO Weekly Epidemiological Record.

Japanese encephalitis - consider vaccination only for those going to live or work in Torres Strait Islands.

USA

Proof of immunisation against diphtheria, measles, poliomyelitis and rubella is now universally required for entry into school. Schools in most states also require proof of immunisation against tetanus (49 states), pertussis (44 states), mumps (43 states) and hepatitis B (26 states). Some universities and schools may ask for varicella immunisation.