Read below for travel health advice on Bangladesh from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Bangladesh will need vaccinations for hepatitis A, typhoid fever, and polio, as well as medications for malaria prophylaxis and travelers' diarrhea. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Insect repellents are recommended, in conjunction with other measures to prevent mosquito bites. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.
Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas except the city of Dhaka.
|Hepatitis A||Recommended for all travelers|
|Typhoid||Recommended for all travelers|
|Polio||One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult|
|Yellow fever||Required for all travelers greater than one year of age arriving from or transiting through a yellow-fever-infected area in Africa or the Americas. Not recommended otherwise.|
|Japanese encephalitis||For travelers who may spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors in rural areas, especially after dusk|
|Hepatitis B||Recommended for all travelers|
|Rabies||For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats|
|Measles, mumps, rubella (MMR)||Two doses recommended for all travelers born after 1956, if not previously given|
|Tetanus-diphtheria||Revaccination recommended every 10 years|
Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.
Malaria in Bangladesh: prophylaxis is recommended for all areas except the city of Dhaka. Malaria epidemics occur especially in the northeast and southeast parts of the country. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
Insect protection measures are essential.
For further information concerning malaria in Bangladesh, go to Roll Back Malaria.
The following are the recommended vaccinations for Bangladesh:
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.
Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.
Polio vaccine is recommended, because of the persistence of polio in Bangladesh. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.
Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening. There are few data, but the disease is probably widespread. An outbreak has been reported from Tangail district, Dacca division. Sporadic cases are reported in Rajshahi division. Transmission is possibly from July to December, as in northern India.
The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months.
Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Cholera vaccine is not generally recommended, even though cholera is reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan, Togo, Uganda, Tanzania, Zambia.
America: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, Venezuela.
Any person (including infants) arriving by air or sea without a certificate within 6 days of departure from or transit through an infected area will be quarantined for up to 6 days.
Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Anyone (except infants up to six months of age) arriving without a certificate is detained in isolation for up to six days.
Yellow fever vaccine is not recommended or required for those arriving directly from the North America, Europe, or other Asian countries. In general, yellow fever vaccine should not be given to children less than 9 months of age, pregnant women, immunocompromised individuals, or those allergic to eggs.
A resurgence of Nipah virus infections was reported from Bangladesh in early 2013, causing 24 cases, all but two of them fatal, by April. Cases were reported from 13 different districts. Most were associated with consumption of raw date palm sap. In January 2012, a Nipah virus outbreak was reported from Jaipurhat, killing six people. In January 2011, an ourbreak occurred in Lalmonirhat and Rangpur, killing 35 people as of February. At around the same time, an outbreak was reported from Faridpur and Rajbari districts, killing four people. A number of Nipah virus outbreaks have been reported from Bangladesh over the past few years, chiefly in the western part of the country. The largest occurred in the Faridpur district in March-April 2004, resulting in 36 cases and 27 deaths. Other outbreaks occurred in Meherpur in April-May 2001, Naogaon in January 2003, Faridpur in March-April 2004, Tangail in January 2005, Kushtia in April 2007, Manikganj and Rajbari districts (Dhaka Division) in February 2008 (nine fatalities), and Faridpur district (Dhaka division) in January 2010 (3 fatal cases).
Nipah virus infections begin with flu-like symptoms, including high fevers and muscle pains, which may be followed by inflammation of the brain (encephalitis), resulting in drowsiness, disorientation, convulsions, coma, and death. In most cases, the disease is acquired by close contact with contaminated tissue or body fluids from infected animals, but there is evidence that the virus may also be transmitted from person-to-person. A recent study suggested that some of the recent outbreaks in Bangladesh were caused by consumption of fresh date palm sap, a local sweet delicacy, which had been contaminated by fruit bats. Travelers should avoid eating fruit on which bats might have been feeding or drinking fruit juice possibly contaminated by bats. See the World Health Organization and ProMED-mail for further information.
An outbreak of dengue fever was reported from Dhaka in August 2011, causing more than 400 cases. A dengue outbreak between August and October, 2009, caused more than 300 cases. Previous dengue outbreaks occurred in the summers of 2000, 2002, 2004, and 2006, chiefly affecting Dhaka (see ProMED-mail and NATHNAC). In the year 2000 outbreak, three travelers from the United States were infected, one of whom died. Dengue fever is a flu-like illness which may be complicated by hemorrhage or shock. The infection is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are essential, as outlined below.
For further information on dengue fever in Bangladesh, go to the Bangladesh Dengue Website and SDNP Bangladesh.
An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, was reported from Bangladesh in November 2011, causing 46 cases (see ProMED-mail). Cases were reported from Dhaka in April 2014. Symptoms of chikungunya fever include fever, joint pains, muscle aches, headache, and rash. The disease is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites.
An outbreak of cutaneous anthrax was reported from Bangladesh in August 2010, causing more than 600 cases by October. The outbreak appeared to have been spread by infected buffalo, cattle, and goats. Smaller outbreaks are frequently reported from Bangladesh. In May 2013, a small outbreak occurred in Tangail Sadar upazila. In June 2012, an outbreak was reported from Panchil and Ultadab villages in Sirajganj district, causing 67 cases. In August 2011, a total of 16 cases were reported from Khirshin Tikar village under Paba sub-district of northwestern Rajshahi district. In July 2011, a total of 39 human cases were reported from Meherpur district. In May and June 2011, dozens of anthrax cases were reported from Sirajganj and Pabna districts. In August 2009, an anthrax outbreak occurred in Pabna village, Rajshahi Division (see ProMED-mail). Anthrax generally occurs in those who have direct contact with infected farm animals or who consume infected meat. Most travelers are at low risk.
A cholera outbreak was reported from the Dhaka district in March 2010, causing more than 1000 cases. The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.
An outbreak of meningococcal meningitis was reported in February 2009 from the Chittagong Hill Tracts in Bangladesh. The outbreak appeared to have spread from Mizoram State in India, which borders Bangladesh. Meningococcal infections are spread person-to-person by exposure to secretions from the nose or throat, and may lead to meningitis, marked by the abrupt onset of fever, headache, stiff neck, and lethargy, frequently with a rash. Meningococcal vaccine is recommended for travelers to the Chittagong Hill Tracts.
The first human case of avian influenza ("bird flu") was reported from Bangladesh in May 2008. A second was reported in a 16-month-old girl from Kamalapur, Dhaka, in March 2011. A third was reported in a 2-year-old boy from Kamalapur, Dhaka, in April 2011. Three cases were reported in March 2012 from Dhaka City. None of the human cases in Bangladesh were fatal. Poultry outbreaks were first reported in March 2007 from central and northern Bangladesh. Fresh outbreaks were reported from the northern part of the country in November 2007 and spread to other areas, ultimately affecting 47 out of Bangladesh's 64 districts. This wave of outbreaks appeared to end by May 2008, but fresh outbreaks appeared across the country in March 2009. Additional poultry outbreaks were reported from Narayanganj district and Kishoreganj district in January 2011 and from Gazipur and Noakhali in March 2011.
Most travelers are at extremely low risk for avian influenza, since almost all human cases have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Bangladesh should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
A total of 17 cases of polio were reported for the year 2006, representing the first cases of polio in Bangladesh since August 2000. The infections were believed to be imported from neighboring India. The government responded by initiating a nationwide polio immunization campaign. See the World Health Organization for further information. A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult. Children should be fully immunized against polio before traveling to Bangladesh.
A malaria outbreak was reported in the summer of 2002 from the hill districts of Bandarban, Rangamati and Khagrachari in eastern Bangladesh. More than 50,000 people were affected. See The Lancet Infectious Diseases for further information.
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
Food and water precautions
Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.
All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Surface waters in Bangladesh may be heavily contaminated with human waste, and well water in much of central and southern Bangladesh may contain arsenic.
Insect and Tick Protection
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
Ambulance and Emergency Services
Emergency services are extremely limited. The Apollo Hospital, which recently opened in Dhaka (emergency tel. 880 2 9896623), plans to develop an ambulance service.
Medical care in Bangladesh is extremely limited, even in tourist areas. Probably the best facilities are the Apollo Hospital (81, Block: E, Bashundhara R/A, Dhaka 1229; emergency tel. 880 2 9896623, 88 01714090000, 88 01911555555; website http://www.apollodhaka.com; includes 24-hour emergency room; part of a large hospital chain based in India), and SQUARE Hospital (18/F West Panthapath, Dhaka - 1205; ER tel. 8144466, 8144477, 8144488, ER Mobiletel. 01713377773-5, tel. 8159457 (10 Numbers), 8142431 (10 Numbers), 8141522(10 Numbers), 8144400(10 Numbers), 8142333(10 Numbers), Operator Help -9; website http://www.squarehospital.com/index.htm; affiliate partner of Methodist Healthcare, Memphis, Tennessee, USA). For a list of other physicians and dentists in Bangladesh, go to the U.S. Embassy website at http://dhaka.usembassy.gov/medical_assistance.html. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a city with state-of-the-art medical facilities, usually Bangkok or Singapore.
Many pharmacies are unlicensed. Counterfeit medications are widely distributed, though medications from major pharmacies and hospitals are generally reliable. Long-term visitors should try to obtain their medications over the Internet or by mail rather than buying them locally.
The blood supply is not adequately screened for HIV and other blood-borne pathogens. Transfusions should be avoided if at all possible.
Traveling with children
Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.
When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.
Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.
Travel and pregnancy
International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.
Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary (see the U.S. Embassy website). In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.
Pregnant women should avoid visiting areas outside Dhaka City because of the risk of malaria. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.
Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.
Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Americans living in or visiting Bangladesh are encouraged to register at the Consular Section of the U.S. Embassy in Dhaka where they may also obtain updated information on travel and security within Bangladesh. The U.S. Embassy is located some four miles south of Zia International Airport, and five miles north of downtown in the Diplomatic Enclave, Madani Avenue, Baridhara, Dhaka, telephone (880-2) 885-5500, fax number (880-2) 882-3744. The work week is Sunday - Thursday. The Consular Section is open for American citizens services Sunday through Thursday from 1:00 to 4:00 p.m. For emergency services during business hours, please call (880-2) 882-3805. For emergency services after hours, please call (880-2) 885-5500 and ask for the duty officer. The Embassy's Internet home page is http://dhaka.usembassy.gov/.
For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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