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) (PDF) 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.

The following are the recommended vaccinations for major cities in China:

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.

Certain lots of VAQTA were recalled in December 2001 because some prefilled syringes were found not to contain enough antigen. Those who received VAQTA between August 1999 and December 2001 should go to hepatitis A to determine whether or not they may require reimmunization.

Travelers who are less than one year of age, are pregnant, or have less than two weeks before departure should receive a single intramuscular dose of gammaglobulin (see hepatitis A for dosage) instead of vaccine.

Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers. 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.

Meningococcal vaccine is recommended for all travelers to Anhui Province, due to a recent outbreak there (see "Recent outbreaks" below). Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.

All travelers should be up-to-date on routine immunizations, including

• Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.)
• Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.)
• Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. 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. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

An outbreak of meningococcal disease was reported in January 2005 from 11 cities in Anhui Province in eastern China. Most cases occurred in students 13-18 years of age. Meningococcal vaccine (Menomune - A/C/Y/W-135; Aventis Pasteur Inc.) is recommended for all travelers to Anhui Province. For details, go to the Centers for Disease Control.

Outbreaks of H5N1 avian influenza ("bird flu") were reported in January-February 2004 from poultry farms in many parts of the country. Suspected or confirmed cases were described in the provinces of Guangxi, Hunan, Hubei, Gansu, Shaanxi, Anhui, Shanghai, Guangdong, Zhejiang, Yunnan, Henan, Jiangxi, and Xinjiang Uygar Autonomous Region. New poultry outbreaks were reported in July 2004, as well as cases of avian influenza occurring in pigs in August 2004. No human cases have been reported from China to date.

Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries 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 does not advise against travel to China, but recommends 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 China should seek immediate medical attention, which may include testing for avian influenza. It is not recommended that travelers bring along an antiviral medication, such as Tamiflu, or treat themselves. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

A fresh outbreak of severe acute respiratory syndrome (SARS) was reported from China in April 2004, resulting in nine new cases (seven in Beijing and two in Anhui Province) before the outbreak was declared over in May. Two of those affected were laboratory workers who had been performing research on the SARS virus at the National Institute of Virology. All the others either had close contact with one of the laboratory workers or with a nurse who became ill after caring for one of the researchers. The National Institute of Virology has been closed. No travel restrictions are recommended for China at this time. For further information, go to the World Health Organization.

The initial SARS outbreak began in Guangdong province in November 2002 and ultimately spread to many other areas, resulting in 5327 cases and 349 deaths before the outbreak was terminated in July 2003 by an aggressive program of contact identification and quarantine. In December 2003, a new case of SARS was reported from Guangdong province, followed in January 2004 by three more cases. All contacts of these patients were promptly quarantined and remained disease-free. No further cases were reported until April 2004, as described above.

The disease appears to be caused by a previously unknown virus belonging to the coronavirus family. The incubation period usually ranges from two-to-seven days, but may be as long as ten days. The first symptom is usually fever, often accompanied by chills, headache, body aches, and malaise. This is typically followed by dry cough and difficulty breathing, at times severe enough to require intubation and mechanical ventilation. The most recent analysis indicates that the overall fatality rate is approximately 15%, ranging from less than 1% in those younger than 25 years old to greater than 50% in those aged 65 years or older.

For the time being, anyone who develops pneumonia or fever after travel to mainland China or Taiwan, or after close contact with someone who developed fever or pneumonia after visiting one of these areas, should be placed in strict respiratory isolation with barrier precautions and reported promptly to public health authorities. Those who travel to SARS-affected areas should be aware that, if they develop symptoms compatible with SARS while abroad, a variety of logistical issues may make it impossible to arrange medical evacuation. For further information, go to the SARS pages of the World Health Organization, the Centers for Disease Control, and Health Canada.

An outbreak of measles was reported in April 2004 among children in the United States and Norway who had been adopted in China. A total of 14 cases (ten in the United States and four in Norway) were identified before the outbreak ended. The cases were all traced to a single orphanage, the Zhuzhou Child Welfare Institute in Hunan Province, where a measles outbreak was in progress. On June 2, 2004, the Centers for Disease Control announced that the measles outbreak had been terminated and that adoptions from the orphanage could be resumed. See the Centers for Disease Control for further information. All those who are traveling abroad to adopt children should make sure they have had two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1956, who are presumed to be immune to measles.

An epidemic of hand, foot and mouth disease complicated by meningitis, encephalitis and acute flaccid paralysis was reported among young children in Taiwan from April through July 1998. The outbreak appeared to be caused by an organism known as enterovirus 71. The illness may be prevented by avoiding public places and by frequent handwashing.

Dengue fever occurs in China, chiefly in the southern part of the country. Dengue is a flu-like illness, sometimes complicated by hemorrhage or shock, 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 advised, as outlined below.

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.

Other infections include

• Hepatitis E (western China; transmitted by contaminated food and water)
• Schistosomiasis (central Chang Jiang (Yangtze) river basin; swimming and bathing precautions advised, as below)
• Leptospirosis (animal reservoir includes mice, pigs, rats, buffalo, dogs, and cattle)

For further information regarding schistosomiasis and other parasitic infections in China, see Peter Hotez et al., Emerging and Reemerging Helminthiases and the Public Health of China (Emerging Infectious Diseases Vol.3/No.3 July-September 1997)

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, sea bass, and a large number of tropical reef fish.

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.

Wear long sleeves, long pants, hats and shoes (rather than sandals). 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 accomodation 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.

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

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.

For an online directory of physicians and medical facilities in China, go to the U.S. Embassy website. For an overview of health care in China, go to the World Health Organization - Western Pacific Region.

Western-style medical facilities with international staffs are available in Beijing, Shanghai, Guangzhou and a few other large cities. Many other hospitals in major Chinese cities have so-called VIP wards (gaogan bingfang). These feature reasonably up-to-date medical technology and physicians who are both knowledgeable and skilled. Most VIP wards also provide medical services to foreigners and have English-speaking doctors and nurses. Most hospitals in China will not accept medical insurance from the United States, with the exception of the following hospitals, which are on the BlueCross BlueShield worldwide network providers - overseas network hospitals(http://www.fepblue.org/wasite/wabenefits/wa-benefitsoverseas04.html): Hong Kong Adventist Hospital, Beijing United Family Hospital, Beijing Friendship Hospital, International Medical Center in Beijing, and Peking Union Medical Center. Travelers will be asked to post a deposit prior to admission to cover the expected cost of treatment. Hospitals in major cities may accept credit cards for payment. Even in the VIP/Foreigner wards of major hospitals, however, American patients have frequently encountered difficulty due to cultural and regulatory differences. Physicians and hospitals have sometimes refused to supply American patients with complete copies of their Chinese hospital medical records, including laboratory test results, scans, and x-rays. All Americans traveling to China are strongly encouraged to buy foreign medical care and medical evacuation insurance prior to arrival. Travelers who want a list of modern medical facilities in China can access that information at the Embassy's website. Ambulances do not carry sophisticated medical equipment, and ambulance personnel generally have little or no medical training. Therefore, injured or seriously ill Americans may be required to take taxis or other immediately available vehicles to the nearest major hospital rather than waiting for ambulances to arrive. In rural areas, only rudimentary medical facilities are generally available. Medical personnel in rural areas are often poorly trained, have little medical equipment or availability to medications. Rural clinics are often reluctant to accept responsibility for treating foreigners, even in emergency situations.

Foreign-operated medical providers catering to expatriates and visitors are available in China.

SOS International, Ltd., operates modern medical and dental clinics and provides medical evacuation and medical escort services in Beijing, Nanjing, Tianjin and Shekou, as well as 24hr Alarm Centers in Beijing and Shanghai. Through clinics in Beijing (24 hours), Tianjin, Nanjing and Shekou, SOS offers international standard family practice services, emergency medical services and a range of clinical services.

The emergency assistance services SOS offers through alarm centers in Hong Kong, Shanghai and Beijing compliment their clinics. Each Alarm Center provides 24-hour hotline services to all our global members when they are in China. Any problem from lost luggage to a serious medical condition can be reported to the alarm center, where multilingual coordinators and doctors are on duty to respond to all manners of emergencies.

To provide these services, SOS has developed an external network of hospitals, airlines and local authorities with whom they work to deliver a fast and efficient response. These services also support the many remote site medical staff, equipment and facilities that SOS provides to clients.

For medical emergencies anywhere in mainland China, Americans can call the SOS International, Ltd., 24-hour Alarm Center in Beijing at telephone (86-10) 6462-9100 or in Shanghai at (86-21) 6295-0099 for advice and referrals to local facilities. SOS International Alarm Centers can also be contacted in Hong Kong at telephone (852) 2428-9900 and in the United States at (215) 245-4707. For a full list of SOS locations and phone numbers, consult the SOS website at http://www.internationalsos.com .

*Beijing United Family Hospital and Clinics ("BJU") is the first and remains the only foreign-invested full service international standard 50 bed hospital operating in Beijing, China. BJU was opened in 1997 by Chindex International, an American company, which in 2002 was awarded the US Secretary of State's Award for Corporate Excellence. BJU offers the full range of specialties including Family Practice, Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Dentistry, Psychiatry and Physiotherapy, in addition to a 24 hour Emergency Room staffed solely by Expatriate Staff Specialists. These Physicians are all board qualified (or equivalent) in their respective fields and include specialties such as Anesthesiology, and Intensive Care Medicine. Additionally, staff are fluent in not only English, but also a wide range of languages including French, German, Japanese, Spanish, Swedish, and Finnish to name a few.

Facilities include 2 Operating Theatres, international standard 5 star LDRP birthing suites, Neonatal ICU, a 4-bed Adult ICU, General Inpatient facilities, and standard support services such as Digital Radiology, Ambulance services, Pharmacy, Laboratory and a 24 hour on-site Blood Bank with emergency blood pre-screened to the American Blood Bank standard.

Bayley Jackson Beijing Medical Center #7 Ritan Dong Lu, Chaoyang District, Beijing 100020 ( 8610) 8562-9998 Fax: (8610) 8562-3497 email: info@bjhealthcare.com Website: www.bjhealthcare.com

World Link Shanghai Clinics. Expatriate doctors and imported vaccines.

Portman Clinic: Shanghai Center #203 W, 1376 Nanjing Xi Lu, 200040 Tel: 6279-7688. For appointments: 6279-8678 Fax: 6279-7698 Hong Qiao Clinic: Mandarin City Unit 30, 788 Hong Xu Lu, 201103 Tel: 6405-5788; Fax: 6405-3587

GlobalDoctor, Ltd., has opened clinics staffed by English-speaking doctors within the VIP wards of government-run hospitals in Chengdu, Nanjing, and Beijing. GlobalDoctor can be reached by telephone from China at 86-10-8456-9191 or on the Internet at http://www.eglobaldoctor.com/.

Additional information on medical providers specializing in treating foreigners for general medical, dental and orthodontic problems are available at http://www.usembassy-china.org.

The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and if it will cover emergency expenses such as a medical evacuation. U.S. medical insurance plans seldom cover health costs incurred outside the United States unless supplemental coverage is purchased. Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. However, many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency services such as medical evacuations.

When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the U.S. may cost well in excess of $50,000. Uninsured travelers who require medical care overseas often face extreme difficulties. When consulting with your insurer prior to your trip, ascertain whether payment will be made to the overseas healthcare provider or if you will be reimbursed later for expenses you incur. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.

Two private emergency medical assistance firms, SOS International, Ltd., and Medex Assistance Corporation, offer medical insurance policies designed for travelers. Both of these companies have staff in China who can assist in the event of a medical emergency.

SOS International, Ltd. Beijing Clinic address: Building C, BITIC Leasing Center No. 1 North Road, Xingfu Sancun, Sanlitun, Chaoyang District, Beijing 100027 Beijing SOS International Clinic, telephone: (86-10) 6462-9112, Fax (86-10) 6462-9111.

For medical emergencies, please telephone the SOS International Alarm Center at (86-10) 6462-9100 from anywhere in Mainland China. From Hong Kong: (852) 2528-9900. From the U.S.: 1-215-245-4707. These phone lines are answered 24 hours by SOS International Alarm Center personnel. For information on purchasing health or travel insurance from SOS International, please telephone (1-800) 523-8930 ( 8:30 a.m. to 4:30 p.m. Eastern Time, Monday through Friday) in the U.S. or visit http://www.intsos.com/ on the Internet or e-mail: china.marketing@internationalsos.com .

SOS members calling with a medical emergency should first telephone the Alarm Center in Beijing at (86-10)6462-9100.

MEDEX Assistance Corporation 871 Poly Plaza Beijing 100027 Toll Free Number from China to U.S.: 10811-800-527-0218 Email: info@medexassist.com (Baltimore, Maryland) U.S. telephone: (1-800) 537-2029 or (1-410) 453-6300 (24 hours) Emergencies (members only): (1-800) 527-0218 or (1-410) 453-6330 Web site: http://www.medexassist.com/

Medex members calling with a medical emergency should call Medex-Emergency in China at telephone (86-10) 6595-8510.

Other Evacuation Insurance Options:

Heathrow Air Ambulance Heathrow is an air evacuation service with offices in the United States and England. Travelers can pre-arrange air evacuation insurance and other emergency travel assistance. This service also has a business plan to assist foreigners who lack travel insurance. Heathrow Air Ambulance Service,

15554 FM, Suite 195 Houston, TX. 77095-2704. Office telephone 1-800-513-5192. Office fax 1-832-934-2395. E-mail: info@heathrowairambulance.com

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State's Bureau of Consular Affairs brochure, Medical Information for Americans Traveling Abroad, available via the Bureau of Consular Affairs home page.

Most roads and towns in Tibet, Qinghai, parts of Xinjiang, and western Sichuan are situated at altitudes over 10,000 feet. Travelers in these areas should seek medical advice in advance of travel, allow time for acclimatization to the high altitude, and remain alert to signs of altitude sickness. Reuse or poor sterilization practices are problems in China, contributing to transmission of diseases such as Hepatitis, which is endemic in China. In order to protect themselves from blood and other tissue borne disease such as Hepatitis and HIV, travelers should always ask doctors and dentists to use sterilized equipment and be prepared to pay for new syringe needles in hospitals or clinics. Tuberculosis is endemic in China. Air pollution is also a significant problem throughout China. Travelers should consult their doctor prior to travel and consider the impact seasonal smog and heavy particulate pollution may have on them. Travelers are advised to consult the CDC's travelers' health website at: http://www.cdc.gov/travel/eastasia.htm prior to departing for China.

Alcoholics Anonymous can be reached in Beijing at telephone (86-10) 139-1138-9075, e-mail: Beijingfellows@yahoo.com . On the Internet, http://members.cox.net/mppowers1/aa-china3.html lists AA meeting locations and contact information for other cities in China. Visit the U.S. Embassy web page in advance of travel to China for additional contact numbers. There is an Al-Anon chapter in Beijing that can be reached at (86-10) 6940-3935. Information on vaccinations and other health precautions may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-394-8747; fax -888-232-3299, or via the CDC's Internet site at http://www.cdc.gov/ . For information about outbreaks of infectious diseases abroad consult the World Health Organization's website at http://www.who.int/en . Further health information for travelers is available at http://www.who.int/ith.

LifeLine Shanghai is a community-based, confidential hotline providing emotional support and information to Shanghai's expatriate community. HOTLINE: (86 21) 6279-8990

Some areas of China frequented by Americans, notably Yunnan Province, are prone to earthquakes. Coastal areas of Hainan, Guangdong, Fujian, and Zhejiang provinces are subject to typhoons during the summer rainy season. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov. Travelers should check weather conditions for cities and areas in China prior to departure. Winter weather and summer typhoons often cause the closure of airports in some parts of the country.

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).

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.

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.

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.

Americans living in or visiting China are encouraged to register at the Consular Section of the U.S. Embassy in China and obtain updated information on travel and security within China.

Beijing: The U.S. Embassy in China is located at 2 Xiu Shui Dong Jie, Beijing 100600, telephone:

(86-10) 6532-3431, 6532-3831, and after-hours: (86-10) 6532-1910; fax (86-10) 6532-4153. The U.S. Embassy web site address is http://www.usembassy-china.org.cn .cn/ and the e-mail address is AmCitBeijing@state.gov . The Embassy consular district includes the following provinces/regions of China: Beijing, Tianjin, Shandong, Shanxi, Inner Mongolia, Ningxia, Shaanxi, Qinghai, Xinjiang, Hebei, Henan, Hubei, Hunan, and Jiangxi.

Chengdu: The U.S. Consulate General in Chengdu is located at Number 4, Lingshiguan Road, Section 4, Renmin Nanlu, Chengdu 610041, telephone: (86-28) 558-3992, 555-3119; fax (86-28) 8558-3520 and the e-mail address is ACSchengdu@state.gov; after-hours (86-0) 13708001422. This consular district includes the following provinces/regions of China: Guizhou, Sichuan Xizang (Tibet), and Yunnan, as well as the municipality of Chongqing.

Guangzhou: The U.S. Consulate General in Guangzhou is located at Number 1 South Shamian Street, Shamian Island 200S1, Guangzhou 510133; telephone: (86-20) 8121-8418; after-hours:

(86-)139-0229-3169; fax: (86-20) 8121-8428 and the e-mail address is GuangzhouACS@state.gov . This consular district includes the following provinces/regions of China: Guangdong, Guangxi, Hainan, and Fujian.

Shanghai: The Consular Section of the U.S. Consulate General in Shanghai is located in the Westgate Mall, 8 th fl, 1038 Nanjing Xi Lu, Shanghai 200031 telephone: (86-21) 3217-4650, ext. 2102, 2013, or 2134; after-hours: (86-21) 6433-3936; fax: (86-21) 6217-2071; e-mail address: shanghai_acs@yahoo.com . This consular district includes the following provinces/regions of China: Shanghai, Anhui, Jiangsu, and Zhejiang.

Shenyang: The U.S. Consulate General in Shenyang is located at No. 52, 14th Wei Road, Heping District, Shenyang 110003, telephone: (86-24) 2322-1198, 2322-0368; after-hours: (86-0) 13704019790; fax (86-24) 2322-2374 and the e-mail address is ShenyangACS@state.gov . This consular district includes the following provinces/regions of China: Liaoning, Heilongjiang, and Jilin.

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.