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Summary of recommendations:
In general, no special immunizations or medications are necessary for travel to Canada. In view of recent reports of West Nile virus, insect repellents and other measures to prevent mosquito bites are advised after dusk in the late summer and early fall.
Measles, mumps, rubella (MMR)
Two doses recommended for all travelers born after 1956, if not previously given
Revaccination recommended every 10 years
Recommended for all travelers from November through April
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel.
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.
Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.
Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.
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An outbreak of Legionnaires' disease was reported from Quebec City in August 2012, causing 180 cases and 13 deaths by September. The source of the outbreak was found to be a cooling tower in a building on St-Joseph Street in Quebec City's lower-town area. An outbreak was reported from southweat Calgary in Decmber 2012, causing six cases. The source has not yet been determined (see ProMED-mail). Legionnaires' disease is a bacterial infection which typically causes pneumonia but may also involve other organ systems. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires' disease is not transmitted from person-to-person. Any traveler to Quebec City or Calgary who develops fever, cough, chest pain, or difficulty breathing should seek immediate medical attention.
A measles outbreak was reported from Quebec in September 2011, causing more than 700 cases. In March-April 2010, a measles outbreak in British Columbia caused 44 cases. In April 2008, a measles outbreak occurred in southern Ontario, resulting in ten confirmed cases. All international travelers born after 1956 should make sure they have had either two documented measles or MMR immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune. Children greater than 12 months of age should be given two doses of MMR vaccine, separated by one month, before travelto Canada.
A mumps outbreak was reported from the Lower Mainland of British Columbia, including Vancouver, in June 2011. This followed a mumps outbreak in Whistler and Squamish in April 2011. A total of 90 cases had been reported by July. A cluster of 11 cases of mumps was reported from Toronto in July-August 2011, caused by an infected traveler from Vancouver. All travelers born after 1956 should make sure they have had either two documented mumps immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune. Children greater than 12 months of age should be given two doses of MMR vaccine, separated by one month, before travel to Canada.
A previous mumps outbreak occurred in February 2007, causing 1284 confirmed cases in 10 out of 13 Canadian provinces and territories as of March 2008 (777 in Nova Scotia, where the outbreak began; 258 in Alberta; 124 in New Brunswick; 48 in Ontario; 25 in British Columbia; 20 in Quebec; 13 in Prince Edward Island; 10 in Newfoundland; 7 in Manitoba; 2 in Saskatchewan). Most cases occurred in those aged 20-29 years. In November 2007, an increasing number of cases was reported from Alberta, chiefly in college students and young adults and mostly from Calgary and the Chinook region of southern Alberta. In August 2008, a mumps outbreak was reported from the Fraser Valley in British Columbia, east of Vancouver and north of Washington state. A small mumps outbreak was reported from Whistler, British Columbia, in april 2011 (see ProMED-mail, March 31, April 6, 9, and 22; May 1 and 5; June 2; November 18; and December 2, 2007; March 11, April 3, June 15, and August 27, 2008; and April 15, 2011).
An outbreak of H1N1 influenza ("swine flu") was reported from Canada in April 2009, resulting in 7775 cases and 21 fatalities by June 29. The outbreak was caused by a previously unknown strain of influenza that contained a unique combination of swine, avian, and human influenza gene segments. Initial reports from Mexico, where the outbreak started, indicated a high fatality rate in previously healthy young adults and older children, raising concerns that a worldwide pandemic might occur, similar to 1918. However, subsequent data from Mexico, as well as experience from the United States, Canada, and other countries, indicate the H1N1 strain from 2009 is not nearly as lethal as some people initially feared. For further information, go to the World Health Organization and the Centers for Disease Control.
Outbreaks of West Nile virus infections are now reported annually in the late summer and early fall, though the number of cases varies greatly from year to year. A total of 36 cases were reported for the year 2008: 19 from Saskatchewan, 13 from Manitoba, two from Ontario, and one each from Alberta and British Columbia. For the year 2007, a total of 2338 cases were identified: 1410 from Saskatchewan, 577 from Manitoba, 318 from Alberta, 12 from Ontario, 18 from British Columbia, two from Quebec, and one from Nova Scotia (the cases from BC, Quebec, and Nova Scotia were probably acquired outside those provinces). For the year 2006, a total of 127 cases were identified: 50 from Manitoba, 41 from Ontario, 24 from Alberta, 11 from Saskatchewan, and one from Quebec. For further details, including a map showing the distribution of West Nile virus in Canada, go to the Health Canada website. The largest outbreak occurred in August-November 2003, resulting in 1335 cases and ten deaths, chiefly in Saskatchewan and Alberta, but also in Ontario, Manitoba, and Quebec. By contrast, in the year 2004, only 25 cases were identified. West Nile virus is carried by Culex mosquitoes, which breed in stagnant water and are most active after dusk. Insect protection measures, as described below, are advised for outdoors activities after sundown in the late summer and early fall, especially in Ontario, Manitoba, and Saskatchewan. For further information, go to Health Canada and ProMED-mail.
A disproportionate number of infections caused by Cryptococcus gattii have been observed on Vancouver Island since 1999, chiefly along the warmer, drier east coast of the island. More than 200 cases have been reported since the outbreak started, including eight fatalities. One case occurred in a Danish tourist. A small number of cases have also been reported on the British Columbia mainland. Cryptococcus, which is a type of fungus, may cause pneumonia or meningitis. Symptoms may include fever, headache, neck stiffness, cough, chest pain, or difficulty breathing, generally not occurring until months after exposure. Despite the increase, the disease remains uncommon and travelers are at low risk. No special precautions are recommended. For further information, go to Emerging Infectious Diseases, the British Columbia Centre for Disease Control, and ProMED-mail (June 9, 2002; November 25, 2004; January 3 and April 10, 2007; and February 20, 2008).
An outbreak of rubella (German measles) was reported in May 2005 among members of a religious community in southwest Ontario, resulting in 214 cases as of May 17. Most had declined rubella vaccination on the basis of religious beliefs. The outbreak appears to have spread from a religious community in the Netherlands which has close historical and social ties with the Canadian group. For further information, go to Eurosurveillance and Health Canada. All travelers born after 1956 should make sure they have received two doses of MMR vaccine or a blood test showing rubella immunity before foreign travel.
A total of 18 cases of bovine spongiform encephalopathy ("mad cow disease") have been identified in Canada: 13 in Alberta, four in British Columbia, and one in Manitoba. The first case was reported in May 2003. Five of the cases were reported in the year 2006, three in 2007, four in 2008, one in 2009, one n 2010, and one in 2011 (Alberta). At the present time, there are no restrictions on the importation of Canadian beef and no recommendations against the consumption of beef while in Canada. For recent updates, go to ProMED-mail.
An outbreak of hepatitis A was reported in October 2004 among patrons of a restaurant in Kelowna, British Columbia. Those who ate or drank in the restaurant were advised to receive hepatitis A vaccine. For further information, go to ProMED-mail (October 14, 2004) and the British Columbia Centre for Disease Control.
Two cases of H7 avian influenza (bird flu) were reported among poultry workers in British Columbia in March 2004. In both cases, the individuals developed conjunctivitis (pink-eye) after close contact with infected birds, and the infection resolved uneventfully after treatment with oseltamivir, an oral antiviral agent. Unlike H5N1 avian influenza, which is highly pathogenic, H7 avian influenza poses little risk to humans. For further information, go to the World Health Organization and the Centers for Disease Control.
An outbreak of severe acute respiratory syndrome (SARS) was reported in March 2003, resulting in 253 cases and 38 deaths. On July 2, the World Health Organization announced that the outbreak in Toronto had been terminated and all travel advisories for Toronto were lifted.
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.
No special precautions are necessary for travel to Toronto. For further information, go to the SARS pages of Health Canada, the World Health Organization, and the Centers for Disease Control.
An outbreak of E. coli 0157:H7 was reported from Walkerton, Ontario in May 2000, due to contamination of the municipal water supply. A total of 192 people were affected, of whom 26 developed hemolytic-uremic syndrome, a severe complication of the disease, and five died.
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- Tick-borne relapsing fever (southern British Columbia; causes fever, chills, headaches, body aches, and cough, alternating with periods when the fever subsides and the person feels relatively well)
- Lyme disease (transmitted by ticks; chiefly southern Canada; no regions of high transmission)
- Blastomycosis (fungal infection chiefly affecting the lungs; reported from northwestern Ontario and elsewhere; see Emerging Infectious Diseases)
- Q fever (reported among goats in Newfoundland; human illness reported in those who ate goat cheese or had contact with goat placentas; see CCDR for details)
- Trichinellosis (common in northern Canada; usually acquired by eating meat from infected walruses or polar bears; five cases reported in 2009 among French travelers who had consumed meat from a grizzly bear in Cambridge Bay, Nunavut; outbreak reported in September 2005 among hunters who ate barbecued meat from a black bear killed in northern Quebec, in tundra near the George River; see CCDR and Eurosurveillance)
- Hantavirus pulmonary syndrome (associated with exposure to deer mice; reported from western Canada, chiefly Alberta, also from British Columbia, Saskatchewan, and Manitoba; single cases reported recently from Quebec and Saskatchcawan; all cases caused by Sin Nombre virus; see CCDR)
- Histoplasmosis (sporadic cases reported from western Canada; see Emerging Infectious Diseases)
- Rabies (extremely rare; usually associated with exposure to bats)
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.
For disease statistics and updates on recent outbreaks, go to the Health Canada website. For information about medical services in the western part of the country, go to the BC Centre for Disease Control website.
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Insect and Tick Protection
During late summer and early fall, 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 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.
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Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal 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.
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.
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Bring your insurance card, claim forms, and any other relevant insurance documents. Be sure to ask your insurance company before departure whether you are covered for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation by air, 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. The Medicare and Medicaid programs do not pay for medical services outside the United States.
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Ambulance and Emergency Services
For an ambulance in Canada, call 911.
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(reproduced from the U.S. State Dept. Consular Information Sheet)
Good medical care is widely available. The Canadian health care system is run on a provincial basis (e.g. the province of Ontario has its own hospital insurance plan as does each of the other provinces and territories) and is funded by Canadian taxpayer money. Tourists and temporary visitors do not qualify for this health care plan and should have their own insurance to cover any medical expenses. Health care professionals in the province of Quebec might only speak French. Serious medical problems requiring hospitalization and medical evacuation to the United States can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services.
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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.
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(reproduced from the U.S. State Dept. Consular Information Sheet)
Americans living or traveling in Canada are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov , and to obtain updated information on travel and security within Canada. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, you'll make it easier for the Embassy or Consulate to contact you in case of emergency. U.S. citizens who are permanent residents of Canada may also get information on obtaining a valid U.S. passport, which is required by the Canadian government in order to receive the new, modern Canadian residence card.
The U.S. Embassy is in Ottawa, Ontario, at 490 Sussex Drive, K1N 1G8, telephone (613) 238-5335, fax (613) 688-3082. The Embassy website is http://www.usembassycanada.gov . The Embassy's consular district includes Baffin Island, the following counties in eastern Ontario: Lanark, Leeds, Prescott, Renfrew, Russell and Stormont; and the following counties in western Quebec: Gatineau, Hull, Labelle, Papineau, Pontiac and Tamiscamingue.
U.S. Consulates General are located at:
Calgary, Alberta, at Suite 1050, 615 Macleod Trail SE, telephone (403) 266-8962; emergency-after hours (403) 2 66 -8962 then press '0'; fax (403) 264-6630. The consular district includes Alberta, Manitoba, Saskatchewan, and the Northwest Territories, excluding Nunavut.
Halifax, Nova Scotia, at 1969 Upper Water Street, Suite 904, Purdy's Wharf Tower II, telephone (902) 429-2480; emergency-after hours (902) 429-2485; fax (902) 423-6861. The consular district includes New Brunswick, Newfoundland, Nova Scotia, Prince Edward Island and the islands of Saint Pierre and Miquelon.
Montreal, Quebec, at 1155 St. Alexander Street, telephone (514) 398-9695; emergency-after hours (514) 981-5059; fax (514) 398-0702. The consular district includes southwestern Quebec with the exception of the six counties served by the U.S. Embassy in Ottawa.
Quebec City, Quebec, at 2 Place Terrasse Dufferin, telephone (418) 692-2095; emergency-after hours (418) 692-2096; fax (418) 692-4640. The consular district includes the counties of Abitibi-West, Abitibi-East, St. Maurice, Trois-Rivieres, Nicolet, Wolfe, Frontenac and all other counties to the north or east within the province of Quebec. The new arctic territory of Nunavut is also in this district.
Toronto, Ontario, at 360 University Avenue, telephone (416) 595-1700; emergency-after hours (416) 201-4100; fax (416) 595-5466. The consular district includes the province of Ontario except the six counties served by the U.S. Embassy in Ottawa.
Vancouver, British Columbia, at 1095 West Pender Street, telephone (604) 685-4311; fax (604) 685-7175. The consular district includes British Columbia and the Yukon Territory.
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