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Australia
Summary of recommendationsImmunizationsRecent outbreaks
Other infectionsInsect and Tick ProtectionGeneral advice
Ambulance and Emergency ServicesPhysicians and hospitalsMedical facilities
Traveling with childrenMapsEmbassy/Consulate Location
Safety information

 

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Summary of recommendations:

In general, no special immunizations or medications are necessary for travel to Australia. However, insect repellents and other measures to prevent mosquito bites are strongly advised for many areas, especially the Northern Territory and Western Australia, because of the risk of Murray Valley encephalitis, Ross River virus infections, and other mosquito-borne illnesses.


Vaccinations:

Influenza

Recommended for all travelers from May through October

Yellow fever

Required for travelers entering Australia within 6 days of having been in or passed through a yellow-fever-infected area in Africa or the Americas. Not recommended or required otherwise.

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria

Revaccination recommended every 10 years

Immunizations

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. For adults, the following should be considered prior to departure:

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.

Japanese encephalitis has been reported from the islands of the Torres Strait, which separates Australia from Papua New Guinea off the northern coast. For travelers to these islands, Japanese encephalitis vaccine (JE-VAX; Aventis Pasteur Inc.) (PDF) is recommended if travel is long-term (1 month) or if the traveler might engage in extensive unprotected outdoor activities, especially in the evening, during a shorter trip. The vaccine is given as a series of three injections on days 0, 7 and 30. If time is short, the third dose may be given on day 14. Mild side effects including fever, headache, muscle aches, malaise and soreness at the injection site occur in about 20% of those vaccinated. Serious allergic reactions including urticaria, angioedema, respiratory distress and anaphylaxis occur in approximately 0.6% of vaccinees and may occur as long as one week after vaccination. Any person who receives the vaccine should be observed in the doctor's office for at least 30 minutes following the injection and should complete the full series at least 10 days before departure.

Rabies vaccine is recommended for any traveler who may have contact with bats. Rabies is not reported from Australia, but a related virus (Australian bat lyssavirus) has been isolated from insectivorous and fruit-eating bats and has caused three human fatalities, all of them in Queensland. A complete preexposure series consists of three doses of rabies 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.

Influenza vaccine is recommended for all travelers during flu season, which runs from May through October. 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.

Yellow fever vaccine is required for all travelers greater than one year of age entering Australia within 6 days days of having stayed overnight or longer in a country with risk of yellow fever transmission in Africa or the Americas, including São Tomé and Príncipe, Somalia, and Tanzania, but excluding Galápagos Islands in Ecuador and limited to Misiones Province in Argentina. The vaccine 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.

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Recent outbreaks

Cases of melioidosis are reported annually from the Northern Territory during the rainy season, with the number of cases increasing in recent years. A total of 97 cases, nine of them fatal, were reported durng the rainy season in early 2012, and 56 cases were reported in early 2011. An outbreak in October 2009 caused 72 cases and 10 deaths by May 2010. Most of the deaths occurred in those with pre-existing medical conditions, including diabetes, lung disease, and alcohol problems. Two cases of melioidosis were reported from the Northern Territory in January 2009. An outbreak in the Northern Territory in January 2008, apparently related to widespread flooding after Cyclone Helen, caused 11 cases, one of them fatal. An outbreak in December 2006 caused more than 30 cases and five deaths (see ProMED-mail; January 2, 2007; January 23, 2008; January 16, 2009; March 25 and May 6, 2010). Two cases of melioidosis were reported from Queensland in January 2011, both occurring in those who'd been cleaning up flood sites at Caboolture's Centenary Lakes.

Melioidosis is caused by a soil bacterium known as Burkholderia pseudomallei, which gains entrance to the body through cuts or other breaks in the skin, leading to pneumonia or wound infections. The infection may progress to septicemia and may be life-threatening, especially in those with compromised immune systems. In Australia, cases of meliodosis have been reported from the Northern Territory, north Queensland, the Torres Strait islands, and Western Australia, usually during the rainy season (December-January). To prevent melioidosis, travelers are advised to wear waterproof gloves and shoes or boots whenever coming into contact with soil in these areas, especially during the rainy season.

An increase in the number of cases of Ross River virus infections, which are transmitted by mosquitoes, was reported from Western Australia in late 2011 and early 2012, resulting in 1570 cases by the end of the season, more than double the number for the same period in 2011. The increase was thought to be due to heavy rainfall and flooding, leading to proliferation of mosquitoes. Ross River virus infections are characterized by fever and joint pains. Most cases are mild, though symptoms occasionally last for weeks or months. Insect protection measures, as described below, are advised for travel to areas where Ross River and Barmah Forest virus may occur.

In February 2011, an outbreak of Ross River virus infections was reported from the Barwon South Western region of Victoria, causing 52 cases, and from the Loddon/Mallee region, causing 233 cases. An increased number of cases of Ross River and Barmah Forest virus infections, the latter also transmitted by mosquitoes, was reported in January-February 2011 from the Riverland area in South Australia. Both outbreaks were related to heavy rains and flooding, leading to proliferation of mosquitoes.

A four-fold increase in the number of Ross River virus infections was reported in May 2010 from the Riverina Murray region in New South Wales, due to greater rain and a larger number of mosquitoes. An outbreak of Ross River virus infections was reported from the Northern Territory between January and March 2009, causing more than 200 cases, mostly in Darwin (see ProMED-mail, September 23, 2009, May 13, 2010, and February 21, 2011). In September 2007, an outbreak was reported Queensland, involving Brisbane as well as the northern part of the state.

An increased number of Ross River virus infections was reported from Victoria, South Australia and New South Wales in January 2006. A major outbreak was reported from the South West region of Western Australia in December 2003. By March 2004, the outbreak had spread to the northern and inland parts of the state, resulting in more than 2000 cases by April. The outbreak was related to a proliferation of mosquitoes caused by heavy rainfall and flooding. People at greatest risk were those living or traveling near salt marshes and seasonal wetlands, especially in coastal areas between Perth and Augusta, though risk extended to inland areas of the South West and as far east as Esperance. See Health Canada and the Government of Western Australia for details.

Outbreaks of Ross River virus infection were previously reported from Tasmania in April 2002 (mostly the eastern coast and the southeast; see Health Canada for details), the Northern Territory in January 2001 and coastal areas in the southwestern part of Western Australia in 1995 and 1996 (chiefly affecting towns in the Swan Coastal Plain south of Perth, though cases were reported from towns farther south or inland as well as from Perth itself). See MDA Lindsay et al. in Emerging Infectious Diseases for further information.

A total of 15 cases of Q fever were reported nationwide in 2011, ten of them from Queensland. Most of the Queensland cases did not have any contact with farm animals, which is the most common risk factor. A Q fever outbreak was reported in June 2007 from the Riverland town of Waikerie, northeast of Adelaide, in South Australia (see ProMED-mail, July 13, 2007). A total of five cases were identified. The source of infection appeared to be a nearby abattoir, which was closed. A Q fever outbreak was also reported from South Australia in December 2004 (see ProMED-mail, December 14, 2004, and June 24, 2007).

Symptoms of Q fever typically include fever, chills, nausea, headache, and body aches. Complications may include pneumonia, hepatitis, endocarditis (heart valve infection), and infections of the bones and joints. In pregnant women, Q fever may lead to miscarriage. Q fever is primarily a disease of ruminants such as cattle, sheep, and goats, which shed the Q fever bacteria in their body fluids, especially birth products. Humans become infected by inhaling dust or aerosols contaminated by body fluids from infected animals. The disease is not transmitted from person-to-person. Most travelers are at extremely low risk.

Measles outbreaks are periodically reported from Australia, most recently from Western Sydney, Wollongong, and New South Wales in April 2011. Most of the Australian outbreaks appear to have been triggered by young, partially vaccinated Australians who returned home after becoming infected overseas. All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Australia.

A marked increase in the number of cases of Murray Valley encephalitis, a mosquito-borne viral infection, was reported in the spring of 2011 due to rains and flooding, leading to proliferation of mosquitoes. A case of Murray Valley encephalitis was reported in May 2011 in a Canadian woman who had been traveling in the Northern Territory. Two cases of Murray Valley encephalitis were reported from the the Riverland region in South Australia in March and April 2011, the state's first human cases in more than 35 years. One of the cases was fatal. Eleven cases of Murray Valley encephalitis, one of them fatal, were reported from Western Australia in April and May 2011. As of August 2011, the virus was still being found in mosquitoes in Western Australia, though no additional human cases were being reported. An alert for Murray Valley encephalitis was issued for Victoria in February 2011 and for New South Wales in March 2011 after the Murray Valley virus was found in sentinel chickens in those states. A new alert was issued for New South Wales in December 2011, for Western Australia in January 2012, and for the Katherine region (Northern Territory) in February 2012, again after finding the virus in sentinel chickens. No human cases of Murray Valley encephalitis have been seen in New South Wales since 2008 and none in Victoria since 1974 (see ProMED-mail). Two fatal cases of Murray Valley encephalitis were reported from the Northern Territory in 2009: one in March, occurring in a mango farmer from the rural area south of Darwin, and one in May, occurring in an elderly man who had spent time along Darwin's coast. Two non-fatal cases were identified in Western Australia: one in March 2009 in a child from Broome and one in May 2009 in a man from Port Hedulund.

Murray Valley encephalitis is transmitted by "common banded" mosquitoes, which breed in grassy and reed swamps and pools and bite after sundown. Murray Valley encephalitis may cause fever, headaches, neck stiffness, confusion, seizures, nausea, vomiting, tremors, and dizziness. Severe cases may progress to coma and death. The disease is reported from northwest Western Australia, the entire Northern Territory, outback Queensland, and outback New South Wales. The risk period lasts from February through the end of March to early April in central Australia and persists until June in northern Western Australia, the northern part of Northern Territory and far north Queensland. Insect protection measures, as described below, are strongly advised. For an excellent series of articles on Murray Valley encephalitis, go to the April 2001 issue of Communicable Diseases Intelligence. For background information on Murray Valley encephalitis, see the New South Wales Health (PDR) fact sheet.

Increased Kunjin virus activity was observed in mosquitoes in the Katherine region (Northern Territory) in February 2012, and in the Kimberley and Pilbara areas in March 2011. Increased viral activity was observed in the north of Western Australia in February 2007 and again in March 2009 (see ProMED-mail, February 16, 2007, March 14, 2009, and March 5, 2011). In April 2004, the government of the Northern Territory issued a warning for Kunjin virus infections after six cases were identified. Kunjin virus, which is closely related to Murray Valley encephalitis and is also transmitted by common banded mosquitoes, may cause fever, severe headaches, and muscle and joint aches and pains, but the illness is milder and complications are uncommon. No vaccine is available. Insect protection measures, as described below, are strongly advised when outbreaks are in progess.

Four cases of leptospirosis were reported from the village of Theodore in central Queensland after flooding in late December 2010 and early January 2011. Four cases were reported in New South Wales in April 2011, thought to related to increased numbers of mice after flooding (see ProMED-mail). Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals. Symptoms may include fever, chills, headache, muscle aches, conjunctivitis (pink eye), photophobia (light sensitivity), and rash. Most cases resolve uneventfully, but a small number may be complicated by meningitis, kidney failure, liver failure, or hemorrhage.

Outbreaks of dengue fever are periodically reported from northern Queensland in the region extending from the Torres Strait south to Cairns, Townsville, and Charters Towers. Outbreaks are also reported from the islands in the Torres Strait. The most recent were reported in February 2011 from Innisfail, south of Cairns in far north Queensland, causing 47 cases, and in December 2010 from Townsville, causing 28 cases and spreading to the suburbs of Annandale and Vincent by the end of the month and then to Cranbrook in February 2011. The outbreaks were declared over in June 2011. Dengue is a mosquito-borne illness which typically causes flu-like symptoms, but which may be complicated by hemorrhage or shock. There is no vaccine at this time. Insect protection measures, as outlined below, are advised for the Torres Strait islands and for northern Queensland.

A major dengue outbreak was reported in December 2008, causing more than 900 cases by May 2009, chiefly in the northern suburbs of Cairns (Cairns North, Parramatta Park and Whitfield). A smaller outbreak, apparently caused by a strain of dengue that was different from the one causing the Cairns outbreak, was reported from Townsville. The Townsville outbreak was officially declared over in May 2009. Cases were also reported from Port Douglas, Yarrabah, Injinoo, and Innisfail. An additional 13 cases were reported from northern Queensland in November and December 2009, followed by seven additional cases in Tully and Townsville between March and May, 2010, and 19 cases in Cairns between September and November 2010, chiefly from the inner city suburb of Parramatta Park.

In March 2008, a dengue outbreak occurred in Port Douglas and Mossman, resulting in at least 14 cases. Before that, in March 2007, an outbreak occurred in the twin cities of Townsville and Thuringowa, resulting in 17 cases as of April. In February 2006, a dengue outbreak was reported from Cranbrook, a suburb of Townsville. In March 2004, an outbreak was reported from Thursday Island in the Torres Strait. In November 2003, a dengue outbreak occurred on several islands in the Torres Strait, including Thursday Island, Murray Island and Yam Island, resulting in a total of 214 cases as of February 2004, including the first death from dengue fever in 100 years. A small number of cases were reported at the same time from Cairns and Townsville on the Australian mainland. The cases in Townsville were acquired locally but, with one exception, the cases in Cairns were imported (see Health Canada and ProMED-mail). A prior dengue outbreak occurred in Cairns in February 2003, resulting in 280 confirmed cases. Affected areas included Parramatta Park, Manunda, Cairns North, Yorkeys Knob, and Trinity Beach. No cases of dengue hemorrhagic fever were reported. See Eurosurveillance for further details.

For further information on dengue fever in Australia, go to Health Canada and the University of Sydney website.

Several cases of malaria were reported from Saibai and Dauan islands in the Torres Strait in March and April, 2011, leading to a travel ban between the Torres Strait and Papua Guinea (see ProMED-mail). A small number of cases of malaria were reported in October 2002 among campers at Noah Beach, within the Daintree National Park (Cape Tribulation) north of Cairns in far north Queensland. The source of the outbreak appeared to have been a person who had stayed in the park in late September, following previous trips to Indonesia and Africa. See ProMED-mail (November 2 and 6, 2002) and Eurosurveillance for further information. There is no evidence of sustained malaria transmission in this area. Malaria prophylaxis is not advised for any parts of Australia.

An increase in the number of cases of pertussis (whooping cough) was reported from several Australian states in early 2009, including New South Wales, Queensland, and Victoria. More than 7000 cases had been recorded nationwide as of April 13, 2009, chiefly in babies and young children. As of early November 2009, almost 3500 cases, three of them fatal, had been reported from southern Australia. In October 2010, a pertussis outbreak was reported from the Gladstone region in Queensland. For further information, see the New South Wales Department of Health and the Chief Health Officer in Victoria. Pertussis is a highly contagious respiratory infection, spread by exposure to an infected person who is coughing or sneezing. Early symptoms resemble those of the common cold, but may progress to a severe cough. In young children, the cough is violent and associated with a loud "whooping" sound. In older children and adults, the cough is milder and does not produce a “whoop.” All travelers to Australia should be fully immunized against pertussis. The vaccine is generally given in combination with the vaccines for tetanus and diphtheria.

An outbreak of cryptosporidiosis, a parasitic intestinal infection, was reported from New South Wales in February 2009, causing almost 250 cases. The infection might have been spread by contaminated swimming pools. An outbreak was reported from South Australia in March 2007, thought to be spread by swimming pools and by children bathing together (see ProMED-mail, March 22, 2007). The main symptoms of cryptosporidiosis are diarrhea and abdominal cramps, which may last 1-2 weeks. Most cases resolve uneventfully without treatment, though the infection may be protracted in those with compromised immune systems, such as those with HIV.

An outbreak of Hendra virus infections was reported in July 2008 among horses on two properties in Queensland: a veterinary clinic at Redlands and a property at Cannonvale, near Prosperine. Two humans, both veterinary clinic staff, developed flu-like symptoms and were found to be infected; one died from the disease, the other appeared to be recovering. In August 2009, a fatal case of Hendra virus infection occurred in a Queensland veterinarian who had treated two infected horses. Hendra virus was first identified in 1994 following an outbreak among race horses in Queensland. Three humans who worked with the horses became infected, two of whom died. The natural reservoir for the Hendra virus is the fruit bat, but it is unclear how horses become infected. A small number of Hendra virus infections have also been reported from New South Wales. The disease appears to be uncommon. Only those who work with horses appear to be at risk.

A mosquito alert was issued for New South Wales in March 2008 after a threefold increase in mosquito-borne diseases, including Ross River virus and Barmah Forest virus infections, in the first two months of the year. For further information, go to ProMED-mail (March 17, 2008). Insect protection measures, as described below, are strongly recommended for New South Wales.

A mumps outbreak was reported in September 2007 among university students in Adelaide. All those affected lived in the same student housing. A mumps outbreak was reported from Perth between December 2012 and March 2013, causing 30 confirmed cases. All those born after 1956 should make sure they have received two mumps or MMR vaccinations before international travel, as above.

Four cases of Vibrio vulnificus infections, three of them fatal, were reported between the years 2000 and 2005 in people who had been swimming or fishing in rivers or creeks in the Borroloola region, southeast of Darwin in the Northern Territory (see ProMED-mail; March 2, 2007). Vibrio vulnificus may cause a highly aggressive skin infection called necrotizing fasciitis, which may lead to amputation and is often fatal, especially in those with compromised immune systems. Travelers should avoid direct exposure to the coastal waters near Borroloola.

An outbreak of Mycobacterium ulcerans infections was reported in June-July 2004 from the town of Point Lonsdale, a coastal resort approximately one hour drive south of central Melbourne on the Bellarine Peninsula. The infection, also known as Buruli ulcer, causes painless, slowly enlarging skin ulcers which can lead to scarring or deformities if not treated by prompt surgical removal of the affected skin. A previous outbreak of Mycobacterium ulcerans infections was reported in August 2001 from St. Leonards, a small coastal town 50 km southwest of Melbourne. For further information, go to ProMED-mail and the World Health Organization.

A cluster of sporotrichosis cases was reported from the Busselton-Margaret River region of Western Australia from 2000 to 2003, probably caused by contaminated hay initially distributed through a commercial hay supplier. See Emerging Infectious Diseases for further information.

An outbreak of psittacosis was reported in March-May 2002 from the upper Blue Mountains district in New South Wales. Psittacosis is a bacterial infection caused by exposure to droppings and other secretions from infected birds. Among humans, the spectrum of illness ranges from asymptomatic infection to severe pneumonia. In the Australian outbreak, symptoms included fever, fatigue, sweats, chills, aching muscles, headache, shortness of breath, and dry cough. Those reporting illness were more likely than healthy controls to have had direct contact with wild birds and to mow their lawns without a grass catcher. The outbreak ended with the onset of winter. For further information, see Emerging Infectious Diseases.

An outbreak of Legionnaires' disease occurred among visitors to the Melbourne Aquarium during a two-week period in April 2000, causing 76 cases, including two deaths. The outbreak was related to contamination of the aquarium's cooling towers, which were promptly disinfected. For further information, see Communicable Diseases Intelligence. In April 2002, a cluster of five cases was reported from Melbourne, apparently stemming from a contaminated cooling tower in an inner city building. In December 2012, a small outbreak was reported from Bundoora in Melbourne's northeast. 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. A small number of cases have also been associated with use of contaminated potting mix. Legionnaires' disease is not transmitted from person-to-person. See ProMED-mail for further information.

For disease statistics and updates on recent outbreaks in Australia, go to the Communicable Diseases Intelligence.  For New South Wales, see the NSW Public Health Bulletin. For the Northern Territory, go to the NT Disease Control Bulletin.

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Other infections

Leptospirosis occurs in all parts of Australia. The incidence is highest in Queensland (especially in the north) and Victoria. Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals. Symptoms may include fever, chills, headache, muscle aches, conjunctivitis (pink eye), photophobia (light sensitivity), and rash. Most cases resolve uneventfully, but a small number may be complicated by meningitis, kidney failure, liver failure, or hemorrhage. In Australia, most of those infected have had a history of exposure to cattle, rats, or dogs, although the role of dogs is unclear. Other animals that harbor this organism include mice, pigs, native rodents, feral pigs, bandicoots, and sheep. Seasonal workers on banana farms and canefields are at high risk for leptospirosis. Cases have been reported in hunters in the greater Darwin region. All had been hunting in bare feet. See Communicable Diseases Intelligence for details.

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

  • Murine typhus (western Australia; single case reported from New South Wales in June 2011))
  • Queensland tick typhus (Queensland, New South Wales, Tasmania, and coastal areas of eastern Victoria)
  • Scrub typhus (reported from north Queensland, Northern Territory, northwest portion of Western Australia, and the Torres Strait; transmitted by chigger bites)
  • Barmah Forest virus, (reported from Western Australia; increased number of cases reported from Queensland in first quarter 2013; transmitted by mosquitoes; chief symptoms are fever, rash, and inflamed joints; see MDA Lindsay et al. in Emerging Infectious Diseases)
  • Flinder's Island spotted fever (tick-borne rickettsial disease initially described on Flinder's Island in southern Australia; now also reported from Tasmania)
  • Brucellosis (rare; limited number of cases reported from Queensland)
  • Tularemia (two women infected after being bitten or scratched by sick possums in western Tasmania in November 2011; see ProMED-mail, November 22, 2011)
  • Giardiasis (Tasmania)
  • Psittacosis (reported from northern Tasmania; all cases occurred in those who had recent contact with cockatiels; see CDI; also reported among wild birds in New South Wales; see ProMED-mail, May 9, 2003)

For an overview of viral infections in Australia, including Ross River fever, Japanese encephalitis, and dengue fever, see J. S. Mackenzie in Emerging Infectious Diseases.

Jellyfish stings recently caused the deaths of two foreign tourists who were swimming off the coast of northern Queensland. Though fatalities appear to be rare, stings from the Irukandji jellyfish may cause the Irukandji syndrome, characterized by back pain, sweating, and nausea. An increase in the number of Irukandji jellyfish stings was reported in early 2010, probably related to an increase in the length of the stinger season due to rising water temperatures. See ProMED-mail (June 26, 2002, and January 14, 2010) for further information.

For further information on health issues in Australia, go to the World Health Organization - Western Pacific Region.

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Insect and Tick Protection

(see discussion above for areas where mosquito and tick precautions are necessary)

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 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. 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.

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General advice

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.

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Ambulance and Emergency Services

For an ambulance in Australia, call 000.

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Physicians and hospitals

For an introduction to health care in Australia, go to Health Information for Overseas Visitors to Australia. For information on health services in specific states and provinces, go to the health department websites for New South Wales, Western Australia, Australian Capital Territory, Northern Territory, Queensland, Victoria, and Tasmania.

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Medical facilities

(reproduced from the U.S. State Dept. Consular Information Sheet)

Excellent medical care is available. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Most doctors and hospitals expect immediate cash/credit card payment for health services.

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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.

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).

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, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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Maps

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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Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living in or visiting Australia are encouraged to register using the Internet Based Registration System (IBRS), which can be found at https://travelregistration.state.gov/ibrs. Alternatively, you can register in person at the nearest U.S. Consulate to obtain updated information on travel and security within the country.

In the Australian Capital Territory (ACT) or Queanbeyan: For emergency services (i.e. the arrest, death or serious injury of American citizens) please contact the U.S. Embassy in Canberra. The Embassy is located on Moonah Place, Yarralumla, A.C.T. 2600, telephone (61)(2) 6214-5600, fax (61)(2) 6273-3191, website http://canberra.usembassy.gov. NOTE: Passports, and other routine citizen services for Canberra and the rest of the ACT are provided by the U.S. Consulate in Sydney (see contact information below).

In New South Wales, Norfolk Island, Lord Howe Island and Queensland: For registration, passport, and other consular services for American citizens, please contact the U.S. Consulate General in Sydney located on Level 59, MLC Centre, 19-29 Martin Place, Sydney NSW 2000, telephone (61)(2) 9373-9200, fax (61)(2) 9373-9184, web site http://sydney.usconsulate.gov/sydney. Hours open to the public: 8:00 a.m. to noon Monday to Friday (except American and Australian holidays). For emergency services (i.e. the arrest, death or serious injury of American citizens) after 4:30 p.m. weekdays or on holidays and weekends please call (61) (2) 4422-2201.

In Victoria, Tasmania, South Australia and the Northern Territory: For registration, passport and other consular services for American citizens, please contact the U.S. Consulate General in Melbourne located at 553 St. Kilda Road, Melbourne, VIC 3004, telephone (61)(3) 9526-5900, fax (61)(3) 9525-0769, website http://melbourne.usconsulate.gov/melbourne. Hours open to the public: 8:30 a.m. to 12:30 p.m. Monday to Friday (except American and Australian holidays and the last Wednesday of each month). For emergency services (i.e. the arrest, death or serious injury of American citizens) after 4:30 p.m. or on holidays and weekends, please call (61)(3) 9389-3601.

In Western Australia: For registration, passport, and other consular services for American citizens, please contact the U.S. Consulate General in Perth located on Level 13, 16 St. Georges Terrace, Perth WA 6000, telephone: (61)(8) 9202-1224, fax (61)(8) 9231-9444; web site http://perth.usconsulate.gov/perth. Hours open to the public for American Citizen Services: 8:30-11:30 a.m. daily. For emergency services (e.g., the arrest, death, or serious injury of American citizens), please call (61) (8) 9476-0081.

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Safety information

For additional information on safety and security, go to the U.S. Department of State, the United Kingdom Foreign and Commonwealth Office, and the Canadian Department of Foreign Affairs and International Trade.

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