An outbreak of meningococcal infections was reported in January 2005 from Baguio City and the Cordillera Region in the island of Luzon. In retrospect, the outbreak probably began in September 2004. As of July 2005, a total of 376 cases had been identified, including 81 deaths. Meningococcal vaccine is recommended for all travelers to Baguio City and the Cordillera Region, especially if close contact with the populace is likely. For details, go to the World Health Organization and NATHNAC.
A small outbreak of severe acute respiratory syndrome (SARS) was reported from the Philippines, chiefly in the Manila area, in May 2003, resulting in ten cases and two deaths. The outbreak was limited to a single person who acquired her infection in Toronto, her family members, and the medical staff who cared for her. The outbreak was promptly contained. No travel restrictions are recommended. For further information, go to the World Health Organization and the Centers for Disease Control.
Dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, is highly prevalent in the Philippines. The number of dengue cases in the first few months of 2005 increased markedly compared with the same time period in 2004. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. Transmission usually peaks each year from June through November. An unusually large number of cases was reported in 1998, possibly related to climatic changes due to El Nino. Fewer cases were reported in 1999 and 2000, but the numbers began to rise again in 2001. See the World Health Organization for details. No vaccine is available at this time. Insect protection measures are strongly advised, as below. For further information on dengue in the Philippines, go to the World Health
Other infections and toxic exposures include
Schistosomiasis (southern Philippines, caused by Schistosoma japonicum; swimming and bathing precautions advised, as below)
Sea snakes (may be highly venomous, well-camouflaged, and highly aggressive; found in coastal waters, lakes and rivers; anti-venom may not be readily available)
Corals, jellyfish, sharks, and sea urchins (avoid unmarked, unpatrolled beaches)
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
Food and Water Precautions
Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, 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.
Insect and Tick Protection
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 20-35% 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..
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.
