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General information

The information on these pages should be used to research health risks and to
inform the pre-travel consultation. For advice regarding safety and security
please check the UK Foreign and Commonwealth Office (FCO) website.
Travellers should ideally arrange an appointment with their health professional
at least four to six weeks before travel. However, even if time is short, an
appointment is still worthwhile. This appointment provides an opportunity to
assess health risks taking into account a number of factors including
destination, medical history, and planned activities. For those with pre-
existing health problems, an earlier appointment is recommended.
While most travellers have a healthy and safe trip, there are some risks that
are relevant to travellers regardless of destination. These may for example
include road traffic and other accidents, diseases transmitted by insects or
ticks, diseases transmitted by contaminated food and water, sexually
transmitted infections, or health issues related to the heat or cold.
All travellers should ensure they have adequate_travel_health_insurance.
A list of useful resources including advice on how to reduce the risk of
certain health problems is available below.

Resources


* Food_and_water_hygiene
* Insect_and_tick_bite_avoidance
* Personal_safety
* Sexually_transmitted_infections
* Sun_protection


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Vaccine recommendations

Details of vaccination recommendations and requirements are provided below.

All Travellers

Travellers should be up to date with routine vaccination courses and boosters
as recommended_in_the_UK.  These vaccinations include for example measles-
mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine.
Those who may be at increased risk of an infectious disease due to their work,
lifestyle choice, or certain underlying health problems should be up to date
with additional recommended vaccines. See the individual chapters of the ‘Green
Book’ Immunisation_against_infectious_disease for further details.

Certificate Requirements

Please read the information below carefully, as certificate requirements may
be relevant to certain travellers only. For travellers further details, if
required, should be sought from their healthcare professional.

* There is no risk of yellow fever in Bangladesh, however, there is a
  certificate requirement:
* Under International Health Regulations (2005), a yellow fever vaccination
  certificate is required from travellers over 1 year of age arriving from
  countries with risk of yellow fever transmission.
* For this country, the yellow fever vaccination certificate is assumed to be
  valid for 10 years until further notice.
* View_the_WHO_list_of_countries_with_risk_of_yellow_fever_transmission.


Most Travellers

The vaccines in this section are recommended for most travellers visiting this
country. Information on these vaccines can be found by clicking on the blue
arrow. Vaccines are listed alphabetically.
Hepatitis A
Hepatitis A is a viral infection transmitted through contaminated food and
water or by direct contact with an infectious person. Symptoms are often mild
or absent in young children, but the disease becomes more serious with
advancing age.  Recovery can vary from weeks to months. Following hepatitis A
illness immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives,
long-stay travellers, and those visiting areas of poor sanitation.

Prevention

All travellers should take care with personal, food and water hygiene.

Hepatitis A vaccination

As hepatitis A vaccine is well tolerated and affords long-lasting protection,
it is recommended for all previously unvaccinated travellers.
Hepatitis_A_in_brief
Tetanus
Tetanus is caused by a toxin released from Clostridium tetani and occurs
worldwide.  Tetanus bacteria are present in soil and manure and may be
introduced through open wounds such as a puncture wound, burn or scratch.

Prevention

Travellers should thoroughly clean all wounds and seek appropriate medical
attention.

Tetanus vaccination


* Travellers should have completed a primary vaccination course according to
  the UK schedule.
* If travelling to a country where medical facilities may be limited, a booster
  dose of a tetanus-containing vaccine is recommended if the last dose was more
  than ten years ago even if five doses of vaccine have been given previously.

Country specific information on medical facilities may be found in the ‘health’
section of the FCO_foreign_travel_advice website.
Tetanus_in_brief
Typhoid
Typhoid is a bacterial infection transmitted through contaminated food and
water. Previous typhoid illness may only partially protect against re-
infection.
Those at increased risk include travellers visiting friends and relatives,
those in contact with an infected person, young children, long-stay travellers,
and those visiting areas of poor sanitation.

Prevention

All travellers should take care with personal, food and water hygiene.

Typhoid vaccination


* Both oral and injectable typhoid vaccinations are available and are
  recommended for those at increased risk.
* Vaccination could be considered for other travellers.

Typhoid_in_brief

Some Travellers

The vaccines in this section are recommended for some travellers visiting this
country. Information on when these vaccines should be considered can be found
by clicking on the arrow. Vaccines are listed alphabetically.
Cholera
Cholera is a bacterial infection transmitted by contaminated food and water.
Cholera can cause severe watery diarrhoea although mild infections are common.
Most travellers are at low risk.

Cholera in Bangladesh

Cholera is presumed to occur in this country.

Prevention

All travellers should take care with personal, food and water hygiene.

Cholera vaccination

This oral vaccine is recommended for those whose activities or medical history
put them at increased risk.  This includes:

* aid workers
* those going to areas of cholera outbreaks who have limited access to safe
  water and medical care.
* those for whom vaccination is considered potentially beneficial.

Cholera_in_brief
Hepatitis B
Hepatitis B is a viral infection; it is transmitted by exposure to infected
blood or body fluids. This mostly occurs during sexual contact or as a result
of blood-to-blood contact (for example from contaminated equipment during
medical and dental procedures, tattooing or body piercing procedures, and
sharing of intravenous needles).   Mothers with the virus can also transmit the
infection to their baby during childbirth.

Hepatitis B in Bangladesh

2% or more of the population are known or thought to be persistently infected
with the hepatitis B virus (intermediate/high prevalence).

Prevention

Travellers should avoid contact with blood or body fluids. This includes:

* avoiding unprotected sexual intercourse.
* avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile
  equipment is used).
* not sharing needles or other injection equipment.
* following universal precautions if working in a medical/dental/high risk
  setting.

A sterile medical equipment kit may be helpful when travelling to resource poor
areas.

Hepatitis B vaccination

Vaccination could be considered for all travellers, and is recommended for
those whose activities or medical history put them at increased risk including:

* those who may have unprotected sex.
* those who may be exposed to contaminated needles through injecting drug use.
* those who may be exposed to blood or body fluids through their work (e.g.
  health workers).
* those who may be exposed to contaminated needles as a result of having
  medical or dental care e.g. those with pre-existing medical conditions and
  those travelling for medical care abroad including those intending to receive
  renal dialysis overseas.
* long-stay travellers
* those who are participating in contact sports.
* families adopting children from this country.

Hepatitis_B_in_brief
Japanese Encephalitis (JE)
Japanese encephalitis is a viral infection transmitted to humans from animals
(mainly pigs and birds) by mosquitoes which typically breed in rice paddy
fields, swamps and marshes.  These mosquitoes predominantly feed between dusk
and dawn.
Those at increased risk include travellers who are staying for a month or
longer during the transmission season, especially if travel will include rural
areas with rice fields and marshland.
Travellers on shorter trips (typically less than a month), or trips that take
place outside the peak transmission season  and those who restrict their visits
to urban areas are usually considered to be at very low risk.

Japanese encephalitis in Bangladesh

There is little data regarding affected areas, but the disease is probably
widespread. The transmission season is thought to be typically July to
December.  Rarely cases in travellers are reported outside these months

Prevention

All travellers should avoid mosquito bites particularly between dusk and dawn.

Japanese encephalitis vaccination


* Vaccination is recommended for those whose activities put them at increased
  risk (see above).
* Vaccination could be considered for those on shorter trips if the risk is
  considered to be sufficient e.g. those spending time in areas where the
  mosquito breeds such as rice fields or marshlands, or pig farming areas.

Japanese_encephalitis_in_brief
Rabies
Rabies is a viral infection which is usually transmitted following contact with
the saliva of an infected animal most often via a bite, scratch or lick to an
open wound or mucous membrane (such as on the eye, nose or mouth). Although
many different animals can transmit the virus, most cases follow a bite or
scratch from an infected dog. In some parts of the world, bats are an important
source of infection.
Rabies symptoms can take some time to develop, but when they do, the condition
is almost always fatal.
The risk of exposure is increased by certain activities and length of stay (see
below). Children are at increased risk as they are less likely to avoid contact
with animals and to report a bite, scratch or lick.

Rabies in Bangladesh

Rabies has been reported in domestic and wild animals in this country. Bats may
also carry rabies-like viruses.

Prevention


* Travellers should avoid contact with all animals. Rabies is preventable with
  prompt post-exposure treatment.
* Following a possible exposure, wounds should be thoroughly cleansed and an
  urgent local medical assessment sought, even if the wound appears trivial.
* Post-exposure treatment and advice should be in accordance with national
  guidelines.


Rabies vaccination

Pre-exposure vaccinations are recommended for travellers whose activities put
them at increased risk including:

* those at risk due to their work (e.g. laboratory staff working with the
  virus, those working with animals or health workers who may be caring for
  infected patients).
* those travelling to areas where access to post-exposure treatment and medical
  care is limited.
* those planning higher risk activities such as running or cycling.
* long-stay travellers (more than one month).

Rabies_in_brief
Tuberculosis (TB)
TB is a bacterial infection transmitted most commonly by inhaling respiratory
droplets from an infectious person. This is usually following prolonged or
frequent close contact.

Tuberculosis in Bangladesh

The average annual incidence of TB from 2010 to 2012 was greater than or equal
to 40 cases per 100,000 population.

Prevention

Travellers should avoid close contact with individuals known to have infectious
pulmonary (lung) TB.
Those at risk during their work (such as healthcare workers) should take
appropriate infection control precautions.

Tuberculosis (BCG) vaccination

According to current national guidance, BCG vaccine should be recommended for
those at increased risk of developing severe disease and/or of exposure to TB
infection. See Public Health England’s Immunisation against infectious disease,
the_‘Green_Book’.
For travellers, BCG vaccine is also recommended for:

* unvaccinated, children under 16 years of age, who are going to live for more
  than 3 months in this country. A tuberculin skin test is required prior to
  vaccination for all children from 6 years of age and may be recommended for
  some younger children.
* unvaccinated, tuberculin skin test negative individuals under 35 years of age
  at risk due to their work such as healthcare workers, prison staff and vets.
  Healthcare workers may be vaccinated over the age of 35 years following a
  careful risk assessment.

There are specific contraindications associated with the BCG vaccine and health
professionals must be trained to administer this vaccine intradermally (just
under the top layer of skin).
Following administration, no further vaccines should be administered in the
same limb for 3 months.
The BCG vaccine is given once only, booster doses are not recommended.
Tuberculosis_in_brief

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Malaria

Malaria is a serious illness caused by infection of red blood cells with a
parasite called Plasmodium. The disease is transmitted by mosquitoes which
predominantly feed between dusk and dawn.
Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more.
Other symptoms may include feeling cold and shivery, headache, nausea, vomiting
and aching muscles. Symptoms may appear between eight days and one year after
the infected mosquito bite.
Prompt diagnosis and treatment is required as people with malaria can
deteriorate quickly. Those at higher risk of malaria, or of severe
complications from malaria, include pregnant women, infants and young children,
the elderly, travellers who do not have a functioning spleen and those visiting
friends and relatives.

Prevention

Travellers should follow an ABCD guide to preventing malaria:
Awareness of the risk – Risk depends on the specific location, season of
travel, length of stay, activities and type of accommodation.
Bite prevention – Travellers should take mosquito bite avoidance measures.
Chemoprophylaxis – Travellers should take antimalarials (malaria prevention
tablets) if appropriate for the area (see below). No antimalarials are 100%
effective but taking them in combination with mosquito bite avoidance measures
will give substantial protection against malaria.
Diagnosis – Travellers who develop a fever of 38°C [100°F] or higher more than
one week after being in a malaria risk area, or who develop any symptoms
suggestive of malaria within a year of return should seek immediate medical
care. Emergency standby treatment may be considered for those going to remote
areas with limited access to medical attention.

Risk Areas


* There is a high risk of malaria in the Chittagong Hill Tract districts of
  Bangladesh: atovaquone/proguanil OR doxycycline OR mefloquine recommended.
* There is low to no risk in the rest of Bangladesh (including Chittagong
  city): awareness of risk and bite avoidance recommended.


Antimalarial Recommendations Map

_Bangladesh-malaria-map_

Recommended Antimalarials

The recommended antimalarials for Bangladesh are listed below. They are
recommended for certain areas only (see  description of risk areas above). If
these are not suitable please seek further specialist advice.
Please note, the advice for children is different, the dose is based on body
weight and some antimalarials are not suitable.
Atovaquone/Proguanil
Atovaquone 250mg/Proguanil 100mg combination preparation:

* start one to two days before arrival in the malaria risk area
* for adults, one tablet is taken every day, ideally at the same time of day
  for the duration of the time in a malaria risk area and daily for seven days
  after leaving the malaria risk area
* take with a fatty meal if possible
* for children paediatric tablets are available and the dose is based on body
  weight (see table below)

Doxycycline
Doxycycline 100mg:

* start one to two days before arrival in the malaria risk area
* adults and children over 12 years of age take 100mg daily, ideally at the
  same time of day for the duration of the time in a malaria risk area and
  daily for four weeks after leaving the malaria risk area
* take with food if possible; avoid taking this drug just before lying down
* not suitable for children under 12 years of age

Mefloquine
Mefloquine 250mg:

* this drug is taken weekly, adults take one 250mg tablet each week
* start two to three weeks before arrival in the malaria risk area and continue
  weekly until four weeks after leaving the malaria risk area
* for children the dose is based on the body weight (see table below)


Resources


* Malaria_in_brief
* Malaria_factsheet 
* Insect_and_tick_bite_avoidance  
* Children’s_antimalarial_dose_table
* Malaria_prevention_guidelines_for_travellers_from_the_UK


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Other risks

The risk below may be present in all or part of the country.

Dengue

Dengue is a viral infection transmitted by mosquitoes which predominantly feed
between dawn and dusk.  It causes a flu-like illness, which can occasionally
develop into a more serious life-threatening form of the disease. Severe dengue
is rare in travellers.
The mosquitoes that transmit dengue are most abundant in towns, cities and
surrounding areas. All travellers to dengue areas are at risk.

Dengue in Bangladesh

Dengue is known or has the potential to occur in this country.

Prevention


* All travellers should avoid mosquito bites particularly between dawn and
  dusk.
* There is no vaccination or medication to prevent dengue.

Dengue_in_brief


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Important News

12 Feb 2016

Fake_yellow_fever_vaccine_circulating_in_South_East_Asia:_Bangladesh

World Health Organization report falsified AMARIL yellow fever vaccines
circulating in Bangladesh Read_more

*

_Diwali_
03 Nov 2015

Travelling_for_Diwali?

Advice for UK residents planning to celebrate Diwali abroad Read_more

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outbreaks


Acute_diarrhoeal_syndrome_in_Bangladesh

26 May 2015 Khulna. Bangladesh
A total of 345 cases of acute diarrhoea cases have been reported between 16 to
18 May 2015 in Meherpur district. Three persons have died.
Human
Food and Water-borne
New Post
ProMED_-_Read_more

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