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Field Listing :: Major infectious diseases

This entry lists major infectious diseases likely to be encountered in countries where the risk of such diseases is assessed to be very high as compared to the United States. These infectious diseases represent risks to US government personnel traveling to the specified country for a period of less than three years. The degree of risk is assessed by considering the foreign nature of these infectious diseases, their severity, and the probability of being affected by the diseases present. The diseases listed do not necessarily represent the total disease burden experienced by the local population.
The risk to an individual traveler varies considerably by the specific location, visit duration, type of activities, type of accommodations, time of year, and other factors. Consultation with a travel medicine physician is needed to evaluate individual risk and recommend appropriate preventive measures such as vaccines.
Diseases are organized into the following six exposure categories shown in italics and listed in typical descending order of risk. Note: The sequence of exposure categories listed in individual country entries may vary according to local conditions.
food or waterborne diseases acquired through eating or drinking on the local economy:
Hepatitis A - viral disease that interferes with the functioning of the liver; spread through consumption of food or water contaminated with fecal matter, principally in areas of poor sanitation; victims exhibit fever, jaundice, and diarrhea; 15% of victims will experience prolonged symptoms over 6-9 months; vaccine available.
Hepatitis E - water-borne viral disease that interferes with the functioning of the liver; most commonly spread through fecal contamination of drinking water; victims exhibit jaundice, fatigue, abdominal pain, and dark colored urine.
Typhoid fever - bacterial disease spread through contact with food or water contaminated by fecal matter or sewage; victims exhibit sustained high fevers; left untreated, mortality rates can reach 20%.
vectorborne diseases acquired through the bite of an infected arthropod:
Malaria - caused by single-cell parasitic protozoa Plasmodium; transmitted to humans via the bite of the female Anopheles mosquito; parasites multiply in the liver attacking red blood cells resulting in cycles of fever, chills, and sweats accompanied by anemia; death due to damage to vital organs and interruption of blood supply to the brain; endemic in 100, mostly tropical, countries with 90% of cases and the majority of 1.5-2.5 million estimated annual deaths occurring in sub-Saharan Africa.
Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban environments; manifests as sudden onset of fever and severe headache; occasionally produces shock and hemorrhage leading to death in 5% of cases.
Yellow fever - mosquito-borne viral disease; severity ranges from influenza-like symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South America and sub-Saharan Africa, where most cases are reported; fatality rate is less than 20%.
Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease associated with rural areas in Asia; acute encephalitis can progress to paralysis, coma, and death; fatality rates 30%.
African Trypanosomiasis - caused by the parasitic protozoa Trypanosoma; transmitted to humans via the bite of bloodsucking Tsetse flies; infection leads to malaise and irregular fevers and, in advanced cases when the parasites invade the central nervous system, coma and death; endemic in 36 countries of sub-Saharan Africa; cattle and wild animals act as reservoir hosts for the parasites.
Cutaneous Leishmaniasis - caused by the parasitic protozoa leishmania; transmitted to humans via the bite of sandflies; results in skin lesions that may become chronic; endemic in 88 countries; 90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil, and Peru; wild and domesticated animals as well as humans can act as reservoirs of infection.
Plague - bacterial disease transmitted by fleas normally associated with rats; person-to-person airborne transmission also possible; recent plague epidemics occurred in areas of Asia, Africa, and South America associated with rural areas or small towns and villages; manifests as fever, headache, and painfully swollen lymph nodes; disease progresses rapidly and without antibiotic treatment leads to pneumonic form with a death rate in excess of 50%.
Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection may also result from exposure to infected animal blood or tissue; geographic distribution includes Africa, Asia, the Middle East, and Eastern Europe; sudden onset of fever, headache, and muscle aches followed by hemorrhaging in the bowels, urine, nose, and gums; mortality rate is approximately 30%.
Rift Valley fever - viral disease affecting domesticated animals and humans; transmission is by mosquito and other biting insects; infection may also occur through handling of infected meat or contact with blood; geographic distribution includes eastern and southern Africa where cattle and sheep are raised; symptoms are generally mild with fever and some liver abnormalities, but the disease may progress to hemorrhagic fever, encephalitis, or ocular disease; fatality rates are low at about 1% of cases.
Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated with urban environments, similar to Dengue Fever; characterized by sudden onset of fever, rash, and severe joint pain usually lasting 3-7 days, some cases result in persistent arthritis.
water contact diseases acquired through swimming or wading in freshwater lakes, streams, and rivers:
Leptospirosis - bacterial disease that affects animals and humans; infection occurs through contact with water, food, or soil contaminated by animal urine; symptoms include high fever, severe headache, vomiting, jaundice, and diarrhea; untreated, the disease can result in kidney damage, liver failure, meningitis, or respiratory distress; fatality rates are low but left untreated recovery can take months.
Schistosomiasis - caused by parasitic trematode flatworm Schistosoma; fresh water snails act as intermediate host and release larval form of parasite that penetrates the skin of people exposed to contaminated water; worms mature and reproduce in the blood vessels, liver, kidneys, and intestines releasing eggs, which become trapped in tissues triggering an immune response; may manifest as either urinary or intestinal disease resulting in decreased work or learning capacity; mortality, while generally low, may occur in advanced cases usually due to bladder cancer; endemic in 74 developing countries with 80% of infected people living in sub-Saharan Africa; humans act as the reservoir for this parasite.
aerosolized dust or soil contact disease acquired through inhalation of aerosols contaminated with rodent urine:
Lassa fever - viral disease carried by rats of the genus Mastomys; endemic in portions of West Africa; infection occurs through direct contact with or consumption of food contaminated by rodent urine or fecal matter containing virus particles; fatality rate can reach 50% in epidemic outbreaks.
respiratory disease acquired through close contact with an infectious person:
Meningococcal meningitis - bacterial disease causing an inflammation of the lining of the brain and spinal cord; one of the most important bacterial pathogens is Neisseria meningitidis because of its potential to cause epidemics; symptoms include stiff neck, high fever, headaches, and vomiting; bacteria are transmitted from person to person by respiratory droplets and facilitated by close and prolonged contact resulting from crowded living conditions, often with a seasonal distribution; death occurs in 5-15% of cases, typically within 24-48 hours of onset of symptoms; highest burden of meningococcal disease occurs in the hyperendemic region of sub-Saharan Africa known as the "Meningitis Belt" which stretches from Senegal east to Ethiopia.
animal contact disease acquired through direct contact with local animals:
Rabies - viral disease of mammals usually transmitted through the bite of an infected animal, most commonly dogs; virus affects the central nervous system causing brain alteration and death; symptoms initially are non-specific fever and headache progressing to neurological symptoms; death occurs within days of the onset of symptoms.

Country	Major infectious diseases


Afghanistan	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria animal contact disease: rabies note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Angola	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, typhoid fever vectorborne diseases: malaria, African trypanosomiasis (sleeping sickness) water contact disease: schistosomiasis (2009)


Argentina	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea, hepatitis A water contact disease: leptospirosis (2009)

Bangladesh

degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
vectorborne diseases: dengue fever and malaria are high risks in some locations
water contact disease: leptospirosis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Belize	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Benin	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and yellow fever respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)


Bhutan	degree of risk: intermediate food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Bolivia	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever, malaria, and yellow fever water contact disease: leptospirosis (2009)


Botswana	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria (2009)

Burkina Faso

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne disease: malaria and yellow fever
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)

Burma

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Burundi	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis animal contact disease: rabies (2009)

Cambodia

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: dengue fever, Japanese encephalitis, and malaria
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Cameroon	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne diseases: malaria and yellow fever water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)


Central African Republic	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria respiratory disease: meningococcal meningitis water contact disease: schistosomiasis animal contact disease: rabies (2009)


Chad	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)

China

degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: Japanese encephalitis and dengue fever
soil contact disease: hantaviral hemorrhagic fever with renal syndrome (HFRS)
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Colombia	degree of risk: high food or waterborne diseases: bacterial diarrhea vectorborne diseases: dengue fever, malaria, and yellow fever water contact disease: leptospirosis (2009)


Congo, Democratic Republic of the	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria, plague, and African trypanosomiasis (sleeping sickness) water contact disease: schistosomiasis animal contact disease: rabies (2009)


Congo, Republic of the	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria and African trypanosomiasis (sleeping sickness) animal contact disease: rabies water contact disease: schistosomiasis (2009)


Costa Rica	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne diseases: dengue fever (2009)

Cote d'Ivoire

degree of risk: very high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: malaria and yellow fever
water contact: schistosomiasis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Croatia	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne diseases: tickborne encephalitis note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Cuba	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea and hepatitis A vectorborne diseases: dengue fever (2009)


Djibouti	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne disease: malaria note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Dominican Republic	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Ecuador	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)

Egypt

degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne disease: Rift Valley fever
water contact disease: schistosomiasis
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


El Salvador	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever water contact disease: leptospirosis (2009)


Equatorial Guinea	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria and yellow fever animal contact disease: rabies (2009)


Eritrea	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria (2009)


Estonia	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: tickborne encephalitis (2009)


Ethiopia	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne diseases: malaria respiratory disease: meningococcal meningitis animal contact disease: rabies water contact disease: schistosomiasis (2009)


Gabon	degree of risk: very high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria and chikungunya water contact disease: schistosomiasis animal contact disease: rabies (2009)


Gambia, The	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)

Ghana

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: malaria
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Guatemala	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: dengue fever and malaria water contact disease: leptospirosis (2009)


Guinea	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and yellow fever water contact disease: schistosomiasis aerosolized dust or soil contact disease: Lassa fever animal contact disease: rabies (2009)


Guinea-Bissau	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and yellow fever water contact disease: schistosomiasis animal contact disease: rabies (2009)


Guyana	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Haiti	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Honduras	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: leptospirosis (2009)


Hungary	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea and hepatitis A vectorborne diseases: tickborne encephalitis (2009)

India

degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
vectorborne diseases: chikungunya, dengue fever, Japanese encephalitis, and malaria
animal contact disease: rabies
water contact disease: leptospirosis
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Indonesia	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever vectorborne diseases: chikungunya, dengue fever, and malaria note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Iran	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne diseases: Crimean Congo hemorrhagic fever and malaria note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Iraq	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Kenya	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria and Rift Valley fever water contact disease: schistosomiasis animal contact disease: rabies (2009)


Laos	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Latvia	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne diseases: tickborne encephalitis (2009)


Liberia	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and yellow fever water contact disease: schistosomiasis aerosolized dust or soil contact disease: Lassa fever animal contact disease: rabies (2009)


Lithuania	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne diseases: tickborne encephalitis (2009)


Madagascar	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: chikungunya, malaria, and plague water contact disease: schistosomiasis (2009)


Malawi	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and plague water contact disease: schistosomiasis animal contact disease: rabies (2009)


Malaysia	degree of risk: high food or waterborne diseases: bacterial diarrhea vectorborne diseases: dengue fever and malaria note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Mali	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis respiratory disease: meningococcal meningitis (2009)


Mauritania	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and Rift Valley fever respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)


Mexico	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: dengue fever water contact disease: leptospirosis (2009)


Montenegro	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: Crimean Congo hemorrhagic fever (2009)


Mozambique	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and plague water contact disease: schistosomiasis animal contact disease: rabies (2009)


Namibia	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis (2009)


Nepal	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: Japanese encephalitis, malaria, and dengue fever (2009)


Nicaragua	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: dengue fever and malaria water contact disease: leptospirosis (2009)

Niger

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne disease: malaria
water contact disease: schistosomiasis
animal contact disease: rabies
respiratory disease: meningococcal meningitis
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)

Nigeria

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
vectorborne disease: malaria and yellow fever
respiratory disease: meningococcal meningitis
aerosolized dust or soil contact disease: one of the most highly endemic areas for Lassa fever
water contact disease: leptospirosis and shistosomiasis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)

Pakistan

degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
vectorborne diseases: dengue fever and malaria
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Panama	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: dengue fever and malaria (2009)


Papua New Guinea	degree of risk: very high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria (2009)


Paraguay	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: dengue fever and malaria (2009)


Peru	degree of risk: very high food or waterborne diseases: bacterial, hepatitis A, and typhoid fever vectorborne disease: dengue fever, malaria, and yellow fever water contact disease: leptospirosis (2009)


Philippines	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever, malaria, and Japanese encephalitis water contact disease: leptospirosis (2009)


Poland	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: tickborne encephalitis note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Russia	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: tickborne encephalitis note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Rwanda	degree of risk: very high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria animal contact disease: rabies (2009)


Sao Tome and Principe	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria animal contact disease: rabies (2009)


Senegal	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: Crimean-Congo hemorrhagic fever, dengue fever, malaria, Rift Valley fever, and yellow fever water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)


Serbia	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea vectorborne disease: Crimean Congo hemorrhagic fever note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Sierra Leone	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and yellow fever water contact disease: schistosomiasis aerosolized dust or soil contact disease: Lassa fever (2009)


Somalia	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne diseases: dengue fever, malaria, and Rift Valley fever water contact disease: schistosomiasis animal contact disease: rabies (2009)


South Africa	degree of risk: intermediate food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever water contact disease: schistosomiasis (2009)


South Sudan	degree of risk: very high food or waterborne disease: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever vectorborne disease: malaria, dengue fever, African trypanosomiasis (sleeping sickness) water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies


Sri Lanka	degree of risk: high food or waterborne diseases: bacterial diarrhea and hepatitis A vectorborne disease: dengue fever and chikungunya water contact disease: leptospirosis animal contact disease: rabies (2009)

Sudan

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
vectorborne diseases: malaria, dengue fever, African trypanosomiasis (sleeping sickness)
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Suriname	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: dengue fever, Mayaro virus, and malaria water contact disease: leptospirosis (2009)


Swaziland	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis (2009)


Tajikistan	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria (2009)


Tanzania	degree of risk: very high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and plague water contact disease: schistosomiasis animal contact disease: rabies (2009)

Thailand

degree of risk: high
food or waterborne diseases: bacterial diarrhea
vectorborne diseases: dengue fever, Japanese encephalitis, and malaria
animal contact disease: rabies
water contact disease: leptospirosis
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Timor-Leste	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: chikungunya, dengue fever and malaria (2009)

Togo

degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: malaria and yellow fever
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Uganda	degree of risk: very high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria, plague, and African trypanosomiasis (sleeping sickness) water contact disease: schistosomiasis animal contact disease: rabies (2009)


Venezuela	degree of risk: high food or waterborne diseases: bacterial diarrhea vectorborne disease: dengue fever and malaria (2009)

Vietnam

degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: dengue fever, malaria, Japanese encephalitis, and plague
water contact disease: leptospirosis
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009)


Yemen	degree of risk: high food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever vectorborne diseases: dengue fever and malaria water contact disease: schistosomiasis (2009)


Zambia	degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne diseases: malaria and plague are high risks in some locations water contact disease: schistosomiasis animal contact disease: rabies (2009)


Zimbabwe	degree of risk: high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis animal contact disease: rabies (2009)

The online Factbook is updated weekly. ISSN 1553-8133
For additional information on government leaders in selected foreign countries, go to World Leaders.