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Travel Health Warning
Travel Warning: Swine Influenza and Severe Cases of Respiratory Illness in Mexico
Avoid Nonessential Travel to Mexico



Updated: April 27, 2009

Current Situation

As of April 27, 2009, the Government of Mexico has reported 18 laboratory confirmed human cases of swine influenza A/H1N1 infection. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country's 32 states. The World Health Organization (WHO), the Global Alert and Response Network (GOARN), and the Centers for Disease Control and Prevention (CDC) have sent experts to Mexico to work with health authorities. CDC has confirmed that seven of 14 respiratory specimens sent to CDC by the Mexican National Influenza Center are positive for swine influenza virus and are similar to the swine influenza viruses recently identified in the United States.

On April 25, the WHO Director-General declared this event a Public Health Emergency of International Concern under the rules of the International Health Regulations. CDC and state public and animal health authorities are currently investigating 20 cases of swine flu in humans in California, Texas, Kansas, Ohio, and New York City. Some of the U.S. cases have been linked to travel to Mexico. At this time, only two of the 20 cases in the U.S. have been hospitalized and all have recovered, but deaths are reported to have occurred in Mexico. CDC is concerned that continued travel by U.S. travelers to Mexico presents a serious risk for further outbreaks of swine flu in the United States.
CDC Recommendations

At this time, CDC recommends that U.S. travelers avoid all nonessential travel to Mexico. Changes to this recommendation will be posted at http://wwwn.cdc.gov/travel/.

Please check this site frequently for updates.
If you must travel to an area that has reported cases of swine flu:
Stay Informed

* Check updates from the:
o Centers for Disease Control and Prevention,
o Secretaria de Salud,
o World Health Organization
* Monitor announcements from Mexico’s Ministry of Health and local government including information about affected areas, as not all areas are equally affected.
* Follow local public health guidelines, including any movement restrictions and prevention recommendations.
* Be aware that Mexico is checking all exiting airline passengers for signs of swine flu. Exit screening may cause significant delays at airports.

Prepare for your trip before you leave

Antiviral Medications: Travelers from the United States going to Mexico who are at high risk of severe illness from influenza (for example persons with chronic conditions such as diabetes, lung disease, heart disease, and the elderly, see http://www.cdc.gov/flu/professionals/acip/index.htm) are recommended to take antiviral medications for prevention of swine influenza during travel. The recommended antiviral drugs for swine influenza are oseltamivir (brand name Tamiflu®) and zanamivir (brand name Relenza®). Both are prescription drugs that fight against swine flu by keeping flu viruses from reproducing in the body. These drugs can prevent infection if taken as a preventative. Talk to your doctor about correct indications for using influenza antiviral medications. Always seek medical care if you are severely ill.

Antiviral chemoprophylaxis, or taking medicine to prevent flu viruses from reproducing in the body, (pre-exposure or post-exposure) is recommended for the following people:

* Household close contacts who are at high risk for complications of influenza (for example, persons with certain chronic medical conditions and the elderly) of a confirmed or suspected case.
* School-aged children who are at high risk for complications of influenza (for example, persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
* Travelers to Mexico who are at high risk for complications of influenza (for example, persons with certain chronic medical conditions and the elderly).
* Border workers (Mexico) who are at high risk for complications of influenza (for example, persons with certain chronic medical conditions and the elderly).
* Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the ill person’s infectious period.

Antiviral chemoprophylaxis can be considered for the following:

* Any health care worker who is at high risk for complications of influenza (for example, persons with certain chronic medical conditions and the elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
* Persons who are not at high risk but who are travelers to Mexico or first responders or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

Further information about CDC’s recommendations for antiviral use during the swine flu outbreak can be found at the following websites:

* Healthcare professionals
o http://www.cdc.gov/swineflu/recommendations.htm
* General public
o http://www.cdc.gov/swineflu/antiviral_swine.htm

For all travelers, CDC recommends the following steps to help you stay healthy:

* Be sure you are up-to-date with all your routine vaccinations, including a seasonal influenza vaccine. The seasonal vaccine is not expected to offer protection against swine flu viruses, but it can protect against seasonal influenza viruses which may still be circulating in Mexico and the Southern Hemisphere.
* Pack a travel health kit that contains basic first aid and medical supplies. See Pack Smart in Your Survival Guide to Safe and Healthy Travel for a list of what to include in your travel health kit.
* Identify the health-care resources in the area(s) you will be visiting.
* Check if your health insurance plan will cover you abroad. Consider purchasing additional insurance that covers medical evacuation in case you become sick. For more information, see Medical Information for Americans Traveling Abroad from the U.S. Department of State.
* Remember that U.S. embassies, consulates and military facilities do not have the legal authority, capability, and resources to evacuate or to give medications, vaccines or medical care to private U.S. citizens overseas.

During your visit to an area affected by swine flu
Monitor the local situation

* Pay attention to announcements from the local government
* Follow local public health guidelines, including any movement restrictions and prevention recommendations

Practice healthy habits to help stop the spread of swine flu

* Wash your hands often with soap and water. This removes germs from your skin and helps prevent diseases from spreading.
o Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
* Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket.
* If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
* Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand cleaner (with at least 60% alcohol) when soap and water are not available.
* Avoid touching your eyes, nose, or mouth. Germs spread that way.
* Try to avoid close contact with sick people. (Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.)
* It is important to follow the advice of local health and government authorities. You may be asked to restrict your movement and stay in your home to contain the spread of swine flu.

Seek medical care if you feel sick

* If you are ill with fever and other symptoms of swine flu such as cough and sore throat, see a doctor, especially if you think you may have had contact with someone with swine flu or severe respiratory illness in the past 7 days before becoming ill.
* If you need to find local medical care, a U.S. consular officer can help you locate medical services and will inform your family or friends in the United States of your illness. To contact the U.S. Embassy or consulate in the country where you are visiting, call the Overseas Citizens Services at:
o 1-888-407-4747 if calling from the U.S. or Canada,
o 00 1 202-501-4444 if calling from overseas, or
o Find your local US Embassy at Websites of U.S. Embassies, Consulates, and Diplomatic Missions.
* Do not travel while you are sick, except to get local medical care.
* Try to limit contact with others as much as possible. By limiting your contact with other people, you can help prevent the spread of swine flu.
* For more information about what to do if you become sick while you are traveling outside the United States, visit Your Survival Guide for Safe and Healthy Travel.

After your return from an area that has reported cases of swine flu:

* Closely monitor your health for 7 days.
* If you become ill with fever and other symptoms of swine flu like cough and sore throat and possibly vomiting and diarrhea during this period, call your doctor or clinic for an appointment right away. Your doctor may test you for influenza and decide whether influenza antiviral treatment is indicated.
* When you make the appointment, tell the doctor the following:
o Your symptoms,
o Where you traveled, and
o If you have had close contact with a person infected with swine flu.
* Avoid leaving your home while sick except to get local medical care, or as instructed by your doctor. Do not go to work or school while you are ill. If you must leave your home (for example, to seek medical care) wear a surgical mask to keep from spreading your illness to others.
* Always cover your nose and mouth with a tissue when you cough or sneeze. Throw away used tissues in a trash can.
* Wash your hands with soap and water often and especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand gel containing at least 60% alcohol.
* Avoid close contact with other people as much as possible
* Wear a surgical mask if you are in contact with other people

Status of Entry and Exit Screening in the United States and Mexico
Mexico Exit Screening

Swine flu screening has been instituted at airports and land borders for travelers departing Mexico, according to Mexican health authorities. Passengers showing symptoms of swine influenza will be asked to submit voluntarily to physical examination and further evaluation, if needed.
United States

At this time, the United States is not conducting enhanced entry screening of passengers arriving from Mexico, nor is the United States conducting exit screening of passengers departing for Mexico.

The Department of Homeland Security will provide Travel Health Alert Notices to US travelers going to and coming from Mexico at all airports, seaports, and land border crossings. These notices provide advice to travelers on how to reduce their risk of getting sick, the symptoms of swine flu, and what to do if the traveler becomes sick.

CDC will provide all ill passengers and their contacts arriving from Mexico with Travel Health Alert Notices. These notices provide advice information regarding seeking health advice from a physician and how to prevent illness in persons who have been exposed but who are not ill.
Additional Information

If you have specific questions about the swine influenza cases see http://www.cdc.gov/contact/ or call 1-800-232-4636, which is 1-800-CDC-INFO.

To learn more about travel health, visit http://www.cdc.gov/travel.

For the swine Influenza situation in Mexico, visit:

* Secretaria de Salud: Secretary of Health, Mexico [Web page in Spanish]
* World Health Organization: Influenza-Like Illness in the United States and Mexico
* Pan American Health Organization

For the swine Influenza situation in the United States, visit:

* For information on antivirals
o http://www.cdc.gov/swineflu/recommendations.htm (for healthcare professionals)
o http://www.cdc.gov/swineflu/antiviral_swine.htm (for the public)
* For information on swine flu in the United States, visit http://www.cdc.gov/flu/swine

Swine flu travel health updates will be posted on http://wwwn.cdc.gov/travel/ as information becomes available.