EFTA02695292.pdf

From: Sent: Wednesday, November 9, 2011 8:26 PM To: Jeffrey Epstein CC Subject: Ivory Coast CDC Health Information Subject: Ivory =oast CDC Health Information From: lesley.jee@gmail.com Date: =ed, 9 Nov 2011 15:21:02 -0500 CC To Preparing =or Your Trip to Cote d'Ivoire Before visiting Cote d'Ivoire, you may =eed to get the following vaccinations and medications for =accine- preventable diseases and other diseases you might be at risk for =t your destination: (Note: Your doctor or health-care =rovider will determine what you will need, depending on factors such as =our health and immunization history, areas of the country you will be =isiting, and planned activities.) To have the =ost benefit, see a health-care provider at least 4-6 weeks =efore your trip to allow time for your vaccines to take effect and to =tart taking medicine to prevent malaria, if you need it. Even if you have less than 4 weeks before you leave, you should =till see a health-care provider for needed vaccines, anti-malaria drugs =nd other medications and information about how to protect yourself from rllness and injury while traveling. CDC recommends =hat you see a health-care provider who specializes in Travel =edicine. up-to-date. Check =he links below to see which vaccinations adults and children should =et. Routine vaccines, as they are often called, such as for =nfluenza, chickenpox (or varicella), polio, measles/mumps/rubella =MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of =ife; see the childhood and adolescent immunization =chedule and routine adult immunization schedule. Routine vaccines are recommended even if you do not travel. =lthough childhood diseases, such as measles, rarely occur in the United =tates, they are still common in many parts of the world. A traveler who =s not vaccinated would be at risk for infection. EFTA_R1_02045620 EFTA02695292  Vaccine-Preventable Diseases Vaccine recommendations are =ased on the best available risk information. Please note that the level =f risk for vaccine-preventable diseases can change at any time. Vaccination or =isease Recommendations or Requirements for =accine-Preventable Diseases Routine Recommended if you are not =p-to-date with routine shots, such as measles/mumps/rubella (MMR) =accine, diphtheria/pertussis/tetanus (DPI) vaccine, poliovirus vaccine, =tc. see map) where exposure might occur through food or water. Cases =f travel-related hepatitis A can also occur in travelers to developing =ountries with "standard" tourist itineraries, accommodations, and food =onsumption behaviors. Recommended for all unvaccinated persons traveling to or working in =ountries with intermediate to high levels of endemic HBV transmission =see map), especially those who might be exposed to blood or body =luids, have sexual contact with the local population, or be exposed =hrough medical treatment (e.g., for an accident). Typhoid Recommended for all unvaccinated people traveling =o or working in West Africa, especially if staying with friends or =elatives or visiting smaller cities, villages, or rural areas where =xposure might occur through food or water. Recommended for adult travelers who have received a primary series =ith either inactivated poliovirus vaccine (IPV) or oral polio vaccine =OPV). They should receive another dose of IPV before departure. For =dults, available data do not indicate the need for more than a single =ifetime booster dose with IPV. Yellow Fever Requirements: Required upon arrival =rom all countries for travelers ≥1 year of age. Recommendations: Meningococcal (meningitis) Recommended if you plan to =isit countries that experience epidemics of meningococcal disease =uring December through June (see map). Rabies Recommended for =ravelers spending a lot of time outdoors, especially in rural areas, =nvolved in activities such as bicycling, camping, or hiking. Also =ecommended for travelers with significant occupational risks (such as =eterinarians►, for long-term travelers and expatriates living in areas =ith a significant risk of exposure, and for travelers involved in any =ctivities that might bring them into direct contact with bats, =arnivores, and other mammals. Children are considered at higher risk =ecause they tend to play with animals, may receive more severe bites, =r may not report bites. Malaria Areas of Cote d'Ivoire with Malaria: All (more information) If you will be visiting an area of Cote d'Ivoire with =alaria, you will need to discuss with your doctor the best ways for you =o avoid getting sick with malaria. Ways to prevent malaria include the =ollowing: • Taking a =rescription antimalarial drug • Using =nsect repellent and wearing long pants and sleeves to prevent mosquito =ites • Sleeping in air-conditioned or =ell-screened rooms or using bednets All of the =ollowing antimalarial drugs are equal options for preventing malaria in =cite d'Ivoire:Atovaquone- proguanil, doxycycline, or =efloquine. For detailed information about each of these =rugs, see Choosing a Drug to Prevent Malaria. 2 EFTA_R1_02045621 EFTA02695293  Note: Chloroquine is NOT an effective antimalarial drug in C6t= d'Ivoire and should not be taken to prevent malaria in this region. To find out more information on =alaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, =ities, and place names for more specific malaria risk information and =he recommended prevention medicines for that area. Malaria Contact for =ealth-Care Providers For assistance with the =iagnosis or management of suspected cases of malaria, call the CDC =alaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For =mergency consultation after hours, call 770-488-7100 and ask to speak =ith a CDC Malaria Branch clinician. A Special Note about Antimalarial Drugs You should purchase your antimalarial drugs before travel. Drugs =urchased overseas may not be manufactured according to United States =tandards and may not be effective. They also may be dangerous, contain =counterfeit medications or contaminants, or be combinations of drugs =hat are not safe to use. Halofantrine (marketed as =alfan) is widely used overseas to treat malaria. CDC recommends that =ou do NOT use halofantrine because of =erious heart-related side effects, including deaths. You should avoid =sing antimalarial drugs that are not recommended unless you have been diagnosed with =ife-threatening malaria and no other options are immediately =vailable. For detailed information about =hese antimalarial drugs, see Malaria is always a serious disease and may be a deadly =llness. Humans get malaria from the bite of a mosquito infected with =he parasite. Prevent this serious disease by seeing your health-care =rovider for a prescription antimalarial drug and by protecting yourself =gainst mosquito bites (see below). Travelers to =alaria risk-areas in Cote d'Ivoire, including infants, children, =nd former residents of C6te d'Ivoire, should take one of the =ntimalarial drugs listed in the box above. Symptoms Malaria =ymptoms may include • fever • chills • sweats • headache • body aches • nausea and vomiting • fatigue Malaria symptoms will occur at =east 7 to 9 days after being bitten by an infected mosquito. Fever in =he first week of travel in a malaria-risk area is unlikely to be =alaria; however, you should see a doctor right away if you develop a =ever during your trip. Malaria may cause anemia =nd jaundice. Malaria infections with Plasmodium =alciparum, if not promptly treated, may cause kidney failure, =oma, and death. Despite using the protective measures outlined above, =ravelers 3 EFTA_R1_02045622 EFTA02695294 may still develop malaria up to a year after returning from a =alarious area. You should see a doctor immediately if you develop a =ever anytime during the year following your return and tell the =hysician of your travel. Items to Bring With You Medicines you may need: • The prescription medicines you take every day. Make =ure you have enough to last during your trip. Keep them in their =riginal prescription bottles and always in your carry-on =uggage. malaria-risk area <http://www.tsa.gov/> in C8te d'Ivoire and prescribed by =our doctor. • Medicine =or diarrhea, usually over-the-counter. Note: Some drugs available by prescription in the US are illegal =n other countries. Check the US Department of State Consular Information =heets for =he country(s) you intend to visit or the embassy or consulate for that =ountry(s). If your medication is not allowed in the country you will be =isiting, ask your health-care provider to write a letter on office =tationery stating the medication has been prescribed for you. Other items you may need: • Iodine =ablets and portable water filters to purify water if bottled water is =ot available. See A Guide to Commercially-Bottled Water and Other Beverages, =nd Basic Information about Skin Cancer chttp://wwwnc.cdc.gov/travel/page/safe-food-water.htm> for more =nformation. • Antibacterial hand wipes or =lcohol-based hand sanitizer containing at least 60% alcohol. • To prevent insect/mosquito bites, bring: * Lightweight long-sleeved =hirts, long pants, and a hat to wear outside, whenever =ossible. • Flying-insect spray to help =tear rooms of mosquitoes. The product should contain a pyrethroid =nsecticide; these insecticides quickly kill flying insects, including =osquitoes. • Bed nets treated with =ermethrin, if you will not be sleeping in an air-conditioned or =ell- screened room and will be in malaria-risk areas. For use and =urchasing information, seelnsecticide Treated Bed Nets on the CDC malaria site. =verseas, permethrin or another insecticide, deltamethrin, may be =urchased to treat bed nets and clothes. See other suggested over-the-counter medications and first aid =terns for a travelers' health kit. Note: =heck the Air Travel =ection of =he Transportation Security Administration <http://www.tsa.gov/> website for =he latest information about airport screening procedures and prohibited =tems. Top of Page Other =iseases Found in West Africa Risk =an vary between countries within this region and also within a country; =he quality of in-country surveillance also varies. The following are disease risks that might affect travelers; =his is not a complete list of diseases that can be present. =nvironmental conditions may also change, and up to date information =bout risk by regions within a country may also not always be =vailable. 4 EFTA_R1_02045623 EFTA02695295  Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other =iseases carried by insects that also occur in West Africa. African trypanosomiasis (African sleeping =ickness) has increased in Africa (it is epidemic in Angola, =emocratic Republic of the Congo, and the Sudan; and highly endemic in =ameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, =uinea, Mozambique, Uganda, and Tanzania; low levels are found in most =f the other countries), and an increase in travelers has been noted =ince 2000. Most had exposures in Tanzania and Kenya, reflecting =ommon tourist routes. Protecting yourself against insect =ites will help to prevent these diseases. Schistosomiasis, a parasitic infection, can be =ontracted in fresh water in this region. Do not swim in fresh water =except in well-chlorinated swimming pools) in these countries. Polio outbreaks were reported in several =reviously polio-free countries in Central, Eastern, and Western Africa =eginning in 2003. Polio is still endemic in Nigeria. Travelers to rural areas of West Africa may be exposed =o Lassa virus, which is spread through contact =ith rat urine or droppings. People can be exposed to Lassa virus by =nhaling tiny particles of these excretions in the air, especially if =hey stay in traditional dwellings. Travelers should avoid contact with =ats and should not stay in dwellings that may be infested with rats. =uman-to-human transmission of the disease has been described. Proper safety precautions should be =ollowed to prevent human-to-human transmission from infected =eople. Highly pathogenic avian =nfluenza (H5N1) has been found in poultry populations in several =ountries in Africa. Avoid all direct contact with birds, including =omestic poultry (such as chickens and ducks) and wild birds, and avoid =laces such as poultry farms and bird markets where live birds are =aised or kept. For a current list of countries reporting =utbreaks of H5N1 among poultry and/or wild birds, view updates from the =orld Organization for Animal Health (O1E), and for total =umbers of confirmed human cases of H5N1 virus by country see =he World Health =rganization (WHO) Avian Influenza website <http://www.who.int/csr/disease/avian_influenza/en/> . Many countries in this region have high incidence rates =f tuberculosis chttp://wwwnc.cdc.gov/travel/yellowBookCh4-TB.aspx> and high HIV prevalence rates. Top of Page Staying =ealthy During Your Trip Prevent Insect Bites Many diseases, like malaria and dengue, are spread through insect bites. One of =he best protections is to prevent insect bites by: Using =nsect repellent (bug spray) with 30%-50% DEFT. Picaridin, available in =% and 15% concentrations, needs more frequent application. There is =ess information available on how effective picaridin is at protecting =gainst all of the types of mosquitoes that transmit malaria. Wearing long-sleeved shirts, long pants, and a hat =utdoors. 5 EFTA_R1_02045624 EFTA02695296  Remaining indoors in a =creened or air-conditioned area during the peak biting period for =alaria (dusk and dawn). Sleeping =n beds covered by nets treated with permethrin, if not sleeping in an =ir-conditioned or well- screened room. Spraying =ooms with products effective against flying insects, such as those =ontaining pyrethroid. For detailed =nformation about insect repellent use, see Insect and Arthropod Protection. Prevent Animal Bites and Scratches Direct =ontact with animals can spread diseases like rabies or cause serious =njury or illness. It is important to prevent animal bites and =cratches. • Be sure =ou are up to date with tetanus vaccination. • Do not touch or feed any animals, including dogs and cats. Even =nimals that look like healthy pets can have rabies or other =iseases. • Help children stay safe by =upervising them carefully around all animals. • If you are bitten or scratched, wash the wound well with soap and =ater and go to a doctor right away. • After your trip, be sure to tell your doctor or state health =epartment if you were bitten or scratched during travel. For more information about rabies and travel, see the Rabies chapter of the Yellow Book or CDC's Rabies homepage <http://www.cdc.govirabiesk . For more information =bout how to protect yourself from other risks related to animals, seeAnimal-Associated Hazards. Be Careful about Food and Water Diseases from =ood and water are the leading cause of illness in travelers. Follow =hese tips for safe eating and drinking: • Wash your hands often with =oap and water, especially before eating. If soap and water are =ot available, use an alcohol-based hand gel (with at least 60% =lcohol). • Drink only bottled or boiled rater, or carbonated (bubbly) drinks in cans or bottles. Avoid tap =ater, fountain drinks, and ice cubes. If this is not possible, =earn how to make water safer to drink. • Do not eat =ood purchased from street vendors. • Make sure =ood is fully cooked. • Avoid dairy products, unless =ou know they have been pasteurized. Diseases =rom food and water often cause vomiting and diarrhea. Make sure to =ring diarrhea medicine with you so that you can treat mild cases =ourself. Avoid Injuries Car crashes are = leading cause of injury among travelers. Protect yourself =rom these injuries by: Not drinking and driving. 6 EFTA_R1_02045625 EFTA02695297  • Wearing =our seat belt and using car seats or booster seats in the backseat for =hildren. • Following local traffic =aws. • Wearing helmets when you ride =ikes, motorcycles, and motor bikes. • Not =etting on an overloaded bus or mini-bus. " Hiring a =ocal driver, when possible. ▪ Avoiding =ight driving. Other Health Tips • To avoid =nfections such as HIV and viral hepatitis do not share needles for =attoos, body piercing, or injections. To reduce =he risk of HIV and other sexually transmitted diseases always use latex =ondoms. • To prevent fungal and =arasitic infections, keep feet clean and dry, and do not go barefoot, =specially on beaches where animals may have defecated. Top of Page After You =eturn Home If you are not feeling well, =ou should see your doctor and mention that you have recently traveled. =lso tell your doctor if you were bitten or scratched by an animal while =raveling. If you have visited a =alaria-risk area, continue taking your antimalarial drug for 4 weeks =doxycycline or mefloquine) or seven days (atovaquone/proguanil) after =eaving the risk area. Malaria is always a serious disease and may be a =eadly illness. If you become ill with a fever or flu-like =llness either while traveling in a malaria-risk area or after you =eturn home (for up to 1 year), you should seek immediate medical attention and should tell the =hysician your travel history. Important =ote: This document is not a complete medical guide for =ravelers to this region. Consult with your doctor for specific =nformation related to your needs and your medical history; =ecommendations may differ for pregnant women, young children, and =ersons who have chronic medical conditions. Top of Page Map Disclaimer - The boundaries =nd names shown and the designations used on maps do not imply the =xpression of any opinion whatsoever on the part of the Centers for =isease Control and Prevention concerning the legal status of any =ountry, territory, city or area or of its authorities, or concerning =he delimitation of its frontiers or boundaries. Approximate border =ines for which there may not yet be full agreement are generally =arked. * Text size: " * * L * Email page 7 EFTA_R1_02045626 EFTA02695298 ` Print page ` Bookmark and share Favorites ` Digg ▪ Google Bookmarks ` Yahoo MyWeb Get email updates Contact Us: Centers for Disease Control =nd Prevention 1600 Clifton Rd Atlanta, GA 30333 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 New Hours of Operation 8am-8pm =T/Monday-Friday Closed cdcinfo@cdc.gov • Print page ` Bookmark and share ` Add this to... • Favorites • Del.icio.us • Digg • Facebook <http://wwwnc.cdc.gov/travel/destinationstivory-coast.htm#> • Google Bookmarks ` Yahoo MyWeb Get email updates • Page created: February 22, 2011 ` Page last updated: November 03, 2011 • Page last reviewed: September 29, 2011 • Content source: Centers for Disease =ontrol and Prevention National Center =or Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Global Migration and Quarantine =DGMQ) <http://www.cdc.govinceziclidgmq/index.html> Travelers' =ealthAll CDC Topics Search The =DCChoose a topic aboveSearch Button 8 EFTA_R1_02045627 EFTA02695299 On Nov 9, 2011, at 2:53 PM, Jeffrey Epstein =rote: find =ut about disease shots for ivory coast. rasseck tells me malaria =s there The information contained in this =ommunication is confidential, may be attorney-client privileged, =ay constitute inside information, and is intended only for the =se of the addressee. It is the property of Jeffrey Epstein Unauthorized use, =isclosure or copying of this communication or any part thereof is =trictly prohibited and may be unlawful. If you have received =his communication in error, please notify us immediately =y return e-mail or by e-mail to jeevacation@gmail.com, =nd destroy this communication and all copies thereof, including =11 attachments. copyright -all rights =eserved 9 EFTA_R1_02045628 EFTA02695300