Sri Lanka

• Certificate proving yellow fever vaccination is required for travelers 9 months and older coming from countries with risk of YF transmission. This also applies to all airport transit stops (No exit through immigration checkpoint) in risk countries.
• Transmission: Bite of an infected mosquito
• Signs and symptoms: Ranges from nonspecific illness to fatal hemorrhagic fever. Mild disease occurs in 80-90% of infections. Symptoms appear abruptly with fever, headache, chills, myalgia lasting 2-4 days. In most cases, this phase is followed by a period of remission when the virus clears. In 15-25% of infected people, infection can relapse with high fever, vomiting, epigastric pain, jaundice, renal failure and hemorrhaging.

Hepatitis A virus can cause liver disease, and in rare cases, liver failure and death.

• Recommended for all travelers as it is high risk and presumed to have widespread distribution.
• Transmission: Oral-fecal route through contaminated food and water. 
• Signs and symptoms: abrupt onset of fever, anorexia, nausea, vomiting, abdominal pain, diarrhea, and malaise followed within days of jaundice. Dark urine usually occurs before the onset of jaundice.

Hepatitis B is a viral infection that targets the liver and may cause chronic infections.

• Risk is considered widespread.
• Vaccination is advised for healthcare personnel, adventure travelers, long-term or frequent short-term visitors, and individuals at risk of exposure through needles (e.g., acupuncture, tattoos, injection drug use) or new sexual contacts during travel.
• Transmitted through percutaneous, mucosal, or non intact skin exposure to infected blood and blood products and other bodily fluids (semen, vaginal secretions, or saliva).
• Signs and symptoms: The Presence of symptoms varies by age and at least 50% of infections are asymptomatic. Most children < 5 years old and newly infected immunocompromised adults are asymptomatic. When present symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stools, joint pain, hepatomegaly, splenomegaly, and jaundice. HBV infection can be self-limited or chronic.

Low risk exists in urban and rural areas throughout the country.

• Vaccination should be considered for:
  • Travellers over the age of 18 staying for longer than 6 months
  • Travelers over the age of 65 with multiple underlying medical conditions
• Transmission: Through mosquito bites throughout the year, particularly during the rainy seasons. Peak activity is July-October.
• Signs and symptoms: Characteristics signs and symptoms is the abrupt onset of fever, rash and severe joint pain. Acute symptoms should resolve in 7-10 days, but 50% of people at 3 months and 30% at 12 months still had variable severity of joint pain.

Typhoid fever is a bacterial infection caused by salmonella from improperly prepared food or contaminated water.

• High risk exists and is presumed to have widespread distribution. Recommended for all travelers.
• Transmission: Oral-fecal route through contaminated food and water. Can rarely occur through sexual contact, especially among men who have sex with men. 
• Signs and symptoms: Gradually increasing fever, fatigue, headache, malaise, myalgia, anorexia, and the appearance of a transient macular rash on the trunk.

Rabies is a devastating viral infection transmitted through animal bites.

• Significant risk from dogs exists throughout the country. 
• Recommended for
  • All prolonged stays
  • Short stays: adventure travelers, hikers, cyclist and cavers. Travelers more than 24 hours away from a hospital with a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment, animal workers and all travelers likely to have contact with bats.
• Transmission: A scratch, bite, or a lick (of nonintact skin) of a rabid animal.
• Signs and symptoms: Tingling at the bite site followed by fever, headache myalgia, anxiety, depression, irritability, sometimes respiratory or GI symptoms

Risk is present year-round in rural agricultural regions, primarily Anuradhapura, Polonnaruwa, Kurunegala, Puttalam, and parts of Gampaha, with peak transmission from November to February. Mountainous areas pose no risk. Vaccination is recommended for travelers staying over a 1 month in risk areas, and for short-term visitors with significant rural or outdoor exposure. Not advised for those visiting only urban centers or taking brief rural day trips.

• Transmission: Use mosquito precautions; most active at dusk and dawn, can also bite during the day.
• Signs and symptoms: Japanese encephalitis can cause symptoms ranging from mild, flu-like illness to rare but severe brain inflammation. Most infected individuals have no symptoms or only mild ones like fever and headache. In rare severe cases, symptoms may include high fever, stiff neck, confusion, seizures, paralysis, or coma.

Moderate risk for persons who have multiple sex partners, are in social networks that include men who have sex with men. Risk for people outside these groups are low.

• Transmission: Transmission is generally restricted to direct contact with droplets – saliva, urine, feces, semen, respiratory secretions or lesion material)
• Signs and symptoms: Many infections are asymptomatic. For those with symptoms – febrile period includes chills, lymphadenopathy, malaise, headaches, asthenia, fatigue and myalgia. Symptoms then move to the second phase with development of rash (uniformly developing blisters that progress from macules to papules to vesicles to pustules. Lesions ultimately scab and then scar.

• No evidence of sustained transmission in the area.

Most common illness for travelers, from consuming contaminated food & water

• Affects up to 70% of travelers and risks minimized with good hygiene and safe food/drink choices (eg. avoid raw foods, ice in drinks)
• Symptoms may include diarrhea, vomiting, nausea, fever, bloating.
• Consider taking an antibiotic called Azithromycin on travels to treat traveler’s diarrhea.

There is a substantial risk in both urban and rural areas nationwide, particularly in the districts of Batticaloa, Colombo, Jaffna, and Kalutara.

• No vaccine is available in Canada at this time. 
• Transmission: Bite of an infected mosquito. Transmission occurs throughout the year, especially during the rainy season, with peak activity from June through July and from October to December. 
• Symptoms: high fever, severe headache, pain behind the eyes, joint pain and muscle pain. A rash can also appear and in some cases, individuals may experience bleeding from the nose, gums or abnormal and easy bruising.