Bangladesh
Avoid dental treatment in Bangladesh as the standards of care are low and hygiene cannot be guaranteed.
The quality of medication cannot be guaranteed in Bangladesh, heat damaged and out of date supplies may be stocked
Blood supplies should be considered as unsafe in Bangladesh
Medical facilities in Bangladesh do not approach Western standards, even in tourist areas.
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas. Sleep in well-screened accommodations. Carry anti-diarrheal medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.
A new strain of cholera (Bengal cholera) has appeared in Bangladesh. Disease caused by this new strain is characterized by extremely rapid onset of severe symptoms. The current cholera vaccine affords no protection against this new strain; therefore, particular caution should be taken with food, beverages and personal hygiene. Persons becoming ill should seek immediate medical care and rehydration therapy.
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
Surface waters (rivers, ponds, canals, etc.) are heavily contaminated with human waste; however, more than 2 million hand tubewells throughout the country provide access to potable water (although treatment is still recommended). In northern and western Bangladesh, well water has become chemically contaminated and the risk of arsenic poisoning is considerable, particularly in the district of Ishwardi (75 miles northwest of Dhaka) and, to a somewhat lesser extent, in Dhaka itself. In these areas of the country it is advisable to avoid the use of well water and to boil water from surface sources for drinking.
Cholera: Although limited in effectiveness, vaccination may be appropriate for persons living and/or working in less than sanitary conditions for more than 3 months where medical facilities are unavailable. Vaccination may also be appropriate for travelers with impaired gastric defenses who are planning an extended visit or being exposed to unsanitary conditions. Vaccination is not advised for pregnant women, infants younger than 6 months old, or persons with a history of severe reaction to the vaccine.
Hepatitis A: Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese Encephalitis: Consider vaccination if staying a month or more from July to December when transmission is presumed to occur, especially if travel includes rural areas. Also consider if staying less than 30 days during that period and at high risk (in case of epidemic outbreak or extensive outdoor exposure in rural areas).
Polio: A one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Rabies: Preexposure vaccination should be considered for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.
Typhoid: Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited. Contraindications depend on vaccine type.
Note: All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
DISEASE RISK SUMMARY
Insect-borne illness:
Dengue fever - occurs
Encephalitis (Japanese type) - occurs (past outbreaks reported in Tangail district, though risk is probably widespread)
Filariasis - common
Leishmaniasis (visceral) - prevalent
Malaria - prevalent
Sandfly fever - prevalent
Food-borne and water-borne illness: common throughout the area, in particular cholera and other watery diarrheas, the dysenteries, typhoid fever, viral hepatitis, and helminthic (parasitic worm) infections. Note that these usually present a more serious problem during the annual monsoon season (June-October).
Brucellosis - common
Echinococcosis (hydatid disease) - common
Yellow fever: Any person (including infants) arriving by air or sea without a certificate is detained in isolation for a period up to 6 days if he or she arrives within 6 days of departure from an infected area or has been in such an area in transit, or has come by an aircraft that has been in an infected area and has not been disinsected in accordance with Bangladesh or WHO regulations.
The following countries and areas are regarded as infected:
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Mauritania, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan (south of 15 degrees N), Togo, Uganda, United Republic of Tanzania, Zaire, Zambia.
America: Belize, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, French Guiana, Guatemala, Guyana, Honduras, Nicaragua, Panama, Peru, Surinam, Trinidad and Tobago, Venezuela.
Note: When a case of yellow fever is reported from any country, that country is regarded by the Government of Bangladesh as infected with yellow fever and is added to the above list.
