Earlier this week, the U.S. State Department issued a press release concerning the potential for travelers to China to be quarantined due to exposure to the H1N1 flu. If you are considering a trip to China, you should read this document, regardless of your nationality. You could be quarantined if your seat was near that of a passenger who had an elevated temperature when tested after arrival. Now might not be a good time to visit China. Part of the text of the release by the U.S. State Department follows:
“July 09, 2009
The Department of State alerts U.S. citizens to the quarantine measures imposed by the Government of China in response to the 2009-H1N1 pandemic that may affect travel to China. This Travel Alert updates the June 19, 2009 Travel Alert in order to address the potential for quarantine of unaccompanied minors. This Travel Alert expires on September 30, 2009.
In May 2009, China implemented a policy that allows it to quarantine arriving passengers who exhibit fever or flu-like symptoms if they are arriving from a country which has cases of 2009-H1N1, including the U.S. Although the overall percentage of Americans being quarantined remains low, the seemingly random nature of the selection process makes it almost impossible to predict when a traveler may be placed into quarantine. Travelers with even a slightly elevated body temperature risk being placed into hospital quarantine, while passengers sitting in close proximity to another traveler with fever or flu-like symptoms may be taken to a specially-designated hotel for a quarantine of approximately seven days, even if they show no symptoms themselves.
The Department of State has received reports of minors traveling without a parent or adult guardian being taken into quarantine upon arrival. Some of the children were under 10 years of age. Parents considering sending their children unaccompanied to China are urged to consider postponing their travel until the quarantine policy ends or until 2009-H1N1 Influenza subsides. In addition, there have been some instances where children have been separated from their parents during quarantine because only the parent or the child tested positive for 2009-H1N1 or exhibited symptoms. Travelers are advised that Chinese health authorities have not issued a country-wide policy on keeping family members together in quarantine, and the practice of keeping young children with their parents or guardians varies by quarantine facility. In some hospitals, parents have been denied access to their children who were in isolated quarantine. In these situations, there exists the possibility of Chinese medical personnel administering medications to minors without parental permission.
The Department of State continues to receive reports about poor quarantine conditions, including the unavailability of suitable drinking water and food, unsanitary conditions, the lack of telephone access, the absence of English-speaking staff, and limited availability of English-language interpreters.
Travelers to China are reminded that all foreign travelers, including U.S. citizens, are obliged to follow local procedures regarding quarantines and any other public health-related measures. The U.S. Embassy is unable to influence the duration of stay in quarantine for affected travelers. The Chinese government will not compensate people for lost travel expenses. Travelers to China are urged to consider purchasing travel insurance to protect against losses in the event they are quarantined.”
Today, the U.S. State Department posted an announcement about new procedures that have been initiated in China to deal with the outbreak of the H1N1 Influenza. Since these procedures may involve random testing and quarantine of travelers for up to seven days, we thought you might be interested in this “official” information.
“June 19, 2009
The Department of State alerts U.S. citizens to the quarantine measures imposed by the Government of China in response to the 2009-H1N1 pandemic that may affect travel to China. This Travel Alert expires on September 30, 2009.
Current quarantine measures in China include placing arriving passengers who exhibit fever or flu-like symptoms into seven-day quarantine. Although the proportion of arriving Americans being quarantined remains low, the random nature of the selection process increases the uncertainty surrounding travel to China. The selection process focuses on those sitting in close proximity to another traveler exhibiting fever or flu-like symptoms or on those displaying an elevated temperature if arriving from an area where outbreaks of 2009-H1N1 have occurred. We have reports of passengers arriving from areas where outbreaks have occurred (including the U.S. and Mexico) being placed in precautionary quarantine simply because they registered slightly elevated temperatures.
In some instances, children have been separated from their parents because either the parent or the child tested positive for 2009-H1N1 and was placed in quarantine for treatment. This situation presents the possibility of Chinese medical personnel administering medications to minors without first having consulted their parents.
The Department of State has received reports about unsuitable quarantine conditions, including the unavailability of suitable drinking water and food, unsanitary conditions, and the inability to communicate with others.
Travelers to China are reminded that all foreign travelers, including U.S. citizens, are obliged to follow local procedures regarding quarantines and any other public health-related measures. The U.S. Embassy will be unable to influence the duration of stay in quarantine for affected travelers. The Chinese government will not compensate people for lost travel expenses. Travelers to China are urged to consider purchasing travel insurance to protect against losses in the event they are quarantined.
For more information on U.S. Government policy during a pandemic, and for travel safety information, please see the State Department’s “Pandemic/Avian Influenza” and “Remain in Country” fact sheets on www.travel.state.gov. Further information about 2009-H1N1 Influenza, including steps you can take to stay healthy, can be found at the U.S. Centers for Disease Control website at http://www.cdc.gov/h1n1flu/, the U.S. Government pandemic influenza website at http://www.pandemicflu.gov, and the World Health Organization website at http://www.who.int/csr/disease/swineflu/en/index.html. ”
As noted in our recent blog, Influenza H1N1 is spreading to the Southern Hemisphere and the number of countries it has surfaced in has cause the World Health Organization (WHO) to declare the outbreak a global pandemic.
However, when WHO originally set the alert levels for pandemics, it was preparing for deadly flu outbreaks similar to the Avian Flu. The current H1N1 strain currently appears to be a relatively mild form of the flu, although it can and has caused a number of deaths. However, the mortality rates from H1N1 remain low at this time.
As noted previously, Influenza H1N1 appears to be ebbing in parts of the Northern Hemisphere and rising in the Southern Hemisphere, which is experiencing the winter season. There is a possibility that H1N1 will re-invade the Northern Hemisphere during the onset of the normal flu season next October. One issue that is of concern to the health authorities is that the Influenza virus could mutate before it returns to the Northern Hemisphere. As of yet there is no vaccine for the H1N1 strain, so any changes in its composition could delay development of a vaccine.
There are no travel restrictions now in place as a result of H1N1. Travelers should consider their destination and the level of outbreak at the destination when planning travel.
In a press briefing transcript on June 4, 2009, the CDC indicated that the H1N1 flu (swine flu) has likely peaked in Northern Hemisphere countries, although there are some locations that continue to see more cases. The CDC believes that cases of H1N1 will now start to accelerate in the Southern Hemisphere, as this area is approaching winter, the time of year most conducive to proving the “right” environment for a flu season. Travelers should check the Internet for local news on H1N1, regardless of the destination for which they are headed.
Some other factoids about H1N1 emerged from the CDC briefing. H1N1 seems more likely to infect the young rather than seniors. Approximately 60% of the cases and 42% of the hospitalizations have occurred in people between the ages of 5 and 24 and the next highest group is kids under 5 years. Cases in those over 60 years of age have been quite low (fewer than 5% of the total), although this group is usually impacted more than the rest of the population by seasonal influenza. It appears that some people who are 60 or older may have antibodies from other forms of the flu they have contracted during their lives and that these may provide antibodies repelling H1N1.
Just to bring you up to date, over 19,000 cases of H1N1 have been reported in over 66 countries. The United States appears to have been hit harder than most countries with 11,468 probable cases reported, 770 hospitalizations and 19 fatalities. To put this into perspective, seasonal influenza viruses are estimated to cause 200,000 hospitalizations each year in the United States with over 36,000 deaths. Most of the deaths and hospitalizations are in people over 65.
The following Travel Alert was issued by the U.S. Department of State on May 15, 2009:
The Department of State wishes to inform U.S. citizens traveling to and residing in Mexico that on May 15 2009, the U.S. Centers for Disease Control and Prevention (CDC) lifted its recommendation that American citizens avoid all nonessential travel to Mexico. As a result of the CDC’s decision, the State Department’s Travel Alert relating to the 2009-H1N1 influenza outbreak is no longer in effect.
The CDC continues to suggest precautions that travelers and U.S. citizens resident in Mexico (especially those at high risk for complications of influenza) should take to reduce their risk of infection while in Mexico; provides recommendations for those who must travel to an area where cases of 2009-H1N1 influenza have been reported; and recommends measures travelers should take following their return from an area that has reported cases of 2009-H1N1 influenza.
At ThereArePlaces, we report the offical stances to you, but suggest that you decide when you feel that travel is safe. While the Influenza A outbreak has not yet lived up to its potential severity, it is still early in the game. If you have travel plans in Mexico, check locally to determine the severity (or lack of it) at your destination.
Although Influenza A seems to have fallen off the world news chart, the outbreak is still growing, although at a slow speed. For an interesting look at the time series of the outbreak check out this map at the Who website (Flash player required).
Click on the “View the Interactive map” link and you will see the most recent influenza outbreak map. In the upper right hand corner is a button allowing you to see the number of cases and their spatial patterns by day back to April 26. If you are concerned about the influenza in a location for which you intend to travel, this is a good way to see what has and is happening there.
By the way, WHO does not recommend curtailling travel due to the Influenza A outbreak. For more information, see their website.
The World Health Organization has published a detailed map showing the geographic dispersion of the Swine Flu. It is likely that the map underestimates the actual spread of the new influenza due to unreliable reporting in many developing nations. The former Swine Flu in now being called Influenza A (H1N1), as it is caused fo the influenza “A” virus that swince can transmit to humans, although the virus is also found in birds.
Also of interest is the WHO Influenza website, which is updated daily and contains information about the flu that may be of interest to travelers. Finally, see this WHO link for information on what you can do to protect yourself from catching Influenza A (H1N1).