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Health Information for Travelers to FranceClinician View

 
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Vaccines and Medicines

Prepare travelers to France with recommendations for vaccines and medications.

 

  Recommendations Transmission Guidance
Routine vaccines

Recommended for all travelers

varied

Immunization schedules

Hepatitis A

Consider for most travelers; recommended for travelers at higher risk (e.g. visiting smaller cities, villages, or rural areas where exposure might occur through food or water; or prone to "adventurous eating")

Traveling with Children

Hepatitis A vaccine can be given to infants aged 6-11 months traveling outside the United States; however, hepatitis A vaccine doses administered before 12 months of age are not considered for long-term protection. Immunoglobulin (0.1/mL/kg) injection may be used for protection up to 1 month.

Immune-Compromised Travelers

If trip is in <2 weeks, consider immunoglobulin (0.02/mL/kg) injection in addition to first dose of vaccine.

Fecal-oral route (contaminated food and water)

Person-to-person contact

Hepatitis A (Yellow Book)

Dosing info

Hepatitis B

Consider for most travelers; recommended for those who might be exposed to blood or other body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).

Contact with blood and other body fluids:

  • Unprotected sex
  • Injection drug use
  • Contaminated transfusions
  • Exposure to human blood
  • Contaminated tattoo and piercing equipment

Hepatitis B (Yellow Book)

Dosing info

Measles
  • Infants (6 through 11 months old): 1 dose of measles-mumps-rubella (MMR) vaccine before travel. This dose does not count as the first dose in the routine childhood vaccination series.
  • People 12 months old or older, with no evidence of immunity or no written documentation of any doses: 2 doses of MMR vaccine before travel. The 2 doses must be given 28 days apart.
  • People 12 months old or older who have written documentation of 1 dose and no other evidence of immunity: 1 additional dose before travel, at least 28 days after the previous dose.

Airborne

Measles (Rubeola) (Yellow Book)

Rabies

Recommended for the following groups:

  • Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats (such as adventure travelers and cavers).
  • Those with occupational risks (such as wildlife professionals and researchers).

Bites from bats (rabies is not present in canines or other mammals)

Rabies (Yellow Book)

Routine vaccines

Recommendations

Recommended for all travelers

Transmission

varied

Guidance

Hepatitis A

Recommendations

Consider for most travelers; recommended for travelers at higher risk (e.g. visiting smaller cities, villages, or rural areas where exposure might occur through food or water; or prone to "adventurous eating")

Transmission

Fecal-oral route (contaminated food and water)

Person-to-person contact

Guidance

Hepatitis A (Yellow Book)

Dosing info

Traveling with Children

Hepatitis A vaccine can be given to infants aged 6-11 months traveling outside the United States; however, hepatitis A vaccine doses administered before 12 months of age are not considered for long-term protection. Immunoglobulin (0.1/mL/kg) injection may be used for protection up to 1 month.

Immune-Compromised Travelers

If trip is in <2 weeks, consider immunoglobulin (0.02/mL/kg) injection in addition to first dose of vaccine.

Hepatitis B

Recommendations

Consider for most travelers; recommended for those who might be exposed to blood or other body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).

Transmission

Contact with blood and other body fluids:

  • Unprotected sex
  • Injection drug use
  • Contaminated transfusions
  • Exposure to human blood
  • Contaminated tattoo and piercing equipment
Guidance

Hepatitis B (Yellow Book)

Dosing info

Measles

Recommendations
  • Infants (6 through 11 months old): 1 dose of measles-mumps-rubella (MMR) vaccine before travel. This dose does not count as the first dose in the routine childhood vaccination series.
  • People 12 months old or older, with no evidence of immunity or no written documentation of any doses: 2 doses of MMR vaccine before travel. The 2 doses must be given 28 days apart.
  • People 12 months old or older who have written documentation of 1 dose and no other evidence of immunity: 1 additional dose before travel, at least 28 days after the previous dose.
Transmission

Airborne

Guidance

Measles (Rubeola) (Yellow Book)

Rabies

Recommendations

Recommended for the following groups:

  • Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats (such as adventure travelers and cavers).
  • Those with occupational risks (such as wildlife professionals and researchers).
Transmission

Bites from bats (rabies is not present in canines or other mammals)

Guidance

Rabies (Yellow Book)

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Non-Vaccine-Preventable Diseases

The following diseases are possible risks your patients may face when traveling in France. This list is based on our best available surveillance data and risk assessment information at the time of posting. It is not a complete list of diseases that may be present in a destination. Risks may vary within different areas of a destination.

 

  Guidance Patient Education Notes

Vectorborne

Tickborne Encephalitis
  • Spread by tick bites, occasionally by unpasteurized dairy products
  • Risk present only in small areas in many countries
  • Most cases occur
    • in forested areas
    • in areas with <2,500 ft (750 m) elevation
    • from April through November; peaks in early and late summer
  • Higher risk: outdoor activities (such as camping, hiking, fishing, bicycling) and outdoor occupations (such as forestry, military training)
  • No vaccine available in the US. Travelers with high-risk exposures or expatriates may consider vaccination in Canada or Europe.

Airborne & Droplet

H5N1 Avian Influenza
  • No human cases have been reported
  • Cases reported in poultry in France

Vectorborne

Tickborne Encephalitis

Guidance
Patient Education
Notes
  • Spread by tick bites, occasionally by unpasteurized dairy products
  • Risk present only in small areas in many countries
  • Most cases occur
    • in forested areas
    • in areas with <2,500 ft (750 m) elevation
    • from April through November; peaks in early and late summer
  • Higher risk: outdoor activities (such as camping, hiking, fishing, bicycling) and outdoor occupations (such as forestry, military training)
  • No vaccine available in the US. Travelers with high-risk exposures or expatriates may consider vaccination in Canada or Europe.

Airborne & Droplet

H5N1 Avian Influenza

Guidance
Patient Education
Notes
  • No human cases have been reported
  • Cases reported in poultry in France

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Patient Counseling

Counsel your patients on actions they can take on their trip to stay healthy and safe.

Eat and drink safely

Industrialized country—no special precautions. Counsel travelers visiting rural or remote areas that are served by unregulated water sources (such as private wells) to take special precautions to ensure the safety of their drinking water.

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Prevent bug bites

Counsel travelers to take standard precautions against bug bites, including use of an appropriate insect repellent.

More Information on Insect Repellents

DEET (concentration of 20% or more) is the only insect repellent shown to be effective against ticks. However, several EPA-registered active ingredients provide reasonably long-lasting protection against mosquitoes:

  • DEET (chemical name: N,N-diethyl-m-toluamide or N,N-diethyl-3-methyl-benzamide): Concentrations above 50% show no additional protective benefit.
  • Picaridin (KBR 3023 [Bayrepel] and icaridin outside the United States; chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester): Must be reapplied more often than DEET.
  • Oil of lemon eucalyptus (OLE) or PMD (chemical name: para-menthane-3,8-diol), the synthesized version of OLE. “Pure” oil of lemon eucalyptus (essential oil) is not the same product; it has not undergone similar testing for safety and efficacy, is not registered with EPA as an insect repellent, and is not covered by this recommendation.
  • IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester).
  • 2-undecanone

Products with <10% active ingredient may offer only limited protection (1–2 hours).

Encourage patients to use repellents and reapply only as instructed. If sunscreen is also needed, they should apply sunscreen first and repellent second. Encourage them to follow package directions for using repellent on children and avoid applying to their hands, eyes, and mouth.

For more detailed information, visit the Yellow Book: Protection against Mosquitoes, Ticks, & Other Insects & Arthropods

Additional Resources

Traveling with Children

Counsel parents to protect their children with similar precautions to those recommended for adults.

Most insect repellents are safe for use on children. The American Academy of Pediatrics recommends ≤30% DEET for use on children >2 months. Products containing OLE should not be used on children aged <3 years. EPA does not recommend any additional precautions for using registered repellents on children.

For parents of infants <2 months of age, encourage the use of a carrier draped with mosquito netting with an elastic edge for a tight fit to protect against biting insects.

Children should not handle repellents. Instead, adults should apply repellents to their own hands first, then gently spread on the child’s exposed skin. They should avoid applying directly to children’s hands.

Immune-Compromised Travelers

Vectorborne infections can be severe in immunocompromised patients. Urge patients to rigidly adhere to insect precautions.

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Stay safe outdoors

Advise travelers to exercise caution during outdoor activities. Important tips include dressing appropriately for the climate (such as loose, lightweight clothing in hot climates and warm layers in cold climates), staying hydrated, avoiding overexposure to the sun, and practicing safe swimming habits.

Encourage travelers to learn basic first aid and CPR before travel, especially if they will be traveling to remote areas where medical assistance may not be accessible. Help them assemble a travel health kit.

Additional Resources:

Sunburn
Problems with Heat & Cold

Traveling with Children

Advise parents to minimize sun exposure for children. Infants under 6 months have thinner, more sensitive skin, and therefore require additional protection from the sun. Sunscreen is recommended for use on children above 6 months of age; physical precautions such as seeking shade and wearing protective clothing are recommended for infants under 6 months of age, as well as minimal use of sunscreen on exposed areas (face and hands)

Travelers with children should never leave them unattended while swimming, and should be advised of the risk of infection from swimming in and/or swallowing contaminated water.

Chronic Disease

Advise travelers to remain hydrated while engaging in outdoor activities.

Also advise travelers to avoid potentially contaminated water. They should exercise extreme caution while swimming in fresh, untreated water.

Immune-Compromised Travelers

Advise immunocompromised travelers not to swim in fresh, untreated water.

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Keep away from animals

Counsel travelers to be cautious around all animals.

  • Travelers could be at risk for injuries from domestic animals such as dogs or cats, even in industrialized countries.
  • The best course of action is to avoid touching, petting, handling, or feeding animals, including pets.
  • Arthropods such as spiders and scorpions can pose a stinging risk, and travelers should exercise care in environments where these creatures are likely to be present.
  • Stress the urgency of treating suspected and probable rabies infection by:
    • Washing the wound immediately with soap and clean water.
    • Seeking medical attention as soon as possible.
Additional Resources

Animal-Associated Hazards (YB)
Rabies (YB)
Criteria for Preexposure Immunization for Rabies (YB)
Protection against Mosquitoes, Ticks, & Other Insects & Arthropods (YB)

Traveling with Children

  • Counsel families to avoid all stray or unfamiliar animals.
  • Children are at increased risk for animal-associated injuries. They are more likely to suffer severe injuries to the neck or head.
  • Children should be encouraged to tell adults about all contact with animals.
Additional Resources

Traveling Safely with Children & Infants (YB)

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Reduce your exposure to germs

People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.

Traveling with Children

Scrupulous attention should be paid to washing bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others; water used to clean these items should be potable.

Parents should be particularly careful to wash hands after changing diapers.

Immune-Compromised Travelers

Attention to hand hygiene is the best protection against gastroenteritis in immunocompromised travelers. Hands should be washed after contact with public surfaces.

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Avoid sharing body fluids

Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.

Travelers should:

  • Use a latex condom correctly every time they engage in sex (vaginal, anal, and oral-genital).
  • Not inject drugs.
  • Limit alcohol consumption.
  • Not have tattoos, piercings, or other procedures that use needles (acupuncture) unless the needles are packaged new or sterilized.
  • Ensure that medical and dental equipment is sterile or disinfected if seeking care.
Additional Resources:
HIV & AIDS (YB)
Hepatitis B (YB)
Hepatitis C (YB)
Medical Tourism (YB)

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Know how to get medical care while traveling

Travelers should plan for how to obtain health care during their trip, should the need arise.

Discuss supplemental travel health insurance and medical evacuation insurance, and consider helping the traveler obtain an extra month of prescriptions for any needed medications.

Traveling with Children

Adults traveling with children should be counseled about the signs and symptoms of dehydration and the proper use of oral rehydration salts (ORS), and when to seek medical care.

Chronic Disease

Give patients comprehensive documentation that they should take with them that outlines their medical conditions:

  • A letter, printed on office letterhead, explaining the patient’s current medical condition(s).
  • All medication that you have prescribed for the patient (include generic names).
  • A list of equipment the patient needs to manage his/her condition.

Help patients who have chronic conditions develop a health plan for their trip:

  • Instruct how to manage minor problems or exacerbations.
  • Research medical facilities at the destination that are equipped to handle the condition and give the patient contact information for these facilities.
  • Reinforce the importance of medical evacuation insurance, particularly for patients traveling to rural or developing areas.

Extended Stay/Study Abroad

People spending prolonged periods abroad are at increased risk of illness and injury that requires local medical care. Emphasize the need for these travelers to buy travel health and medical evacuation insurance.

Immune-Compromised Travelers

Give patients comprehensive documentation that they should take with them that outlines their medical conditions:

  • A letter, printed on office letterhead, explaining the patient’s current medical condition(s).
  • All medication that you have prescribed for the patient (include generic names).
  • A list of equipment the patient needs to manage his/her condition.

Help patients develop a health plan for their trip:

  • Instruct how to manage minor problems or exacerbations.
  • Research medical facilities at the destination that are equipped to handle the condition and give the patient contact information for these facilities.
  • Reinforce the importance of medical evacuation insurance, particularly for patients traveling to rural or developing areas.

Visiting Friends or Family

Consider whether patients are likely to use risky or unproven traditional medicines at the destination. Discuss any potential risks of traditional therapies.

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Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

Most recommendations for safe transportation are basic and could be considered common sense. However, travelers often do not think about the importance of being aware and careful when walking, riding, driving, or flying. Counsel travelers to think about transportation options before they arrive, especially if they will be driving in France.

Some basic reminders to review with your patients:

  • Choose safe vehicles and avoid motorbikes when possible.
  • Wear a seatbelt or a helmet at all times.
  • Do not drive after drinking alcohol or ride with someone who has been drinking.
  • If they will be driving, remind them to get any driving permits and insurance they may need. It is recommended to get an International Driving Permit (IDP).
  • Avoid using local, unscheduled aircraft, and fly on larger planes (more than 30 seats) when possible.

Helpful Resources
Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, Auto Insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

Traveling with Children

Counsel parents to ensure an appropriate, well-maintained car seat or booster seat is available for their child at the destination or to bring their own from home. They should follow the same guidelines for safety seats as in the United States.

Also remind parents that they should use FAA-approved car or booster seats when flying in aircraft.

Extended Stay/Study Abroad

Patients who will be living or studying abroad may be considering purchasing a bicycle, vehicle, or motorbike. Counsel them to make sure they have the appropriate permits and insurance.

Remind students that crashes involving in-country travel are a major cause of injury to people studying abroad, so they need to be diligent about finding and using safe modes of travel. (Refer to guidance on traveler pages of the website.)

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Maintain personal security

Travelers should be reminded on how to protect their personal safety during travel, regardless of their destination. 

The US Department of State has an extensive website with safety information for international travelers, travel alerts and warnings, and country-specific information. Travelers should be directed to the Department of State resources for information and tips on safe travel.

Stay abreast of current events, particularly those that could pose a safety or health problem for travelers. You can also receive updates on new travel alerts and warnings from the US Department of State by subscribing to their RSS feeds.

Traveling with Children

Because of concerns about illegal transport of children across international borders, if only 1 parent is traveling with the child, he or she may need to carry custody papers or a notarized permission letter from the other parent. Children should also carry their own identifying information and contact numbers, in case family members become separated.

Chronic Disease

Americans have been arrested for possessing prescription drugs, particularly tranquilizers and amphetamines that they purchased legally elsewhere. Some countries have laws against possession of certain prescription drugs that are legal in the United States.

Travelers should check with the embassy of France to make sure any required medications are not considered to be illegal.

Extended Stay/Study Abroad

Students are at risk for heavy drinking. Counsel students on alcohol and drug safety abroad. Emphasize the need to understand and abide by local drug and alcohol laws.

Guide patients to the Students Abroad website from the US Department of State, which has excellent information and resources specifically for study-abroad travel.

Immune-Compromised Travelers

Americans have been arrested for possessing prescription drugs, particularly tranquilizers and amphetamines that they purchased legally elsewhere. Some countries have laws against possession of certain prescription drugs that are legal in the United States.

Travelers should check with the embassy of France to make sure any required medications are not considered to be illegal.

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Healthy Travel Packing List

Remind your patients to pack health and safety items. Use the Healthy Travel Packing List for France for a list of health-related items they should consider packing.

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Travel Health Notices

Stay aware of current health issues in France in order to advise your patients on additional steps they may need to take to protect themselves.

Watch Level 1, Practice Usual Precautions

  • Global Measles Outbreak Notice June 10, 2019 Measles is in many countries and outbreaks of the disease are occurring around the world. Before you travel internationally, regardless of where you are going, make sure you are protected fully against measles.

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Advising Returning Travelers

Although some illnesses may begin during travel, others may occur weeks, months, or even years after return. A history of travel, particularly within the previous 6 months, should be part of the routine medical history for every ill patient. A newly returned, ill international traveler should be preferentially evaluated by a physician versed in travel-related illness.

Here are two professional medical organizations that provide directories of travel clinics throughout the United States:

For more information on advising patients after international travel, see Yellow Book Chapter 5: Post-Travel Evaluation.

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Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.

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