North America
Travel To North America
* Canada * St. Pierre and Miquelon (France) * United States
Good sanitation and clean water are available in major urban areas and most rural areas. Many vector-borne infections are found in focal areas and can pose a risk to travellers, especially adventure travellers to rural areas. In temperate areas they occur during the summer months. Levels of immunisation are high in most areas. Poliomyelitis has been eradicated.
Vector-borne infections: Lyme disease is endemic in northeastern, north central (upper Midwest), and Pacific coastal areas of North America. West Nile fever was first documented in the United States (New York) in 1999 and has since spread throughout continental U.S. and southern Canada. Other vector-borne infections include Rocky Mountain spotted fever, murine typhus, rickettsialpox, St. Louis encephalitis, La Crosse encephalitis, Eastern equine encephalitis, Colorado tick fever, and relapsing fever. Ehrlichiosis (granulocytic and monocytic) has been reported primarily from the central and eastern thirds of the United States. Sporadic local transmission of dengue has occurred since 1995 in Florida and Texas, and the vector mosquito Aedes aegypti inhabits the southeastern United States. An outbreak of dengue in Hawaii in 2001-2002 was transmitted by Aedes albopictus.
Food- and water-borne infections: Outbreaks of diarrhoea caused by enterohaemorrhagic Escherichia coli O157:H7 have occurred in many areas and have increased in the past decade. Campylobacter and Salmonella are the most common causes of acute bacterial diarrhoea. Giardiasis and cryptosporidiosis occur sporadically and in outbreaks. Outbreaks of diarrhoea due to norovirus are increasingly being reported in the United States and Canada.
Airborne and person-to-person transmission: Outbreaks and cases of pertussis have been increasing for more than a decade. The incidence of tuberculosis is low (about 6/100,000 population). Numbers of measles cases have declined in the United States and Canada, and most of these cases are imported or linked to imported cases.
Sexually transmitted and blood-borne infections: The HIV prevalence in adults is estimated to be 0.6%.
Zoonotic infections: Rabies is enzootic in bats, raccoons, foxes, and other wild animals. Human cases are rare. Cases of hantavirus pulmonary syndrome have been widely distributed in North America, with the greatest concentration in the western and southwestern United States. Tularemia* is found in wide areas of the United States, including Alaska, and Canada, with the greatest number of cases in the central states (Missouri and neighboring states). Outbreaks have occurred on Martha's Vineyard (Massachusetts). Q fever* cases occur sporadically, especially in persons having contact with livestock in the western part of region; a number of outbreaks have been documented in the Maritime provinces, eastern Canada. Plague* is enzootic in the western United States, and rare human cases occur, almost 90% from New Mexico, Colorado, Arizona and California, often associated with prairie dogs.
Soil- and water-associated infections: Coccidioidomycosis is endemic in southwestern the United States and can occur in visitors to the area. Its incidence has increased in Arizona and California in recent years. Histoplasmosis is highly endemic, especially in the Mississippi, Ohio, and St. Lawrence River valleys. Sporadic cases and large outbreaks occur. Hawaii has the highest incidence rate of leptospirosis* in the United States, although sporadic cases and outbreaks have occurred elsewhere, primarily in warmer regions or in summer months. It is often associated with water recreational activities. Nonhuman schistosomes that cause cercarial dermatitis are widely distributed in freshwater and seawater along the Atlantic, Pacific, and Gulf coasts, and inland lakes.
Other hazards for travellers include violent injury and death related to guns; rates are higher in the United States than in most industrialized countries. Nineteen species of venomous snakes inhabit North America; the highest bite rates are found in southern states and southwestern desert states. Tick paralysis is most often reported from western Canada and the northwestern United States.
