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Russia and the Far East

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Joseph Daly

on 16 February 2014

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Transcript of Russia and the Far East

We Are Here
Russia and the Far East
2,980 km from Moscow
8,420 km from Beijing
9,680 km from Tokyo
Poor medical care

St. Petersburg
Winter Palace (Hermitage Museum)
(formerly Stalingrad)
"The Motherland Calls"
The Kremlin
St. Basil's Cathedral
Cathedral of Christ the Saviour
Red Square
Peterhof Palace
Peter and Paul Fortress
Church of the Saviour on Spilled Blood
Other Reasons to Visit
Mountain Climbing- Mount Elbrus (5,642m)
Adoption Tourism (legally difficult, multiple trips)
Business travel (very large, developing economy)
Trans Siberian Railway
2014 Winter Olympics
Longest railway line in the world
Runs from Moscow in the west to Vladivosok in the east
Branch lines into China, Mongolia & North Korea
Lake Baikal (Deepest and and largest lake by volume in the world)
Taking place in Sochi from 7-23 February
Sochi is part of North Caucausus => risk of terrorism is high
Caucasus Emirate/Imarat Kavkaz
Separatist, radical Islamist group; associated with Al-Qaeda.
Visiting theses disputed areas is not advised due to high risk of violence & terrorist attacks (2013- 523 killed)
December Volgograd bombings- 34 dead
Aim to set up "Pan-Caucasian Islamic Caliphate"
Why Visit Mongolia
Most of the activities undertaken by visitors to Mongolia are outdoors, and include:
Camel riding in the Khongoryn Els sand dunes
Exploring the many national parks or the Eastern Steppe (world's largest expanse of unspoiled grassland)
Horse riding
Trans Mongolian Railway- Moscow to Beijing via Ulanbaatar
Some Safety Risks in Russia
Bootleg Vodka
Risk to pedestrians
Dangerous driving (old cars, bad roads, poor training)
Street crime (pickpockets, muggings, etc.)
Discrimination (Jewish, coloured, Asian, special needs)
"Homosexual propoganda to minors"
World's most dangerous country for air travel
Political protests / demonstrations
Some Health Risks in Russia
(Comprehesive travel insurance including medical evacuation)
1.3 million & 10% increase (2013)
Routine Vaccinations
Some Safety Risks in Mongolia
Street crime (tourists stand out)
Dangerous to drive
Extremes of temperature
Air travel
Protests & Demonstrations
People of Chinese and Korean descent
Some Health Risks in Mongolia
Extremely poor medical care
Tap water
Air pollution (winter, resp. problems)
High altitude (underlying conditions)
Eastern Steppes
Gobi Desert
Altai Mts.
Up to date on:
MMR (sporadic measles outbreaks common)
Diphteria-Tetanus-Pertussis (risk of diphteria outbreaks)
Varicella vaccine (chickenpox)
Poliomyelitis (1 case in 13 years)
Pneumococcal vaccine
Infections without Known Vaccine
West Nile Virus
Sindbis Virus (Karelian Fever)
Lyme Disease
Travellers Diarrhoea
Routine vaccinations- same as those advised for Russia
Recommended for All Travellers:
Shanghai Skyline
Shanghai Ancient Town
Jade Buddha Temple
Tiananmen Square
Forbidden City
The Great Wall
Olympic Sites
Hong Kong
Hong Kong Skyline
Temple of the 10,000
Ngong Ping Cable Car
Potala Palace
Other Reasons to Visit
Business travel
Adoption tourism
Visiting friends and relatives
Tour groups
Tokyo Skyline
Mount Fuji
Hakone Shrine

Fushimi Inari Shrine
Sanjusangendo Hall
Golden Pavillion
Other Reasons to Visit
Beach Holiday
The War Memorial of Korea
Bukhansan National Park
Changdeokgung Palace
Bongeunsa Temple
Vaccines for Travelling to Russia
Lyme Disease
West Nile Virus
Sindbis Virus
Travellers Diarrhoea
Phlebotomine sandfly
Seasonal Influenza vaccine
(esp. >65s, long term medical conditions)
Recommended for All Travellers:
Hepatitis A
Recommended for Some Travellers:
Hepatitis B
Tick-Borne Encephalitis
Japanese Encephalitis
Hepatitis A
Meningococcal Disease
Recommended for some travellers:
Hepatitis B
Tick-Borne Encephalitis
Japanese Encephalitis
Infections without Known Vaccine
Travellers Diarrhoea
Hepatitis C
Hepatitis C
Hepatitis C
Medium to high risk (8-15%)
General safety precautions for food and water
Fecal-Oral route
Esp. areas of poor sanitation
Prevalence- 2 to 2.9% of population
Viral infection
Difficult to treat
<10 Disability Adjusted Life Years; comparatively low
Not endemic; sporadic outbreaks
Bacterial infection, genus Borrelia
Fever, headache, fatigue, rash
Early treatment with antibiotics, difficult to treat later
Zoonotic; Birds -> Mosquito -> humans
Asymptomatic in 80% of cases
Fever, headache, tiredness, body aches, nausea, vomiting
Can lead to neuroinvasive disease eg. West Nile Encephalitis
Difficult to treat
Steps to avoid bites- DEET insect repellant, wear long sleeves, long pants and socks, avoid dusk to dawn, permethrin sprayed clothes, mosquito nets
Karelian Fever (in Russia)
Most common in summer months and in more northern regions
Mainly in south around Volga Delta
Mainly forested areas
Maculopapular exanthema over trunk and limbs, mild fever, joint pain.
No fatalities reported
Endemic; intermittent large outbreaks
Protozoan infection
Visceral- fever, weight loss, swelling of spleen and liver, anaemia; 2nd biggest parasitic killer
Cutaneous- ulcers on face, arms and legs (permanent scars)
Area between Black Sea and Caspian Sea
Avoidance of bites
Hepatitis A
Hepatitis B
Tick-Borne Encephalitis
Japanese Encephalitis
References contd.
Rose, S (2006). International Travel Health Guide 2006-2007. Philadelphia: Elsevier
"Travel Advice for 2014 Olymic and Paralympic winter games" from gov.uk
"How safe is Sochi: Travelers weigh their options as Olympics near" from CNN.com
"Consular advice for Irish citizens travelling to Sochi for the Winter Olympics" from DFA.ie
"Sochi 2014- Visitor Information for the Olympic and Paralympic Games" from travel.state.gov
"Important health and safety tips for Russia travel" from about.com
"Russia dubbed world's most dangerous country for air travel" from RT.com
"Russian Federation Travel Information" from DFA.ie
"Russia travel advice"from GOV.uk
"Russia" from Travel.state.gov
"HIV epidemic plagues Russia" from bloomberg.com
"Epidemiology of Travelers Diarrhea" from cid.oxfordjournals.org
"Health information for travelers to Mongolia" from CDC.gov
"Mongolia" from DFA.ie
"Mongolia travel advice" from GOV.uk
"Mongolia" from travel.state.gov
"Mongolia (TMB destination guide)" from TMB.ie
"Emerging Infectious diseases in Mongolia" from CDC.gov
"Tick Borne Diseases Abroad" from CDC.gov
Fecal-Oral route: contaminated water and food prepped by infected people
Asymptomatic in many cases
Symptoms- 15 to 50 days; nausea, sudden fever, abdominal pain, jaundice
Can be fatal (esp. older people, chronic liver disease)
Intermediate prevalence
Fecal-Oral route
Salmonella enterica typhi
Symptoms- 1 to 3 weeks; extreme fatigue, increasing fever, headache, malaise
Severe- intestinal hemorrhage or perforation
Vaccine may only be 70% effective => take other precautions with food and water
Intermediate risk- 10 to 100 cases per 100,000 each year
General Safety Risks
Typhoon season: May to November
Road traffic accidents
Avoid demonstrations
Decrease in number of tourists due to smog
Vaccines for Travelling to China
High altitude
Recommended for all travelers:
Routine vaccinations
Hepatitis A
Recommended for some travelers:
Hepatitis B
Japanese Encephalitis
Yellow fever
Xingjiang province, especially aid workers
Viral infection, fecal-oral route
90% asymptomatic
Muscle weakness and acute flaccid paralysis
Very low risk of contracting polio in China
Yellow Fever
No risk of contracting yellow fever

Bites, scratches, licks from infected animal (esp. dogs)
Arriving from country that is yellow fever endemic
Virus transmitted by Aedes aegypti mosquito
Fever, chills, nausea, muscle pain
Infectious Diseases
Seek urgent medical care after potential exposure
Remote areas, high risk of contact with animals and bats
Dengue fever
Symptoms- 1 to 3 months; fever, pain/tingling at wound, anxiety, convulsions
~100% fatal for those who don't get treatment
Low risk, unless traveling to rural areas
P. vivax and P. falciparum
Chemoprophylaxis : Atovaquone-proguanil, doxycline, mefloquine
Avoid bites
Fever like symptoms
Infected blood products, needles, sexual intercourse
Chronic liver disease, cirrhosis
Dengue Fever
Symptoms- 2 to 6 months; jaundice, extreme fatigue, nausea, abdominal pain
Mosquito borne virus associated with urban environments
Aedes aegypti
Fever, headache, muscle and joint pain
Avoid bites
No specific drug. Treatment involves rehydration or if very severe a blood transfusion.
90% of healthy adults make full recovery
Intermediate level prevalence (2-7%)
Vaccinations for Traveling to Japan
Stays > 3 months, high risk travellers
Recommended for all travelers:
Routine Vaccinations
Recommended for some travelers
Hepatitis A
Hepatitis B
Japanese Encephalitis
General Safety Risks
Radiation: High degree of caution in areas 1 and 2 near Fukushima Daiichi Nuclear Power Station and don't travel to area 3
Road traffic accidents
Do's and Don'ts
Do bow politely
Do respect the hierarchical structure
Always remove footwear when entering a house
Don't blow your nose in public
Do's and Don'ts
Do remove you shoes when entering a home
Do greet eldest member of a family first
Don't refuse food or drink from you host
Don't Write anything in red
Don't leave your chopsticks upright in a bowl
Vaccinations for Traveling to South Korea
Recommended for all travelers:
Routine Vaccines
Recommended for most travelers:
Hepatitis A
Recommended for some travelers
Hepatitis B
Japanese Encephalitis
General Safety Risks
Typhoon season: June to November
Relationship with DPPK
Low risk of terrorism
Civil Emergency Exercises
March to December in rural areas
P. vivax
Low risk
Do's and Don'ts
Do remove footwear
Do bow to each individual after a meal
Don't leave half your meal
Don't point with your chopsticks
Don't directly introduce yourself
Tower of the Juche Idea
Arch of Reunification
Monument to the Korean Workers Party
Central European Encephalitis Virus & Russian Spring-Summer Encephalitis Virus
Measures to avoid tick bites (DEET repellant, permethrin sprayed clothes
March to November; recreational activities in forested areas
Symptoms- 7 to 14 days; phase I (flu-like), remission period, phase II (drowsiness, confusion, sensory disturbances)
Mortality rate= 1-2%
Tourism in DPPK
Japanese Encephalitis
Southeast of Russia (area of Vladivostok)
Those staying > 1 month
Mosquito borne virus
Majority of infections are asymptomatic
Incubation period 5-15days: Fever, headaches and weakness
Evidence of a neurological infection such as: acute flaccid paralysis, meningitis and encephalitis
Avoid mosquito bites
Low risk
High risk- >20% chance
Very high risk (>500 per 100,000 each year)
Contact with / Milk or meat from infected animals (esp. cattle)
Symptoms- 5 to 30 days; flu-like
Difficult to treat, can take months
Deaths are rare; endocarditis & CNS infection
High prevalence (>10%)
Infection of the small intestine caused by Virbrio cholerae bacterium
Contaminated food or water
Diarrhea and vomiting
Very low risk
Vaccination not normally recommended
Huge public health problem in China
World's second largest tuberculosis epidemic
Mycobacterium tuberculosis
Chronic cough with blood tinged sputum
Low risk
Meningococcal Disease
Sever acute respiratory syndrome
Caused by a virus first identified in 2003 it is a member of the coronavirus family.
Believed to have spread from small mammals
8000 cases 750 deaths
Rapidly spread worldwide
Spread through coughs and sneezes
Flu like symptoms
Strict supervised tours only
Can't go anywhere without guide
Avoid political discussions
Safe as long as you follow the rules
Be careful with your camera
"China Warnings and Dangers" virtualtourist.com
"China dos and don'ts" lonelyplanet.com
Tuberculosis in China msfaccess.org
Severe Acute Respiratory Syndrome nlm.nih.gov
"Japan Travel Advice" gov.uk
"Japan dos and don't" lonelyplanet.com
"20 tips on North Korea: Warnings and Dangers"
Bacterial (
Neisseria meningitidis
Exchange of respiratory secretions
Meningitis- sensitivity to light, neck stiffness, headache, confusion
Meningococcal septicaemia- non-blanching petechial rash, fever, disseminated intravascular coagulation
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