Guidelines for Travelers Visiting Friends and Family in Areas with Chikungunya, Dengue, or Zika

Tip: Before your trip, checkwww.CDC.gov/travel for the latest disease updates for the country you are visiting.

When you visit friends and family in areas with chikungunya, dengue, or Zika, you may be at risk of getting those diseases. Visiting friends and family can pose different health needs than other kinds of travel because you might stay longer at your destination, be in places with less protection against mosquitoes (such as houses without screens or air conditioning), or be in a familiar place where you might not take as many precautions to say healthy. Protect yourself and your family by knowing the facts.

Prevent Mosquito Bites

If chikungunya, dengue, or Zika is spreading in the country you’re visiting, you and your family are at risk of getting sick from mosquito bites when you visit. Follow these steps to prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts and long pants.
Use insect repellents that are registered with the Environmental Protection Agency (EPA) and contain DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), or para-menthane-diol. Always use as directed.
- Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
- Most repellents, including DEET, can be used on children older than 2 months of age. To apply, adults should spray insect repellent onto hands and then apply to a child’s face.
- If it might be difficult to find recommended repellent at your destination. Pack enough to last the entire trip.
Use permethrin-treated clothing and gear (boots, pants, socks, tents). You can buy pre-treated items or treat them yourself.*
Stay and sleep in screened-in and air-conditioned rooms whenever possible.
- Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites.

*Permethrin is not effective in Puerto Rico.

What is chikungunya?

Chikungunya is a disease caused by a virus spread through mosquito bites. The most common symptoms of chikungunya are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Chikungunya disease rarely results in death, but the symptoms can be severe and disabling. Most people who get sick feel better within a week. In some people, the joint pain may last for months or years.

What is dengue?

Dengue is a disease caused by a virus that is spread through mosquito bites. Symptoms include fever, headache, nausea, vomiting, rash, and pain in the eyes, joints, and muscles. After you are bitten by an infected mosquito, symptoms can take up to 2 weeks to develop but usually end in a week. In severe cases, symptoms may include intense stomach pain, repeated vomiting, bleeding from the nose or gums, and death.

What is Zika?

Zika is a disease caused by a virus that is primarily spread to people through the bite of an infected mosquito. Most people who get infected never have symptoms. In people who get sick, symptoms (fever, rash, joint pain, and red eyes) are usually mild and resolve completely.

Zika can cause serious birth defects in babies born to women who were infected with Zika during pregnancy. Zika has also been linked to Guillain-Barré syndrome (GBS), a rare disorder that can cause muscle weakness and sometimes paralysis. Most people fully recover from GBS, but some have permanent damage and, in some cases, people have died.

Zika can also spread when a man who has Zika has sex with female or male sex partners. A man can pass Zika to his partners even if he does not have symptoms at the time, or if his symptoms have gone away. We do not know how long a man who has had Zika can pass it on to his partners from sex.

The mosquitoes that spread Zika usually do not live at elevations above 6,500 feet (2,000 meters). People who live in or visit areas above this elevation are at a very low risk of getting Zika from a mosquito unless they visit or travel through areas of lower elevation. Because there is no vaccine or treatment for Zika, people visiting areas with Zika should take steps to prevent infection.

Pregnant Women and Zika

Zika virus can pass from a pregnant woman to her fetus and can cause a serious birth defect of the brain called microcephaly in babies of women who had Zika virus while pregnant. Babies with microcephaly often have smaller brains that might not have developed properly. Other problems, such as eye defects, hearing loss, and impaired growth, have been detected among fetuses and infants infected with Zika virus before birth.

Pregnant women should not travel to any area with Zika. If you must travel to one of these areas, talk to your doctor or other healthcare provider first and strictly follow steps to prevent mosquito bites and practice safe sex during your trip.

For more information about pregnancy and Zika, visit http://www.cdc.gov/zika/pregnancy/.

Practice Safe Sex for Zika prevention

Condoms can reduce the chance of getting Zika from sex. To be effective, condoms must be used correctly from start to finish, every time during vaginal, and oral sex. A man can pass Zika to his partners even if he does not have symptoms at the time, or if his symptoms have gone away. Not having sex can eliminate the risk of getting Zika from sex.

Men with pregnant partners should use condoms every time during sex or not have sex during the pregnancy.
All pregnant women with male sex partners who live in or have traveled to an area with Zika should use condoms or not have sex during their pregnancy, even if their partners do not have Zika symptoms or if their symptoms have gone away.
All men who live in or have traveled to an area with Zika should consider using condoms to protect their sex partners.

For more information about Zika and sexual transmission, visit http://www.cdc.gov/zika/transmission/sexual-transmission.html.

Zika Testing For Pregnant Women

All pregnant women who have visited areas with Zika should receive routine prenatal care, including an ultrasound at 18–20 weeks.
Pregnant women who have symptoms of Zika (fever, rash, joint pain, red eyes) and have visited areas with Zika should be tested as soon as symptoms start.
Pregnant women who do not have symptoms and have visited an area with Zika should be tested at the start of prenatal care, and again halfway through the second trimester (18-20 weeks).
Pregnant women with possible exposure to Zika virus from sex should be tested if either they or their male partners develop symptoms of Zika.

Discuss Pregnancy Planning with Healthcare Provider

Women and their partners should discuss pregnancy planning with a doctor or healthcare provider. Women who want to get pregnant should talk with their healthcare provider about their goals for having children. They should also talk with their healthcare provider about the potential risk of Zika virus infection during pregnancy as well as their male partner’s potential exposures to Zika virus. As part of counseling with healthcare providers, some women and their partners who have visited an area with Zika might decide to delay pregnancy. CDC has guidance to help doctors counsel women who have visited an area with Zika who want to get pregnant. The recommended times to wait before trying to get pregnant after visiting an area with Zika, based on whether either partner has had symptoms, are described below:

How Long to Wait Before Trying to Have a Baby After Visiting an Area with Zika
	Women	Men
Zika symptoms	At least 8 weeks after symptoms start	At least 6 months after symptoms start
No Zika symptoms	At least 8 weeks after return from visit	At least 8 weeks after return from visit

Women who are at risk of Zika and do not want to get pregnant should talk with their doctor or other healthcare provider about ways to prevent unintended pregnancy, including birth control methods. Women should consider safety, effectiveness, availability, and acceptability when choosing a birth control method.

Women who become pregnant within 8 weeks after visiting an area with Zika should talk with their doctor:

CDC recommends testing at the first prenatal visit and a second test in the second trimester.
If you have been exposed to Zika and have symptoms (fever, rash, joint pain, or red eyes) at any time during your pregnancy, you should be tested for Zika. A healthcare provider may also test for similar diseases, like dengue or chikungunya.
CDC has guidance to help doctors decide what tests are needed for pregnant women who may have been exposed to Zika.