Zika Virus in Palau

Warning - Level 3, Avoid Nonessential Travel

Alert - Level 2, Practice Enhanced Precautions

Watch - Level 1, Practice Usual Precautions

What is the current situation?

Public health officials have reported that mosquitoes in Palau are infected with Zika virus and are spreading it to people. Text PLAN to 855-255-5606 to receive Zika updates for your destination.

Because Zika virus is primarily spread by mosquitoes, CDC recommends that travelers to Palau protect themselves from mosquito bites.

Zika Virus in Pregnancy

A pregnant woman can pass Zika virus to her fetus. Infection during pregnancy can cause serious birth defects. CDC recommends special precautions for the following groups:

Women who are pregnant:
- Should not travel to Palau.
- If you must travel, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.
- Because Zika can also be spread by sex, if you have a partner who lives in or has traveled to Palau, either use condoms or do not have sex (vaginal, anal, or oral) or share sex toys during your pregnancy.
Women who are trying to become pregnant:
- Before you or your partner travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection.
- See CDC guidance for how long you should wait to get pregnant after travel to Palau.
- You and your partner should strictly follow steps to prevent mosquito bites.
If you have traveled to Palau and have a pregnant partner, use condoms or don’t have sex (vaginal, anal, or oral) or share sex toys during the pregnancy.

Sexual transmission of Zika virus is also possible, so you should use condoms or not have sex during your trip.

Many people infected with Zika virus do not get sick. Among those who do develop symptoms, sickness is usually mild, with symptoms that last for several days to a week. Guillain-Barré syndrome (GBS) is a rare disorder that can cause muscle weakness and paralysis for a few weeks to several months. CDC research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS. Most people fully recover from GBS, but some have permanent damage. For more information, see Zika and GBS.

As more information becomes available, this travel notice will be updated. Please check back frequently for the most up-to-date recommendations.

What can travelers do to prevent Zika?

There is no vaccine or medicine for Zika. You can protect yourself by preventing mosquito bites:

Cover exposed skin by wearing long-sleeved shirts and long pants.
Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE, also called para-menthane-diol [PMD]), IR3535, or 2-undecanone (methyl nonyl ketone). 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. (OLE should not be used on children younger than 3 years.)
Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
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.

Because Zika can be spread by sex, if you have sex (vaginal, anal, or oral) while traveling, you should use condoms.

After travel:

Many people infected with Zika virus do not feel sick. If a mosquito bites an infected person while the virus is still in that person’s blood, it can spread the virus by biting another person. If you travel to Palau, you should take steps to prevent mosquito bites for 3 weeks after your trip, even if you don’t feel sick, so that you don’t spread Zika to uninfected mosquitoes that can spread the virus to other people.

If you have visited Palau and have a pregnant partner, you should either use condoms or not have sex during the pregnancy.

If you are thinking about pregnancy, talk with your health care provider and wait to become pregnant (see “Women Trying to Become Pregnant” for how long to wait). You also should use condoms after travel to protect your sex partners from Zika even if you are not pregnant or trying to become pregnant.

For more information, see Zika and Sexual Transmission.

If you feel sick and think you may have Zika:

Talk to your doctor if you develop a fever with a rash, joint pain, or red eyes. Tell him or her about your travel.
Take acetaminophen (paracetamol) to relieve fever and pain. Do not take aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs, such as ibuprofen.
Get lots of rest and drink plenty of liquids.

If you are pregnant:

Talk to a doctor or other health care provider after your trip, even if you don't feel sick. Pregnant travelers returning from Palau, or who have had possible sexual exposure, should be offered testing for Zika virus infection.

If you develop a fever with a rash, joint pain, or red eyes, talk to your doctor immediately and tell him or her about your travel or possible sexual exposure.
If you do not have symptoms, testing should be offered if you see a health care provider, up to 12 weeks after you return from travel or your last possible sexual exposure.

Clinician Information

All pregnant women should be assessed for Zika virus exposure at each prenatal care visit. Possible exposures to Zika virus that warrant testing include:

Travel to or residence in an area with a current Zika outbreak.
Sex (vaginal, anal, or oral) with a partner who has traveled to or resides in an area with a current Zika outbreak.

The type of testing recommended varies according to when a woman’s last possible exposure occurred or when her symptoms began. For more information, please visit the clinical guidance for healthcare providers caring for pregnant women.

Clinical Guidance for Healthcare Providers Caring for Infants & Children is also available.