a hybrid intergovernmental and supranational
organization
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@2191
Field Listing :: Member states
Country
Member states
European Union
27 countries: Austria, Belgium, Bulgaria, Cyprus,
Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta,
Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain,
Sweden, UK; note - candidate countries: Croatia, Iceland, Macedonia,
Montenegro, Turkey
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@2192
Field Listing :: Preliminary statement
Country
Preliminary statement
European Union
The evolution of the European Union (EU) from a
regional economic agreement among six neighboring states in 1951 to
today's supranational organization of 27 countries across the
European continent stands as an unprecedented phenomenon in the
annals of history. Dynastic unions for territorial consolidation
were long the norm in Europe. On a few occasions even country-level
unions were arranged - the Polish-Lithuanian Commonwealth and the
Austro-Hungarian Empire were examples - but for such a large number
of nation-states to cede some of their sovereignty to an overarching
entity is truly unique.
Although the EU is not a federation in the strict sense, it is far
more than a free-trade association such as ASEAN, NAFTA, or
Mercosur, and it has many of the attributes associated with
independent nations: its own flag, anthem, founding date, and
currency, as well as an incipient common foreign and security policy
in its dealings with other nations.
In the future, many of these nation-like characteristics are likely
to be expanded. Thus, inclusion of basic intelligence on the EU has
been deemed appropriate as a new, separate entity in The World
Factbook. However, because of the EU's special status, this
description is placed after the regular country entries.
======================================================================
@2193
Field Listing :: Major infectious diseases
This entry lists major infectious diseases likely to be encountered
in countries where the risk of such diseases is assessed to be very
high as compared to the United States. These infectious diseases
represent risks to US government personnel traveling to the
specified country for a period of less than three years. The degree
of risk is assessed by considering the foreign nature of these
infectious diseases, their severity, and the probability of being
affected by the diseases present. The diseases listed do not
necessarily represent the total disease burden experienced by the
local population.
The risk to an individual traveler varies considerably by the
specific location, visit duration, type of activities, type of
accommodations, time of year, and other factors. Consultation with a
travel medicine physician is needed to evaluate individual risk and
recommend appropriate preventive measures such as vaccines.
Diseases are organized into the following six exposure categories
shown in italics and listed in typical descending order of risk.
Note: The sequence of exposure categories listed in individual
country entries may vary according to local conditions.
food or waterborne diseases acquired through eating or drinking on
the local economy:
Hepatitis A - viral disease that interferes with the functioning of
the liver; spread through consumption of food or water contaminated
with fecal matter, principally in areas of poor sanitation; victims
exhibit fever, jaundice, and diarrhea; 15% of victims will
experience prolonged symptoms over 6-9 months; vaccine available.
Hepatitis E - water-borne viral disease that interferes with the
functioning of the liver; most commonly spread through fecal
contamination of drinking water; victims exhibit jaundice, fatigue,
abdominal pain, and dark colored urine.
Typhoid fever - bacterial disease spread through contact with food
or water contaminated by fecal matter or sewage; victims exhibit
sustained high fevers; left untreated, mortality rates can reach 20%.
vectorborne diseases acquired through the bite of an infected
arthropod:
Malaria - caused by single-cell parasitic protozoa Plasmodium;
transmitted to humans via the bite of the female Anopheles mosquito;
parasites multiply in the liver attacking red blood cells resulting
in cycles of fever, chills, and sweats accompanied by anemia; death
due to damage to vital organs and interruption of blood supply to
the brain; endemic in 100, mostly tropical, countries with 90% of
cases and the majority of 1.5-2.5 million estimated annual deaths
occurring in sub-Saharan Africa.
Dengue fever - mosquito-borne (Aedes aegypti) viral disease
associated with urban environments; manifests as sudden onset of
fever and severe headache; occasionally produces shock and
hemorrhage leading to death in 5% of cases.
Yellow fever - mosquito-borne viral disease; severity ranges from
influenza-like symptoms to severe hepatitis and hemorrhagic fever;
occurs only in tropical South America and sub-Saharan Africa, where
most cases are reported; fatality rate is less than 20%.
Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus)
viral disease associated with rural areas in Asia; acute
encephalitis can progress to paralysis, coma, and death; fatality
rates 30%.
African Trypanosomiasis - caused by the parasitic protozoa
Trypanosoma; transmitted to humans via the bite of bloodsucking
Tsetse flies; infection leads to malaise and irregular fevers and,
in advanced cases when the parasites invade the central nervous
system, coma and death; endemic in 36 countries of sub-Saharan
Africa; cattle and wild animals act as reservoir hosts for the
parasites.
Cutaneous Leishmaniasis - caused by the parasitic protozoa
leishmania; transmitted to humans via the bite of sandflies; results
in skin lesions that may become chronic; endemic in 88 countries;
90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia,
Brazil, and Peru; wild and domesticated animals as well as humans
can act as reservoirs of infection.
Plague - bacterial disease transmitted by fleas normally associated
with rats; person-to-person airborne transmission also possible;
recent plague epidemics occurred in areas of Asia, Africa, and South
America associated with rural areas or small towns and villages;
manifests as fever, headache, and painfully swollen lymph nodes;
disease progresses rapidly and without antibiotic treatment leads to
pneumonic form with a death rate in excess of 50%.
Crimean-Congo hemorrhagic fever - tick-borne viral disease;
infection may also result from exposure to infected animal blood or
tissue; geographic distribution includes Africa, Asia, the Middle
East, and Eastern Europe; sudden onset of fever, headache, and
muscle aches followed by hemorrhaging in the bowels, urine, nose,
and gums; mortality rate is approximately 30%.
Rift Valley fever - viral disease affecting domesticated animals and
humans; transmission is by mosquito and other biting insects;
infection may also occur through handling of infected meat or
contact with blood; geographic distribution includes eastern and
southern Africa where cattle and sheep are raised; symptoms are
generally mild with fever and some liver abnormalities, but the
disease may progress to hemorrhagic fever, encephalitis, or ocular
disease; fatality rates are low at about 1% of cases.
Chikungunya - mosquito-borne (Aedes aegypti) viral disease
associated with urban environments, similar to Dengue Fever;
characterized by sudden onset of fever, rash, and severe joint pain
usually lasting 3-7 days, some cases result in persistent arthritis.
water contact diseases acquired through swimming or wading in
freshwater lakes, streams, and rivers:
Leptospirosis - bacterial disease that affects animals and humans;
infection occurs through contact with water, food, or soil
contaminated by animal urine; symptoms include high fever, severe
headache, vomiting, jaundice, and diarrhea; untreated, the disease
can result in kidney damage, liver failure, meningitis, or
respiratory distress; fatality rates are low but left untreated
recovery can take months.
Schistosomiasis - caused by parasitic trematode flatworm
Schistosoma; fresh water snails act as intermediate host and release
larval form of parasite that penetrates the skin of people exposed
to contaminated water; worms mature and reproduce in the blood
vessels, liver, kidneys, and intestines releasing eggs, which become
trapped in tissues triggering an immune response; may manifest as
either urinary or intestinal disease resulting in decreased work or
learning capacity; mortality, while generally low, may occur in
advanced cases usually due to bladder cancer; endemic in 74
developing countries with 80% of infected people living in
sub-Saharan Africa; humans act as the reservoir for this parasite.
aerosolized dust or soil contact disease acquired through inhalation
of aerosols contaminated with rodent urine:
Lassa fever - viral disease carried by rats of the genus Mastomys;
endemic in portions of West Africa; infection occurs through direct
contact with or consumption of food contaminated by rodent urine or
fecal matter containing virus particles; fatality rate can reach 50%
in epidemic outbreaks.
respiratory disease acquired through close contact with an
infectious person:
Meningococcal meningitis - bacterial disease causing an inflammation
of the lining of the brain and spinal cord; one of the most
important bacterial pathogens is Neisseria meningitidis because of
its potential to cause epidemics; symptoms include stiff neck, high
fever, headaches, and vomiting; bacteria are transmitted from person
to person by respiratory droplets and facilitated by close and
prolonged contact resulting from crowded living conditions, often
with a seasonal distribution; death occurs in 5-15% of cases,
typically within 24-48 hours of onset of symptoms; highest burden of
meningococcal disease occurs in the hyperendemic region of
sub-Saharan Africa known as the "Meningitis Belt" which stretches
from Senegal east to Ethiopia.
animal contact disease acquired through direct contact with local
animals:
Rabies - viral disease of mammals usually transmitted through the
bite of an infected animal, most commonly dogs; virus affects the
central nervous system causing brain alteration and death; symptoms
initially are non-specific fever and headache progressing to
neurological symptoms; death occurs within days of the onset of
symptoms.
Country
Major infectious diseases
Afghanistan
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Angola
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, typhoid fever
vectorborne diseases: malaria, African trypanosomiasis (sleeping
sickness)
water contact disease: schistosomiasis (2009)
Argentina
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A
water contact disease: leptospirosis (2009)
Bangladesh
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A and E, and typhoid fever
vectorborne diseases: dengue fever and malaria are high risks in
some locations
water contact disease: leptospirosis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Belize
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Benin
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria and yellow fever
respiratory disease: meningococcal meningitis
animal contact disease: rabies (2009)
Bhutan
degree of risk: intermediate
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Bolivia
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever, malaria, and yellow fever
water contact disease: leptospirosis (2009)
Botswana
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne disease: malaria (2009)
Burkina Faso
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria and yellow fever
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Burma
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Burundi
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria
water contact disease: schistosomiasis
animal contact disease: rabies (2009)
Cambodia
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: dengue fever, Japanese encephalitis, and
malaria
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Cameroon
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A and E, and typhoid fever
vectorborne diseases: malaria and yellow fever
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies (2009)
Central African Republic
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria
respiratory disease: meningococcal meningitis
water contact disease: schistosomiasis
animal contact disease: rabies (2009)
Chad
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies (2009)
China
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: Japanese encephalitis and dengue fever
soil contact disease: hantaviral hemorrhagic fever with renal
syndrome (HFRS)
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Colombia
degree of risk: high
food or waterborne diseases: bacterial diarrhea
vectorborne diseases: dengue fever, malaria, and yellow fever
water contact disease: leptospirosis (2009)
Congo, Democratic Republic of the
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria, plague, and African trypanosomiasis
(sleeping sickness)
water contact disease: schistosomiasis
animal contact disease: rabies (2009)
Congo, Republic of the
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria and African trypanosomiasis (sleeping
sickness)
animal contact disease: rabies
water contact disease: schistosomiasis (2009)
Costa Rica
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea
vectorborne diseases: dengue fever (2009)
Cote d'Ivoire
degree of risk: very high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: malaria and yellow fever
water contact: schistosomiasis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Croatia
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea
vectorborne diseases: tickborne encephalitis
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Cuba
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea and hepatitis A
vectorborne diseases: dengue fever (2009)
Djibouti
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A and E, and typhoid fever
vectorborne disease: malaria
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Dominican Republic
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Ecuador
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Egypt
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne disease: Rift Valley fever
water contact disease: schistosomiasis
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
El Salvador
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever
water contact disease: leptospirosis (2009)
Equatorial Guinea
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne disease: malaria and yellow fever
animal contact disease: rabies (2009)
Eritrea
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne disease: malaria (2009)
Estonia
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea
vectorborne disease: tickborne encephalitis (2009)
Ethiopia
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A and E, and typhoid fever
vectorborne diseases: malaria
respiratory disease: meningococcal meningitis
animal contact disease: rabies
water contact disease: schistosomiasis (2009)
Gabon
degree of risk: very high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne disease: malaria and chikungunya
water contact disease: schistosomiasis
animal contact disease: rabies (2009)
Gambia, The
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies (2009)
Ghana
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria
water contact disease: schistosomiasis
respiratory disease: meningococcal meningitis
animal contact disease: rabies
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Guatemala
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne disease: dengue fever and malaria
water contact disease: leptospirosis (2009)
Guinea
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria and yellow fever
water contact disease: schistosomiasis
animal contact disease: rabies
aerosolized dust or soil contact disease: Lassa fever (2009)
Guinea-Bissau
degree of risk: very high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: malaria and yellow fever
water contact disease: schistosomiasis
animal contact disease: rabies (2009)
Guyana
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Haiti
degree of risk: high
food or waterborne diseases: bacterial and protozoal diarrhea,
hepatitis A and E, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Honduras
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and
typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2009)
Hungary
degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea and hepatitis A
vectorborne diseases: tickborne encephalitis (2009)
India
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A and E,
and typhoid fever
vectorborne diseases: chikungunya, dengue fever, Japanese
encephalitis, and malaria
animal contact disease: rabies
water contact disease: leptospirosis
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)
Indonesia
degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A and E,
and typhoid fever
vectorborne diseases: chikungunya, dengue fever, and malaria
note: highly pathogenic H5N1 avian influenza has been identified in
this country; it poses a negligible risk with extremely rare cases
possible among US citizens who have close contact with birds (2009)