The 2009 CIA World Factbook

by United States. Central Intelligence Agency

Country Comparison :: 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.

Rank country Major infectious diseases Date of Information

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Rank code: 2194

Country Comparison :: Refugees and internally displaced persons

This entry includes those persons residing in a country as refugees or internally displaced persons (IDPs). The definition of a refugee according to a United Nations Convention is "a person who is outside his/her country of nationality or habitual residence; has a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail himself/herself of the protection of that country, or to return there, for fear of persecution." The UN established the Office of the UN High Commissioner for Refugees (UNHCR) in 1950 to handle refugee matters worldwide. The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has a different operational definition for a Palestinian refugee: "a person whose normal place of residence was Palestine during the period 1 June 1946 to 15 May 1948 and who lost both home and means of livelihood as a result of the 1948 conflict." However, UNHCR also assists some 400,000 Palestinian refugees not covered under the UNRWA definition. The term "internally displaced person" is not specifically covered in the UN Convention; it is used to describe people who have fled their homes for reasons similar to refugees, but who remain within their own national territory and are subject to the laws of that state.

Rank country Refugees and internally displaced personsDate of

Information 1 Iraq 2,400,000.00 2007 2 Jordan 1,835,704.00 2007 3 Congo, Democratic Republic of the 1,400,000.00 2007 4 Uganda 1,270,000.00 2007 5 Somalia 1,100,000.00 2007 6 Pakistan 1,043,984.00 2007 7 Gaza Strip 1,017,000.00 2007 8 Iran 914,268.00 2007 9 West Bank 722,000.00 2007 10 Cote d'Ivoire 709,000.00 2007 11 Zimbabwe 569,685.00 2007 12 Syria 522,100.00 2007 13 Burma 503,000.00 2007 14 Jordan 500,000.00 2007 15 Sri Lanka 460,000.00 2007 16 Lebanon 405,425.00 2007 17 Tanzania 352,640.00 2007 18 Syria 305,000.00 2007 19 China 300,897.00 2007 20 Philippines 300,000.00 2007 21 Saudi Arabia 240,015.00 2007 22 Chad 234,000.00 2007 23 Uganda 215,700.00 2007 24 Cyprus 210,000.00 2007 25 Serbia 206,000.00 2007 26 Ethiopia 200,000.00 2007 27 Lebanon 200,000.00 2007 28 Central African Republic 197,000.00 2007 29 Chad 178,918.00 2007 30 Kenya 173,702.00 2007 31 Jordan 160,000.00 2007 32 Sudan 157,220.00 2007 33 Congo, Democratic Republic of the 132,295.00 2007 34 Thailand 132,241.00 2007 35 Bosnia and Herzegovina 131,600.00 2007 36 Tanzania 127,973.00 2007 37 Armenia 113,295.00 2007 38 Nepal 107,803.00 2007 39 Burundi 100,000.00 2007 40 Timor-Leste 100,000.00 2007 41 Yemen 91,587.00 2007 42 Algeria 90,000.00 2007 43 China 90,000.00 2007 44 India 77,200.00 2007 45 Kenya 73,004.00 2007 46 Serbia 71,111.00 2007 47 Egypt 70,198.00 2007 48 India 69,609.00 2007 49 Ethiopia 66,980.00 2007 50 Bangladesh 65,000.00 2007 51 Angola 61,700.00 2007 52 Zambia 60,874.00 2007 53 Chad 54,200.00 2007 54 Iran 54,024.00 2007 55 Congo, Republic of the 48,000.00 2007 56 Congo, Republic of the 46,341.00 2007 57 Rwanda 46,272.00 2007 58 Zambia 42,565.00 2007 59 Uzbekistan 39,202.00 2007 60 Congo, Democratic Republic of the 37,313.00 2007 61 Ghana 35,653.00 2007 62 Pakistan 34,000.00 2007 63 Eritrea 32,000.00 2007 64 Uganda 28,880.00 2007 65 Serbia 27,414.00 2007 66 Sierra Leone 27,311.00 2007 67 Bangladesh 26,268.00 2007 68 Cote d'Ivoire 25,615.00 2007 69 Sudan 25,023.00 2007 70 Uganda 24,900.00 2007 71 Cameroon 24,000.00 2007 72 Senegal 22,400.00 2007 73 Guinea 21,856.00 2007 74 Malaysia 21,544.00 2007 75 Kosovo 21,000.00 2007 76 Nepal 20,153.00 2007 77 Senegal 19,630.00 2007 78 Guinea 19,000.00 2007 79 Congo, Democratic Republic of the 17,777.00 2007 80 Lebanon 17,000.00 2007 81 Iraq 16,832.00 2007 82 Ethiopia 16,576.00 2007 83 Kenya 16,428.00 2007 84 Montenegro 16,192.00 2007 85 Malaysia 15,174.00 2007 86 Congo, Democratic Republic of the 13,904.00 2007 87 Ethiopia 13,078.00 2007 88 Liberia 13,000.00 2007 89 Angola 12,615.00 2007 90 Liberia 12,600.00 2007 91 Egypt 12,157.00 2007 92 Iraq 11,773.00 2007 93 Ecuador 11,526.00 2007 94 Turkmenistan 11,173.00 2007 95 Sudan 11,009.00 2007 96 South Africa 10,772.00 2007 97 United States 10,586.00 2006 98 Papua New Guinea 10,177.00 2007 99 Burundi 9,849.00 2007 100 India 9,472.00 2007 101 Benin 9,444.00 2007 102 Djibouti 8,642.00 2007 103 United States 8,549.00 2006 104 Ghana 8,517.00 2007 105 Armenia 8,400.00 2007 106 Libya 8,000.00 2007 107 Central African Republic 7,900.00 2007 108 Sudan 7,895.00 2007 109 South Africa 7,818.00 2007 110 Guinea-Bissau 7,454.00 2007 111 Bosnia and Herzegovina 7,269.00 2007 112 Gabon 7,178.00 2007 113 Montenegro 7,000.00 2007 114 United States 6,666.00 2006 115 Congo, Republic of the 6,564.00 2007 116 United States 6,479.00 2006 117 Mali 6,300.00 2007 118 Congo, Democratic Republic of the 6,181.00 2007 119 Gambia, The 5,955.00 2007 120 Nigeria 5,778.00 2007 121 South Africa 5,759.00 2007 122 Solomon Islands 5,400.00 2007 123 Guinea 5,259.00 2007 124 Congo, Democratic Republic of the 5,243.00 2007 125 Sudan 5,023.00 2007 126 Togo 5,000.00 2007 127 Namibia 4,700.00 2007 128 Rwanda 4,400.00 2007 129 Zambia 4,100.00 2007 130 Guinea 3,900.00 2007 131 Central African Republic 3,700.00 2007 132 Kazakhstan 3,700.00 2007 133 Uzbekistan 3,400.00 2007 134 United States 3,100.00 2006 135 Cameroon 3,000.00 2007 136 Zimbabwe 2,500.00 2007 137 Azerbaijan 2,400.00 2007 138 United States 2,136.00 2006 139 Togo 1,500.00 2007 140 Georgia 1,100.00 2007 141 Uzbekistan 1,060.00 2007 142 Kazakhstan 508.00 2007

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