Safety Abroad Handbook -- How to Get There... and Back

Most students have a positive, healthy, and sometimes life-changing experience during study abroad. It is important, however, that travelers understand the possible impact of various health concerns while overseas. Recently, Swine Flu has been a topic of discussion in the news media and by health professionals. Swine flu has reached a pandemic level and has occured in every region of the world.

There is a heightened level of concern following the World Health Organization announcement on June 11, 2009 that the Swine Flu (H1N1) has reached pandemic/Level 6 (http://www.who.int/csr/disease/swineflu/frequently_asked_questions/levels_pandemic_alert/en/index.html). As of August 23rd, they noted that 177 countries have officially reported over 209,438 cases of influenza A(H1N1) infection, including at least 2,185 deaths (http://www.who.int/csr/don/2009_08_28/en/index.html). According to Dr Margaret Chan, Director-General of the World Health Organization, "Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable... Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection... WHO continues to recommend no restrictions on travel and no border closures. Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection. We are all in this together, and we will all get through this, together." (http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html).

Over the past ten years, other messages have come forward with worldwide concerns about the possibility of other worldwide crises like Avian Flu, SARS and in 1999 about all technology around the world not working at the end of the millennium (Y2K). In the end Avian Flu and SARS were contained and Y2K didn't result in severe problems. It is critical that faculty, staff, students, and parents put appropriate perspective on the possibility of the spread of Swine Flu. However, it is clear that containing Swine Flu may become a challenge for the world community.

While there have been no reported cases of study abroad participants being ill or dying because of Swine Flu, to address any concerns parents or students may have we provide the resources and background information below to help better understand about Swine Flu and make appropriate decisions and adequate preparations before you go abroad and determine whether it would be a good idea to return home early if you are already abroad. The challenge is to balance being prepared for worst-case scenarios while living life and taking advantage of life-changing opportunities such as study abroad in a place and with a program where your health and safety can be well supported. Turn to information to make informed decisions and adequate preparation for worst-case scenarios with the hope that they will never be necessary. If no pandemic occurs, it may seem like you've done too much. However, if there is a severe problem, you want to be prepared. Preparing for the possibility of Swine Flu can also help prevent another problem and be prepared for other possible emergencies abroad (crime, accident, illness, etc.).

Background Information: Swine Flu
(From the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/swineflu/key_facts.htm)

What is Swine Influenza? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there? Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by swine influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or swine influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Swine Flu in Humans

Can humans catch swine flu? Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans? In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza were reported.

What are the symptoms of swine flu in humans? The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork? No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products are safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread? Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Each institution carries its own responsibility when determining best practices, policies and procedures. However, to help ensure the health and safety of students currently studying abroad in those regions where cases of Swine Flu have been identified, as well as those students who have recently returned from study abroad programs in such areas, the Center for Global Education sets forth the following recommendations for parents and students seeking answers to Swine Flu-related questions.

The Center supports efforts by students and parents to be active participants in supporting all areas of health and safety during study abroad. Swine Flu issues require an active response to try to prevent getting Swine Flu and being prepared to respond to Swine Flu infection by a student, another student on their program, in their plane, hotel, family or other housing arrangement. Through advance preparation, students can respond effectively and support their health and safety during study abroad.

The Center for Global Education recommends that among other actions, all students and parents consult institution and program staff in the U.S. and abroad for guidelines, review institutional/program and personal emergency action plans, and take necessary precautions to make informed travel decisions. Besides practicing good personal hygiene, students should consider staying away from people and areas of potential risk, and seeking medical attention at the first indication of symptoms is important. Check other available resources for information regarding treatment and avoidance of Swine Flu. (Please see below for links to these resources.)

Swine Flu challenges do not only involve the potential of a student getting Swine Flu while abroad. As many of the cases of Swine Flu have impacted U.S. citizens, countries around the world are on a heightened alert with concerns that U.S. citizens traveling abroad may be infected by Swine Flu. The CDC has suggested that U.S. citizens with symptoms of influenza-like illness should not travel. There is concern that if a student or anyone on a flight is found to have symptoms of H1N1, that all the passengers could be delayed. As a result, students should be both concerned about the possibility of getting the HINI virus and dealing with potential delays if authorities in other countries think they may have been infected or been around others who have.

The Center for Global Education offers online resources regarding Crisis and Risk Management and Emergency Planning information for students studying abroad. You may wish to review our online resources, including our Safety Abroad Student Handbook and SAFETI Adaptation of Peace Corps Resources. (Please see below for links to these resources.)

In addition, the Center strongly suggests all parents and students review Swine flu information, travel and country-specific warnings provided by the U.S. Department of State, the U.S. Centers for Disease Control and Prevention and the World Health Organization (WHO). The Center also suggests you seek alternative information from international sources in the European Union, United Kingdom, Canada, Australia, and from the World Health Organization. (Please see below for links to these resources).

As program support varies from institution to institution, check to make sure that study abroad program staff at your U.S. home institution and abroad are monitoring the situation daily, reviewing the possible impact of Swine Flu on students and programs, and updating their emergency plans accordingly. Ask whether or not your institution is currently in the process of deciding whether or not to cancel programs in affected areas, reviewing transportation plans, or postponing pending study abroad programs in certain areas due to a potential health risk. For students returning from affected regions, inquire to see if your institution encourages you to get a check-up at your campus health center and remember to report any Swine Flu-like symptoms.

Initially, there were some study abroad programs bringing students back from Mexico and canceling programs in Mexico because of Swine Flu concerns, but institutional responses in Mexico and other parts of the world have taken place on an institution – to – institution and program – to – program basis. However, it is critical that each student (with advice from others) makes a decision supporting his/her health and safety on whether to study abroad, or continue studying, in countries affected by Swine Flu. It is important to respond with a balanced perspective, understanding that Swine Flu has shown up across the U.S., not just abroad. Requiring the return of students abroad to the United States ultimately remains a decision that your institution and experts on campus, along with local and international guidance, will make. Students who voluntarily or non-voluntarily return to the United States before the ending date of their programs should consult their institution’s policies regarding program refunds and credit-transfer.

If you have any further questions, your first point of contact should be study abroad administrators in the U.S. and abroad, your personal physician and/or the physicians at your college or university health center. In terms of preparing for return to the U.S. in case of a problem, check to see if there is emergency assistance coverage and what the response would be if an outbreak of Swine Flu took place on the program abroad. For other health and safety issues that may affect study abroad students, please refer to the Health and Safety section of the Safety Abroad Handbook and our Country-Specific Study Abroad Student Handbooks.

Following is important information to help you better understand issues surrounding Swine Flu:

The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both provided resources and information to help you understand Swine Flu.

CDC Swine Flu Info
WHO Swine Flu Info