Sri Lanka is a south Asian island country located off the southern coast of India. Surrounded by the Indian Ocean, Gulf of Mannar, and the Palk Strait, Sri Lanka lies in the vicinity of India and Maldives. The geography of Sri Lanka includes coastal plains in the north and hills and mountains in the interior. The government system is a republic. The chief of state and head of government is the President. Sri Lanka has transitioned to a market-orientated economy but the central government is still involved in economic planning. Sri Lanka is a member of Bay of Bengal Initiative for MultiSectoral Technical and Economic Cooperation (BIMSTEC) and the South Asian Association for Regional Cooperation (SAARC).
For a small island, Sri Lanka has many nicknames: Teardrop of India, Pearl of the Orient etc. This colourful collection reveals its richness and beauty, and the intensity of the affection it evokes in its visitors. Consequently this small island state contains an exotic mixture of languages, cultures and religions.
Sri Lanka, the Isle of Serendipity is a tourist paradise with an abundance of tourist attractions like the sunny beaches, glorious ancient cities, salubrious hill country, beautiful fauna & flora, exquisite handicrafts, world renowned gems, traditional dance & drama, colourful festivals, smiling people and not forgetting the mouth watering Sri Lankan cuisine. Sri Lanka is fast becoming the shopping centre of South Asia.
Sri Lanka has seduced travellers for centuries. Marco Polo described it as the finest island of its size in the world, while successive waves of Indian, Arab and European traders and adventurers flocked to its palm-fringed shores, attracted by reports of rare spices, precious stones and magnificent elephants. Poised just above the Equator amid the balmy waters of the Indian Ocean, the island’s legendary reputation for natural beauty and plenty has inspired an almost magical regard even in those who have never visited the place. Romantically inclined geographers, poring over maps of the island, compared its outline to a teardrop falling from the tip of India or to the shape of a pearl (the less impressionable Dutch likened it to a leg of ham), while even the name given to the island by early Arab traders – Serendib – gave rise to the English word “serendipity”.
The glories of this early Buddhist civilization continue to provide a benchmark of national identity for the island’s Sinhalese population, while Sri Lanka’s historic role as the world’s oldest stronghold of Theravada Buddhism lends it a unique cultural identity that permeates life at every level. There’s more to Sri Lanka than just Buddhists, however. The island’s geographical position at one of the most important staging posts of Indian Ocean trade laid it open to a uniquely wide range of influences, as generations of Arab, Malay, Portuguese, Dutch and British settlers subtly transformed its culture, architecture and cuisine, while the long-established Tamil population in the north have established a vibrant Hindu culture that owes more to India than to the Sinhalese south.
Medication and Vaccination
All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.
Malaria:Â Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas except the districts of Colombo, Kalutara, Galle, and Nuwara Eliya.
Travelers’ diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers’ diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.
Malaria in Sri Lanka:
prophylaxis is recommended year-round for all areas, except for the districts of Colombo, Galle, Gampaha, Kalutara, Matara, and Nuwara Eliya. A total of 580 cases were reported for the year 2010, representing a 25% increase over 2009. The highest incidence is in Dry Zone districts such as Anuradhapura, Polonnaruwa, Hambanthota, Ampara and the Northern and Eastern Provinces. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
Insect protection measures are essential.
For further information concerning malaria in Sri Lanka, go to Roll Back Malaria, the World Health Organization – South East Asia Region, or the Malaria Journal (“Sri Lanka Malaria Maps”, Olivier JT Briet, Dissanayake M Gunawardena, Wim van der Hoek and Felix P Amerasinghe)
The following are the recommended vaccinations for Sri Lanka:
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.
Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.
Japanese encephalitis vaccine is recommended for long-term (1 month) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. The disease occurs throughout the country, except for mountainous areas. Outbreaks have been reported recently from central (Anuradhapura) and northwestern provinces. Transmission occurs from October to January and May to June. For a map of Japanese encephalitis cases in Sri Lanka, go to the World Health Organization Â— South-East Asia Region.
The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months.
Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. In Sri Lanka, most cases of rabies are caused by dog bites. A total of 56, 51, 56, and 59 deaths from rabies were reported from Sri Lanka in 2007, 2008, 2009, and 2010, respectively. A total of 31 deaths were reported for the first nine months of 2011, and 28 deaths in the first nine months of 2012, chiefly from Jaffna, Kegalle, Hambantota and Matara. (For further information, go to Emerging Infectious Diseases and ProMED-mail.) A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.
Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Polio vaccine is not generally recommended for adult travelers who completed the recommended childhood immunizations, since polio has not been reported from Sri Lanka for several years. A one-time booster of inactivated polio vaccine may be considered for extended travel to rural areas.
Cholera vaccine is not generally recommended, except for relief workers in tsunami-affected areas, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.
Yellow fever vaccine is required for all travelers over one year of age arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those younger than nine months of age, pregnant, immunocompromised, or allergic to eggs.
Medical information is sourced for mdtravelhealth.com