EPA (Emerging Pathogen Policy)

The National Institute of Allergy and Infectious Diseases defines “emerging infectious diseases/pathogens” as those “that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range.”

Many of the emerging pathogens of greatest concern are pathogenic viruses. How long these viruses last on surfaces can play a role in the disease transmission.

Because the occurrence of emerging viral pathogens (EVPs) is less common and less predictable than established pathogens, few if any EPA-registered disinfectant product labels specify use against this category of infectious agents. Therefore, in 2016, EPA provided a voluntary, two-stage process to enable use of certain EPA-registered disinfectant products against emerging viral pathogens not identified on the product label.

A company can apply for an emerging viral pathogen claim, even before an outbreak occurs, based on previous EPA-approved claims for specific hard-to-kill viruses.

EPA reviews the supporting information and determines if the claim is acceptable. Once approved, a company can make certain off-label claims as specified in that guidance in the event of an outbreak. For instance, the preapproved company can include certain statements about expected efficacy on:

• technical literature distributed to health care facilities, physicians, nurses, and public health officials;
• non-label-related websites;
• consumer information services; and
• social media sites.

Active Cases Triggering the Emerging Viral Pathogens Policy

The Emerging Viral Pathogens guidance is currently active for the following pathogens:

Information for Registrants

The following documents provide general guidance to registrants and address public concerns on a process that can be used to identify effective disinfectant products for use against emerging viral pathogens and to permit registrants to make limited claims of their product’s efficacy against such pathogens. The guidance outlines a voluntary, two stage process involving product label amendments and modified terms of registration and applies only to emerging viruses. Actions described by this guidance may be taken for eligible products only after the Centers for Disease Control and Prevention has identified the emerging pathogen and recommended environmental surface disinfection to help control its spread.

After reading the guidance document linked below, registrants and applicants interested in making product claims against emerging viral pathogens should submit a non-PRIA fast-track amendment.

To ensure the efficient processing of your submissions, please include the following in a cover letter to EPA:

• a subject line that clearly indicates “Emerging Viral Pathogen Claim”;
• a request to make emerging viral pathogen claims;
• a description of how the product meets the eligibility criteria for use against one or more categories of viral pathogens consistent with the guidance;
• the identification of the virus(es) from the product label that you are using to support the emerging viral pathogen claims and the study ID number (MRID) that supports the claim;
• an up-to-date matrix (Form 8570-35); and
• a request to add the Terms of Registration outlined in Attachment I of the Emerging Viral Pathogens Guidance.

A revised master label with a separate section for emerging viral pathogen claims that includes the generic claim statements identified in Attachment I of the guidance document below. Submit your application via the CDX portal.

CDC travel to and from Mexico

Vaccination Requirements

State and local vaccination requirements for daycare and school entry are important tools for maintaining high vaccination coverage rates, and in turn, lower rates of vaccine-preventable diseases (VPDs).

State laws establish vaccination requirements for school children. These laws often apply not only to children attending public schools but also to those attending private schools and day care facilities. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons. State laws also establish mechanisms for enforcement of school vaccination requirements and exemptions.

Studies have shown that vaccine exemptions tend to cluster geographically, making some communities at greater risk for outbreaks (Wang et al; Lieu et al; other clustering references).

Practices suggested in the literature to reduce non-medical exemptions include:

• States can consider strengthening the rigor of the application process, frequency of submission, and enforcement as strategies to improve vaccination rates (Yang and Silverman; also Gostin; Stadlin et al.).
• In addition to state vaccination requirements, stronger health care practices such as more in-depth discussions with hesitant parents and establishing vaccination as the default are strategies to improve vaccination coverage rates (Opel and Omer; Yang and Silverman).

In summary, vaccination requirements that reach more children through a broad range of facilities, that have more requirements for receiving an exemption, that require parental documentation of exemption requests, and that are implemented with strong enforcement and monitoring may help promote higher rates of vaccination coverage, and in turn, lower rates of VPDs. Ongoing provider outreach and public education about vaccines and the diseases they prevent may also lead to such an increase.

CDC’s Public Health Law Program (PHLP) has compiled state statutes and regulations regarding school vaccinations. For more information, please visit the State School and Childcare Vaccination Laws.

See selected references.

Resources

• Public Health Law Program Vaccination Laws
  This page includes a series of menus developed by CDC’s Public Health Law Program that summarize state vaccination laws for healthcare workers and patients in different types of healthcare facilities.
• Improving Vaccination Coverage Fact Sheet Cdc-pdf[3 pages]
  There is some evidence suggesting vaccination requirements that have broad reach, limited exemption criteria, and strong enforcement may help promote higher rates of vaccination coverage along with complementary actions such as monitoring VPD cases, vaccination coverage, and exemption rates; and also reporting on recent VPD outbreaks.
• State Immunization Laws for Healthcare Workers and Patients
  This database tool displays results from a 50-state legislative review of laws requiring assessment of vaccination status and vaccine administration for healthcare workers and patients/residents. Data on laws for various healthcare facilities (hospitals, ambulatory care facilities, individual providers’ practices, correctional facilities, and facilities for the developmentally disabled) were compiled in 2005 and most recently updated in November 2014.
• Immunization requirements, by diseaseExternal
  Lists vaccine-preventable diseases, and then shows state mandates (prenatal, daycare, childcare, kindergarten, elementary, secondary, K-12, colleges and universities, long-term care facilities) on immunization requirements
  Immunization Action Coalition (IAC)
• Also, see SchoolVaxView School Vaccination Requirements and Exemptions

Water Guidance

Can you drink the local water? How do you avoid Montezuma’s Revenge? What diseases do I need to worry about? Find out how to stay healthy while traveling in Mexico with these tips.

Vaccinations for Mexico

The following vaccinations are recommended for travelers to Mexico:

• Typhoid
• Hepatitis A
• Hepatitis B
• Rabies

Don’t forget to check that you’re up to date with the following routine vaccinations: tetanus, diphtheria, pertussis, measles, mumps, rubella, and polio.

Yellow fever isn’t present in Mexico however it’s endemic in many other countries within Latin America so if you are arriving in Mexico from a yellow fever endemic country, you will need proof of vaccination.

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Medical Treatment in Mexico

Mosquito-Borne Diseases

Can I Drink Local Water in Mexico?

Water treatment and filtration systems have improved in some parts of Mexico over the years, with many resorts and major tourist spots like Mexico City, Monterrey, and Cancun claiming water is safe straight from the tap. It’s up to you if you want to take their word and try it. Otherwise, you will need to make sure your water is boiled or treated especially if you are out traveling in rural locations.

It’s easy to forget while on vacation the many things cleaned or prepared with water — ice, salad, pasta, etc. You need to be careful when brushing your pearly whites, too. Even if water is purified, it still might give you diarrhea because you’re not used to the microbes swimming around in it.

Montezuma’s Revenge

Travel diarrhea aka Montezuma’s Revenge can literally put a cramp in your travels and your stomach. However, there are ways you can avoid being stuck riding the porcelain bus by observing good personal hygiene practices and taking precautions with where and what you eat.

Food stalls are common throughout Mexico, even in the rural areas, where families make a living selling homemade cooking. Some food is prepared safely and kept well, but watch out for hot foods that aren’t actually hot and anything that looks like it’s been sitting uncovered for a while. Always eat at spots where the food is cooked on the spot and has a high turnover and if you eat meat, ask for it to be cooked more on the well-done side.

Avoid buffet-style restaurants where the food may be prepared in a questionable way or left to sit out all day. For more handy tips, check out our article on street food safety.

It goes without saying but always wash your hands before eating (use an antibacterial gel if running water and soap aren’t available).

If unfortunately, you do end up sick, often it’s a case of just riding it out. Read our article on what to do should you end up with a dose of traveler’s diarrhea.

Food and Water Borne Diseases

Other Health Concerns

In Mexico you can drink:

• Sealed bottled water
• Water that has been disinfected
• Ice made with bottled or disinfected water
• Carbonated drinks
• Hot coffee or tea
• Pasteurized milk
• In Latin America, coconut milk has been deemed a panacea for every conceivable stomach ailment, and then some.

In Mexico don’t drink:

• Tap or well water
• Ice made with tap or well water
• Drinks made with tap or well water (such as reconstituted juice)
• Unpasteurized milk

Tropical Diseases in Mexico

There’s more to worry about than water and food if you travel to certain areas of the country.

Although it doesn’t offer much reassurance, you are far more likely to be hurt in a car accident in Mexico than contract a tropical disease. While risks of succumbing to a medieval-sounding ailment like leishmaniasis are slim to none, it’s wise to

In certain areas, there is a very low risk of contracting malaria and dengue fever. Depending on where you are traveling, and during which season, malaria prophylaxis may be advised.

From skin-burrowing parasites to blood-sucking mosquitos, pesky insects are omnipresent in low-lying tropical areas in the following states:

Chiapas. Chihuahua. Durango. Nayarit. Sinaloa. Campeche. Jalisco. Oaxaca. Sonora. Tabasco. and the southern part of Quintana Roo that borders Belize.

There have been reports that dengue fever is spreading in Mexico. The U.S. Centers for Disease Control and Prevention website (http://www.cdc.gov) provides updated information and health advisories for travelers to Mexico.