Infectious Diseases

Oregon State University places high priority on preventing the spread of infectious diseases such as influenza, HPVmeningococcal disease, MRSA, norovirus, pertussis and scabies. To promote the health and well-being of the campus community, Student Health Services offers preventive information on these diseases, as well as supplying any immunizations that are available for specific diseases.

Immunization Schedules

Following are the recommended immunization schedules for adults and adolescents for 2016-2017. These schedules are approved by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/acip/index.html).

For timely, accurate, and proven information about vaccines and the diseases they prevent, visit the Immunization Action Coalition website.

Is It a Cold or the Flu?

Different viruses cause the cold and flu. The two sicknesses share symptoms, but flu is more severe.

  • Cold – runny nose, mild aches, mild cough, sore throat, may have a low fever.
  • Flu – fever is usually 101 degrees or higher, more severe aches, headache, mild runny nose.
SYMPTOM COLD FLU
Fever Rare High fever
Headache Rare Prominent
General aches and pains Slight Usual, often intense
Fatigue and weakness Very mild Common. can last 2–3 weeks
Extreme exhaustion Never Early and prominent
Stuffy nose Common Sometimes
Sneezing Common Sometimes
Sore throat Common Sometimes
Chest discomfort, cough Mild Common, can get severe
Sputum Common Rare

Posters to Download and Print

Additional "Cover Your Cough" posters in various languages are available at http://www.cdc.gov/flu/protect/covercough.htm.

Infectious Diseases Response

Student Health Services is the lead department for OSU's Infectious Diseases Response Team (IDRT). The purpose of the IDRT is to prepare and implement strategies for the prevention and control of communicable disease threats to the university community.

For more information, download the OSU Infectious Disease Response Protocol (PDF) (revised September 2014).

HPV

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

  • There is no general test for men or women to check one’s overall “HPV status,” nor is there an HPV test to find HPV on the genitals or in the mouth or throat. The HPV tests on the market are only used to help screen for cervical cancer.
  • HPV is the main cause of cervical cancer in women. There are about 11,000 new cervical cancer cases each year in the United States. Cervical cancer causes about 4,000 deaths in women each year in the United States.
  • About 1 in 100 sexually active adults in the United States have genital warts at any one time.

Signs and Symptoms of HPV

Most people with HPV do not develop symptoms or health problems from it. In 90 percent of cases, the body’s immune system clears HPV naturally within two years. But the potential for problems such as genital warts and cervical cancer is very real.

Potential Health Problems of HPV

  • Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.
  • Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.
  • Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat). For signs and symptoms of these cancers, see www.cancer.gov.
  • Recurrent respiratory papillomatosis (or RRP) causes warts to grow in the throat. It can sometimes block the airway, causing a hoarse voice or troubled breathing.

How HPV Spreads

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

How to Prevent HPV

There are several ways that people can lower their chances of getting HPV:

  • Vaccines can protect males and females against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person’s first sexual contact, when he or she could be exposed to HPV.
    • Girls and women: Two vaccines (Gardasil and Cervarix) are available to protect females against the types of HPV that cause most cervical cancers. Gardasil also protects against most genital warts. Both vaccines are recommended for 11- and 12-year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
    • Boys and men: Gardasil protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.
    • Gardasil is available to male and female OSU students through SHS. Call 541-737-9355 for an appointment.
  • For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom, so condoms may not fully protect against HPV.
  • People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. That’s why the only sure way to prevent HPV is to avoid all sexual activity.

Source: Centers for Disease Control and Prevention - www.cdc.gov/std/hpv/default.htm

Meningococcal Disease

Meningococcal disease is a serious, potentially fatal infection that most often causes severe swelling of the tissue around the brain and spinal cord (meningitis) or a serious blood infection (meningococcemia). The best defense is getting vaccinated.

Symptoms of Meningococcal disease

Early symptoms may be difficult to distinguish from the flu or an upper respiratory infection, or symptoms may appear suddenly and progress rapidly.

  • Fever and/or shaking chills
  • Headache
  • Stiff neck
  • Nausea and/or vomiting
  • Sensitivity to light
  • Severe aches and pains
  • Rash
  • Rapid breathing
  • Weakness
  • Confusion

If symptoms occur

Immediately contact your health care provider or go to the emergency department for sudden severe symptoms.

How Meningococcal disease spreads

The bacteria are spread by exchanging respiratory and throat secretions (saliva or spit) during close (for example, coughing or kissing) or lengthy contact with an infected person.

Other factors that increase risk: 

  • first-year college students living in residence halls
  • college students age 25 and under living in group settings (such as fraternities and sororities)
  • military recruits
  • those who lack a spleen or have certain immune disorders.

How to reduce the spread of Meningococcal disease

  • Get vaccinated
  • Do not share:
    • drinking containers
    • eating utensils
    • toothbrushes
    • cosmetics
    • smoking devices
  • Do not drink out of a common source such as a punch bowl
  • Cover coughs and sneezes
  • Know that kissing poses a risk
  • Wash and sanitize your hands often
  • Know that smoking increases your risk

Vaccines available at Student Health

Student Health Services has vaccinations to cover all serotypes (strains) of meningococcus. The mandated meningococcal vaccine required at Oregon State University protects against groups A, C, W and Y. This vaccine does not cover against group B, the strain that has infected three OSU students since fall term 2016.  The MenB vaccine is available at Student Health Services.

Students currently enrolled may come to Student Health Services to receive a vaccine. Students should check with their insurance company to see if the cost will be covered. The charges can also be billed to students’ accounts. 

Want more information?

Read these PDFs from the Oregon Health Authority:

Also visit: Centers for Disease Control and Prevention - www.cdc.gov/meningitis/index.html

MRSA

MRSA is methicillin-resistant Staphylococcus aureus, a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause skin and other infections. You can get MRSA through direct contact with an infected person or by sharing personal items, such as towels or razors that have touched infected skin.

MRSA imagesStaph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. MRSA infections that occur in otherwise healthy people who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as community-associated (CA)-MRSA infections. These infections are usually skin infections, such as abscesses, boils, and other pus-filled lesions.

Symptoms of MRSA

Most staph skin infections, including CA-MRSA, appear as a bump or infected area on the skin that may be:

  • Red
  • Swollen
  • Painful
  • Warm to the touch
  • Full of pus or other drainage
  • Accompanied by a fever

If you or someone in your family or living situation experiences these signs and symptoms, cover the area with a bandage and contact a healthcare professional. It is especially important to see a healthcare professional if signs and symptoms of an MRSA skin infection are accompanied by a fever.

Complications of MRSA

MRSA can develop into more serious infections. It is fairly uncommon, however, that a complication of a CA-MRSA skin infection develops. Complications are more common within the healthcare setting, where more serious infections can affect tissues inside the body, not just the skin. Some of the most common areas affected (and the types of infections caused) include:

  • Lungs (pneumonia)
  • Bloodstream (bacteremia or septicemia)
  • Soft tissue (cellulitis)
  • Bone (osteomyelitis)
  • Inner lining of the heart (endocarditis)

How MRSA is Treated

Treatment for MRSA skin infections may include having a healthcare professional drain the infection and, in some cases, prescribe an antibiotic. Do not attempt to drain the infection yourself – doing so could worsen or spread it to others. If you are given an antibiotic, be sure to take all of the doses (even if the infection is getting better), unless your healthcare professional tells you to stop taking it.

How MRSA Spreads

MRSA infections can be spread through skin-to-skin contact or less frequently by touching surfaces that have MRSA on them. MRSA is typically spread by:

  • Having direct contact with another person’s infection
  • Sharing personal items, such as towels or razors, that have touched infected skin
  • Touching surfaces or items such as used bandages contaminated with MRSA

How to Prevent MRSA Infections

  • Keep cuts and scrapes clean and covered
  • Practice good hygiene such as cleaning hands regularly
  • Avoid sharing personal items such as towels and razors

MRSA sports poster

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COLOR POSTERS

MRSA sharing poster

MRSA spider bite poster

Source: Centers for Disease Control and Prevention - http://www.cdc.gov/mrsa

Norovirus

Noroviruses are a group of viruses that cause the "stomach flu," or gastroenteritis. Viruses are very different from bacteria and parasites, some of which can cause illnesses similar to norovirus infection. Like all viral infections, noroviruses are not affected by treatment with antibiotics, and cannot multiply outside of a person's body.

Symptoms of Illness

Symptoms usually begin about 24 to 48 hours after ingestion of the virus, but they can appear as early as 12 hours after exposure.

Symptoms usually include nausea, vomiting, diarrhea, and some stomach cramping. In addition, people sometimes have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people the symptoms last about 1 or 2 days and require no medical treatment to stop them.

Sources of Norovirus

Noroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways, including:

  • Eating food or drinking liquids that are contaminated with norovirus;
  • Touching surfaces or objects contaminated with norovirus, and then placing their hands in their mouth;
  • Having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill).

Transmission

Noroviruses are very contagious and can spread easily from person to person. Both stool and vomit are infectious. Particular care should be taken when dealing with young children in diapers who may have diarrhea.

People infected with norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. The virus "sheds" for 72 hours after the last symptoms. Therefore, it is particularly important for people to use good handwashing and other hygienic practices after they have recently recovered from a norovirus illness.

Treatment/Self-Care

Currently, there is no antiviral medication that works against norovirus and there is no vaccine to prevent infection. Norovirus infection cannot be treated with antibiotics because antibiotics work to fight bacteria, not viruses.

If you are ill with vomiting and diarrhea, stay home and stay hydrated with plenty of fluids. Dehydration is the most serious health effect that can result from norovirus infection. By drinking oral rehydration fluids (ORF), juice, or water, you can reduce your chance of becoming dehydrated. Sports drinks do not replace the nutrients and minerals lost during this illness. If you can't keep down any fluids and are feeling very thirsty or lightheaded, please see your health care provider.

Prevention of Norovirus

You can decrease your chance of contracting or spreading norovirus by following these preventive steps:

  • Stay home when you are feeling ill.
  • If you work in food service, day care or other health care facilities, stay away from work for 72 hours after your last symptoms.
  • It is best to stay away from group situations for 72 hours after your last symptoms. If you must attend class or other group gatherings, use scrupulous handwashing with soap and water and limit direct contact with others.
  • Frequently wash your hands, especially after using the toilet or changing diapers and before eating or preparing food.
  • Handwashing with soap and water is highly recommended. There is evidence that waterless hand cleansers may not provide full skin disinfection against noroviruses.
  • Thoroughly wash fruits and vegetables, steam oysters before eating them and cook foods well. (Transmission can occur through eating contaminated foods).
  • Norovirus is a very robust and durable virus that is highly transmissible and can live for extended periods on environmental surfaces. Disinfect potentially contaminated surfaces thoroughly with diluted bleach: one part bleach to 9 parts water (1/3 cup bleach to 1 gallon of water.)
  • Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap).
  • Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean.

    Source: Centers for Disease Control and Prevention - www.cdc.gov/norovirus

    Pertussis

    Whooping cough (known medically as pertussis) is a highly contagious respiratory tract infection caused by a type of bacteria called Bordetella pertussis. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants. Whooping cough is most contagious before the coughing starts.

    This is one of the most common vaccine-preventable childhood diseases in the United States. It's important to remember that both children and adults can get whooping cough. Since the 1980s, there's been a dramatic increase in the number of cases of whooping cough, especially among teens (10 – 19 years of age) and babies less than 5 months of age. In 2005, there were more than 25,000 total reported cases. In rare cases, whooping cough can be deadly; the disease causes an estimated 10 to 20 deaths each year in the United States.

    Symptoms of Whooping Cough

    • Runny nose
    • Sneezing
    • Low grade fever
    • Cough

    After 1-2 weeks, severe coughing begins. Children with the disease cough violently and rapidly, over and over, until the air is gone from their lungs and they're forced to inhale with a loud "whooping" sound.

    Complications of Whooping Cough

    Adults are at highest risk for:

    • Bacterial pneumonia
    • Rib fracture

    Other complications of adult pertussis occur rarely.

    Infants are at highest risk for:

    • Apnea
    • Pneumonia (about 1 in 10 children)
    • Seizures (about 1 in 50)
    • Encephalopathy (about 1 in 250)

    How Whooping Cough Spreads

    People with whooping cough usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get whooping cough are infected by older siblings or parents who might not even know they have the disease, making it important for all teens and adults to be adequately vaccinated.

    How to Prevent Whooping Cough

    The best way to prevent whooping cough is to get vaccinated. There are vaccines for children, pre-teens, teens and adults. The childhood vaccine is called DTaP, and the vaccine for adolescents and adults is called Tdap. Both protect against tetanus, diphtheria and pertussis. A Tdap booster can be given anytime regardless of the date of one’s last tetanus booster. Adults who want to protect themselves and any infants and children they may be in contact with should contact their healthcare provider about receiving Tdap.

    Source: Centers for Disease Control and Prevention - www.cdc.gov/pertussis

    Scabies

    Scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.

    Scabies occurs worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body contact is frequent.

    Signs and Symptoms of Scabies

    When a person is infested with scabies mites the first time, symptoms usually do not appear for up to two months (2-6 weeks) after being infested. If a person has had scabies before, symptoms appear much sooner (1-4 days) after exposure.

    The most common signs and symptoms of scabies are intense itching, especially at night, and a pimple-like itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales.

    Tiny burrows sometimes are seen on the skin; these are caused by the female scabies mite tunneling just beneath the surface of the skin. These burrows appear as tiny raised and crooked grayish-white or skin-colored lines on the skin surface. The mites are often few in number (only 10-15 mites per person), so these burrows may be difficult to find.

    Complications of Scabies

    The intense itching of scabies leads to scratching that can lead to skin sores. The sores sometimes become infected with bacteria on the skin, such as Staphylococcus aureus. Sometimes the bacterial skin infection can lead to an inflammation of the kidneys called post-streptococcal glomerulonephritis.

    How Scabies Spreads

    Scabies usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Contact generally must be prolonged; a quick handshake or hug usually will not spread scabies. Scabies in adults frequently is sexually acquired. Scabies sometimes is spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person.

    A person infested with scabies mites can transmit scabies, even if they do not have symptoms, until they are successfully treated and the mites and eggs are destroyed.

    How Scabies is Treated

    Treatment for scabies involves either oral medications or topical creams called scabicides because they kill scabies mites; some also kill eggs. Scabicides to treat human scabies are available only with a doctor’s prescription; no “over-the-counter” (non-prescription) products have been tested and approved for humans. Always follow carefully the instructions provided by the doctor and pharmacist, as well as those contained in the box or printed on the label.

    In addition to the infested person, treatment also is recommended for household members and sexual contacts, particularly those who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time in order to prevent re-infestation. Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear.

    In addition to medicinal treatment, bedding and clothing should be decontaminated (i.e., either machine-washed, machine-dried using the hot cycle, or dry cleaned) or removed from body contact for at least 72 hours. Fumigation of living areas is not necessary.

    How to Prevent Scabies

    Scabies is prevented by avoiding direct skin-to-skin contact with an infested person or with items such as clothing or bedding used by an infested person. Scabies treatment usually is recommended for members of the same household, particularly for those who have had prolonged skin-to-skin contact. Bedding and clothing worn or used next to the skin anytime during the 3 days before treatment should be machine washed and dried using the hot water and hot dryer cycles or be dry-cleaned. Items that cannot be dry-cleaned or laundered can be disinfested by storing in a closed plastic bag for several days to a week. Scabies mites generally do not survive more than 2 to 3 days away from human skin. Children and adults usually can return to child care, school, or work the day after treatment.

    Source: Centers for Disease Control and Prevention - www.cdc.gov/scabies

    Tuberculosis

    Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

    Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist:

    • Latent TB Infection: TB bacteria can live in the body without making you sick. This is called latent TB infection. People with latent TB infection do not feel sick and do not have any symptoms. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease.
    • Active TB Disease: TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

    Symptoms of Active TB Disease

    • A bad cough that lasts three weeks or longer
    • Pain in the chest
    • Coughing up blood or sputum
    • Weakness or fatigue
    • Weight loss
    • No appetite
    • Chills
    • Fever
    • Sweating at night

    Complications of TB

    Once a person is infected with TB bacteria (LTBI), the chance of developing TB disease is higher if the person:

    • Has HIV infection;
    • Has been recently infected with TB bacteria (in the last 2 years);
    • Has other health problems, like diabetes, that make it hard for the body to fight bacteria;
    • Abuses alcohol or uses illegal drugs; or
    • Was not treated correctly for TB infection in the past.

    Testing for TB

    Two tests may be used to detect TB bacteria in the body: a TB skin test (TST) or a TB blood test. At Oregon State, incoming students from high-risk countries will be required to have the TB blood test. If you have a positive reaction to the test, you will be given a chest X-ray to see if you have TB disease.

    TB Screening Requirements at Oregon State University

    Students from countries identified as high TB risk are required to complete TB screening upon arrival at Oregon State. Students from exempt countries who have lived in a high-risk country for more than six (6) months are recommended to complete a TB screening as well. The TB screening will be available through OSU Student Health Services. In many cases, TB screening will be included in the new student orientation schedules as coordinated by INTO-OSU and OSU International Programs. The testing must be completed within the United States, so please do not pursue advance testing in your country prior to your arrival. If you are from one of the high-risk countries, please expect to complete your TB screening upon arrival at OSU.

    How TB Spreads

    TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

    TB is NOT spread by:

    • Shaking someone’s hand
    • Sharing food or drink
    • Touching bed linens or toilet seats
    • Sharing toothbrushes
    • Kissing

    How TB is Treated

    • Treatment for Latent TB Infection: If you have latent TB infection but not TB disease, your health care provider may want you be treated to keep you from developing TB disease. Treatment of latent TB infection is essential to controlling and eliminating TB in the United States. The decision about taking treatment for latent TB infection will be based on your chances of developing TB disease.
    • Treatment for Active TB Disease: TB disease can be treated by taking several drugs, usually for six to nine months. It is very important to finish the medicine, and take the drugs exactly as prescribed.

    How to Prevent TB

    Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments (for example, clinics, hospitals, prisons, or homeless shelters).

    Travelers who will be working in clinics, hospitals, or other health care settings where TB patients are likely to be encountered should consult infection control or occupational health experts. They should ask about administrative and environmental procedures for preventing exposure to TB. Once those procedures are implemented, additional measures could include using personal respiratory protective devices.

    If you think you have been exposed to someone with TB disease, contact your health care provider or local health department to see if you should be tested for TB. Be sure to tell the doctor or nurse when you spent time with someone who has TB disease.

    Source: Centers for Disease Control and Prevention - www.cdc.gov/tb

    Countries of High Tuberculosis Incidence

    Students from any of the countries listed below are required to complete TB screening upon arrival at Oregon State. Domestic students who have lived in one of these countries for more than six (6) month are not required to be screened, but it is recommended.

    Source: World Health Organization (WHO) estimates of tuberculosis incidence by country, 2015 (2015 data released December 2016). Countries with rates of ≥20 cases per 100,000 population.

    Afghanistan
    Algeria
    Angola
    Anguilla
    Argentina
    Armenia
    Azerbaijan
    Bahrain
    Bangladesh
    Belarus
    Belize
    Benin
    Bhutan
    Bolivia (Plurinational State of)
    Bosnia and Herzegovina
    Botswana
    Brazil
    Brunei Darussalam
    Bulgaria
    Burkina Faso
    Burundi
    Cambodia
    Cameroon
    Cape Verde
    Central African Republic
    Chad
    China
    China, Hong Kong SAR
    China, Macao SAR
    Colombia
    Comoros
    Congo
    Côte d'Ivoire
    Democratic People's Republic of Korea
    Democratic Republic of the Congo
    Djibouti
    Dominican Republic
    Ecuador
    El Salvador
    Equatorial Guinea
    Eritrea
    Ethiopia
    Fiji
    Gabon
    Gambia
    Georgia
    Ghana
    Greenland
    Guam
    Guatemala
    Guinea
    Guinea-Bissau
    Guyana
    Haiti
    Honduras
    India
    Indonesia
    Iraq
    Kazakhstan
    Kenya
    Kiribati
    Korea (Republic of)
    Kuwait
    Kyrgyzstan
    Lao People's Democratic Republic
    Latvia
    Lesotho
    Liberia
    Libyan
    Lithuania
    Madagascar
    Malawi
    Malaysia
    Maldives
    Mali
    Marshall Islands
    Mauritania
    Mauritius
    Mexico
    Micronesia (Federated States of)
    Moldova (Republic of)
    Mongolia
    Montenegro
    Morocco
    Mozambique
    Myanmar
    Namibia
    Nauru
    Nepal
    New Caledonia
    Nicaragua
    Niger
    Nigeria
    Northern Mariana Islands
    Pakistan
    Palau
    Panama
    Papua New Guinea
    Paraguay
    Peru
    Philippines
    Portugal
    Qatar
    Republic of Korea
    Republic of Moldova
    Romania
    Russian Federation
    Rwanda
    Sao Tome and Principe
    Senegal
    Serbia
    Sierra Leone
    Singapore
    Solomon Islands
    Somalia
    South Africa
    South Sudan
    Sri Lanka
    Sudan
    Suriname
    Swaziland
    Syria (Syrian Arab Republic)
    Taiwan
    Tajikistan
    Tanzania
    Thailand
    Timor-Leste
    Togo
    Tunisia
    Turkey
    Turkmenistan
    Tuvalu
    Uganda
    Ukraine
    United Republic of Tanzania
    Uruguay
    Uzbekistan
    Vanuatu
    Venezuela (Bolivarian Republic of)
    Viet Nam
    Yemen
    Zambia
    Zimbabwe