| 3 Disease
risks
and
recommendations
by
continental
group
and
country
|
3.1 Europe, including Cyprus
and countries of the former USSR
(Albania, Andorra, Armenia, Austria, Azerbaijan,
Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus,
Czech Republic, Denmark (with the Faroe Islands), Estonia, Finland,
France, Georgia, Germany, Gibraltar, Greece, Hungary, Iceland,
Ireland, Italy, Kazakhstan, Kyrgyzstan, Latvia, Liechtenstein,
Lithuania, Luxembourg, Macedonia, Malta, Moldova, Monaco, Netherlands,
Norway, Poland, Portugal (with the Azores and Madeira), Romania,
Russia, San Marino, Slovakia, Slovenia, Spain (with the Canary
Islands), Sweden, Switzerland, Tajikistan, Turkmenistan, Ukraine,
Uzbekistan, Yugoslavia (including Kosovo, Montenegro and Serbia)
3.1.1 Disease risks
For much of the area communicable diseases are unlikely
to prove a hazard greater than in the UK. The risks may be higher
in parts of Eastern Europe, but lack of information makes risk
assessment difficult.
Food and water-borne diseases
(bacillary dysentery, other diarrhoeas, and typhoid) are most
likely to occur in the south-eastern and south-western parts of
the area, especially in summer and autumn. The incidence of certain
food-borne diseases, eg salmonella and campylobacter infections,
is increasing in some countries. Hepatitis A is commoner in the
eastern European countries.
Malaria
is confined to small foci in Armenia, Azerbaijan, Georgia, Tajikistan
and Turkmenistan.
Other arthropod-borne diseases
(see Chapter 7) occur of which the most common are:
- Tick-borne
encephalitis - mainly in forests and surrounding areas in central
and eastern Europe and Scandinavia and across the former USSR
to the Pacific coast.
- Lyme disease
- Tick-borne typhus -
in Siberia and the Mediterranean
- Japanese encephalitis
- in a small area in the far eastern maritime areas of the former
USSR neighbouring China
- Murine typhus (endemic)
- sporadic cases occur in some countries bordering the Mediterranean
littoral
- West Nile Fever - cases
sometimes occur in Mediterranean and eastern European countries
- Cutaneous and visceral
leishmaniasis and sand fly fever reported from Southern Europe
- Leishmania/HIV co-infection
reported from France, Greece, Italy
- Tularaemia in parts
of continental Europe.
- Louse-borne relapsing
fever in Turkey and areas of the former USSR.
- Tick-borne
relapsing fever - foci in Portugal and Spain
Diseases of close association:
- In
recent years, Azerbaijan, Belarus, Russia and Ukraine have experienced
extensive epidemics of diphtheria. Cases of diphtheria, mostly
imported from these three countries, have also been reported in
neighbouring countries (Estonia, Finland, Latvia, Lithuania, Poland,
the Republic of Moldova).
- All countries are making
intense efforts to eradicate polio, and the risk of infection
in most countries is very low.
- Tuberculosis
rates are increasing in parts of eastern Europe and the former
USSR, including drug resistant disease.
Sexually transmitted and blood-borne infections:
Hepatitis B is generally of low prevalence; prevalence
higher in the eastern and southern parts of the region. HIV is
predominantly in high risk groups, but the risk of all STIs, particularly
for young travellers, should not be forgotten.
Other hazards could include:
3.1.2 Recommendations
for
immunisations
and
malaria
chemoprophylaxis
(see
later
chapters
for
general
health
precautions)
FOR
ALL
COUNTRIES
Check
routine
immunisations
including
tetanus.
For
immunisation
recommendations
for
poliomyelitis
boosters,
hepatitis
A
and
typhoid
please
see
the
country
by
country
guide
below,
noting
that
immunisation
against
typhoid
and/or
hepatitis
A
may
be
less
important
for
short
stays
in
standard
business
or
tourist
conditions.
For
polio,
see
also
paragraph
1.8.
Those
walking
or
camping
in
late
spring
and
summer
in
rural
parts
of
central
and
eastern
Europe
(including
the
former
USSR)
and
Scandinavia,
are
at
increased
risk
of
tick-borne
encephalitis
-
consider
immunisation
(see
also
Chapter
7).
For
long
stay
visitors
to
eastern
Europe
and
the
former
USSR
consider
immunisation
against
diphtheria
and
hepatitis
B,
and
check
BCG
status;
for
those
going
to
live
or
work
with
local
people,
a
diphtheria
booster
may
be
considered
even
for
shorter
stays
if
the
last
dose
was
more
than
10
years
ago.
For
remote
areas
out
of
reach
of
medical
attention,
possibly
also
consider
rabies
vaccine.
|
3.1.3 Country by country variations and malaria
chemoprophylaxis:
Albania
Yellow fever vaccination certificate required
from travellers over one year old coming from infected areas.
Immunisation against poliomyelitis and hepatitis
A usually advised.
Armenia
Immunisation against hepatitis A usually advised.
Malaria risk: P.vivax
malaria focally in Ararat Valley, from June to October, outside
tourist areas.
Recommended prophylaxis: for the risk area only,
chloroquine.
Austria
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Azerbaijan
Immunisation against hepatitis A and typhoid usually
advised.
Malaria risk: P.vivax
malaria focally, from June to October.
Recommended prophylaxis: chloroquine.
Belarus
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Bosnia
Immunisation against hepatitis A usually advised.
Bulgaria
Immunisation against hepatitis A usually advised.
Croatia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Czech Republic
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Estonia
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Georgia
Immunisation against hepatitis A usually advised.
Malaria risk: P.vivax
malaria focally in rural areas in the south-east, June to October.
Recommended prophylaxis: for those areas only, chloroquine.
Germany
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Greece
Yellow fever vaccination certificate required
from travellers over six months old coming from infected areas.
Hepatitis A immunisation occasionally advised, eg
for those on extensive backpacking holidays where food hygiene
might be in doubt.
Herzegovina
Immunisation against hepatitis A usually advised.
Hungary
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Kazakhstan
Yellow fever vaccination certificate required
from travellers coming from infected areas.
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised.
Kyrgyzstan
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised.
Latvia
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Lithuania
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Macedonia
Immunisation against hepatitis A usually advised.
Malta
Yellow fever vaccination certificate required
from travellers over nine months old coming from infected areas.
(If indicated on epidemiological grounds, infants under nine months
of age coming from infected areas are subject to isolation or
surveillance).
Moldova
Immunisation against hepatitis A usually advised.
Poland
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Portugal, with the Azores and Madeira
Yellow fever vaccination certificate required from
travellers over one year old coming from infected areas and arriving
in or bound for the Azores and Madeira. No certificate is required
from passengers in transit at Funchal, Porto Santo and Santa Maria.
Hepatitis A immunisation occasionally advised, eg
for those on extensive backpacking holidays where food hygiene
might be in doubt.
Romania
Immunisation against hepatitis A usually advised.
Russia
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised for areas east of the Urals.
Japanese encephalitis and Russian spring summer encephalitis
- consider immunisation against JE for far eastern maritime areas,
south of Khabarousk, July-September.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Slovakia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Slovenia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Tajikistan
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised.
Malaria risk: malaria (mostly P.vivax)
patchily distributed, June to October.
Recommended prophylaxis: chloroquine.
Turkmenistan
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised.
Malaria risk: P.vivax
from June to October in south-eastern region.
Recommended prophylaxis: in the risk area, chloroquine.
Ukraine
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances
(see 7.4).
Uzbekistan
Immunisation against poliomyelitis, hepatitis A and
typhoid usually advised.
Yugoslavia
Immunisation against hepatitis A usually advised.
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