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Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

Spain

Latest news

News_HealthyTravel_22_05_20_Monkeypox.JPG

In the beginning of May 2022, one case of monkeypox was detected in England, which had occurred after travel to Nigeria. In the course of this, 6 further cases of monkeypox were diagnosed in England in people with no previous travel and no contact with known travel-associated cases. These are two cases in one family and four cases in men who have sex with men (MSM). The latter apparently got infected in London. Apart from the family and two of the MSM cases, there are no known links between the cases. Further 2 cases have been reported in the meantime. Investigations into the sources of infection and other suspected cases are in progress.

Additional cases are reported by GeoSentinel and various media reports from the following countries:

  • France: 1 suspected case (Île-de-France region).
  • Italy: 3 cases, one confirmed, 1 case with travel history Canary Islands (link)
  • Canary Islands: 1 suspected case
  • Portugal: 14 confirmed cases, another 6 suspected cases (link), Lisbon Region and Tagus Valley Region
  • Spain: 7 confirmed, 23 suspected cases, (link)
  • Sweden: 1 confirmed case, 1 suspected case
  • Canada: 17 suspected cases (link)
  • USA: 1 confirmed case with travel history to Canada (link)

 

Description: Monkeypox is a zoonosis caused by an orthopoxvirus, a DNA virus genetically related to the variola and vaccinia viruses. Monkeypox is endemic in West and Central Africa. Increased cases have been recorded in Nigeria since September 2017, and imports by returning travellers to England and the USA have also been recorded more frequently in recent years. There are two types of monkeypox virus: the West African type and the Central African type (Congo Basin).

Transmission: Monkeypox is transmitted from infected animals by a bite or by direct contact with blood, body fluids or lesions of the infected animal. It can be transmitted via abrasions in the mouth to people who eat infected animals. It can also be transmitted from person to person via the respiratory tract, through direct contact with body fluids of an infected person or with virus-contaminated objects. The incubation period is 5-21 days, usually about 7 to 17 days.

Symptoms: Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes and chills. 1- 3 days after the onset of symptoms, a rash develops that may look like chickenpox or syphilis and spreads from the face to other parts of the body, including the genitals. The disease is usually mild. In immunocompromised individuals, the disease can be severe. The mortality rate is about 1% for the West African type and up to 10% for the Central African type.

 

For further details, see WHO factsheet, ECDC and CDC.

Further cases must be expected. Persons showing symptoms as described above should contact a doctor, ideally in advance by telephone. Persons who have several sexual partners or practice casual sex should be particularly vigilant!

Prevention: Good personal hygiene, avoid contact with infected persons and animals at all costs. During stays in West and Central Africa: No consumption of bushmeat. The individual risk of contact with a patient with monkeypox depends on the type and duration of contact. In the case of very close contact with a case (e.g. family members, aeroplane neighbours, medical personnel), the risk of infection has so far been classified as moderate; in the case of sexual / intimate contact, it is probably high.

In case of corresponding clinic, persons without travel history should also be isolated, tested and reported for monkeypox.

 

MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (Tel. +41 58 463 87 06) ! Special laboratories, such as the Spiez Laboratory or the Reference Laboratory for Imported Viral Diseases (HUG) or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for identifying monkeypox infections (material: crust or vesicular fluid).

 

A vaccine against smallpox, including monkeypox, is licensed in Europe (Imvanex®). This is available in Zurich at the Centre for Travel Medicine of the University of Zurich. It is a "3rd generation smallpox vaccine" with a live-attenuated vaccine virus (modified vaccinia virus Ankara; MVA-BN), but which has become replication-incompetent after many passages. Two vaccine doses s.c. at an interval of 28d are indicated for laboratory personnel on a pre-exposure basis. Indication for post-exposure vaccination must be discussed with a specialist.

Geosentinel asks to report confirmed and suspected cases at: geosennel@geosentinel.org

Source image: NCDC

WHO 18.5.2022, RKI 19.5.2022, UK GOV, 16.5.2022, Outbreak News Today, 18.5.2022, CDC, Labor Spiez

General Information

  • Avoid all non-essential travel
  • If travel is unavoidable: get full COVID-19 vaccination protection before travel and adhere strictly to the recommendations and regulations of your host country
  • Check entry requirements of destination country: see regulary updated COVID-19 Travel Regulations Map of IATA (LINK) or list of HUG (LINK)
  • Check the Federal Office of Public Health (FOPH) requirements for return to Switzerland from your travel destination (see LINK)

Vaccinations for all travellers

 
Risk Area
Factsheet
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Worldwide
 
 
 
 

 
Recommendation

Vaccination recommended, see Swiss Federal Office of Public Health (FOPH), LINK.

Entry requirement per country, see IATA LINK and HUG LINK

 

  • Covid-19 is a disease that affects the whole body, but mainly shows with respiratory symptoms such as cough and difficulty in breathing. It is caused by the SARS-CoV-2 virus.
  • The infection is mainly spread through respiratory droplets and possibly aerosols when infected persons cough, sneeze, speak or sing without wearing a mask.
  • The infection can be prevented very effectively by vaccination and an increasing number of vaccines are now approved and available for protection.
  • Vaccination is recommended according to the Swiss recommendations of the Federal Office of Public Health (FOPH), see LINK.
  • Furthermore, prevention relies heavily on people wearing face masks, on hand hygiene and on physical distancing (min. 1.5 m) if masks are not worn and people are not vaccinated.
For information, see LINK of the Federal Office of Public Health (FOPH)
 
 
 
 
 

 
Recommendation
All travellers should have completed a basic immunisation to the Swiss vaccination schedule, LINK.
 

Worldwide
 
 
 
 
 

 
Recommendation

All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.

 

Worldwide
 
 
 
 
 

 
Recommendation

All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.

 

Worldwide
 
 
 
 
 

 
Recommendation

Travellers should be immune to chickenpox. Persons between 11 and 40 years of age who have not had chickenpox should be vaccinated (2 doses with minimum interval of 4-6 weeks).

 

Vaccinations for some travellers

 
Risk Area
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  • Hepatitis B is a viral liver infection that is transmitted via contaminated blood or via sexual contact.
  • A safe and very effective vaccine is available that affords life-long protection.
  • Hepatitis B vaccination is recommended for all young people and at-risk travellers, especially if:
    • You travel regularly or spend long periods of time abroad.
    • You are at risk of practicing unsafe sex.
    • You might undergo medical or dental treatment abroad, or undertake activities that may put you at risk of acquiring hepatitis B (tattoos, piercing, acupuncture in unsafe conditions).
Under construction
Countrywide
 
 
 
  • There is a risk of rabies in the African territories of Ceuta and Melila in Spain.
  • Rabies has not been reported in domestic or wild animals in the rest of Spain (including the Balearic Islands and Canary Islands). However, bats may carry bat lyssavirus (bat rabies).
  • Rabies is a viral infection that is mainly transmitted by dogs (and bats), but any mammal can be infectious. Infection occurs via contact with the saliva of an infected mammal.
  • It is invariably fatal at the time when symptoms occur.
  • The only way to prevent death is pre-travel vaccination or immediate wound cleaning and immunizing after a contact in countries where vaccines and immunoglobulins are often difficult to get.
  • Rabies is best prevented by pre-exposure vaccination. This is highly recommended for
    • long-term stay in endemic countries,
    • short journeys with high individual risk such as travellers on ‘two wheels’ or treks in remote areas  or travel with toddlers and children up to 8 years,
    • professional work with animals or cave explorers (bats!).

EKRM_Factsheet_Layperson_EN_Rabies.pdf

This fact sheet contains important information about rabies. For optimal travel preparation, we recommend that you read this information carefully and take the fact sheet on your trip!
  • Rabies is mainly transmitted through the saliva or other body fluids of dogs (and bats), but any mammal can be infectious.
  • Rabies is invariably fatal once symptoms occur.
  • The only way to prevent death is pre-travel vaccination or immediate wound cleaning and immunizing after exposure.
  • In many countries vaccines and immunoglobulins are often unavailable.
  • Rabies is best prevented by pre-exposure vaccination that is highly recommended for
    • long-term stay in endemic countries,
    • short journeys with high individual risk such as travellers on ‘two wheels’ or treks in remote areas, toddlers and children up to 8 years of age,
    • professionals working with animals, or cave explorers (bats!).
Dogs are responsible for more than 95% of human cases. Bats (Latin America), cats, and (rarely) monkeys, predators, and other mammals can transmit rabies. The highest risk areas are Asia, Sub-Saharan Africa, and some Latin American countries (e.g. Bolivia). Rabies may occur anywhere in the world, except in countries where successful eradication has been achieved.
Bleeding scratch injuries, licks over injured skin, bites by infected animals: when saliva or other body fluids of infected animals enter the human body, the rabies virus multiplies at the site of entry and later spreads to the peripheral nerves and eventually moves to the central nervous system. Once it has reached the brain, the infection is invariably fatal.
When symptoms such as abnormal skin sensation, paralysis, or hydrophobia (fear of water) appear at 2-12 weeks after contact (range: 4 days-4 years!), the point of no return is reached, and the disease is fatal. Therefore, vaccination before exposure and immediate action after contact are crucial.

No reliable treatment of rabies disease exists!

Post-exposure measures:

  • Immediate cleaning of the wound with plenty of water and soap for 10-15 minutes, followed by disinfection (e.g. Betadine, Merfen) and emergency post-exposure vaccination at the nearest health institution within 24 hours.
  • Tetanus booster vaccination is also required.
  • For those having received full pre-exposure rabies vaccination before travel: two additional vaccine shots (any available brand) at an interval of 3 days suffice.
  • If full pre-exposure vaccination has not been given, in addition to vaccination, passive immunization is required with immunoglobulins.
  • It should be noted that immunoglobins (and sometimes vaccines) are often unavailable in low-resource settings, causing stress and uncertainty.

Stroking cute pets is not a good idea; refrain from touching wild or unfamiliar or dead animals.
All travellers to places where rabies may occur and who are likely to take repeated trips to areas where rabies occurs should have a pre-exposure vaccination. In addition, pre-exposure vaccination is highly recommended for travellers at particular risk:

  • long-term stay in endemic countries,
  • short journeys with high individual risk such as travellers on ‘two wheels’ or treks in remote areas, toddlers and children up to 8 years of age,
  • professionals working with animals, or cave explorers (bats!).

The shortened vaccination schedule can be proposed to most travellers: 2 shots, the first one at one month before departure if possible (minimum: 8 days before departure). A single third rabies booster vaccination is recommended before the next trip, at least after one year.

  • Obtain information about prevention of rabies in time before travelling.
  • In case of trips planned for longer than a few weeks, schedule a visit at the travel clinic 4 weeks before departure at the latest.
  • After possible exposure (bite, scratch injury) wound treatment and additional vaccinations are necessary even for those with a completed series of basic vaccinations.
  • This information leaflet should be printed and kept handy during the trip!
  • FOPH Switzerland (German): https://www.bag.admin.ch/dam/bag/de/dokumente/mt/infektionskrankheiten/tollwut/bag-bulletin-15-2021-tollwut-prep-und-pep.pdf.download.pdf/210412_BAG_Bulletin_15_2021_Tollwut%20PrEP%20und%20PEP_d.pdf 
  • FOPH Switzerland (French): https://www.bundespublikationen.admin.ch/cshop_mimes_bbl/14/1402EC7524F81EDBA5D6C3EBC18BA9FB.pdf 
Countrywide
 
 
Map
HealthyTravel_Map_TBE_Europe.JPG
  • Tick-borne encephalitis is a viral infection that is transmitted by ticks. It is often referred to by the German name and abbreviation ’Frühsommer meningoenzephalitis’ (FSME).
  • Tick-borne encephalitis occurs in certain forested areas in Europe through to the Far East.
  • A safe and effective vaccine is available that is recommended for all stays in endemic areas.

EKRM_Factsheet_Layperson_DE_TBE.pdf

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

HealthyTravel_Map_TBE_Europe.JPG

Under construction
Countrywide
 
 
 
 
  • Influenza is common all over the world including sub-tropical and tropical countries.
  • Vaccination offers the best protection. 
  • Vaccination against flu is recommended for all travellers who belong to an “at risk” group such as pregnant travellers, travellers with comorbidities, elderly people (>65 years), or who plan a a high-risk trip (e.g. cruise-ship, pilgrimage).
  • The influenza vaccine does not offer protection against avian flu.
Under construction

Important health risks

 
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During 2018 the first locally acquired dengue cases were reported, with transmission occurring in the provinces of Cádiz, Catalonia and Murcia. Risk is low.

  • Dengue is a viral disease transmitted by mosquitoes that bite during daytime.
  • As a prevention measure, great attention should be given to protection from mosquito bites.
  • There is neither a vaccination nor a specific medication against dengue for travellers.
  • In case of fever: do not use acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) as this can worsen bleeding in case of dengue infection.
  • Read the following information for optimal travel preparation.

EKRM_Factsheet_Layperson_EN_Dengue.pdf

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

CDC Map: Distribution of dengue

  • Dengue fever is the world's most common insect-borne infectious disease.
  • Great attention should be paid to mosquito protection during the day!
  • The disease can cause high fever, muscle and joint pain, and skin rashes. In rare cases, bleeding may occur. There is no specific treatment.
  • For personal safety, we strongly recommend that you inform yourself in detail about dengue.

Dengue fever is the most common insect-borne infectious disease worldwide. There are 4 known serotypes of dengue virus, so it is possible to be infected with dengue more than once. Approximately 1 in 4 infected individuals develop symptoms of dengue, resulting in high fever, muscle and joint pain, and skin rash. In rare cases, most often after a second infection, life-threatening bleeding and shock (severe drop of blood pressure) may occur.

Dengue fever occurs in all tropical and subtropical regions between latitudes 35°N and 35°S (see also CDC map: https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html).
Dengue virus is transmitted mainly by day- and dusk-active mosquitoes, namely Stegomyia (Aedes) aegypti and Stegomyia (Aedes) albopictus. These mosquitoes breed in small water puddles, as they are often found around residential buildings or at industrial zones / waste dumps of human settlements. The main transmission season is the rainy season.

In 3 out of 4 cases, an infection with the virus remains asymptomatic. After a short incubation period (5-8 days), 1 out of 4 infected people present an abrupt onset of fever, headache, joint, limb and muscle pain, as well as nausea and vomiting. Eye movement pain is also typical. A rash usually appears on the 3rd or 4th day of illness. After 4 to 7 days, the fever finally subsides but fatigue may persist for several days or weeks.

In rare cases, severe dengue can occur. Particularly susceptible are local children and seniors as well as people who have experienced a prior dengue infection. Tourists extremely rarely present with severe dengue. In the first days, the disease resembles the course of classic dengue fever, but on the 4th/5th day, and usually after the fever has subsided, the condition worsens. Blood pressure drops, and patients complain of shortness of breath, abdominal discomfort, nosebleeds, and mild skin or mucosal hemorrhages. In the most severe cases, life-threatening shock may occur.

There is no specific treatment for dengue virus infection. Treatment is limited to mitigation and monitoring of symptoms: fever reduction, relief of eye, back, muscle and joint pain, and monitoring of blood clotting and blood volume. Patients with severe symptoms must be hospitalised.

For treatment of fever or pain, paracetamol or acetaminophen are recommended (e.g. Acetalgin® Dafalgan®). Drugs containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) must be avoided.

Effective mosquito protection during the day and especially during twilight hours (i.e. sunset) is the best preventive measure:

  1. Clothing: Wear well-covering, long-sleeved clothing and long pants and spray clothing with insecticide beforehand (see factsheet “prevention of arthropod bites”)
  2. Mosquito repellent: Apply a mosquito repellent to uncovered skin several times a day (see factsheet “prevention of arthropod bites”)
  3. Environmental hygiene: Do not leave containers with standing water (coasters for flower pots, etc.) in your environment to avoid mosquito breeding sites.

No vaccination against dengue virus is currently available for travellers.

Do not take any products containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) if you have symptoms, as they may increase the risk of bleeding in the event of a severe dengue infection!
Dengue Map (Center for Disease Control and Prevention – CDC): https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html 
Countrywide
 
 
  • Chikungunya is a viral disease transmitted by mosquitoes that bite during daytime.
  • As a prevention measure, great attention should be given to protection from mosquito bites.
  • There is neither a vaccination nor a specific medication against chikungunya for travellers.
  • In case of fever: do not use acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) as this can worsen bleeding in case of dengue infection.
  • Read the following information for optimal travel preparation.

EKRM_Factsheet_Layperson_EN_Chikungunya.pdf

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

CDC Map: Distribution of Chikungunya

  • Chikungunya is a viral disease transmitted by Aedes mosquitoes.
  • Chikungunya can be prevented by protection against mosquito bites.
  • It typically presents with severe joint pain of the hands and feet. In a few patients, these may persist for weeks or months.
Chikungunya is caused by the chikungunya virus, which was first described in 1952 in Tanzania. The name is believed to come from a local African language, meaning ‘to become bent over’, and refers to the posture of affected persons who lean on walking sticks due to severe joint pain.
Indian subcontinent, South-East Asia and Pacific islands, Central and South America, Caribbean islands, Sub-Sahara Africa, Arabian peninsula. In Europe, cases are mainly imported from endemic countries. However, local transmission has occurred in 2007, in 2014, and in 2017 (Italy and France).
The chikungunya virus is transmitted through the bite of Aedes mosquitoes, which predominantly bite humans during daytime.

The infection may present with some or all of the following symptoms: sudden onset of high-grade fever, chills, headache, redness of eyes, muscle and joint pain, and rash. The rash usually occurs after the onset of fever and typically involves the trunk and extremities, but can also include the palms, soles of the feet, and the face.

Often fever occurs in two phases of up to one week duration, with an interval of one to two fever-free days in between. The second phase may present with much more intense muscle and joint pain, which can be severe and debilitating. These symptoms are typically bilateral and symmetric and mainly involve hands and feet, but may also involve the larger joints, such as the knees or shoulders.

About 5-10% of infected people continue to experience severe joint pain even after the fever has subsided, in some cases lasting up to several months or, albeit rare, even years.

Diagnosis can be confirmed by blood tests: PCR in the first week of symptoms or serology (antibody measurement) from the second week of illness.
There is no treatment against the virus itself, only symptomatic treatment for the joint pains (anti-inflammatory drugs).
Mosquito bite prevention during the daytime (when Aedes mosquitoes are active): repellants on uncovered skin, wearing long clothes, treating clothes with insecticide. A further very important protective factor is ‘environmental hygiene’, meaning preventing the occurrence of breeding sites for mosquitoes within close proximity of human housing by eliminating all forms of recipients containing water.
  • FOPH Switzerland: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/chikungunya.html
  • WHO - Chikungunya fact sheet: https://www.who.int/news-room/fact-sheets/detail/chikungunya
  • Center for Disease Control and Prevention (CDC): https://www.cdc.gov/chikungunya/index.html
 
 
 

There is a risk of arthropod-borne diseases other than malaria, dengue, chikungunya or zika in sub-/tropical regions, and some areas of Southern Europe. These include the following diseases [and their vectors]:

  • in Europe
    • Borreliosis, FSME (= tick-borne encephalitis), rickettsiosis [ticks]
    • Leishmaniasis [sand flies]
    • West-Nile fever [mosquitoes]
  • in Africa
    • Rickettsiosis, in particular African tick bite fever [ticks]
    • Leishmaniasis [sand flies]
    • African trypanosomiasis = sleeping sickness [tsetse flies]
    • West-Nile fever [mosquitoes]
  • in Asia 
    • Scrub typhus [mites]
    • Rickettsiosis [fleas or ticks]
    • Leishmaniasis [sand flies]
    • West-Nile fever [mosquitoes]
    • Crimea-Congo-hemorrhagic fever [ticks]
  • in North and Latin America  
    • Rickettsioses and in particular Rocky Mountain spotted fever [ticks]
    • Leishmaniasis and Carrion's disease [sand flies]
    • American trypanosomiasis = Chagas disease [triatomine bugs]
    • West Nile fever [mosquitoes]

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

Under construction
Worldwide
 
 
 
  • Sexually transmitted infections (STIs) are a group of viral, bacterial and parasitic infections; while many are treatable, some can lead to complications, serious illness or chronic infection.
  • STIs are increasing worldwide.
  • Read the following fact sheet for more information.

EKRM_Factsheet_Layperson_EN_STI.pdf

EKRM_Factsheet_Layperson_DE_HIV-AIDS.pdf

Under construction
Areas above 2500 meters
 
 
 
 
  • Altitude sickness may be experienced in areas above 2500 meters.
  • People differ in their susceptibility to altitude sickness; this is not related to their physical fitness.
  • Young people are generally more susceptible to altitude sickness than older people.
  • Severe altitude sickness with fluid accumulation in the brain or lungs can rapidly result in death.
  • If you are planning high altitude hiking, we strongly recommend you to consult your doctor for detailed recommendations and instructions.
  • If you are planning a trip above 2500m, we strongly recommend for your own safety that you read this factsheet and carry it with you on the trip.
 
 
 
 
 
  • There are other important travel related health risks such as diarrhoea, road traffic accidents, air pollution and more.
  • For more information, see the section "Healthy Travelling".

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