Health Advice

for Travellers

Swiss Expert Committee for Travel Medicine
Norfolk Island

Norfolk Island

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)
  • Check the Federal Office of Public Health (FOPH) requirements for return to Switzerland from your travel destination (see LINK)

Detailed information by diseases (key aspects | maps | fact sheets etc.) are primary included in the section 'important health risks' otherwise to be found under the respective vaccination.

Important health risks

  • 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.
  • 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.

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  • Dengue and chikungunya are viral diseases 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 or 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.

Distribution of dengue, see DENGUE MAP

  • 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 

Distribution of Chikungunya, see CHIKUNGUNYA MAP

  • 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.

  • 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.

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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)]

Read the following factsheet for more information.

  • 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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Vaccinations

Vaccination recommended according to Swiss recommendations.

  • Hepatitis A vaccination is recommended for all travellers going to tropical or subtropical countries.

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All travellers should have completed a primary vaccination course and boosters according to the Swiss vaccination schedule to prevent the following conditions:

  • Tetanus-diphtheria-pertussis-polio
  • Measles-mumps-rubella

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)

In special situations, additional vaccinations are recommended or mandatory. Discuss with your doctor whether one of the following vaccinations is recommended for you:

  • 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).

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Hepatitis B - Fact sheet

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  • Typhoid fever is a serious disease that is caused by bacteria and transmitted through contaminated food or water.
  • The risk is very low for travellers who have access to safe food and drinks.
  • The best protection against typhoid fever is to follow optimal basic hygiene.
  • A vaccination against typhoid is available that is recommended in following circumstances
    • Visit to an area with poor hygienic conditions (e.g. travelling to rural areas)
    • Short stay (>1 week) in a high-risk (hyper-endemic) country (see country page)
    • long-term stays (> 4 weeks) in an endemic country
    • Presence of individual risk factors or pre-existing health conditions. In that case, please talk to your health advisor.

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  • Typhoid fever, also called enteric fever, is caused by the bacteria Salmonella Typhi and Salmonella Paratyphi.
  • Infected persons shed the bacteria in their feces. In countries with low sanitation standards, the bacteria can then enter the drinking water system and lead to infections in other people.
  • Frequent sources of infection are contaminated food and beverages.
  • The main preventive measure therefore is “cook it, peel it, boil it or forget it” – meaning: avoid drinking uncooked water or water from unsealed bottles; avoid cooled/frozen products (e.g. ice cubes in drinks, ice cream) unless from a known safe source; avoid uncooked vegetables, peel and clean fruit and vegetables yourself and only with known safe drinking water.
  • A vaccine is available and recommended: a) for travelers to the Indian subcontinent or to West Africa, b) for travelers visiting friends and relatives or for long-term travelers also to other sub-/tropical areas.

Typhoid fever is a bacterial disease that affects the whole body and mainly presents with high fever, often accompanied by drowsiness (“typhos” in Greek stands for delirium) and severe headaches. If the infection is treated with appropriate antibiotics, mortality is very low. If left untreated however, complications may follow, which can lead to significant mortality. Typhoid fever must be clearly distinguished from salmonellosis, caused by a large range of non-typhoidal salmonella species that mainly cause benign diarrheal symptoms worldwide.

The highest occurrence of typhoid fever is on the Indian subcontinent (Afghanistan, Pakistan, Nepal, Bhutan, India and Bangladesh). This is also the region with a steady increase in antibiotic resistance. The disease also occurs in the whole sub-/tropical region, but with lower frequency. It used to occur also in Europe and North America, but the disease has disappeared thanks to improved water and sanitation standards.

Typhoid fever is transmitted via the fecal-oral route: bacteria are shed in the feces of infected persons and – if insufficient hand hygiene is practiced – infected persons may contaminate the food and drinking water supply of their families. In regions with low sanitation standards, contaminated feces may also contaminate the public drinking water supply.

The incubation period – time between infection and first symptoms – can vary between 3 days to 3 weeks. The principle symptom of typhoid fever is high-grade fever (39° - 41° C) accompanied by strong headache and drowsiness. In the initial phase of the disease, patients often complain of constipation. In later stages, this may turn into diarrhea. In later stages of the disease – and in the absence of correct treatment – complications such as septicemia, intestinal hemorrhage or perforation can follow, which may lead to considerable mortality.

Appropriate antibiotic treatment cures typhoid fever. Treatment should be adapted according to the resistance profile of the bacteria. On the Indian subcontinent, some strains may be multi-resistant, necessitating broad-spectrum intravenous antibiotic treatment. In severe typhoid fever with reduced consciousness (delirium) or coma, treatment with corticosteroids may need to be added.

“Cook it, boil it, peel it or forget it” – this simple slogan would be sufficient to prevent typhoid fever nearly entirely. However, only few travelers fully adhere to this advice. Nevertheless, the value of food and water hygiene cannot be stressed enough: avoid buying water bottles without proper sealing, avoid drinking tap water from unknown sources, avoid eating cooled / frozen foods (i.e. ice cubes in water or ice cream) and avoid eating raw fruits and vegetables that you yourself have not peeled and washed with clean drinking water.

Two types of vaccines are available:

  • Oral (live) vaccine consisting of three capsules to be taken on alternate days on empty stomach. These capsules require refrigeration before use. Protection from this vaccine is approximately 70% and starts 10 days after the third dose. After 1 to 3 years, the vaccine needs to be taken again before a new travel into at-risk areas. This vaccine cannot be given to patients with a severe chronic gastrointestinal disease (such as Crohn’s disease or ulcerative colitis) or with severe immunosuppression.
  • The single-dose vaccine is an inactivated vaccine and is injected intramuscularly. Protection also reaches around 70% and starts 14 days after the injection. This vaccine can be given to patients who should not take the oral vaccine. However, it is not registered in Switzerland, but most doctors with specialization in tropical and travel medicine and all travel health centres have the vaccine on stock. Duration of protection is around 3 years.

Vaccination against typhoid fever is advised for long-term travelers and for travelers visiting areas where the risk of transmission is particularly high and/or the disease more difficult to treat due to severe antibiotic resistance.

  • 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.

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