Health Advice

for Travellers

Swiss Expert Committee for Travel Medicine
North Korea

North Korea

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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  • Malaria is a life-threatening parasitic infection, which is transmitted by mosquitoes at night.
  • Great care should be given to preventive mosquito protection from dusk to dawn in all malaria risk areas.
  • In high-risk areas, taking regular prophylactic medication is strongly advised.
  • For stays in low risk areas: discuss with a travel health advisor whether carrying stand-by emergency self-treatment against malaria is recommended.
  • If you belong to a special risk group (pregnant women, small children, senior citizens, persons with pre-existing conditions and/or with immune deficiency): seek medical advice before the trip as malaria can quickly become very severe.
  • If you have a fever >37.5°C on measuring under your arm or in your ear (a functioning thermometer is indispensable!) during or after the trip, see a doctor / hospital immediately and have a blood test done for malaria! This applies regardless of whether you used prophylactic medication or not!
  • For personal safety, we strongly recommend getting informed in detail about malaria and reading the following information.

    • From March to December: provinces in the southern half of the country

    Prevention: Mosquito bite prevention

    Discuss with a travel health advisor whether carrying a stand-by emergency self-treatment against malaria is necessary.

    • From March to December: rest of the country

    Prevention: Mosquito bite prevention

    For personal safety, we strongly recommend getting informed in detail about malaria and taking this factsheet with you on your trip.

    • Malaria is a life-threatening parasitic infection, which is transmitted by mosquitoes at night.
    • Great care should be given to preventive mosquito protection from dusk to dawn in all malaria risk areas.
    • In high-risk areas, the intake of prophylactic medication is strongly advised.
    • For stays in low risk areas: discuss with a travel health advisor whether carrying an emergency self-treatment against malaria is necessary.
    • If you belong to a special risk group (pregnant women, small children, senior citizens, persons with pre-existing conditions and/or with immune deficiency): seek medical advice before the trip as malaria can quickly become very severe.
    • If you have a fever >37.5°C on axillary or tympanic measurement (a functioning thermometer is indispensable!) during or after the trip, see a doctor / hospital immediately and have a blood test done for malaria! This applies regardless of whether you have used prophylactic medication or not!

    Malaria is a life-threatening acute febrile illness caused by parasites called Plasmodia, which are transmitted by mosquitoes at night (between dusk and dawn). Rapid diagnosis and treatment are crucial to prevent complications and death, and to cure the disease. To prevent malaria, diligent mosquito-bite protection is important, as well as taking additional prophylactic (preventive) medication when staying in high-risk areas. Risk groups such as pregnant women, small children, elderly persons or travellers with complex chronic conditions should seek specialized advice.

    Malaria occurs widely in tropical and subtropical areas of Africa, Asia, South and Central America (see also malaria map).

    Plasmodia are transmitted to humans by Anopheles mosquitoes, which only bite between dusk and dawn. They sometimes go unnoticed, because they are small and make almost no noise.

    After visiting a malaria endemic area, the symptoms usually appear seven days to one month after infection, but sometimes after several months or more than a year. Symptoms begin with fever and may appear very similar to flu. Other symptoms may include headache, muscle pain, nausea, and sometimes diarrhea or cough. The diagnosis can only be confirmed with a blood test.

    Fever during or after a stay in a malaria-endemic area is an emergency! Prompt diagnosis and treatment are required as the health of people with malaria can deteriorate very quickly. That means: if you have fever >37.5° (use a thermometer!) you need to test for malaria within a maximum time-frame of 24 hours, regardless of whether or not you have used prophylactic medication (malaria chemoprophylaxis). Try to reach a doctor or hospital where you can reliably receive such a test. If the first test is negative, it should be repeated on the following day if the fever persists.

    Malaria can be treated effectively, but without treatment, this disease can quickly cause complications and become fatal. People who have had malaria in the past are not protected from being infected again.

    Prevention of malaria requires a combination of approaches:

    1. Diligent mosquito-bite protection at dusk and at night until dawn is of key importance. Use it for all regions where malaria is present, including areas where the risk is minimal. Bite protection is also effective against other insect-borne diseases that often occur in the same region. It consists of the following measures:
      • Clothing: Wear long-sleeved clothes and long trousers. For additional protection, impregnate the clothes beforehand with insecticides containing the active ingredient permethrin (e.g. Nobite® Textile).
      • Mosquito repellents: Apply a mosquito repellent to uncovered skin.
      • Sleeping room: Sleep in an air-conditioned room or under an impregnated mosquito net. Cautiously use ‘knockdown’ sprays indoors or burn mosquito coils strictly outside, e.g. under a table in the evening.
      • Chemoprophylaxis: Depending on the region and season, it may be necessary to take a prophylactic medication. This is recommended for all destinations with a high risk of malaria (marked as red on our maps). It needs to be taken with food before, during, and after your stay. Discuss with your travel health advisor to ascertain if you need to take chemoprophylaxis for your trip. The appropriate medication and the right dosage will be prescribed.
    2. Taking standby emergency self-treatment (SBET, drugs used to self-treat malaria) with you is recommended for special risk situations (stay in regions with low malaria risk and if there is no or uncertain medical care available). Following such a course of SBET, please consult a doctor as soon as possible. Talk to your travel health advisor to determine whether carrying SBET is necessary, especially if you plan a trip where reliable medical infrastructure is not assured.
    3. For some risk groups, malaria can quickly develop to a dangerous disease. If you are pregnant, if you are travelling with small children, or if you are a senior citizen and / or if you have other illnesses /pre-existing conditions and / or you are immunocompromised, you should seek advice from a specialist in travel medicine to determine whether chemoprophylaxis is recommended for your trip – even if the area is marked as low risk malaria zone.

    For travellers, there is currently no malaria vaccination available.

    • Take a functioning clinical thermometer with you!
    • Malaria symptoms develop at the earliest 7 days after entering the malaria area. A fever > 37.5° always means suspicion of malaria!
    • In case you have fever during or even months after a stay in a malaria area:
      • Immediately consult a health care facility to rule out malaria through a blood test.
      • This should be done within a maximum of 24 hours and applies regardless of whether you have used prophylactic medication or not!
      • The blood tests should be repeated if the result is negative or doubtful and fever persists or recurs.
    • For persons having visited a malaria area with low risk and for whom SBET was prescribed:
      • If you have fever: immediately try to get tested for malaria.
      • If this is not possible, and fever persists for longer than 24 hours or recurs: start taking the standby emergency-self-treatment as it was prescribed by your travel health advisor.
      • Even if you have started your self-treatment against malaria: seek medical advice as quickly as possible to get the cause of your fever diagnosed.

    • 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!).
    • For optimal travel preparation, we recommend that you read the below mentioned information carefully and take the fact sheet on your trip!

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    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!

    • 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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    • 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.
    • Read the following information when planning high altitude mountain hikes.

    • 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 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".

    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:

    • 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!).

    • 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.

    • 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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    • The risk of Japanese encephalitis is very low for travellers.
    • Follow diligent mosquito bite prevention measures in the evening and night.
    • A safe and effective vaccine is available that is recommended for high-risk travellers such as.
      • Work / extensive outdoor activities in rural areas.
      • Long-term stays (>4 weeks) or during an ongoing outbreak

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    • 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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