Health Advice

for Travellers

Swiss Expert Committee for Travel Medicine
Libya

Libya

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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  • 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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  • Schistosomes are parasitic worms that infect humans while bathing or walking in fresh water ponds, lakes, or slow-flowing rivers.
  • Avoid bathing, washing, or walking in fresh water in areas endemic for schistosomiasis, also called bilharzia.
  • Consult a general practitioner or a specialist in travel and tropical medicine after suspected skin contact with fresh water during a trip.
  • Specific diagnostic tests and an effective treatment are available, which can prevent long-term complications.

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  • Schistosomes are parasitic worms that infect humans while bathing or walking in fresh water ponds, lakes, or slow-flowing rivers.
  • Avoid bathing, washing, or walking in fresh water in areas endemic for schistosomiasis, also called bilharzia.
  • Consult a general practitioner or a specialist in travel and tropical medicine after suspected skin contact with fresh water during a trip.
  • Specific diagnostic tests and an effective treatment are available, which can prevent long-term complications.

Schistosomes are parasitic worms that infect humans while bathing or walking in fresh water ponds, lakes, or slow-flowing rivers. The larvae of the worm penetrate the skin and migrate in the body until they settle as adults in the veins surrounding the intestines or the genital and urinary tracts, depending on the parasite type. Chronic complications are due to the worms’ eggs, which trigger inflammation and fibrosis (scar tissue) in affected organs.

Schistosomiasis occurs in Sub-Saharan Africa and the Arabian Peninsula, Asia (China, the Philippines, South-East Asia), north-eastern South America, and some Caribbean islands.

The larvae of schistosomes are shed by fresh water snails and penetrate the skin of humans when they bath or swim in the water. The worms develop in various organs of the human body, producing eggs that later migrate through the walls of the intestines and the urinary bladder where they trigger an inflammation and can impair the function of the respective organ systems over the course of months or years. The eggs are deposited in fresh water bodies when humans defecate or urinate into them. Larvae hatch from these eggs and infect water snails, thus completing the parasitic cycle.

Many infections do not cause any signs or symptoms. These depend on the stage of infection: soon after the larvae penetrate the human skin in fresh water, an itching rash may appear (‘swimmer’s itch’). An immunological reaction after 4-8 weeks sometimes occurs with fever and feeling sick, the so-called ‘Katayama fever’. Chronic symptoms such as bloody urine, pain in passing urine, (bloody) diarrhea, and abdominal pain eventually occur after months or years. If those symptoms occur and treatment is not given, damage to the urinary and gastrointestinal tract can lead to dysfunction of the organs.

Consult a tropical disease specialist for diagnosis and management. Specific drugs are effective and prescribed when eggs are detected in the urine or stool, or when the blood test shows antibodies against the worms (see below).

Avoid bathing, washing, or walking in fresh water ponds or slow-flowing rivers in endemic areas. Correctly treated swimming pools and sea water are safe! There is not enough evidence for post-exposure treatment.

If any suspicious fresh water contacts occurs during a trip, a tropical medicine specialist or general practitioner should be consulted for a blood test, approximately 2 months after exposure.

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.

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  • 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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  • Polio is a vaccine-preventable viral disease of the nervous system that is acquired mainly through the consumption of food or water contaminated by feces.
  • The infection with the poliovirus can affect children and adults and may lead to permanent limb or respiratory muscle paralysis and death.
  • An effective, well-tolerated vaccine is available! Check if booster doses are recommended (on top of completed basic vaccination schedule).

  • In addition to the basic immunisation against polio, a booster vaccination is recommended every 10 years.

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  • Polio is a vaccine-preventable viral disease of the nervous system that is acquired mainly through the consumption of food or water contaminated by feces.
  • The infection with the polio virus can affect children and adults and may lead to permanent limb or respiratory muscle paralysis and death.
  • An effective, well- tolerated vaccine is available! Check if booster doses are recommended for the travel destination (on top of completed basic vaccination schedule).

Poliomyelitis, or polio, is a highly infectious viral disease that affects the nervous system and can cause total limb paralysis within a very short time period. People of all ages can be infected through consumption of contaminated food or water. Humans are the only known reservoir of the polio virus.  Infection may be mild or even without symptoms. If symptoms of muscular or nervous system complications appear, sequelae (long-term complications) almost always occur. There is no medication to cure polio but the vaccine against polio is highly efficacious.

Polio due to wild types of viruses has been eradicated from most countries. In Afghanistan and Pakistan, however, new infections still occur. In some countries, polio viruses derived from live, oral vaccines are circulating and cause outbreaks of polio disease, especially in countries where vaccination coverage against polio is low in the population.

Polio virus is mainly transmitted through the consumption of food or water contaminated by feces. The virus can also be acquired through secretions or saliva of an infected person. In the tropics, transmission occurs year round, whereas in temperate zones, a peak can be seen in summer.

Symptoms most commonly appear 3 to 21 days following exposure. Initial symptoms may include fever, fatigue, headache, vomiting, and diarrhea. Those with mild cases may recover within a week. More serious cases result in stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible limb or respiratory muscle paralysis.

There is no cure for polio. Treatment targets symptom alleviation only.

Regular hand washing after using the bathroom and before eating or preparing food. Avoidance of undercooked or raw food that is potentially contaminated with fecal material.

The most important prevention is vaccination. A very effective and well-tolerated vaccine against polio is available (inactivated (killed) polio vaccine (IPV)), which is part of the basic vaccination schedule during childhood. Combination vaccines (e.g. with diphtheria and tetanus) are also available. After basic vaccination, a booster dose is recommended every 10 years for travel to certain countries (see country page recommendations). WHO recommends a yearly vaccination for residents or long-stay visitors (minimum 4 weeks) in a country with ongoing polio infections or circulating vaccine-derived polio viruses. This recommendation not only targets individual protection, but aims to prevent the international spread of the virus.

Check the risk for polio in the region of travel, and ensure vaccination if recommended (see country page recommendations).

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:

There is no risk of yellow fever in this country. However, there is an entry requirement by the country regarding yellow fever vaccination certificate, see below.

  • Vaccination is mandatory for entry within 6 days from a yellow fever endemic area (not for airport transit there).
  • Exempt from this entry requirement are: children <9 months old.

  • All travellers to yellow fever endemic countries should be vaccinated against yellow fever (even if vaccination is not mandatory in the country). A booster single booster dose is recommended for immuncompetent persons after 10 years.
  • The yellow fever vaccination must be administered by an authorized doctor or center at least ten days before your arrival in the destination country with record in the yellow vaccination booklet ('International Certificate for Vaccination’).
  • For travellers who are pregnant, breastfeeding, or who have a condition that leads to immunosuppression, please consult a travel health advisor.

  • Yellow fever occurs in sub-Saharan Africa and South America and is transmitted by mosquitoes.
  • Disease may be severe in unvaccinated travelers and death may occur in over 50%.
  • A highly effective vaccine is available.
  • Due to potentially severe side effects the vaccine is used with caution in immunocompromised or elderly individuals, as well as in pregnant women.

Yellow fever is an acute viral infection transmitted through the bite of mosquitoes. The disease occurs in sub-Saharan Africa and South America. It is a potentially lethal disease. However, the vaccination offers very high protection.

Yellow fever is endemic in countries of sub-Saharan Africa and South America, and in Panama. Transmission occurs all over the year but may peak in the rainy season. Although the same species of mosquitoes are present, yellow fever has not been found in Asia.

The yellow fever virus is transmitted to people primarily through the bite of infected daily active Aedes mosquitoes, or Haemagogus species mosquitoes, which are day and night active. Mosquitoes acquire the virus by feeding on infected primates (human or non-human) and then can transmit the virus to other primates (human or non-human). Yellow fever transmission and epidemics are facilitated by the interface of jungle, savannah and urban areas. Humans working in the jungle can acquire the virus and become ill. The virus then can be brought to urban settings by infected individuals and may be transmitted to other people.

Most people infected with yellow fever virus have mild or no symptoms and recover completely. Some people will develop yellow fever illness with onset of symptoms typically 3 to 6 days after infection. Symptoms are unspecific and flu-like (fever, chills, head and body pain). After a brief remission, about 10-20% will develop more severe disease. Severe disease is characterized by high fever, yellow skin and eyes, bleeding, shock and organ failure. About 30 to 60% of patients with severe disease die.

There is no specific medication. Treatment is only supportive and consists of providing fluid and lowering fever. Aspirin and other nonsteroidal anti-inflammatory drugs, for example ibuprofen or naproxen, should be avoided due to the risk of enhanced bleeding.

As against all mosquito-borne diseases, prevention from mosquito bites is during day and night (see “Insect and tick bite protection” factsheet). The available vaccine is highly efficacious and provides a long-term protection. It is recommended for people aged 9 months or older who are travelling to yellow fever endemic areas. In addition, providing proof of vaccination may be mandatory for entry into certain countries.

The vaccine is a live-attenuated form of the virus. In immunocompetent persons, protection starts about 10 days after the first vaccination. Reactions to yellow fever vaccine are generally mild and include headache, muscle aches, and low-grade fevers.  Side effects can be treated with paracetamol but aspirin and other nonsteroidal anti-inflammatory drugs, for example ibuprofen or naproxen, should be avoided.  On extremely rare occasions, people may develop severe, sometimes life-threatening reactions to the yellow fever vaccine – which is why this vaccine is used with caution in immunocompromised individuals, pregnant women and the elderly for safety reasons. Talk to your travel health advisor if you belong to this group.

In 2016, WHO changed from yellow fever booster doses every 10 years to a single dose, which is considered to confer life-long protection. However, this decision was based on limited data and mainly from endemic populations, potentially exposed to natural boosters (through contact with infected mosquitoes), which does not apply to travellers from non-endemic regions. As several experts have raised concerns about the WHO single dose strategy, the Swiss Expert Committee for Travel Medicine recommends a single booster dose ≥10 years (max. 2 doses per life-time) in immunocompetent persons after primo-vaccination before considering life-long immunity.

Yellow Fever Map - Centers for Disease Control and Prevention: https://www.cdc.gov/yellowfever/maps/index.html 
Yellow Fever Info - Centers for Disease Control and Prevention: https://www.cdc.gov/yellowfever/index.html 
Yellow Fever Info - European Centre for Disease Prevention and Control: https://www.ecdc.europa.eu/en/yellow-fever/facts 

  • 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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  • 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.

  • 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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