Health Advice

for Travellers

Swiss Expert Committee for Travel Medicine
Bermuda

Bermuda

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.

Under construction

Under construction

  • 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.

  • Zika is a viral disease transmitted by mosquitoes that bite during the day.
  • Zika virus infection during pregnancy (any trimester) can cause fetal malformation.
  • In areas at increased risk of transmission (epidemic), specific recommendations must be given to women who are – or wish to become – pregnant.
  • If you or your partner is pregnant or if you are planning a family, we strongly recommend that you inform yourself in detail about zika.

    Distribution of Zika, see ZIKA  MAP

    • The fact sheet contains important information on zika and prevention measures.
    • If you or your partner is pregnant or if you are planning a family, we strongly recommend that you inform yourself in detail about zika.

    • Zika is a viral disease transmitted by mosquitoes that bite during the day.
    • Zika virus infection during pregnancy (any trimester) can cause fetal malformation.
    • In areas at increased risk of transmission (epidemic), specific recommendations must be given to women who are – or wish to become – pregnant.

        Zika is a viral disease transmitted by mosquitoes that bite during the day. In general, the disease is mild and heals spontaneously. About one in five people develop symptoms such as fever, skin rash, conjunctivitis, joint pain, muscle pain, and sometimes headaches. Rarely, immunological and neurological complications occur. Infection during pregnancy can have serious consequences for the fetus. Pregnant women are advised against travelling to countries with increased risk (current epidemic).

        The Zika virus was identified in 1947 in monkeys from the Zika forest in Uganda. Virus circulation has long been limited (a few cases each year) in Africa and South-East Asia. In May 2015, the American continent was affected for the first time, with an epidemic in Brazil that rapidly spread to South America, Central America, and the Caribbean. Since then, the disease has been reported in most tropical and subtropical regions.

        The risk of infection is currently low in most regions and does not require specific measures. However, epidemics may occasionally reappear. During epidemics, the risk of transmission is high, and specific recommendations for the traveller are necessary.

        Zika virus is transmitted by the bites of infected mosquitoes (Aedes spp. including ‘tiger mosquito’), which bite during the day, with maximum activity at dawn and around sunset. These mosquitoes are common in cities in tropical and subtropical regions. The virus can be transmitted from person to person, during pregnancy by an infected mother to the fetus, or during unprotected sex with an infected person (with or without symptoms). Transmission by blood transfusion is also possible.

        About 80% of infected people have no symptoms. Clinical signs begin within 2 weeks after the bite of an infected mosquito and are generally mild: moderate fever, rash often with itching, conjunctivitis, joint pain, headache, muscle pain, and digestive disorders. In general, the patient heals spontaneously after 5-7 days. Neurological (Guillain-Barré syndrome) and immunological complications can occur, but are rare. Zika virus infection during pregnancy (any trimester) can cause fetal malformation.

        In case of fever, it is recommended to consult a doctor. The symptoms of a Zika virus infection may seem similar to those of malaria, for which urgent treatment is necessary, or dengue fever. Treatment for Zika aims for reduction of fever and joint pain (paracetamol). Avoid aspirin and anti-inflammatory drugs (e.g. ibuprofen) as long as dengue fever is not excluded. There is no vaccine available.

        In case of pregnancy and fever during or upon return from a Zika virus transmission area, blood and/or urine tests are indicated. In case of confirmed infection, the medical management should be discussed with the gynecologist and infectious/travel medicine specialists.

        The risk of infection can be reduced by effective protection from mosquito bites during the day and in the early evening (long clothing, mosquito repellents, mosquito net).

        When travelling in an area of increased risk (= declared epidemic) and in order to prevent possible sexual transmission of the virus, it is recommended to use a condom / Femidom during the trip and at least 2 months after return.

        Due to the risk of fetal malformation, pregnant women are advised against travelling to areas at increased risk (= declared as epidemic) of Zika transmission at any time during pregnancy (in case of essential travel, a consultation with a travel medicine specialist is advised before departure). Women who wish to become pregnant should wait at least 2 months after their return (or that of their partner) from an area at increased risk of Zika transmission.

        • Zika virus infection during pregnancy (any trimester) can cause fetal malformation.
        • For most up-to-date information on Zika distribution and / or Zika outbreaks, please consult CDC Zika Travel Information: https://wwwnc.cdc.gov/travel/page/zika-information 

        Swiss TPH - Information on the Zika Virus: https://www.swisstph.ch/en/travelclinic/zika-info/ 

        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.

        • 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.

        Under construction

        • 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".

        Under construction

        Vaccinations

        Vaccination recommended according to Swiss recommendations.

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

        Under construction

        Under construction

        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).

        Under construction

        Under construction

        • 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

        Under construction