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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

Saint Barthélemy

Latest news

(source image: PAHO Zika weekly report, accessed 19.11.2021) The high incidence in Guatemala compared to the other countries is striking. However, these numbers need to be interpreted with caution, as epidemiological surveillance may be limited due to the COVID-19 pandemic. Case numbers in the Caribbean are incomplete, see link for details.

 

Consequences for travelers

Currently, none of the above countries is classified as an area with a current outbreak (see CDC map). Prevention: Optimal mosquito protection is necessary around the clock (24/7): during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria). Detailed information on Zika can be found in the Zika factsheet.

 

References

PAHO Zika weekly report, accessed 19.11.2021

News_HealthyTravel_21_11_18_Bild_2.JPG

The 'Pan American Health Organization' (PAHO) has reported 122,203 chikungunya fever cases in the Americas in the year 2021, compared to 103,000 cases reported for the entire year of 2020. Brazil accounts for the majority of cases (97%).

Chikungunya fever is a viral infection transmitted by Aedes mosquitoes. The disease is typically manifested by severe joint pain in the hands and feet, which can last for weeks or months in some patients.

 

Consequences for travelers

Optimal mosquito protection measures 24/7: during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).

 

References

Outbreak News Today, 30.10.2021

General Information

  • Get full COVID-19 vaccination protection before travel
  • 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
Flyer
SOP
MAP
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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)
Countrywide
 
 
 
 

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

  • Hepatitis A is a liver infection caused by a virus. It is also known as infectious jaundice.
  • The virus is easily transmitted by contaminated food or water but can also be transmitted through sexual contact.
  • A safe and very effective vaccine is available that affords long-lasting protection.
  • Hepatitis A vaccination is recommended for all travelers going to tropical or subtropical countries, and for risk groups.

EKRM_Factsheet_Layperson_EN_Hepatitis-A.pdf

  
 
 
 
 

 
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
Factsheet
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No risk
 
 
 
 

 
Country requirement at entry
  • 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 <1 year old.
 

  • Yellow fever is a life-threatening viral infection. A highly effective vaccine is available. 
  • Vaccination is strongly recommended for all travellers to regions where yellow fever occurs, even if it is not a mandatory entry requirement of 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.

EKRM_Factsheet_Layperson_EN_Yellow-fever.pdf

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

  • 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 <1 year old.
CDC Map: Areas with Risk of Yellow Fever Virus Transmission in Africa
CDC Map: Areas with Risk of Yellow Fever Virus Transmission in South America
  • 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 
Worldwide
  
 
 
 
  • 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
  
 
 
 
  • 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

Other health risks

 
Risk Area
Factsheet
Flyer
Infosheet
MAP
Bookmark
Countrywide
 
 
  • 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
Countrywide
  
 
 
Worldwide
  
 
 
 
  
 
 

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

  
 
 
 
  • 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".

EKRM_Factsheet_Layperson_EN_Rabies.pdf

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