Health Advice

for Travellers

Swiss Expert Committee for Travel Medicine
Tanzania

Tanzania

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.

    • Regions: mainland (incl. national parks), including Dar es Salaam, also for Zanzibar.

    Prevention: Mosquito bite prevention and chemoprophylaxis.

    Discuss with your travel health advisor which prophylactic medication is suitable for you. The doctor will prescribe the appropriate medication and dosage.

    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.

    • Yellow fever occurs only in certain regions in Africa and Latin America.
    • It is a life-threatening viral infection and is transmitted by day-active mosquitoes.
    • Vaccination is strongly recommended for all travellers to regions where yellow fever occurs, even if it is not a mandatory requirement of the country, see vaccinations.
    • Read the following information for optimal travel preparation.

    • 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 

    • 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/ 

          • 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.

          • 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.

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          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.

          • 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.

          • 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.

          • Vaccination not generally recommended for travel to Tanzania.

          • Vaccination is mandatory for entry within 6 days from a yellow fever endemic area (not for airport transit there), including at entry from Rwanda.

          Country specific requirements for arrival (mainland Tanzania and Zanzibar): yellow fever vaccination is mandatory on

          1. arrival from a yellow fever endemic region
          2. transit of ≥12 hours in a yellow fever endemic region   

          According to recommendations of the Swiss Expert Committee in Travel Medicine (ECTM), a yellow fever vaccination may not be required if following conditions are fulfilled:

          • direct travel to Zanzibar from Europe or via airport on mainland Tanzania
          • transit time of less than 12 hours in a yellow fever endemic region

          It is strongly recommended to bring the documents (see attachment below) on the entry regulations for Zanzibar and from the Tanzanian Embassy in Berlin with you.
           
          Additional note: The entry regulations for yellow fever change frequently in Tanzania! Proof of yellow fever vaccination is often required for entry via Kilimanjaro Airport in Arusha, although officially there is no vaccination requirement, i.e. travellers without proof of vaccination may have to be vaccinated there; it is unclear how the entry requirements for yellow fever are handled in the rest of mainland Tanzania. The Swiss Expert Committee for Travel Medicine therefore recommends proof of at least one yellow fever vaccination for all travellers to mainland Tanzania.

          • 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 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:

          • 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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