Netherlands

Hantaviruses are rodent-borne zoonotic viruses transmitted to humans primarily through contact with contaminated rodent urine, droppings, or saliva. Human infections are rare but can cause severe and sometimes fatal disease.

Two main clinical syndromes are associated with hantavirus infection:

• Hantavirus cardiopulmonary syndrome (HCPS) occurs mainly in the Americas; it can rapidly progress from fever and flu-like symptoms to respiratory failure, pulmonary oedema, shock, and death. Case fatality is high, typically ranging from 20–40% and may reach up to 50%, particularly among older adults and people with comorbidities.
  
• Hemorrhagic fever with renal syndrome (HFRS) occurs mainly in Europe and Asia. It primarily affects the kidneys and blood vessels, potentially causing hypotension, bleeding disorders, and renal failure. Case fatality is generally lower, ranging from less than 1% to 15%, depending on the virus and setting.
  

Transmission: Most hantaviruses are associated with specific rodent reservoir species that carry the virus without apparent illness. Human-to-human transmission is not typically and has only been documented with Andes virus in South America, primarily among close and prolonged contacts. Exposure risk increases during activities that disturb rodent-contaminated environments, such as cleaning enclosed spaces, farming, forestry work, or sleeping in rodent-infested dwellings.

Symptoms usually begin 1–8 weeks after exposure and include fever, headache, myalgia, abdominal pain, nausea, and vomiting.

Diagnosis can be difficult in the early stages because symptoms overlap with influenza, COVID-19, leptospirosis, dengue, viral pneumonia, and sepsis Confirmation relies on serology, especially IgM or rising IgG titres, and RT-PCR during acute illness.

Treatment: There is no licensed specific antiviral treatment or vaccine. Management is supportive, with close monitoring and treatment of respiratory, cardiac, and renal complications. Early recognition and access to intensive care when needed are essential to improve survival.

The risk to the general population is considered very low, while the risk for cruise ship passengers is assessed as moderate. Of note: Even if transmission from evacuated passengers occurs, widespread community spread is unlikely, as Andes virus (ANDV) does not transmit easily and infection prevention measures are in place.

Travel in areas where hanta virus is: Very low risk for travellers.

• Avoid contact with rodents and their feces (wear a mask and gloves when handling a dead/sick animal or cleaning contaminated surfaces). When camping/ecotourism, close tents and cabins to prevent rodents from entering and protect your food from contamination in airtight boxes.

Risk very low for general populations but moderate for at risk groups.

• Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
  
• Wash your hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
  
• Avoid touching potentially contaminated personal items such as cups, bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
  
• Avoid sex with sick persons; use of condoms for up to 12 weeks if your sexual partner has had mpox.
  
• Follow advice of local authorities.
• If you belongs to a group at risk, vaccination might be indicated see Mpox factsheet.

Contamination of pasteurised soft cheese is a rare event.

Prevention: respect usual rules of hygiene (e.g., good kitchen hygiene, hand hygiene, storage temperature of perishable food items).

People who are pregnant, 65 or older, or with serious pre-existing health conditions and/or a compromised immune system are at higher risk of complication of listeriosis. Given the long incubation time of listeriosis (usually until 28 days, but could last up to eight weeks), vulnerable people who are possibly affected should pay attention to signs like fever or severe headache and seek for medical advice without delay.

The chain of transmission is ongoing, and new cases are likely to occur.

Vaccination against hepatitis A is recommended for people visiting friends and relatives in remote rural areas and/or where hygiene conditions are poor as well as for risk persons, see SOP hepatitis A at www.healthytravel.ch PRO version.  

Confirmation of an EBLV-1 infection in a domestic cat highlights that vigilance for rabies is necessary, also in countries free from classical rabies but where EBLV is endemic in the bat population.

To avoid further transmission of the virus to other (domestic) animals or humans, recognition of the clinical disease (particuarly in predators such as cats), rapid laboratory diagnosis and timely implementation of control measures are of paramount importance.

Lassen Sie Ihren Impfstatus überprüfen!

Alle nach 1963 geborenen Personen, die keinen nachgewiesenen Schutz gegen Masern haben (Antikörper oder 2 nachgewiesene Impfungen), sollten zweimal mit dem MMR-Impfstoff geimpft werden. Im Falle einer Epidemie in der Region oder bei Kontakt mit einem Masernfall wird die Impfung ab einem Alter von 6 Monaten empfohlen.

The following precautions are recommended: 

• Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
  
• Do not touch sick or dead birds, as they may also be infected.
• If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning. 

• Hepatitis B is a liver infection caused by a virus.
• The virus is transmitted through sexual contact, but can also be transmitted through blood (products), e.g. when sharing syringes, tattoo needles, etc.
• There is a safe and very effective vaccine that offers long-lasting protection.
• The hepatitis B vaccination is recommended for all infants and adolescents up to the age of 16 and for risk groups regardless of age. 

• Federal Office of Public Health (FOPH). Hepatitis B:
  https://www.bag.admin.ch/bag/en/home/krankheiten/krankheiten-im-ueberblick/hepatitis-b.html
  
• Hepatitis Switzerland: https://en.hepatitis-schweiz.ch/all-about-hepatitis/hepatitis-b/

• Only a few tick species bite and spread pathogens that cause disease in humans.
  
• The diseases transmitted in an area depend on the local tick species.
  
• Ticks live in grassy, brushy, or wooded areas and on animals.
  
• Outdoor activities like walking your dog, camping, gardening, or hunting increase risk off exposure—even in your own yard.
  
• Get vaccinated against tick-borne encephalitis (TBE) if in an affected area.

Depending on the geographical region and the species, ticks may carry and transmit different pathogens. Diseases include the human ehrlichiosis, Lyme disease, tularemia, babesiosis, tick-borne relapsing fever, Rocky Mountain spotted fever, other rickettsioses, some arboviral diseases, and several flaviviruses causing encephalitis such as tick-borne encephalitis (TBE). Some ticks may also cause tick paralysis.

In Europe, commonly transmitted disease by ticks include Lyme disease (borreliosis), tick-borne encephalitis and tularemia.
In the US (and less so in South America) important tick-borne diseases represent babesiosis, anaplasmosis and ehrlichiosis, Powassan disease and severe fever with thrombocytopenia syndrome (STFS).

Other important pathogens transmitted by ticks are bacterial organisms causing rickettsial diseases, which are found throughout the world. Among returned travelers, rickettsial diseases have been estimated to be the fourth most common cause of fever, with symptoms such as rash, abdominal pain, and a dry, black/dark scab at the site of the infecting bite.

Tick-borne diseases may occur worldwide, but distribution is based on geographical location (see map).

Areas with increased risk of TBE include central and eastern Europe and the Baltic and Nordic countries. TBE is also prevalent in Russia all the way from the western border with Europe to its eastern border.

Lyme borreliosis is the most prevalent tick-transmitted infection in temperate areas of Europe, North America and Asia, and its geographic distribution is ever-increasing. Central Europe is the region with the highest tick infection rates (young ticks/nymphs >10%; adult ticks >20%) in Europe, specifically in Austria, Czech Republic, southern Germany, Switzerland, Slovakia and Slovenia.

Babesiosis is found in certain regions of North America and forested areas in Europe and East Asia. Anaplasmosis is common in North America, Europe, and China.

Ehrlichiosis is common in the US, certain areas of Europe, South America, and Africa.

Powassan disease is found in the northeastern US and far eastern Russia, whereas Severe Fever with Thrombocytopenia Syndrome (SFTS) occurs in the US and Asia-Pacific region.

Rickettsial infections are present worldwide. African Tickbite Fever (ATBF) is the most commonly reported rickettsial infection acquired during travel and occurs in southern Africa (especially Botswana, South Africa, and Zimbabwe).Mediterranean Spotted Fever (MSF), reported among returning US and UK travelers, occurs over much of Africa, Europe, India, and the Middle East; whereas Rocky Mountain Spotted Fever (RMSF) is commonly found throughout Canada, parts of Central and South America, and the US.

Crimean-Congo hemorrhagic Fever (CCHF) is a rare but serious viral disease transmitted by tick bites or contact with infected animal blood. It is the most widespread viral hemorrhagic fever, found in Eastern and Southern Europe, the Mediterranean, northwestern China, central Asia, Africa, the Middle East, and the Indian subcontinent. Healthcare workers and those handling livestock face higher risk.

The key to prevent tick-borne diseases is to protect yourself from tick bites (see also fact-sheet "Mosquito and tick bite prevention"):

• Use insect repellent
  
• Wear long-sleeved shirts, pants and socks
  
• Treat clothing and gear with 0.5% permethrin
  
• Perform thorough tick checks after spending time outdoors. Important: with some pathogens, attachment time of the tick is key for successful disease transmission, and quick riddance may therefore prevent infection.
  

The best prevention against tick-borne encephalitis (TBE) is to get vaccinated; this is recommended if living or travelling in an endemic area. The vaccine protects against all virus subtypes.

• In risk areas, make sure you have good tick protection: Wear skin-covering clothing and closed shoes and use repellents.
  
• After spending time in risk areas: check your body for ticks remove them immediately, and disinfect the bite.
  
• Monitor the bite site and see a doctor if symptoms appear. For post-travel symptoms, consult a tropical medicine specialist.
• Vaccination against TBE is recommended for all residents of an endemic areas and for travelers visiting such areas, especially those engaging in outdoor activities.

• Bundesamt für Gesundheit
  
• CDC
  
• ECDC
  
• TripPrep Tick-Borne Diseases
  
• TripPrep Arthropod Infestation and Envenomation in Travelers
  
• Global Health Press

• Mpox is a viral disease that typically causes a rash, swollen lymph nodes and fever.
• An emerging variant is spreading rapidly in eastern D.R. Congo and neighboring countries prompting a new WHO declaration of a public health emergency of international concern (PHEIC), as of August 14th 2024.
• Close physical contact (sexual or non-sexual) is the main mode of transmission.
• The disease generally follows a mild course. Children, pregnant women, and people with weak immune systems are the most at risk of complications.
• Vaccination against mpox is available, but limited to groups at high risk of exposure. 

Mpox has been commonly found in West and Central Africa for many years where the suspected reservoir - small mammals - is endemic. There are two types of Monkeypox virus called ‘clades’ that cause the disease mpox - clade I in Central Africa and clade II in West Africa. Since the end of smallpox vaccination campaigns in the early 1980’s, cases of mpox have increased, slowly at first and significantly in the last 5-10 years, especially in the Democratic Republic of Congo (DRC).

In 2022, a new emerging subclade of clade II was responsible for a global epidemic that spread mainly through sexual contact among men who have sex with men. It resulted in the first public health emergency of international concern (PHEIC) declared by the WHO until 2023. Although the clade II epidemic is now under control, this virus variant continues to circulate worldwide.

In 2024, the continued spread of mpox clade I in endemic regions of Central Africa, particularly in the DRC, and the emergence of a new subclade Ib in Eastern DRC and neighboring countries have raised global concern and prompted the WHO to declare a PHEIC for the second time in two years. The current geographical spread of the mpox clade Ib variant occurs via commercial routes through sexual contact (e.g. sex workers), followed by local transmission in households and other settings (which is becoming increasingly important).

Animal to human transmission
Mpox can spread from animal to human when they come into direct contact with an infected animal (rodents or primates).

Human to human transmission
Mpox can be spread from person to person through close physical contact (sexual and non-sexual contact) with someone who has symptoms of mpox. Skin and mucous membrane lesions, body fluids, and scabs are particularly infectious. A person can also become infected by touching or handling clothing, bedding, towels, or objects such as eating utensils/dishes that have been contaminated by contact with a person with symptoms. Household members, family caretakers, and sexual partners of a confirmed case of mpox are at higher risk for infection as are health care workers who treat a case without adequate personal protection.

The incubation period (time between infection and onset of symptoms) ranges from a few days up to 3 weeks. Mpox causes a rash / skin eruption that can be painful associated with swollen lymph nodes and fever. Fever may start already before the rash phase. Other symptoms include muscle aches, back pain, and fatigue. The rash may be localized or generalized, with few or hundreds of skin lesions. It mainly affects the face, the trunk and the palms of hand and soles of the feet. It can also be present in genital areas and on mucous membranes such as in the mouth and throat. Symptoms usually last 2 to 4 weeks and the person remains contagious until all lesions have healed (once the cabs have fallen off).

Complications include secondary bacterial infections, infections of the lung and brain and involvement of other organs, still birth and others. Children, pregnant women, and people with weak immune systems are at higher risk to develop a severe form of mpox.

The majority of person with mpox recovers spontaneously and do not need specific antiviral treatment. Care management consists of relieving pain and other symptoms and preventing complications (e.g., superinfection). Several antiviral treatments are studied in various countries and may be used in trials or in clinical situations according to the recommendations of national medical societies.

In case of symptoms: 

• Seek medical attention immediately
• If you are diagnosed with mpox
  • Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
  • Wash your hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
  • You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
  • For more information on what do if you are sick, see CDC LINK.

General precautions:

• Worldwide:
  • avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
  • Wash your hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
  • Avoid touching potentially contaminated personal items such as cups, bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
  • Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
  • Follow advice of local authorities.

• When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions: 
  • Avoid contact with and animals in areas where mpox regularly occurs.
  • Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.

Vaccination:

There are several vaccines against mpox (e.g. Jynneos®, manufacture Bavarian Nordic). The Bavarian Nordic vaccine was originally developed to fight against smallpox, but offers a cross-protection against mpox. In Switzerland, the Jynneos® vaccine has been licensed by Swissmedic since 2024. Groups at risk (e.g., men who have sex with men or transgender people with multiple sex partners) are eligible for vaccination since 2022 and this recommendation remains unchanged (see FOPH recommendations). In light of the epidemiological situation in Africa in 2024, the Swiss Expert Committee for Travel Medicine recommends vaccination against mpox for professionals who are / will be in contact with suspect mpox patients or animals in endemic/epidemic regions or who work in a laboratory with the virus (for updates, see news).

The risk to the general population and travelers (tourists) is considered extremely low if the above-mentioned general precautions are followed and vaccination is not recommended.

• Seek medical attention immediately.
• Mpox is not a sexual transmitted disease in the strict sense, physical contact with a person with symptoms of mpox (rash at any stage) is sufficient to transmit the disease. Condoms do not protect you from getting mpox!

• Swiss Federal Office of Public Health (FOPH)                                                            
• World Health Organisation: WHO FAQ
• European Center of Disease Control and Prevention (ECDC)
• US Center of Disease Control and Prevention (CDC)

• STIs are a common health problem worldwide and can be managed through safer sex, regular testing and treatment.
• If you have had a risk situation, it is important to consult a health care professional as soon as possible to discuss whether HIV post-exposure prophylaxis (PEP) should be given to prevent contracting HIV.
• After a high-risk situation, you are advised to get tested for STIs even if you have no symptoms.

Enjoying your sexuality freely and responsibly is part of a healthy life. Knowing how to take care of yourself and others is especially important when you are in new situations – like during travel.

Travelers who engage in casual sex tend to be at higher risk of contracting sexually transmitted infections (STIs), including HIV. Being abroad, while also meeting new people, can involve behaving differently and taking more risks than you would at home. It is important to know that certain practices – such as unprotected sex and/or having multiple new sexual partners – can significantly increase the risk for STIs. Some STIs can cause serious complications in some circumstances and can also be transmitted to additional partners if not diagnosed and treated in time. If you are not sure whether you are at risk, Love Life's 'Risk Check' can help.

• Burning or itching in the genital area
  
• Painful or frequent urination or pain in the lower abdomen
  
• Pain or soreness with bowel movements.
  
• Unusual discharge from the penis, anus or vagina
  
• Sores, redness, blisters or warts in the mouth/lips or genital area In some cases fever

Important: STIs can also occur without any or only mild symptoms. Even if you are not aware of it, you can infect others. Even if you have no symptoms, you should consult your doctor if you have had unprotected sex with a new partner or multiple partners. This is because early detection and treatment are important to prevent transmission and complications from untreated STIs.

STIs can be diagnosed during a physical exam or by examining urine, a sore, a blister, or a swab from the vagina, penis, throat or anus. Blood tests can help with certain diagnosis (hepatitis A, B and C, HIV and syphilis).

The timing of testing is important, as some infections may not be detectable immediately after exposure (diagnostic window). To rule out an infection, HIV and syphilis should usually be tested at least 6 weeks after the sexual contact. In the case of chlamydia and gonorrhea, testing should be done at least 2 weeks after the contact. This applies only if there are no symptoms.

Take also into consideration that access to reliable testing and treatment may be limited in some destinations.

Before you travel:

• Consider STI screening if you have had recent risk exposure
  
• Ensure vaccinations are up to date (hepatitis B, HPV and depending on sexual practices hepatitis A and mpox)
  
• Discuss HIV-PrEP with a healthcare provider if appropriate
  

During travel:

• Follow Love Life's safer sex rules.
  
• Carry condoms from reliable sources, as quality or availability may vary in some destinations.
  
• Remember that oral sex can also lead to transmission of STIs.
  
• If you have had a high-risk situation, it is important to consult a health care professional as soon as possible to discuss whether HIV post-exposure prophylaxis (PEP) should be given to prevent HIV infection. HIV PEP is most effective when given early i.e. within first hours after exposure (max 48 hours after contact).
  
• Remember that alcohol or drugs may lead to increased risk behavior.
  
• Remember that you can infect another person/known partner during sex if you have an untreated STI.
  
• People with a newly diagnosed STI are encouraged to inform their former sexual partners so that they can also be treated.
  
• Even without symptoms, screening is recommended after risk exposure.

• If you are experiencing symptoms (see above)
  
• If you have multiple sexual partners, it’s recommended to do an STI-Check at least once a year.
  
• If you belong to a demographic group with a higher STI-risk. For example, MSM or sex workers and their clients
  
• If a sexual partner has been recently diagnosed with an STI
  
• Returning from travel if you had a high-risk contact
  
• At the beginning of a new monogamous relationship

• Love Life: www.lovelife.ch
  
• Sexual Health Switzerland: www.sexuelle-gesundheit.ch
  
• Hepatitis Switzerland: https://en.hepatitis-schweiz.ch/all-about-hepatitis/what-is-hepatitis
  
• World Health Organization (WHO). Factsheets. Sexually transmitted infections (STIs). 20.12.2025: www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)