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The number of people affected by leptospirosis and related deaths in Kerala is increasing. In the first 4 days of October 2024 alone, 45 people were diagnosed with the disease.
According to the Health Department, from 1 Jan to 4 Oct 2024, a total of 2’512 people have been diagnosed with leptospirosis, including 155 confirmed deaths. Additionally, 1’979 people sought treatment for symptoms related to the illness. Similarly, 131 deaths suspected to be caused by leptospirosis symptoms were also reported.
Health officials warn that the disease is now spreading during all seasons.
Leptospirosis: Leptospires are transmitted via the urine of rodents (especially rats), e.g. in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs through direct or indirect contact with rodent urine via small skin lesions or mucosal surfaces. The clinical picture ranges from flu-like general symptoms to aseptic meningitis and sepsis. Vaccination is not available.
Prevention: Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination is not available for travelers.
The number for Zika cases in Pune have increased to more than 100 cases, including 5 deaths. All deaths were in elderly people with co-morbidities.
End of August 2024, the US CDC issued an alert on a Zika outbreaks in the state of Maharashtra.
There is currently an increased risk of transmission of the Zika virus in the state of Maharashtra, India. Please note that the Zika virus can also be transmitted sexually!
Prevention: Optimal mosquito protection 24/7: during the day against Zika, dengue and other arboviruses, at dusk and at night against malaria.
When travelling to areas with a Zika outbreak, as is now the case in the state of Maharashtra, India, the Swiss Expert Committee for Travel Medicine recommends using a condom/femidom during the trip and for at least 2 months after returning home to prevent possible sexual transmission of the virus.
Due to the risk of malformations in the unborn child, pregnant women are currently advised not to travel to the state of Maharashtra in India. If travelling is absolutely necessary, it is recommended that you speak to a specialist in travel medicine before departure.
Women planning to become pregnant should wait at least 2 months after their return (or that of their partner) from India before starting family planning. In the case of medically assisted reproduction, this period should be extended to at least 3 months. Please also read the Zika information sheet, especially if you are pregnant or if you or your partner are planning a pregnancy.
The number of cases in 2024 period already cross those of the entire 2023 (n= 19’300).
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
Between early June and 15 August 2024, the Ministry of Health and Family Welfare of the Government of India reported 245 cases of acute encephalitis syndrome (AES) including 82 deaths (CFR 33%). Of these, 64 are confirmed cases of Chandipura virus (CHPV) infection. CHPV is endemic in India, with previous outbreaks occurring regularly, especially during the monsoon season. However, the current outbreak is the largest in the past 20 years.
The Chandipura virus (Vesiculovirus chandipura, CHPV) is a zoonotic arbovirus in the family Rhabdoviridae. The virus is endemic in several regions of India and has been detected in other countries in the South Asian subcontinent. Sporadic cases and limited outbreaks have been reported in India since 1965. The virus has also been detected in animals in some African countries (e.g. Nigeria, Senegal, Tanzania) without reported human cases.
The principal vector of CHPV in India is the sand fly Phlebotomus papatasi, which is also present in several regions of Europe. Other sand fly, mosquito and tick species are also potential vectors of the virus. A broad range of animals are suspected as vertebrate hosts of CHPV; however, little information is available on the natural ecological cycle of the virus.
The incubation period is typically short, ranging from 3 to 6 days.
CHPV infection may manifest in rapid course as a general febrile disease with meningitis and/or encephalitis (Acute Encephalitis Syndrome). Predominantly children below the age of 15 years are affected. The case fatality rate can reach 55–75%. Serological data indicate asymptomatic human infections.
There is no specific treatment or vaccine available.
WHO assessed the risk as moderate at the national level. The risk assessment will be reviewed as the situation of the outbreak evolves.
Prevention: Optimal insect bite protection 7/24 is of great importance. In case of symptoms: see medical advice immediately.
Two suspected Nipah cases have been reported from the state of Kerala. The case are hospitalized and isolated. Investigations are ongoing.
The Nipah virus (NiV) is a viral disease that can cause a severe clinical picture. It was first detected in 1999 during an outbreak in Malaysia and Singapore. Since then, several outbreaks have been reported in South and Southeast Asia.
NiV is most commonly transmitted via fruit bats through direct or indirect contact with their faeces. Tree fruit or sap made from it that is contaminated with bat faeces is often considered a source of infection. Human-to-human transmission has been reported when caring for infected patients. In addition, pigs can also be infected. The disease spectrum ranges from (mostly) asymptomatic courses to flu-like symptoms with high fever, headache and muscle pain to encephalitis with severe neurological or other complications. Mortality is high (40-70%).
According to Médecins Sans Frontières (MSF), 3,965 patients were treated for measles in Borno State in Nigeria from October to December 2023. The increase in the number of cases could be due to the fact that public health actors were unable to achieve the 95% vaccination rate due to the uncertain situation in the region. In addition, the interruption of routine childhood vaccinations during the COVID-19 pandemic contributed to the increase in cases.
On February 12, 2024, the Centres for Disease Control and Prevention (CDC) published the top 10 countries with measles outbreaks (data refer to the period July - December 2023):
- Yemen 18,464
- Azerbaijan 13,721
- Kazakhstan 13,195
- India 12,301
- Ethiopia 10,060
- Russian Federation 7,720
- Iraq 7,601
- Pakistan 7,027
- Kyrgyzstan 5,777
- Indonesia 3,205
Measles outbreaks are reported when the number of reported cases in an area is higher than the expected number of cases.
An 8-year-old girl died of rabies in Agra, Uttar Pradesh, on October 25, 2023, after being bitten by a stray dog two weeks earlier. The child did not inform anyone in her family except her mother about the incident, and she was only given some home remedies instead of the necessary rabies vaccine. The family only contacted the Community Health Center when the girl developed symptoms after 15 days.
According to officials, as many as 5000 cases of dog bites are reported every month in both rural and urban Agra.
Prevention: Avoid contact with animals! Do not feed animals either! Vaccination before exposure (2 injections and a booster after 1 year) is particularly recommended for travelers with increased individual risk (travel on two-wheelers, to remote areas, long-term stays, small children, spelunkers, contact with bats, etc.).
What to do after exposure: After an animal bite/scratch: Immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a good medical facility for vaccination/revaccination as soon as possible!
In the Indian state of Assam (north-eastern part of the country), 432 cases of Japanese encephalitis (JE) were reported by the end of August, 24 of which were fatal. Cases have increased almost tenfold since the beginning of August 2023.
Ranchi district in Jharkhand state in northern India has also reported an increase in JE cases, although the numbers are still modest, with 12 cases in recent weeks.
The risk for travellers is low. Optimal protection against mosquito bites, especially at dusk and at night.
The indication for vaccination against Japanese encephalitis should be discussed individually and is recommended for:
- Long-term (>1 month) stay in endemic rural areas during the transmission period.
- Short-term travel (<1 month) to endemic areas during the transmission period, outside urban areas and when activities are planned that increase the risk of JE virus exposure.
- Travel to an area with an ongoing outbreak.
Restrictions such as lockdowns were announced to prevent the spread of the virus. Some schools, colleges and offices have been closed and 7 villages have been declared a containment zone. Wearing masks and using disinfectants were made mandatory in the containment zone. The source of the infection is still under investigation. The last documented case of NiV infection in India occurred in 2021, also in Kozhikade district.
Nipah virus (NiV) is a highly pathogenic virus belonging to the family Paramyxoviridae, genus Henipavirus. It was first isolated and identified in 1999 during an outbreak in Malaysia and Singapore. Since then, several outbreaks have been reported in South and Southeast Asia.
NiV is most commonly transmitted via fruit bats, a species of bat that is the natural reservoir, through direct or indirect contact with their excreta. Tree fruits or sap produced from them contaminated with bat droppings are often considered a source of infection. Human-to-human transmission has been reported during the care of infected patients. In addition, pigs may also be infected. The spectrum of disease ranges from (usually) asymptomatic courses to flu-like symptoms with high fever, headache, and muscle pain to encephalitis with severe neurologic or even pulmonary complications. Mortality is high (40-70%).
Mumbai: The local health department had already registered 397 malaria cases by mid-July. Within a week, malaria cases increased by 63%. The number of dengue cases is also on the rise.
In India, two women from Vemulamada village in the southern state of Andhra Pradesh died of rabies on the same day, two months after being bitten by a cat. According to the villagers, the cat had contracted rabies because it had previously been bitten by a rabid dog. The cat also died later on. According to the report, the women received tetanus toxoid injections and medication for the cat bite, but no mention was made of post-exposure prophylaxis (PEP) against rabies.
Consequences for travelers
Avoid contact with animals (never feed them!). After an animal bite/scratch, wash the wound with running water and soap for 15 minutes, disinfect and in any case visit a high-quality medical centre (post-exposure vaccination). For long-term travellers and travellers with increased individual risk (travelling with two-wheelers, to remote areas, long-term stays, small children, etc.), a pre-exposure vaccination is recommended before the stay.
References
Das «Center for Disease Control and Prevention» (CDC) hat ganz Indien als Land mit einer aktuellen Zika-Epidemie eingestuft, wobei der Ausbruch hauptsächlich in Uttar Pradesh stattfindet. Seit Oktober 2021 wurden 109 bestätigte Fälle gemeldet. Wie in früheren Nachrichten berichtet, wurden auch in anderen Teilen Indiens (Kerala, Maharasthra) Zika-Fälle registriert.
Das Zika-Virus wird v.a. von Mücken übertragen, die tagsüber stechen und in vielen tropischen Regionen vorkommen. Etwa 80% der Infektionen verlaufen asymptomatisch. Die klinischen Symptome sind in der Regel nicht schwerwiegend und dauern zwischen 5 und 7 Tagen: Fieber, roter Hautausschlag (Rash) mit Juckreiz, Gelenkschmerzen, Bindehautentzündung (rote Augen), manchmal Kopf- und Muskelschmerzen. Es kann zu neurologischen (Guillain-Barré-Syndrom) und immunologischen Komplikationen kommen. Es gibt keinen Impfstoff und keine spezifische Therapie gegen das Zika-Virus. Eine besondere Situation besteht für schwangere Frauen, da ein Risiko schwerer Missbildungen beim ungeborenen Kind besteht.
Folgen für Reisende
Aktuell besteht ein erhöhtes Übertragungsrisiko für das Zika-Virus in Indien. Beachten Sie, dass das Zika-Virus auch sexuell übertragen werden kann! Prävention: Optimaler Mückenschutz 24/7: Tagsüber gegen Zika, Dengue und andere Arbovirosen, in der Dämmerung und nachts gegen Malaria.
Bei Reisen in Gebieten mit einem Zika Ausbruch, wie dies in Indien nun der Fall ist, empfiehlt das Schweizerische Expertenkomitee für Reisemedizin während der Reise und mindestens 2 Monate nach der Rückkehr ein Kondom/Femidom zu verwenden, um eine mögliche sexuelle Übertragung des Virus zu verhindern.
Wegen des Risikos für Fehlbildungen beim ungeborenen Kind wird schwangeren Frauen derzeit davon abgeraten, nach Indien zu reisen. Bei unbedingt notwendigen Reisen wird empfohlen, vor der Abreise mit einem Facharzt für Reisemedizin zu sprechen.
Frauen, die planen, schwanger zu werden, sollten nach ihrer Rückkehr (oder der des Partners) aus Indien mindestens 2 Monate mit der Familienplanung abwarten. Im Falle einer medizinisch unterstützten Fortpflanzung sollte dieser Zeitraum auf mindestens 3 Monate verlängert werden. Lesen Sie auch das Informationsblatt Zika, insbesondere wenn Sie schwanger sind oder Sie oder Ihre Partnerin eine Schwangerschaft planen.
Referenzen
CDC Travel News, 9.12.2021, ECDC 13.11.2021, EKRM statement 2019
India, Delhi: Health authorities in Delhi have reported 531 additional dengue fever cases in one week, bringing the total number of cases in the city to over 1,500. This is the highest number of reported cases since 2018, with over 46,000 cases recorded in India, which now ranks second in the world after Brazil (60,000 cases). According to media reports, this sharp increase in dengue fever cases has led to a shortage of hospital beds in both government and private hospitals.
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, 1.11.2021, Outbreak News Today, 23.10.2021
In the district of Ghaziabad in the state of Uttar Pradesh, 13 diphtheria cases were registered until October 2021, compared to 14 cases in the entire 2020.
Consequences for travelers
A booster vaccination is necessary in addition to a basic immunization against diphtheria (together with tetanus, etc.). The optimal time for the booster vaccination for stays in areas with a diphtheria epidemic is unclear. Travelers to countries with diphtheria outbreaks should receive a booster vaccination if the previous booster vaccination is more than 10 years old, as the diphtheria protection is shorter-lasting than the tetanus protection. For high-risk individuals, such as those on humanitarian missions, a shorter interval (e.g., 5 years) should be considered. Please talk to your doctor if you belong to this group.
References
Outbreak News Today, 27.10.2021, Outbreak News Today, 23.10.2021
In Ernakulam district, Kerala state, the number of confirmed leptospirosis cases have continued to increase in October 2021 (now 29 confirmed cases and 48 suspected cases) compared to September 2021 (18 confirmed 51 suspected cases). Since the beginning of 2021, 304 suspected cases have been reported in Ernakulam (confirmed: 133 cases).
Monsoon-related flooding occurs regularly between June and September, with October and November constituting the post-monsoon season. As a result, outbreaks of leptospirosis are common during this period.
Consequences for travelers
Wear protective clothing/boots when wading through water! Leptospira are transmitted through the urine of rodents (mainly rats), which can contaminate small bodies of water (creeks, puddles, etc.) and mud. Transmission to humans occurs through small skin lesions or mucosal contacts through direct or indirect contact with the rodent urine. Symptoms range from flu-like symptoms, aseptic meningitis to sepsis. Vaccination is not generally available.
References
General Information
- Although the public health emergency of international concern for COVID-19 was declared over on 5 May 2023, COVID-19 remains a health threat
- Adhere 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)
Vaccinations for all travellers
- 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.
- Hepatitis A is a liver infection caused by a virus.
- 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.
Hepatitis A occurs all over the world, but the risk of infection is higher in countries with poor hygiene standards. There is an increased risk in most tropical and subtropical countries, as well as in some countries in Eastern Europe and around the Mediterranean.
In recent years, there have also been increasing cases in North America and Europe, including Switzerland, especially among men who have sex with men (MSM). Outbreaks in northern European countries can also occur when unvaccinated children become infected during family visits to tropical and subtropical countries. Upon return, they may transmit the virus within their care facilities.
There is a safe and very effective vaccine that consists of two injections at least 6 months apart. It provides lifelong protection after the second dose. Hepatitis A vaccination can also be given in combination with hepatitis B vaccination (3 doses required).
Vaccination against hepatitis A is recommended for all travellers to risk areas, as well as for persons at increased personal risk: persons with chronic liver disease, men who have sex with men, people who use or inject drug, persons with increased occupational contact with persons from high-risk areas or populations, and others.
- Federal Office of Public Health (FOPH). Hepatitis A. https://www.bag.admin.ch/bag/en/home/krankheiten/krankheiten-im-ueberblick/hepatitis-a.html
- Swiss Hepatitis: https://en.hepatitis-schweiz.ch/all-about-hepatitis/hepatitis-a
- 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.
- 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.
“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.
- 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).
EKRM_Factsheet_Layperson_EN_Polio.pdf
- 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).
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.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
Travellers should be immune to chickenpox. Persons between 13 months and 39 years of age who have not had chickenpox and who have not received 2 doses of chickenpox vaccine should receive a booster vaccination (2 doses with minimum interval of 4 weeks), see Swiss vaccination schedule, LINK.
Vaccinations for some travellers
- For medical reasons: vaccination is not recommended.
For administrative reasons, there is the following entry regulation of the country:
- Passengers arriving within 6 days after leaving or transiting countries with risk of yellow fever transmission and not holding a yellow fever vaccination certificate are subject to quarantine for 6 days. Quarantine facilities are only available at Delhi (DEL), Chennai (MAA) and Mumbai (BOM). At other airports passengers will be deported.
- Certificate issued by India is only accepted if it is a single page with Hindi, English and French language.
Exempt from this entry requirement:
- Children under 6 months of age.
- Passengers transiting India by the same aircraft.
- Passengers transiting countries with risk of yellow fever transmission if not leaving the transit areas.
- 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
- For medical reasons: vaccination is not recommended.
For administrative reasons, there is the following entry regulation of the country:
- Passengers arriving within 6 days after leaving or transiting countries with risk of yellow fever transmission and not holding a yellow fever vaccination certificate are subject to quarantine for 6 days. Quarantine facilities are only available at Delhi (DEL), Chennai (MAA) and Mumbai (BOM). At other airports passengers will be deported.
- Certificate issued by India is only accepted if it is a single page with Hindi, English and French language.
Exempt from this entry requirement:
- Children under 6 months of age.
- Passengers transiting India by the same aircraft.
- Passengers transiting countries with risk of yellow fever transmission if not leaving the transit areas.
CDC Map: Yellow fever vaccine recommendations for the Americas
Footnotes
- Current as of November 2022. This map is an updated version of the 2010 map created by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.
- In 2017, the Centers for Disease Control and Prevention (CDC) expanded its yellow fever vaccine recommendations for travelers going to Brazil because of a large outbreak in multiple states in that country. For more information and updated recommendations, refer to the CDC Travelers’ Health website.
- Yellow fever (YF) vaccination is generally not recommended for travel to areas where the potential for YF virus exposure is low. Vaccination might be considered, however, for a small subset of travelers going to these areas who are at increased risk for exposure to YF virus due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Factors to consider when deciding whether to vaccinate a traveler include destination-specific and travel-associated risks for YF virus infection; individual, underlying risk factors for having a serious YF vaccine-associated adverse event; and country entry requirements.
- 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.
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.
Yellow Fever Info - Centers for Disease Control and Prevention: https://www.cdc.gov/yellowfever/index.html
Yellow Fever Info - European Centre for Disease Prevention and Control: https://www.ecdc.europa.eu/en/yellow-fever/facts
- Hepatitis B is a viral liver infection that is transmitted via contaminated blood or via sexual contact.
- A safe and very effective vaccine is available that affords life-long protection.
- Hepatitis B vaccination is recommended for all young people and at-risk travellers, especially if:
- You travel regularly or spend long periods of time abroad.
- You are at risk of practicing unsafe sex.
- You might undergo medical or dental treatment abroad, or undertake activities that may put you at risk of acquiring hepatitis B (tattoos, piercing, acupuncture in unsafe conditions).
- Rabies is mainly transmitted by dogs (and bats), but any mammal can be infectious.
- It is invariably fatal at the time when symptoms occur.
- Rabies is best prevented by a pre-travel vaccination and appropriate behavior towards mammals.
- Pre-travel vaccination is also recommended because vaccines and immunoglobulins are often not available in many travel countries. Vaccination before travel is highly recommended in particular 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!),
- for details, see SOP vaccination rabies (only available in HealthyTravel PRO).
- Attention: a bite or scratch wound as well as contact with mammal saliva is an emergency! Find out about the necessary actions below!
- Rabies is mainly transmitted by dogs (and bats), but any mammal can be infectious.
- It is invariably fatal at the time when symptoms occur.
- Rabies is best prevented by a pre-travel vaccination and appropriate behavior towards mammals.
- Pre-travel vaccination is also recommended because vaccines and immunoglobulins are often not available in many travel countries. Vaccination before travel is highly recommended in particular 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!).
- long-term stay in endemic countries,
- Attention: a bite or scratch wound as well as contact with mammal saliva is an emergency! Find out about the necessary actions below!
No treatment against 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!
- FOPH Switzerland (German): https://www.bag.admin.ch/dam/bag/de/dokumente/mt/infektionskrankheiten/tollwut/bag-bulletin-15-2021-tollwut-prep-und-pep.pdf.download.pdf/210412_BAG_Bulletin_15_2021_Tollwut%20PrEP%20und%20PEP_d.pdf
- FOPH Switzerland (French): https://www.bundespublikationen.admin.ch/cshop_mimes_bbl/14/1402EC7524F81EDBA5D6C3EBC18BA9FB.pdf
- Japanese encephalitis is a viral infection that is endemic in South and Southeast Asia and in Australia.
- The virus causes an infection of the brain.
- The risk of Japanese encephalitis is very low for travellers.
- Follow diligent mosquito bite prevention measures in the evening and night.
- A safe and effective vaccine is available that is recommended for high-risk travellers such as
- Work / extensive outdoor activities in rural areas
- Long-term stays (>4 weeks) or during an ongoing outbreak
- For details, see SOP vaccination japanese encephalitis (only available in HealthyTravel PRO)
EKRM_Factsheet_Layperson_EN_Japanese-Encephalitis.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
EKRM_Factsheet_Layperson_IT_Japanese_Encephalitis.pdf
- Viral disease transmitted by night-biting mosquitoes in rural/suburban areas.
- Very rare in travelers.
- Mostly mild or without symptoms; severe illness is rare but has a high mortality.
- Vaccine available for those at increased risk, such as long-term travelers to endemic areas.
- WHO Factsheet Japanese Encephalitis: https://www.who.int/news-room/fact-sheets/detail/japanese-encephalitis
- Solomon et al., Japanese Encephalitis, BMJ 2000: https://jnnp.bmj.com/content/jnnp/68/4/405.full.pdf
- CDC Japanese Encephalitis: https://www.cdc.gov/japaneseencephalitis/index.html
- 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.
- 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.
Malaria
- Regions: <2000m elevation in some regions in the east and northeast (see map).
Prevention: Mosquito bite prevention and chemoprophylaxis.
Discuss with your travel health advisor which prophylactic medication is suitable for you. The travel health advisor will prescribe the appropriate medication and dosage.
- Regions: <2000m elevation in further regions in the east and northeast (see map), and Nicobar Islands.
Prevention: Mosquito bite prevention.
Discuss with a travel health advisor whether carrying a stand-by emergency self-treatment against malaria is necessary.
- Regions: <2000m elevation in the rest of the country, also in New- Delhi, Kolkata, Mumbai, Rajasthan and other cities, and the Andaman islands, (exceptions see above).
Prevention: Mosquito bite prevention.
- Regions: in regions >2000m elevation in the states Himachal Pradesh, Jammu, Kashmir and Sikkim.
- 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.
EKRM_Factsheet_Layperson_EN_Malaria.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
- Regions: <2000m elevation in some regions in the east and northeast (see map).
Prevention: Mosquito bite prevention and chemoprophylaxis.
Discuss with your travel health advisor which prophylactic medication is suitable for you. The travel health advisor will prescribe the appropriate medication and dosage.
- Regions: <2000m elevation in further regions in the east and northeast (see map), and Nicobar Islands.
Prevention: Mosquito bite prevention.
Discuss with a travel health advisor whether carrying a stand-by emergency self-treatment against malaria is necessary.
- Regions: <2000m elevation in the rest of the country, also in New- Delhi, Kolkata, Mumbai, Rajasthan and other cities, and the Andaman islands, (exceptions see above).
Prevention: Mosquito bite prevention.
- 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!
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.
Prevention of malaria requires a combination of approaches:
- 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.
- 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.
- 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.
Other health risks
- Dengue fever is a viral disease that is disease that bite during daytime.
- The best way to prevent these diseases is to protect yourself from mosquito bites, see LINK!
- A vaccination (Qdenga®) against dengue is available.
- However, based on the data available, the Swiss Expert Committee for Travel Medicine (ECTM) currently recommends vaccination with Qdenga® only for travellers who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission, for details see LINK.
- In case of fever: do not use any medication containing 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. Vaccination is recommended only for people with evidence of previous dengue infection.
- 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.
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:
- Clothing: Wear well-covered, long-sleeved clothing and long pants and treat clothing with insecticide beforehand (see factsheet “prevention of arthropod bites”).
- Mosquito repellent: Apply a mosquito repellent to uncovered skin several times a day (see factsheet “prevention of arthropod bites”).
- Environmental hygiene: Do not leave containers with standing water (coasters for flower pots, etc.) in your environment to avoid mosquito breeding sites.
For further information, please refer to the factsheet on "Mosquito and tick bite protection".
Note on the dengue vaccine Qdenga®:
- Based on the data available, many European countries, as well as the Swiss Expert Committee for Travel Medicine (ECTM), currently recommend vaccination with Qdenga® only for travelers who have evidence of a previous dengue infection and who will be exposed in a region with significant dengue transmission. This is a precautionary decision, since the current data also include the possibility that people who are vaccinated with Qdenga® before a first dengue infection may experience a more severe course of the disease. A consultation with a specialist in tropical and travel medicine is recommended.
Consistent mosquito protection during the day (see above) is still considered the most important preventive measure against dengue!
Of note
- Do not take any products containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) if you have symptoms, as they increase the risk of bleeding in the event of a dengue infection!
- However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
- Do not take any products containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) if you have symptoms, as they increase the risk of bleeding in the event of a dengue infection!
- However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
- 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 for 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.
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.
- 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
- 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.
EKRM_Factsheet_Layperson_EN_Zika.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
- 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.
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.
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
- 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.
- Geschlechtskrankheiten sind ein weltweit verbreitetes Gesundheitsproblem und können durch Prävention, regelmässiges Testen und Behandlung in den Griff bekommen werden.
- Das Wissen um Risiken sowie Safer-Sex-Praktiken inklusive Kondomgebrauch sind wichtig. Falls Sie mehr dazu erfahren wollen, wie Sie sich während der Reise optimal schützen können, besprechen Sie dies mit einer Fachperson.
- Hatten Sie eine Risikosituation, ist es wichtig mit einer Fachperson so rasch wie möglich Rücksprache zu halten, um zu erörtern, ob eine HIV-Post-Expositions-Prophylaxe (PEP) durchgeführt werden soll, um eine Ansteckung mit HIV zu verhindern.
- Im Nachgang einer Risikosituation ist es wichtig sich auf Geschlechtskrankheiten testen zu lassen. Auch dann, wenn Sie keine Symptome haben.
- Brennen oder Juckreiz im Genitalbereich
- Schmerzhaftes oder häufiges Wasserlösen oder auch Schmerzen im Unterleib
- Ungewöhnlicher Ausfluss aus dem Penis oder der Vagina
- Wunden, Rötungen, Bläschen im Mund/Lippen oder Genitalbereich sowie Warzen im Intimbereich
- Manchmal auch Fieber (eher selten)
Wichtig: Eine STI kann auch ohne oder mit nur leichten Symptomen auftreten. Auch wenn Sie sich dessen nicht bewusst sind, können Sie andere anstecken. Deshalb ist es wichtig sich testen zu lassen.
- Beachten Sie die Safer Sex Regeln von Love Live. Dazu gehört auch bei jedem Anal- oder Vaginalverkehr Kondome zu verwenden.
- Denken Sie daran, dass es bei Oralverkehr auch zu Übertragungen von STIs kommen kann.
- Lassen Sie sich impfen! Es gibt Impfstoffe zum Schutz vor HPV, Hepatitis A und Hepatitis B.
- Hatten Sie eine Risikosituation, ist es wichtig mit einer Fachperson so rasch wie möglich Rücksprache zu halten, um zu erörtern, ob eine HIV-Post-Expositions-Prophylaxe (PEP) durchgeführt werden soll, um eine HIV-Infektion zu verhindern. Am wirksamsten ist eine HIV-PEP innerhalb weniger Stunden danach.
- Es gibt auch weitere Präventionsmassnahmen für spezielle Situationen (Präexpositionsprophylaxe HIV-PrEP). Sprechen Sie mit einer damit erfahrenen Fachperson vor Abreise darüber.
- Denken Sie daran, dass Alkohol oder Drogen zu erhöhtem Risikoverhalten führen.
- Denken Sie daran, dass Sie eine weitere Person/bekannter Partner*in bei ungeschütztem Sex anstecken können, sofern bei Ihnen eine unbehandelte STI vorliegt.
- Menschen mit einer neu diagnostizierten STI sind angehalten ihre früheren Sexualpartner*innen zu informieren, damit auch sie behandelt werden können.
Durch Bakterien oder Parasiten hervorgerufen
Alle diese Krankheiten können geheilt werden. Wichtig ist dabei, frühzeitig zu testen und umgehend zu therapieren, um Komplikationen und v.a. weitere Übertragungen zu vermeiden.
- Syphilis
Auch bekannt als Lues. Sie wird durch das Bakterium Treponema pallidum verursacht. Das erste Anzeichen ist eine schmerzlose Wunde an den Genitalien, im Mund, auf der Haut oder im Rektum, die hochgradig ansteckend ist und nach 3 bis 6 Wochen spontan abklingt. Da diese schmerzlos ist, nehmen nicht alle Patienten*innen diese Läsion wahr. Oft heilt diese Infektion jedoch nicht von selbst aus. In der zweiten Phase können Hautausschlag, Halsschmerzen und Muskelschmerzen auftreten. Unbehandelt kann die Krankheit im Verborgenen (latent) bleiben, ohne dass Symptome auftreten. Etwa ein Drittel der Infizierten mit unbehandelter Syphilis entwickelt im Verlauf Komplikationen. Diese Spätform wird als sogenannt tertiäre Syphilis bezeichnet . In diesem Stadium kann die Krankheit alle Organe befallen: am häufigsten das Gehirn, die Nerven und die Augen. Die Infektion kann während der Schwangerschaft auf den Fötus und bei der Geburt auf das Kind übertragen werden. - Chlamydia trachomatis
Chlamydien können ungewöhnlichen Ausfluss aus dem Penis oder der Vagina, Unbehagen beim Wasserlösen und Unterleibsschmerzen verursachen. Oft treten keine Symptome auf. Unbehandelt können sie zu Unfruchtbarkeit führen und die Krankheit kann auf Sexualpartner*innen übertragen werden. Die Bakterien können auch während der Schwangerschaft auf den Fötus, oder während der Geburt auf das Kind übertragen werden und Augeninfektionen oder Lungenentzündungen verursachen. - Gonorrhoe
Auch bekannt als Tripper. Zu den häufigsten Symptomen gehören Ausfluss aus der Vagina oder dem Penis und schmerzhaftes Wasserlassen. Symptome müssen aber nicht immer auftreten. Sowohl bei Männern als auch bei Frauen kann Gonorrhoe auch den Mund, den Rachen, die Augen und den Anus infizieren und sich auf das Blut und die Gelenke ausbreiten, wo sie in eine schwere Krankheit übergehen kann. Bleibt sie unbehandelt, kann sie eine Beckenentzündung verursachen, die zu chronischen Beckenschmerzen und Unfruchtbarkeit führen kann. Die Krankheit kann während der Schwangerschaft auf den Fötus übertragen werden. - Weitere bakterielle STIs: Mykoplasmen und Ureaplasmen. Diese können ebenfalls behandelt werden.
- Trichomoniasis
Sie wird durch einen Parasiten verursacht, der mit einer einzigen Dosis eines Antibiotikums behandelt werden kann. Trichomoniasis kann bei Frauen einen übel riechenden Scheidenausfluss, Juckreiz im Genitalbereich und schmerzhaftes Wasserlassen verursachen. Bei Männern treten in der Regel weniger oder keine Symptome auf. Zu den Komplikationen gehört das Risiko einer vorzeitigen Entbindung bei schwangeren Frauen. Um eine Reinfektion zu verhindern, sollten beide Sexualpartner behandelt werden.
Durch Viren hervorgerufen
- HIV/AIDS - siehe Informationsblatt HIV-AIDS
- Herpes simplex Virus
Im Lippen-Mundbereich, auch bekannt als Fieberbläschen, ist nicht heilbar. Herpes kann aber mit Medikamenten bei akuten Beschwerden kontrolliert werden. Die Symptome sind in der Regel schmerzhafte, wässrige Hautbläschen und finden sich an oder um die Genitalien, den Anus oder den Mund. Nach der Erstinfektion ruht das Virus im Körper und die Symptome können über Jahre hinweg wieder auftreten. Schwangere Frauen können die Infektion an ihre Neugeborenen weitergeben, was zu einer bedrohlichen Infektion führen kann. - Virale Hepatitis (siehe auch Hepatitis Schweiz)
- Hepatitis A (HAV)
Hepatitis A ist eine durch Impfung vermeidbare Leberinfektion, die durch das Hepatitis-A-Virus verursacht wird. Das Hepatitis-A-Virus findet sich im Stuhl und im Blut infizierter Personen. Hepatitis A kann durch verunreinigtes Wasser und Lebensmittel sowie bei anal-oralen sexuellen Aktivitäten übertragen werden. Die Patienten*innen leiden an einer akuten und oft schweren Erkrankung, erholen sich aber allermeist spontan. - Hepatitis B (HBV)
Das Hepatitis-B-Virus wird durch sexuelle Kontakte sowie durch den Kontakt mit anderen Körperflüssigkeiten, wie z.B. Blut, übertragen. Zur Übertragung kann es z.B. auch bei medizinischen Eingriffen oder Brennen eines Tatoos unter nicht optimalen hygienischen Bedingungen kommen. Hepatitis B kann eine schwere Leberinfektion verursachen, die sowohl zu einer sofortigen Erkrankung, als auch zu einer lebenslang andauernden Infektion führen kann mit möglicher Folge einer dauerhaften Lebervernarbung (Zirrhose) und Krebs. Schwangere Frauen mit Hepatitis B können das Virus während der Geburt auf ihr Kind übertragen. Zu Beginn der Infektion haben Sie möglicherweise keine Symptome. Das Virus kann auf Sexualpartner*innen übertragen werden. Hepatitis B kann mit antiviralen Medikamenten behandelt werden, ist aber nur selten heilbar. Eine Impfung kann eine Hepatitis-B-Infektion verhindern. - Hepatitis C (HCV)
In den meisten Fällen wird Hepatitis C durch den Kontakt mit infiziertem Blut übertragen. Seltener kann es durch analen Sexualkontakt oder von der Mutter auf das Kind während der Schwangerschaft und Geburt übertragen werden. Die meisten Infizierten sind sich ihrer Infektion nicht bewusst, weil sie keine Symptome entwickeln, aber diese chronische Infektion kann zu Leberzirrhose und Krebs führen. Hepatitis C kann behandelt werden, eine Impfung gibt es nicht.
- Hepatitis A (HAV)
- Humanes Papillomavirus (HPV)
HPV ist die häufigste Geschlechtskrankheit. Es gibt eine Vielzahl verschiedener HPV-Typen, und einige von ihnen können Genital-, Anal- und Mundwarzen sowie Gebärmutterhals-, Penis- oder Rachenkrebs verursachen. Die Symptome können auch noch Jahre nach dem Sex mit einer infizierten Person auftreten. Zwei verfügbare Impfstoffe schützen gegen die wichtigsten HPV-Typen, die Gebärmutterhals-, Penis- oder Analkrebs verursachen. - Zika - siehe Informationsblatt Zika
In den meisten Fällen wird es vor allem durch Stechmücken übertragen. Es kann aber auch sexuell übertragen werden. Eine Ansteckung mit Zika während der Schwangerschaft kann bei dem sich entwickelnden Fötus Geburtsfehler wie Mikrozephalie (kleiner Kopf mit neurologischen Ausfällen) verursachen. Die einzige Möglichkeit, eine sexuelle Übertragung des Virus während der Schwangerschaft zu verhindern, besteht darin, Vorsichtsmassnahmen (Kondome) zu treffen oder Sex (mindestens 2 Monate nach der Rückkehr) mit jemandem zu vermeiden, der kürzlich in ein Risikogebiet gereist ist, auch wenn der Reisende keine Symptome hat.
- Love Life: www.lovelife.ch
- Sexuelle Gesundheit Schweiz: www.sexuelle-gesundheit.ch
- Hepatitis Schweiz: https://hepatitis-schweiz.ch/formen/was-ist-hepatitis
- World Health Organization (WHO). Factsheets. Sexually transmitted infections (STIs). 14 June 2019: www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
- Centers for Disease Control and Prevention (CDC). Factsheet: Information for Teens and Young Adults: Staying Healthy and Preventing STDs (2017): www.cdc.gov/std/life-stages-populations/stdfact-teens.htm
- Centers for Disease Control and Prevention (CDC). How You Can Prevent Sexually Transmitted Diseases: www.cdc.gov/std/prevention/
- Centers for Disease Control and Prevention (CDC) Sexual Transmission and Prevention. Zika Virus: www.cdc.gov/zika/prevention/protect-yourself-during-sex.html
- Centers for Disease Control and Prevention (CDC) Zika and Pregnancy; Pregnant Women and Zika (March 2021): www.cdc.gov/pregnancy/zika/protect-yourself.html
- Altitude sickness can be life-threatening and may be experienced by any traveler.
- The danger begins at around 2500m and rises with increasing altitude.
- People differ in their susceptibility to altitude sickness; this is not related to their physical fitness.
- Severe altitude sickness with fluid accumulation in the brain or lungs can rapidly result in death.
- If you are planning a stay in high altitudes, we strongly recommend you to consult your doctor for detailed recommendations and instructions.
- Eine Höhenkrankheit kann lebensgefährlich sein und bei jedem Reisenden auftreten.
- Die Gefahr beginnt bei ca. 2500m und nimmt mit zunehmender Höhe zu.
- Wenn Sie einen Höhenaufenthalt planen, lesen sie bitte dieses Merkblatt aufmerksam durch!
- Je nach Reiseart und / oder Vorerkrankungen wird die Beratung durch eine Fachperson dringend angeraten.
- Langsamer Aufstieg. Aufstiegsregeln: oberhalb von 2500m sollte die Schlafhöhe um nicht mehr als 300-500m pro Tag gesteigert werden und pro 1000m Schlafhöhengewinn sollte ein zusätzlicher Ruhetag eingelegt werden.
- Treten Beschwerden auf, die auf eine Bergkrankheit hinweisen (siehe oben), muss der Anstieg pausiert werden und er darf erst wieder bei Beschwerdefreiheit fortgesetzt werden. Bei Zunahme der Beschwerden muss abgestiegen werden bzw. Patient:innen in tiefere Lagen abtransportiert werden. Bei Ignorieren zunehmender Beschwerden können sich die lebensbedrohlichen Formen der Höhenkrankheit, das Höhenhirnödem und/oder das Höhenlungenödem entwickeln.
- Ist das Einhalten der oben genannten Aufstiegsregeln situativ oder geländebedingt nicht möglich, kann die Einnahme von Acetazolamid (DIAMOX®) das Risiko eine akute Höhenkrankheit zu entwickeln, vermindern. Die Verschreibung des Medikaments bedingt eine ärztliche Indikationsstellung sowie eine Aufklärung über allfällige Nebenwirkungen!
- Kopfschmerzen: Paracetamol (z.B. PANADOL®, DAFALGAN®). Keine Schlafmittel verwenden!
- Höhenhirnödem: sofortiger Abstieg. Falls verfügbar: Sauerstoffgabe, medikamentöse Notfalltherapie.
- Höhenlungenödem (Atemnot auch in Ruhe, rasselndes Atemgeräusch, Reizhusten) Sofortiger Abstieg. Falls verfügbar: Sauerstoffgabe, medikamentöse Notfalltherapie.
- Marburg virus disease is a rare but severe hemorrhagic fever.
- The disease spreads through contact with infected animals or people.
- Symptoms can be similar to other tropical diseases
- There is no licensed treatment or vaccine for Marburg disease, and
- Please have a look to the factsheet below.
- Marburg virus disease is a rare but severe hemorrhagic fever.
- The disease spreads through contact with infected animals or people.
- Symptoms can be similar to other tropical diseases
- There is no licensed treatment or vaccine for Marburg disease, and
- Prevention measures are important to follow, see below.
The incubation period (time between infection and onset of symptoms) ranges from a 2 to 21 days (usually 5 to 10 days). The onset of MVD is usually abrupt, with initially non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhoea. As the disease advances, clinical manifestations can become more severe and include liver failure, delirium, shock, bleeding (hemorrhaging), multi-organ dysfunction and death.
In case of symptoms
If think that you have had an exposure at risk and develop fever with nonspecific symptoms such as chills, headache, muscle pain, malaise or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- immediately seek medical advice by contacting the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
The risk for travellers is very low if the below precautions are followed, but it is high for family members and caregivers who have contact with sick people.
General precautions during travel to affected areas:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals; alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
- Swiss Federal Office of Public Health: LINK
- European Center for Disease Control and Prevention (ECDC): Marburg virus disease
- US Center for Disease Control and Prevention (CDC): About Marburg Disease
- World Health Organization: Marburg Virus Disease
- 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 neighbouring countries, leading the WHO to declare a new Public Health Emergency International (PHEIC) in August 2024.
- Close physical contact (sexual or non-sexual) is the main route of transmission.
- The disease is usually mild. Children, pregnant women and people with weakened immune systems are most at risk of complications.
- Take general precautions (see factsheet) to prevent the disease.
- There is a vaccination against Mpox, but it is currently only available for people at high risk.
- 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!
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".