Saint Barthélemy

For details, see yellow fever recommendations and countries’ entry requirements at the respective country page on www.healthytravel.ch and CDC map.

Prevention: Optimal mosquito protection 24/7, also in cities (also against other mosquito-borne diseases such as Zika, chikungunya, oropouche, malaria).

In case of fever, ensure adequate hydration and apply paracetamol products. If you have a fever, avoid tak-ing medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop tak-ing medications containing acetylsalicylic acid if it is already part of your regular treatment for an underly-ing 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 evi-dence of previous dengue infection and who will be exposed in a region with significant dengue transmission. 
  
• Studies have shown reduced seroprotection against dengue serotype DENV-3 in patient vac-cinated with Qdenga®, especially in dengue-naïve individuals.
  

For details, see ECTM Statement.

Oropouche virus

• is spread primarily by the bite of infected midges (small flies) and mosquitoes (Culex quinquefasciatus).
  
• has been found in semen, but it is unknown if it can be spread through sex. No cases of sexual transmission of Oropouche virus have yet been reported.
  
• transmission to the unborn child has been reported. The extent of possible malformations or death in the unborn baby in the context of an OROV outbreak situation is currently still unclear and is being investigated.
  
• Illness can occur in people of any age and is often mistaken for dengue.
  
• There is no vaccine and not specific treatment available

Prevention: The best way to protect yourself from Oropouche is to prevent insect bites 24/7 (also against other mosquito-borne diseases such as Dengue, Zika, Chikungunya), see factsheet.

Pregnant women and women planning to be pregnant should be provided with comprehensive information during pre-travel consultation on the Oropouche virus outbreaks and the potential of miscarriage, fetal malformation or death.

In the event of increased OROV transmission (= declared as an OROV outbreak according CDC Level 2 Travel Health Notice for Oropouche), the Swiss Expert Commission for Travel Medicine recommends:

• Pregnant women should re-consider non-essential travel
  
• If travel is unavoidable, strictly adhere to insect prevention measures (see LINK) and talk to your health care provider.
  
• To avoid sexual transmission: males should consider using condoms during travel and up to 2 months after return.

• 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.

• 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/

• 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:

1. Clothing: Wear well-covered, long-sleeved clothing and long pants and treat clothing with insecticide beforehand (see factsheet “prevention of arthropod bites”).
2. Mosquito repellent: Apply a mosquito repellent to uncovered skin several times a day (see factsheet “prevention of arthropod bites”).
3. Environmental hygiene: Do not leave containers with standing water (coasters for flower pots, etc.) in your environment to avoid mosquito breeding sites.

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, for details see LINK. 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.

• Vaccination against Dengue fever for Travellers – Statement of the Swiss Expert Committee for Travel Medicine, an organ of the Swiss Society for Tropical and Travel Medicine, July 2024, LINK.
• Dengue Map (Center for Disease Control and Prevention – CDC): https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html

• Chikungunya fever is a viral infection that is transmitted by mosquitoes. 
• The disease typically manifests itself with fever and severe joint pain in the hands and feet, which can last for weeks to months in some patients.
• Chikungunya fever can be prevented by protecting yourself from mosquito bites.
  

The infection may cause some or all of the following symptoms: sudden onset of high fever, headache, muscle and joint pain, joint swelling, rash. The rash usually appears after the onset of the fever and usually affects the trunk and extremities. The joint pain and swelling usually occur symmetrically on both sides and mainly affect the hands and feet - but larger joints such as the knees or shoulders can also be affected. The intense joint pain can be very debilitating for those affected.

Around 5 - 10 % of those infected have persistent severe joint and limb pain even after the fever has subsided, which in some cases lasts for several months or, although rarely, even years.

Preventive measures against mosquito bites during the day: Apply mosquito repellent to uncovered skin; wear long clothing; treat clothing with insecticide. For more information, see the information sheet "Protection against insect and tick bites". Another very important protective factor is so-called 'environmental hygiene': breeding sites for mosquitoes in the immediate vicinity of human dwellings should be avoided by removing all forms of containers with water (e.g. flowerpot saucers, uncovered water containers, etc.).

Vaccination: Two Chikungunya vaccines are currently approved in the US and EU (IXCHIQ® and VIMKUNYA®), but not yet in Switzerland. The Swiss Expert Committee for Travel Medicine has issued preliminary recommendations for travellers, see LINK.

• BAG Switzerland EN
• WHO - Chikungunya information sheet EN
  
• Centre for Disease Control and Prevention (CDC) EN
  
• European Centre for Disease Prevention and Control (ECDC) EN

• 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)