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Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

Vaccinations

 
 
Factsheet
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Recommendation

Vaccination recommended, see Swiss Federal Office of Public Health (FOPH), LINK.

Entry requirement per country, see IATA LINK and HUG LINK

 

  • Covid-19 is a disease that affects the whole body, but mainly shows with respiratory symptoms such as cough and difficulty in breathing. It is caused by the SARS-CoV-2 virus.
  • The infection is mainly spread through respiratory droplets and possibly aerosols when infected persons cough, sneeze, speak or sing without wearing a mask.
  • The infection can be prevented very effectively by vaccination and an increasing number of vaccines are now approved and available for protection.
  • Vaccination is recommended according to the Swiss recommendations of the Federal Office of Public Health (FOPH), see LINK.
  • Furthermore, prevention relies heavily on people wearing face masks, on hand hygiene and on physical distancing (min. 1.5 m) if masks are not worn and people are not vaccinated.
For information, see LINK of the Federal Office of Public Health (FOPH)
  
 
 
 
 

 
Recommendation

All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.

 

 
 
 
 

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

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

EKRM_Factsheet_Layperson_EN_Hepatitis-A.pdf

  • 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 is caused by a highly contagious virus that affects the liver. It is also known as infectious jaundice. Hepatitis A is very common in unvaccinated travelers.

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.

Transmission occurs mainly through drinking water or food contaminated by faeces. Other transmission routes are close personal contacts, especially sexual contacts (anal-oral sex) or insufficient hand hygiene.
Several weeks after the infection symptoms such as fever, fatigue, nausea, lack of appetite, abdominal discomfort and diarrhea may occur. Within a few days yellow skin and eyes (jaundice) may follow. Most symptoms disappear after a few weeks, but fatigue can often last for months. Young children usually have few or no symptoms, but in older people, the disease can be severe and prolonged.
No specific treatment is available. Recovery from an acute hepatitis A infection can take several weeks or months and requires physical rest and diet.

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 
  
 
 
 
  • Hepatitis B is a viral liver infection that is transmitted via contaminated blood or via sexual contact.
  • A safe and very effective vaccine is available that affords life-long protection.
  • Hepatitis B vaccination is recommended for all young people and at-risk travellers, especially if:
    • You travel regularly or spend long periods of time abroad.
    • You are at risk of practicing unsafe sex.
    • You might undergo medical or dental treatment abroad, or undertake activities that may put you at risk of acquiring hepatitis B (tattoos, piercing, acupuncture in unsafe conditions).
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  • Influenza is common all over the world including sub-tropical and tropical countries.
  • Vaccination offers the best protection. 
  • Vaccination against flu is recommended for all travellers who belong to an “at risk” group such as pregnant travellers, travellers with comorbidities, elderly people (>65 years), or who plan a a high-risk trip (e.g. cruise-ship, pilgrimage).
  • The influenza vaccine does not offer protection against avian flu.
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  • Japanese encephalitis is a viral infection that is endemic in South and Southeast Asia and the most northern part of 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

CDC Map: Geographic Distribution of Japanese Encephalitis Virus
  • 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.
Japanese encephalitis is caused by the Japanese encephalitis virus (JEV), a flavivirus, which is spread by mosquitoes. Epidemics of Japanese encephalitis were first described in Japan from the 1870s onward. It is the main cause of viral encephalitis in the Asia-Pacific region.
JEV is endemic in tropical regions of Eastern and Southern Asia and the Western Pacific regions. Epidemics are reported in these regions in subtropical and temperate climate zones. In 2016, a first autochthonous human case was reported in Angola, Africa. The virus exists naturally in a transmission cycle between mosquitoes, pigs and water birds. Birds may be responsible for the spread of JEV to new geographical areas. Humans mainly become infected in rural or suburban areas, when staying in close proximity to pigs.
JEV is transmitted through the bite of female Culex mosquitoes (mainly Culex tritaeniorrhynchus), which are active throughout the night, indoors and outdoors. For most travelers to Asia, the risk is very low but varies based on destination, season, length of travel and activities.
Most people infected are asymptomatic or experience only mild symptoms with fever and headache. About 1/250 people develop severe symptoms after 4-14 days of getting infected, as the infection spreads to the brain, characterized by an abrupt onset of high fever, headache, neck stiffness, disorientation, coma, seizures and paralysis. Up to 1 in every 3 persons developing severe symptoms consequently die. Permanent sequelae, such as behavioural changes, muscle weakness, or recurrent seizures occur in 30%–50% of those with encephalitis.
The diagnosis can be confirmed by serology in cerebrospinal fluid and serum, IgM antibodies usually become detectable 3-8 days after onset of symptoms.
There is no directed antiviral treatment available. Treatment consists of supportive care to relieve symptoms.
Mosquito bite prevention from dusk to dawn (Culex are active during the night) – sleeping under a mosquito net or in an air-conditioned room; repellants on exposed skin; wearing long clothes; treating clothes with insecticide. Vaccination is recommended in travelers at increased risk of infection (longer periods of travel in endemic regions, travel during the JEV transmission season, staying in rural areas especially near rice paddies or pig farms and participating in outdoor activities). The inactivated vaccine IXIARO® is given in two doses (ideally spaced 28 days apart, though the second dose can be given as early as 7 days after the first dose) before travel. In case of continuous risk, a booster dose can be given after 15 months. For children 12 months to 18 years, the use is "off-label". Reactions to the vaccine are generally mild and may include pain and tenderness at the injection site, headache, muscle aches, and low-grade fever.
  • 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 
  
 
 
 
 

 
Recommendation

All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.

 

 
 
  • Meningococcal disease is a very severe, life threatening bacterial infection that can lead to death within a few hours if untreated.
  • Transmission occurs from person to person by droplets.
  • The risk is higher for travelers to regions with seasonal epidemics (Meningitis Belt in Sub-Saharan Africa: outbreaks occur each year during the dry season, mainly between December and the end of June).
  • The disease can be prevented by one dose of four-valent meningococcal vaccine and protection lasts for at least 5 years.
  • Vaccination is compulsory for everyone over the age of two years going on a pilgrimage in Saudi Arabia.

EKRM_Factsheet_Layperson_EN_Meningococci.pdf

Vaccination is recommended for stays in the meningitis belt:

  • During an alert or epidemic (typically occurring during dry season from December to June → check News)
    • for those travelling more than 7 days OR
    • for those who will be in close contact with the local population or living/travelling in crowded conditions
  • For those who will be staying for more than four weeks
  • For those who will be working in a medical setting
  • For those with predisposing factors or who have ever had an invasive meningococcal infection
  • For those with a condition affecting the spleen or who have a poorly functioning spleen


For details, see SOP vaccination meningococcal meningitis (only available in HealthyTravel PRO).

CDC Map: Areas with frequent epidemics of meningococcal meningitis
  • Meningococcal disease is a very severe, life threatening bacterial infection that can lead to death within a few hours if untreated.
  • Transmission occurs from person to person by droplets. The risk is higher for travelers to regions with seasonal epidemics (meningitis belt in sub-Saharan Africa).
  • The disease can be prevented by one dose of four-valent meningococcal vaccine and protection lasts for at least 5 years.
Meningococcal disease is a very severe, life threatening infection caused by bacteria called Neisseria meningitidis. Patients with meningococcal infection typically have sudden onset of fever, chills and headache rapidly followed by other symptoms like skin rash, nausea, vomiting, tiredness or confusion. Immediate medical attention and antibiotic treatment is needed.
Meningococcal infections occur worldwide. The highest incidence is observed during seasonal epidemics in the dry season (December – June) in the so-called "meningitis-belt" in sub-Saharan Africa. There is also a higher risk of infection in situations with overcrowding or close contacts to many people, especially participants in the Hajj or Umrah pilgrimages in Saudi Arabia. Everyone can be infected, but young children and persons with certain medical conditions or treatments (e.g. non-functional spleen) are at higher risk for meningococcal infection.
The bacteria are transmitted from person to person by droplets, mostly through close personal contact such as living together or kissing.
Meningococcal disease typically presents as meningitis or septicemia. Patients have sudden onset of fever, headache and malaise rapidly followed by other symptoms such as stiff neck, limb pain, rash, confusion, diarrhea and vomiting. Meningococcal infections are very serious and can be deadly within a few hours.
Patients with meningococcal disease need immediate medical attention and rapid intravenous antibiotic treatment. Severe complications such as breathing problems, low blood pressure, seizures or tissue necrosis can occur and need specific treatment.
For travelers to epidemic areas and persons with risk factors, vaccination is the best way to prevent meningococcal disease. One dose of a four-valent meningococcal conjugate vaccine (e.g. Menveo®) protects against the majority of meningococcal infections from 7-10 days after vaccination. The protection lasts for at least 5 years and the vaccine is licensed from the age of two years. Younger children can be vaccinated off label (i.e. not within the official recommendations); under the age of 12 months, a three-dose schedule is indicated. In case of recurrent exposure or continued risk, a booster dose is recommended every 5 years. For pilgrimages to Saudi Arabia (Hajj / Umrah), meningococcal vaccine (booster dose every 3-5 years, depending on vaccine) is mandatory. The vaccine is well tolerated, transient side effects such as fever, injection site pain, headache or tiredness can occur, but disappear by their own within a few days after vaccination.

Meningococcal vaccination is recommended in Switzerland as a complementary vaccination for children between 2 – 4 years and for adolescents between 11 – 15 years. Furthermore, it is recommended as a risk group vaccination for persons with certain medical conditions, for persons with close contact to a patient with meningococcal disease and for travelers to endemic areas.

For more detailed information on the disease and Swiss national recommendations (in German, French, Italian) see: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/meningokokken-erkrankungen.html

 
 
 
 

 
Temporary WHO recommendations
  • For some countries, specific temporary WHO recommendations regarding polio vaccination apply. These can be changed by the WHO at short notice.
  • The details can be found in the respective countries.
 

  • 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

  • For some countries, specific temporary WHO recommendations regarding polio vaccination apply. These can be changed by the WHO at short notice.
  • The details can be found in the respective countries.
  • Polio is a vaccine-preventable viral disease of the nervous system that is acquired mainly through the consumption of food or water contaminated by feces.
  • The infection with the polio virus can affect children and adults and may lead to permanent limb or respiratory muscle paralysis and death.
  • An effective, well- tolerated vaccine is available! Check if booster doses are recommended for the travel destination (on top of completed basic vaccination schedule).
Poliomyelitis, or polio, is a highly infectious viral disease that affects the nervous system and can cause total limb paralysis within a very short time period. People of all ages can be infected through consumption of contaminated food or water. Humans are the only known reservoir of the polio virus.  Infection may be mild or even without symptoms. If symptoms of muscular or nervous system complications appear, sequelae (long-term complications) almost always occur. There is no medication to cure polio but the vaccine against polio is highly efficacious.
Polio due to wild types of viruses has been eradicated from most countries. In Afghanistan and Pakistan, however, new infections still occur. In some countries, polio viruses derived from live, oral vaccines are circulating and cause outbreaks of polio disease, especially in countries where vaccination coverage against polio is low in the population.
Polio virus is mainly transmitted through the consumption of food or water contaminated by feces. The virus can also be acquired through secretions or saliva of an infected person. In the tropics, transmission occurs year round, whereas in temperate zones, a peak can be seen in summer.
Symptoms most commonly appear 3 to 21 days following exposure. Initial symptoms may include fever, fatigue, headache, vomiting, and diarrhea. Those with mild cases may recover within a week. More serious cases result in stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible limb or respiratory muscle paralysis.
There is no cure for polio. Treatment targets symptom alleviation only.

Regular hand washing after using the bathroom and before eating or preparing food. Avoidance of undercooked or raw food that is potentially contaminated with fecal material.

The most important prevention is vaccination. A very effective and well-tolerated vaccine against polio is available (inactivated (killed) polio vaccine (IPV)), which is part of the basic vaccination schedule during childhood. Combination vaccines (e.g. with diphtheria and tetanus) are also available. After basic vaccination, a booster dose is recommended every 10 years for travel to certain countries (see country page recommendations). WHO recommends a yearly vaccination for residents or long-stay visitors (minimum 4 weeks) in a country with ongoing polio infections or circulating vaccine-derived polio viruses. This recommendation not only targets individual protection, but aims to prevent the international spread of the virus.

Check the risk for polio in the region of travel, and ensure vaccination if recommended (see country page recommendations).

WHO: https://www.who.int/news-room/fact-sheets/detail/poliomyelitis

FOPH Switzerland: Swiss vaccination plan: https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/schweizerischer-impfplan.html

 
 
 
  • 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!

EKRM_Factsheet_Layperson_EN_Rabies.pdf

This fact sheet contains important information about rabies. For optimal travel preparation, we recommend that you read this information carefully and take the fact sheet on your trip!
  • Rabies is mainly transmitted 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!).
  • Attention: a bite or scratch wound as well as contact with mammal saliva is an emergency! Find out about the necessary actions below!
Rabies disease is invariably fatal, transmitted through the saliva or other body fluids of infected warm-blooded animals (i.e. mammals).
Dogs are responsible for more than 95 % of human cases. Bats, cats and (rarely) monkeys and other mammals can transmit rabies as well. The highest risk areas are Asia, Africa and some Latin American countries (e.g. Bolivia). Rabies may occur anywhere in the world except in countries where successful eradication has been achieved.
Saliva from infected animals enters the human body through injured skin, either via bites and scratches or by licking already wounded skin. Once it has entered the body through the skin lesion, the rabies virus migrates along nerve pathways towards the brain. In most cases, this migration takes several weeks to months and proceeds without accompanying symptoms.
Symptoms usually only appear when the virus has reached the brain. In most cases, this is the case after 2-12 weeks (range: 4 days - several years!) and manifests itself as encephalitis (inflammation of the brain), which in 99.99% of cases is fatal within a few weeks. As soon as symptoms of encephalitis appear, a fatal course can no longer be prevented.

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 
 
 
Map
  • Tick-borne encephalitis is a viral infection that is transmitted by ticks. It is often referred to by the German name and abbreviation ’Frühsommer meningoenzephalitis’ (FSME).
  • Tick-borne encephalitis occurs in certain forested areas in Europe through to the Far East.
  • A safe and effective vaccine is available that is recommended for all stays in endemic areas.

EKRM_Factsheet_Layperson_DE_TBE.pdf

EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

HealthyTravel_Map_TBE_Europe.JPG

Under construction
 
 
 
  • 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.

EKRM_Factsheet_Layperson_EN_Typhoid-fever.pdf

  • Typhoid fever, also called enteric fever, is caused by the bacteria Salmonella Typhi and Salmonella Paratyphi.
  • Infected persons shed the bacteria in their feces. In countries with low sanitation standards, the bacteria can then enter the drinking water system and lead to infections in other people.
  • Frequent sources of infection are contaminated food and beverages.
  • The main preventive measure therefore is “cook it, peel it, boil it or forget it” – meaning: avoid drinking uncooked water or water from unsealed bottles; avoid cooled/frozen products (e.g. ice cubes in drinks, ice cream) unless from a known safe source; avoid uncooked vegetables, peel and clean fruit and vegetables yourself and only with known safe drinking water.
  • A vaccine is available and recommended: a) for travelers to the Indian subcontinent or to West Africa, b) for travelers visiting friends and relatives or for long-term travelers also to other sub-/tropical areas.
Typhoid fever is a bacterial disease that affects the whole body and mainly presents with high fever, often accompanied by drowsiness (“typhos” in Greek stands for delirium) and severe headaches. If the infection is treated with appropriate antibiotics, mortality is very low. If left untreated however, complications may follow, which can lead to significant mortality. Typhoid fever must be clearly distinguished from salmonellosis, caused by a large range of non-typhoidal salmonella species that mainly cause benign diarrheal symptoms worldwide.
The highest occurrence of typhoid fever is on the Indian subcontinent (Afghanistan, Pakistan, Nepal, Bhutan, India and Bangladesh). This is also the region with a steady increase in antibiotic resistance. The disease also occurs in the whole sub-/tropical region, but with lower frequency. It used to occur also in Europe and North America, but the disease has disappeared thanks to improved water and sanitation standards.
Typhoid fever is transmitted via the fecal-oral route: bacteria are shed in the feces of infected persons and – if insufficient hand hygiene is practiced – infected persons may contaminate the food and drinking water supply of their families. In regions with low sanitation standards, contaminated feces may also contaminate the public drinking water supply.
The incubation period – time between infection and first symptoms – can vary between 3 days to 3 weeks. The principle symptom of typhoid fever is high-grade fever (39° - 41° C) accompanied by strong headache and drowsiness. In the initial phase of the disease, patients often complain of constipation. In later stages, this may turn into diarrhea. In later stages of the disease - and in the absence of correct treatment - complications such as septicemia, intestinal hemorrhage or perforation can follow, which may lead to considerable mortality.
Appropriate antibiotic treatment cures typhoid fever. Treatment should be adapted according to the resistance profile of the bacteria. On the Indian subcontinent, some strains may be multi-resistant, necessitating broad-spectrum intravenous antibiotic treatment. In severe typhoid fever with reduced consciousness (delirium) or coma, treatment with corticosteroids may need to be added.

“Cook it, boil it, peel it or forget it” – this simple slogan would be sufficient to prevent typhoid fever nearly entirely. However, only few travelers fully adhere to this advice. Nevertheless, the value of food and water hygiene cannot be stressed enough: avoid buying water bottles without proper sealing, avoid drinking tap water from unknown sources, avoid eating cooled / frozen foods (i.e. ice cubes in water or ice cream) and avoid eating raw fruits and vegetables that you yourself have not peeled and washed with clean drinking water.

Two types of vaccines are available:

  • Oral (live) vaccine consisting of three capsules to be taken on alternate days on empty stomach. These capsules require refrigeration before use. Protection from this vaccine is approximately 70% and starts 10 days after the third dose. After 1 to 3 years, the vaccine needs to be taken again before a new travel into at-risk areas. This vaccine cannot be given to patients with a severe chronic gastrointestinal disease (such as Crohn’s disease or ulcerative colitis) or with severe immunosuppression.
  • The single-dose vaccine is an inactivated vaccine and is injected intramuscularly. Protection also reaches around 70% and starts 14 days after the injection. This vaccine can be given to patients who should not take the oral vaccine. However, it is not registered in Switzerland, but most doctors with specialization in tropical and travel medicine and all travel health centres have the vaccine on stock. Duration of protection is around 3 years.
Vaccination against typhoid fever is advised for long-term travelers and for travelers visiting areas where the risk of transmission is particularly high and/or the disease more difficult to treat due to severe antibiotic resistance.
Federal Office of Public Health Switzerland: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/typhus-abdominalis-paratyphus.html 
  
 
 
 
 

 
Recommendation

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.

 

 
 
 

 
Recommendation
  • 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.
  • The details can be found in the respective countries.
     

     
    Country requirement at entry
    • Vaccination is mandatory for entry into some countries.
    • The details can be found in the respective countries.
     

    • Yellow fever is a life-threatening viral infection. A highly effective vaccine is available. 
    • Vaccination is strongly recommended for all travellers to regions where yellow fever occurs, even if it is not a mandatory entry requirement of the country.
    • A booster single booster dose is recommended for immuncompetent persons after 10 years.
    • The yellow fever vaccination must be administered by an authorized doctor or center at least ten days before your arrival in the destination country with record in the yellow vaccination booklet ('International Certificate for Vaccination').
    • For travellers who are pregnant, breastfeeding, or who have a condition that leads to immunosuppression, please consult a travel health advisor.

    EKRM_Factsheet_Layperson_EN_Yellow-fever.pdf

    EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf

    • Vaccination is strongly recommended for all travellers to regions where yellow fever occurs, even if it is not a mandatory entry requirement of the country.
    • The details can be found in the respective countries.
      • Vaccination is mandatory for entry into some countries.
      • The details can be found in the respective countries.
      CDC Map: Areas with Risk of Yellow Fever Virus Transmission in Africa
      CDC Map: Areas with Risk of Yellow Fever Virus Transmission in South America
      • Yellow fever occurs in sub-Saharan Africa and South America and is transmitted by mosquitoes.
      • Disease may be severe in unvaccinated travelers and death may occur in over 50%.
      • A highly effective vaccine is available.
      • Due to potentially severe side effects the vaccine is used with caution in immunocompromised or elderly individuals, as well as in pregnant women.
      Yellow fever is an acute viral infection transmitted through the bite of mosquitoes. The disease occurs in sub-Saharan Africa and South America. It is a potentially lethal disease. However, the vaccination offers very high protection.
      Yellow fever is endemic in countries of sub-Saharan Africa and South America, and in Panama. Transmission occurs all over the year but may peak in the rainy season. Although the same species of mosquitoes are present, yellow fever has not been found in Asia.
      The yellow fever virus is transmitted to people primarily through the bite of infected daily active Aedes mosquitoes, or Haemagogus species mosquitoes, which are day and night active. Mosquitoes acquire the virus by feeding on infected primates (human or non-human) and then can transmit the virus to other primates (human or non-human). Yellow fever transmission and epidemics are facilitated by the interface of jungle, savannah and urban areas. Humans working in the jungle can acquire the virus and become ill. The virus then can be brought to urban settings by infected individuals and may be transmitted to other people.
      Most people infected with yellow fever virus have mild or no symptoms and recover completely. Some people will develop yellow fever illness with onset of symptoms typically 3 to 6 days after infection. Symptoms are unspecific and flu-like (fever, chills, head and body pain). After a brief remission, about 10-20% will develop more severe disease. Severe disease is characterized by high fever, yellow skin and eyes, bleeding, shock and organ failure. About 30 to 60% of patients with severe disease die.
      There is no specific medication. Treatment is only supportive and consists of providing fluid and lowering fever. Aspirin and other nonsteroidal anti-inflammatory drugs, for example ibuprofen or naproxen, should be avoided due to the risk of enhanced bleeding.

      As against all mosquito-borne diseases, prevention from mosquito bites is during day and night (see “Insect and tick bite protection” factsheet). The available vaccine is highly efficacious and provides a long-term protection. It is recommended for people aged 9 months or older who are travelling to yellow fever endemic areas. In addition, providing proof of vaccination may be mandatory for entry into certain countries.

      The vaccine is a live-attenuated form of the virus. In immunocompetent persons, protection starts about 10 days after the first vaccination. Reactions to yellow fever vaccine are generally mild and include headache, muscle aches, and low-grade fevers.  Side effects can be treated with paracetamol but aspirin and other nonsteroidal anti-inflammatory drugs, for example ibuprofen or naproxen, should be avoided.  On extremely rare occasions, people may develop severe, sometimes life-threatening reactions to the yellow fever vaccine – which is why this vaccine is used with caution in immunocompromised individuals, pregnant women and the elderly for safety reasons. Talk to your travel health advisor if you belong to this group.

      In 2016, WHO changed from yellow fever booster doses every 10 years to a single dose, which is considered to confer life-long protection. However, this decision was based on limited data and mainly from endemic populations, potentially exposed to natural boosters (through contact with infected mosquitoes), which does not apply to travellers from non-endemic regions. As several experts have raised concerns about the WHO single dose strategy, the Swiss Expert Committee for Travel Medicine recommends a single booster dose ≥10 years (max. 2 doses per life-time) in immunocompetent persons after primo-vaccination before considering life-long immunity.
      Yellow Fever Map - Centers for Disease Control and Prevention: https://www.cdc.gov/yellowfever/maps/index.html 
      Yellow Fever Info - Centers for Disease Control and Prevention: https://www.cdc.gov/yellowfever/index.html 
      Yellow Fever Info - European Centre for Disease Prevention and Control: https://www.ecdc.europa.eu/en/yellow-fever/facts 

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