Europe, including Cyprus and countries of the former USSR
3.1 Europe, including Cyprus and countries of the former USSR
(Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark (with the Faroe Islands), Estonia, Finland, France, Georgia, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Kyrgyzstan, Latvia, Liechtenstein, Lithuania, Luxembourg, Macedonia, Malta, Moldova, Monaco, Netherlands, Norway, Poland, Portugal (with the Azores and Madeira), Romania, Russia, San Marino, Slovakia, Slovenia, Spain (with the Canary Islands), Sweden, Switzerland, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, Yugoslavia (including Kosovo, Montenegro and Serbia)
3.1.1 Disease risks
For much of the area communicable diseases are unlikely to prove a hazard greater than in the UK. The risks may be higher in parts of Eastern Europe, but lack of information makes risk assessment difficult.
Food and water-borne diseases (bacillary dysentery, other diarrhoeas, and typhoid) are most likely to occur in the south-eastern and south-western parts of the area, especially in summer and autumn. The incidence of certain food-borne diseases, eg salmonella and campylobacter infections, is increasing in some countries. Hepatitis A is commoner in the eastern European countries.
Malaria is confined to small foci in Armenia, Azerbaijan, Georgia, Tajikistan and Turkmenistan.
Other arthropod-borne diseases (see Chapter 7) occur of which the most common are:
- Tick-borne encephalitis - mainly in forests and surrounding areas in central and eastern Europe and Scandinavia and across the former USSR to the Pacific coast.
- Lyme disease
- Tick-borne typhus - in Siberia and the Mediterranean
- Japanese encephalitis - in a small area in the far eastern maritime areas of the former USSR neighbouring China
- Murine typhus (endemic) - sporadic cases occur in some countries bordering the Mediterranean littoral
- West Nile Fever - cases sometimes occur in Mediterranean and eastern European countries
- Cutaneous and visceral leishmaniasis and sand fly fever reported from Southern Europe
- Leishmania/HIV co-infection reported from France, Greece, Italy
- Tularaemia in parts of continental Europe.
- Louse-borne relapsing fever in Turkey and areas of the former USSR.
- Tick-borne relapsing fever - foci in Portugal and Spain
Diseases of close association:
- In recent years, Azerbaijan, Belarus, Russia and Ukraine have experienced extensive epidemics of diphtheria. Cases of diphtheria, mostly imported from these three countries, have also been reported in neighbouring countries (Estonia, Finland, Latvia, Lithuania, Poland, the Republic of Moldova).
- All countries are making intense efforts to eradicate polio, and the risk of infection in most countries is very low.
- Tuberculosis rates are increasing in parts of eastern Europe and the former USSR, including drug resistant disease.
Sexually transmitted and blood-borne infections:
Hepatitis B is generally of low prevalence; prevalence higher in the eastern and southern parts of the region. HIV is predominantly in high risk groups, but the risk of all STIs, particularly for young travellers, should not be forgotten.
Other hazards could include:
- Legionnaires' disease - both sporadic cases and clusters of cases associated with holiday hotels and apartments continue to be reported in returning travellers.
- Leptospirosis.
- Rodent-borne haemorrhagic fever with renal syndrome (Hanta virus infection) is now recognised as occurring in some areas in this region.
- Rabies is endemic in wild animals (particularly foxes) in rural areas of northern and eastern Europe and in most countries of southern Europe apart from: Cyprus, Faroe Islands, Finland, Greece, Iceland, Ireland, mainland Italy (except the northern and eastern borders), mainland Norway, mainland Spain (except the N African coast), Sweden, Gibraltar, Malta, Portugal and Monaco. However, the latter country has land borders with France (see 1.9).
Parts of northern Europe can be extremely cold in winter.
3.1.2 Recommendations for immunisations and malaria chemoprophylaxis (see later chapters for general health precautions)
| FOR ALL COUNTRIES Check routine immunisations including tetanus. For immunisation recommendations for poliomyelitis boosters, hepatitis A and typhoid please see the country by country guide below, noting that immunisation against typhoid and/or hepatitis A may be less important for short stays in standard business or tourist conditions. For polio, see also paragraph 1.8. Those walking or camping in late spring and summer in rural parts of central and eastern Europe (including the former USSR) and Scandinavia, are at increased risk of tick-borne encephalitis - consider immunisation (see also Chapter 7). For long stay visitors to eastern Europe and the former USSR consider immunisation against diphtheria and hepatitis B, and check BCG status; for those going to live or work with local people, a diphtheria booster may be considered even for shorter stays if the last dose was more than 10 years ago. For remote areas out of reach of medical attention, possibly also consider rabies vaccine. |
3.1.3 Country by country variations and malaria chemoprophylaxis:
Albania
Yellow fever vaccination certificate required from travellers over one year old coming from infected areas.
Immunisation against poliomyelitis and hepatitis A usually advised.
Armenia
Immunisation against hepatitis A usually advised.
Malaria risk: P.vivax malaria focally in Ararat Valley, from June to October, outside tourist areas.
Recommended prophylaxis: for the risk area only, chloroquine.
Austria
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Azerbaijan
Immunisation against hepatitis A and typhoid usually advised.
Malaria risk: P.vivax malaria focally, from June to October.
Recommended prophylaxis: chloroquine.
Belarus
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Bosnia
Immunisation against hepatitis A usually advised.
Bulgaria
Immunisation against hepatitis A usually advised.
Croatia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Czech Republic
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Estonia
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Georgia
Immunisation against hepatitis A usually advised.
Malaria risk: P.vivax malaria focally in rural areas in the south-east, June to October.
Recommended prophylaxis: for those areas only, chloroquine.
Germany
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Greece
Yellow fever vaccination certificate required from travellers over six months old coming from infected areas.
Hepatitis A immunisation occasionally advised, eg for those on extensive backpacking holidays where food hygiene might be in doubt.
Herzegovina
Immunisation against hepatitis A usually advised.
Hungary
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Kazakhstan
Yellow fever vaccination certificate required from travellers coming from infected areas.
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised.
Kyrgyzstan
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised.
Latvia
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Lithuania
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Macedonia
Immunisation against hepatitis A usually advised.
Malta
Yellow fever vaccination certificate required from travellers over nine months old coming from infected areas. (If indicated on epidemiological grounds, infants under nine months of age coming from infected areas are subject to isolation or surveillance).
Moldova
Immunisation against hepatitis A usually advised.
Poland
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Portugal, with the Azores and Madeira
Yellow fever vaccination certificate required from travellers over one year old coming from infected areas and arriving in or bound for the Azores and Madeira. No certificate is required from passengers in transit at Funchal, Porto Santo and Santa Maria.
Hepatitis A immunisation occasionally advised, eg for those on extensive backpacking holidays where food hygiene might be in doubt.
Romania
Immunisation against hepatitis A usually advised.
Russia
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised for areas east of the Urals.
Japanese encephalitis and Russian spring summer encephalitis - consider immunisation against JE for far eastern maritime areas, south of Khabarousk, July-September.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Slovakia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Slovenia
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Tajikistan
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised.
Malaria risk: malaria (mostly P.vivax) patchily distributed, June to October.
Recommended prophylaxis: chloroquine.
Turkmenistan
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised.
Malaria risk: P.vivax from June to October in south-eastern region.
Recommended prophylaxis: in the risk area, chloroquine.
Ukraine
Immunisation against hepatitis A usually advised.
Tick-borne encephalitis vaccine in certain circumstances (see 7.4).
Uzbekistan
Immunisation against poliomyelitis, hepatitis A and typhoid usually advised.
Yugoslavia
Immunisation against hepatitis A usually advised.