Serbia Health Overview
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Serbia, in particular Kosovo, suffers from a shortage of medicines and essentials, and there are several health risks for travellers. Recommended vaccinations for visitors to Serbia are Hepatitis A and typhoid (except for very short-term visitors who restrict their meals to major restaurants and hotels). A reciprocal health care agreement entitles British nationals to free emergency treatment in Serbia, but comprehensive travel health insurance is strongly recommended for all visitors because of the insufficient and under-funded medical facilities. Cases of rabid foxes and dogs have been reported in parks and the outskirts of major cities, and bird flu has been identified in the Sombor area of north-eastern Serbia. Tap water and unbottled beverages should not be consumed, and food should be well prepared and well cooked. In the countryside precautions should be taken against tick infestation.
View information on diseases: Typhoid fever, Rabies, Hepatitis A
Typhoid fever
Cause: Salmonella typhi, the typhoid bacillus, which infects only humans. Similar paratyphoid and enteric fevers are caused by other species of Salmonella, which infect domestic animals as well as humans. Transmission: Infection with typhoid fever is transmitted by consumption of contaminated food or water. Occasionally direct faecal-oral transmission may occur. Shellfish taken from sewage-polluted beds are an important source of infection. Infection occurs through eating fruit and vegetables fertilized by night soil and eaten raw, and milk and milk products that have been contaminated by those in contact with them. Flies may transfer infection to foods, resulting in contamination that may be sufficient to cause human infection. Pollution of water sources may produce epidemics of typhoid fever, when large numbers of people use the same source of drinking water. Nature of the disease: Typhoid fever is a systemic disease of varying severity. Severe cases are characterized by gradual onset of fever, headache, malaise, anorexia and insomnia. Constipation is more common than diarrhoea in adults and older children. Without treatment, the disease progresses with sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms and, in some cases, pneumonia. In white-skinned patients, pink spots (papules), which fade on pressure, appear on the skin of the trunk in up to 50% of cases. In the third week, untreated cases develop additional gastrointestinal and other complications, which may prove fatal. Around 2-5% of those who contract typhoid fever become chronic carriers, as bacteria persist in the biliary tract after symptoms have resolved. Geographical distribution: Worldwide. The disease occurs most commonly in association with poor standards of hygiene in food preparation and handling and where sanitary disposal of sewage is lacking. Risk for travellers: Generally low risk for travellers, except in parts of north and west Africa, in south Asia and in Peru. Elsewhere, travellers are usually at risk only when exposed to low standards of hygiene with respect to food handling, control of drinking water quality, and sewage disposal. Prophylaxis (protective treatment): Vaccination. Precautions: Observe all precautions against exposure to foodborne and waterborne infections. Source: WHO.
Back to TopRabies
Cause: The rabies virus, a rhabdovirus of the genus Lyssavirus. Transmission: Rabies is a zoonotic disease affecting a wide range of domestic and wild animals, including bats. Infection of humans usually occurs through the bite of an infected animal. The virus is present in the saliva. Any other contact involving penetration of the skin occurring in an area where rabies is present should be treated with caution. In developing countries transmission is usually from dogs. Person-to-person transmission has not been documented. Nature of the disease: An acute viral encephalomyelitis, which is almost invariably fatal. The initial signs include a sense of apprehension, headache, fever, malaise and sensory changes around the site of the animal bite. Excitability, hallucinations and aerophobia are common, followed in some cases by fear of water (hydrophobia) due to spasms of the swallowing muscles, progressing to delirium, convulsions and death a few days after onset. A less common form, paralytic rabies, is characterized by loss of sensation, weakness, pain and paralysis. Geographical distribution: Rabies is present in animals in many countries worldwide. Most cases of human infection occur in developing countries. Risk for travellers: In rabies-endemic areas, travellers may be at risk if there is contact with both wild and domestic animals, including dogs and cats. Prophylaxis (protective treatment): Vaccination for travellers with a foreseeable significant risk of exposure to rabies or travelling to a hyperendemic area where modern rabies vaccine may not be available. Precautions: Avoid contact with wild animals and stray domestic animals, particularly dogs and cats, in rabies-endemic areas. If bitten by an animal that is potentially infected with rabies, or after other suspect contact, immediately clean the wound thoroughly with disinfectant or with soap or detergent and water. Medical assistance should be sought immediately. The vaccination status of the animal involved should not be a criterion for withholding post-exposure treatment, unless the vaccination has been thoroughly documented and vaccine of known potency has been used. In the case of domestic animals, the suspect animal should be kept under observation for a period of 10 days. Rabies post-exposure treatment: In a rabies-endemic area, the circumstances of an animal bite, other contact with the animal, and the animal's behaviour and appearance may suggest that it is rabid. In such situations, medical advice should be obtained immediately. Post-exposure treatment to prevent the establishment of rabies infection involves first-aid treatment of the wound followed by administration of rabies vaccine and antirabies immunoglobulin in the case of a bite or exchange of saliva. The administration of vaccine, and immunoglobulin if required, must be carried out, or directly supervised, by a physician. Source: WHO.
Back to TopHepatitis A
Cause: Hepatitis A virus, a member of the picornavirus family. Transmission: The virus is acquired directly from infected persons by the faecal-oral route or by close contact, or by consumption of contaminated food or drinking water. There is no insect vector or animal reservoir (although some non-human primates are sometimes infected). Nature of the disease: An acute viral hepatitis with abrupt onset of fever, malaise, nausea and abdominal discomfort, followed by the development of jaundice a few days later. Infection in very young children is usually mild or asymptomatic (e.g. causes no symptoms); older children are at risk of symptomatic disease. The disease is more severe in adults, with illness lasting several weeks and recovery taking several months; case-fatality is greater than 2% for those over 40 years of age and 4% for those over 60. Geographical distribution: Worldwide, but most common where sanitary conditions are poor and the safety of drinking water is not well controlled. Risk for travellers: Non-immune travellers to developing countries are at significant risk of infection. The risk is particularly high for travellers exposed to poor conditions of hygiene, sanitation and drinking water control. Prophylaxis (protective treatment): Vaccination. Precautions: Travellers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Source: WHO.
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