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Immunisation against diphtheria, hepatitis A, tick-borne encephalitis and rabies should be considered. Typhoid vaccinations are recommended for long-term travellers who might eat outside of major hotels and restaurants. Tap water is best avoided, or treated by boiling or with chemicals. Bird flu has been confirmed in parts of Crimea, but no human infections have been reported. Travellers are not at risk, but close contact with domestic, caged and wild birds should be avoided, and all poultry and egg dishes well cooked as a precaution. HIV is widespread and the level of sexually transmitted diseases is high. Due to the risk of exposure to pollutants and radioactive materials, swimming in the Dnieper River should be avoided. Comprehensive medical insurance is advised, and visitors are advised to bring a supply of personal medication.
View information on diseases: Typhoid fever, Tick-borne encephalitis, Rabies, HIV/AIDS and Sexually Transmitted Diseases, Hepatitis A, Diphtheria
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 TopTick-borne encephalitis
Cause: The tick-borne encephalitis (TBE) virus, which is a flavivirus. Other closely related viruses cause similar diseases. Transmission: Infection is transmitted by the bite of infected ticks. There is no direct person-to-person transmission. Some related viruses, also tick-borne, infect animals such as birds, deer (louping-ill), rodents and sheep. Nature of the disease: Infection with tick-borne encephalitis may induce an influenza-like illness, with a second phase of fever occurring in 10% of cases. Encephalitis develops during the second phase and may result in paralysis, permanent sequelae or death. Severity of illness increases with age. Geographical distribution: Tick-borne encephalitis is present in large parts of Europe, particularly Austria, the Baltic States (Estonia, Latvia, Lithuania), the Czech Republic, Hungary and the Russian Federation. The disease is seasonal, occurring mainly during the summer months in rural and forest areas at altitudes up to 1,000 metres. Risk for travellers: In endemic areas during the summer months, travellers are at risk when hiking or camping in rural or forest areas. Prophylaxis (protective treatment): A vaccine against TBE is available. Precautions: Avoid bites by ticks by wearing long trousers and closed footwear when hiking or camping in endemic areas. If a bite occurs, the tick should be removed as soon as possible. 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 TopHIV/AIDS and Sexually Transmitted Diseases
The most important sexually transmitted diseases and infectious agents are HIV/AIDS, hepatitis B, syphilis, gonorrhoea, chlamydia infections, trichomoniasis, chancroid, genital herpes and genital warts. Transmission: Infection occurs during unprotected sexual intercourse. Hepatitis B, HIV and syphilis may also be transmitted in contaminated blood and blood products, by contaminated syringes and needles used for injection, and potentially by unsterilized instruments used for acupuncture, piercing and tattooing. Nature of the diseases: Most of the clinical manifestations are included in the following syndromes: genital ulcer, pelvic inflammatory disease, urethral discharge and vaginal discharge. However, many infections are asymptomatic. Sexually transmitted infections are a major cause of acute illness, infertility, long-term disability and death, with severe medical and psychological consequences for millions of men, women and children. Apart from being serious diseases in their own right, sexually transmitted infections increase the risk of HIV infection. The presence of an untreated disease (ulcerative or non-ulcerative) can increase by a factor of up to 10 the risk of becoming infected with HIV and transmitting the infection. On the other hand, early diagnosis and improved management of other sexually transmitted infections can reduce the incidence of HIV infection by up to 40%. Prevention and treatment of all sexually transmitted infections are therefore important for the prevention of HIV infection. Geographical distribution: Worldwide. Sexually transmitted infections have been known since ancient times; they remain a major public health problem, which was compounded by the appearance of HIV/AIDS around 1980. An estimated 340 million episodes of curable sexually transmitted infections (chlamydial infections, gonorrhoea, syphilis, trichomoniasis) occur throughout the world every year. Viral infections, which are more difficult to treat, are also very common in many populations. Genital herpes is becoming a major cause of genital ulcer, and subtypes of the human papillomavirus are associated with cervical cancer. Risk for travellers: For some travellers there may be an increased risk of infection. Lack of information about risk and preventive measures and the fact that travel and tourism enhance the probability of having sex with casual partners increase the risk of exposure to sexually transmitted infections. In some developed countries, a large proportion of sexually transmitted infections now occur as a result of unprotected sexual intercourse during international travel. In addition to transmission through sexual intercourse (both heterosexual and homosexual-anal, vaginal or oral), most of these infections can be passed on from an infected mother to her unborn or newborn baby. Hepatitis B, HIV and syphilis are also transmitted through transfusion of contaminated blood or blood products and the use of contaminated needles. There is no risk of acquiring any sexually transmitted infection from casual day-to-day contact at home, at work or socially. People run no risk of infection when sharing any means of communal transport (e.g. aircraft, boat, bus, car, train) with infected individuals. There is no evidence that HIV or other sexually transmitted infections can be acquired from insect bites. Prophylaxis: There is a vaccination against hepatitis B. No prophylaxis is available for any of the other sexually transmitted diseases. Precautions: Male or female condoms, when properly used, have proved to be effective in preventing the transmission of HIV and other sexually transmitted infections, and for reducing the risk of unwanted pregnancy. Latex rubber condoms are relatively inexpensive, are highly reliable and have virtually no side-effects. The transmission of HIV and other infections during sexual intercourse can be effectively prevented when high-quality condoms are used correctly and consistently. Studies on serodiscordant couples (only one of whom is HIV-positive) have shown that, with regular sexual intercourse over a period of two years, partners who consistently use condoms have a near-zero risk of HIV infection. A man should always use a condom during sexual intercourse, each time, from start to finish, and a woman should make sure that her partner uses one. A woman can also protect herself from sexually transmitted infections by using a female condom - essentially, a vaginal pouch, which is now commercially available in some countries. It is essential to avoid injecting drugs for non-medical purposes, and particularly to avoid any type of needle-sharing to reduce the risk of acquiring hepatitis, HIV, syphilis and other infections from contaminated needles and blood. Medical injections using unsterilized equipment are also a possible source of infection. If an injection is essential, the traveller should try to ensure that the needles and syringes come from a sterile package or have been sterilized properly by steam or boiling water for 20 minutes. Patients under medical care who require frequent injections, e.g. diabetics, should carry sufficient sterile needles and syringes for the duration of their trip and a doctor's authorization for their use. Unsterile dental and surgical instruments, needles used in acupuncture and tattooing, ear-piercing devices, and other skin-piercing instruments can likewise transmit infection and should be avoided. Treatment: Travellers with signs or symptoms of a sexually transmitted disease should cease all sexual activity and seek medical care immediately. The absence of symptoms does not guarantee absence of infection, and travellers exposed to unprotected sex should be tested for infection on returning home. HIV testing should always be voluntary and with counselling. The sexually transmitted infections caused by bacteria, e.g. chancroid, chlamydia, gonorrhoea and syphilis, can be treated successfully, but there is no single antimicrobial that is effective against more than one or two of them. Moreover, throughout the world, many of these bacteria are showing increased resistance to penicillin and other antimicrobials. Treatment for sexually transmitted viral infections, e.g. hepatitis B, genital herpes and genital warts, is unsatisfactory due to lack of specific medication, and cure is difficult to achieve. The same is true of HIV infection, which in its late stage causes AIDS and is thought to be invariably fatal. Antiretroviral drugs cannot completely eradicate the HIV virus; treatment is expensive and complex and most countries have only a few centres that are able to provide it. 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.
Back to TopDiphtheria
Disease: Diphtheria is a bacterial disease caused by Corynebacterium diphtheriae. The infection commonly affects the throat and may lead to obstruction of the airways, and death. Transmission is from person to person, through close physical contact, and is increased in overcrowded and poor socioeconomic conditions. Exotoxin-induced damage occurs to organs such as the heart. Nasal diphtheria may be mild, and chronic carriage of the organism frequently occurs; asymptomatic infections are common. A cutaneous form of diphtheria is common in tropical countries and may be important in transmission of the infection. Occurrence: Diphtheria is found worldwide, although it is not common in industrialized countries because of long-standing routine use of DTP vaccine. Recently, large epidemics have occurred in several east European countries. Risk for travellers: Potentially life-threatening illness and severe, lifelong complications are possible in incompletely immunized individuals. Vaccine: All travellers should be up to date with the vaccine, which is usually given as "triple vaccine"-DTP (diphtheria/tetanus/pertussis). After the initial course of three doses, additional doses may be given as DT until 7 years of age, after which a vaccine with reduced diphtheria content (Td) is given. Since both tetanus toxoid and diphtheria toxoid can reasonably be given on a booster basis about every 10 years, there is little reason to use monovalent diphtheria vaccine. Precautions and contraindications: Avoid diphtheria-containing vaccines if a severe or life-threatening reaction has occurred to a previous dose. Use a vaccine with reduced diphtheria content (Td) from age 7 years onwards. Source: WHO.
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