HEPATITIS A

Hepatitis A is a viral disease that causes inflammation of the liver.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Hepatitis A is known to occur in this country although the risk to most travellers is considered to be low.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis A is transmitted through contaminated food and water. Travellers who will have access to safe food and water are at low risk. Those at higher risk include travellers visiting friends and relatives, long-term travellers, and those visiting areas of poor sanitation.

Risk management

• Travellers should practice strict food, water and personal hygiene precautions.
• Vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to travellers whose planned activities put them at higher risk of exposure (see above).
• Because hepatitis A vaccine is well tolerated and affords long-lasting protection, it may be givenMost travellers at low risk, consider vaccine for those in risk categories to all previously unvaccinated travellers.
• According to UK immunisation guidance, in addition to its indications for travel, vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to those with chronic liver disease or haemophilia, men who have sex with men, injecting drug users and those at occupational risk.

Resources

HEPATITIS B

Hepatitis B is a viral disease that causes inflammation of the liver and may lead to chronic complications.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Less than 2% of the population in this country is a carrier of hepatitis B virus (low endemicity).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis B is transmitted via infected blood or bodily fluids. Travellers may be exposed when receiving medical or dental treatment, via direct contact between open skin lesions, or if participating in risk behaviour such as needle sharing, unprotected sex or contact sports. Healthcare workers are at higher risk.

Risk management

• Travellers should avoid contact with blood or bodily fluids. Where contact is unavoidable, appropriate protective precautions should be taken.
• A sterile medical kit should be carried.
• Most travellers are at low risk.
• Vaccine should be givenAll travellers in risk categories should receive vaccine to adult and child travellers at risk due to the nature of their activities or occupation (see above).
• Vaccine should also be givenAll travellers in risk categories should receive vaccine to those with chronic kidney failure, liver disease or haemophilia, injecting drug users, men who have sex with men and individuals who change sexual partners frequently.

Resources

RABIES

Rabies is a neurological disease caused by viruses of the Lyssavirus genus.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Rabies occurs or is presumed to occur in wild and domestic animals (including bats).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Transmission may occur following contact with the saliva from an infected wild or domestic animal (including bats), most often via a bite or lick to an open wound. Risk of exposure is increased by type of activity (e.g. running, cycling), occupation (e.g. veterinarians) and longer duration of stay. Children are at increased risk as they are less likely to avoid contact with animals and to report a bite or lick.

Risk management

• Travellers should avoid contact with wild or domestic animals.
• Pre-exposure vaccination should be givenAll travellers in risk categories should receive vaccine to adults and children who are:
  • at risk of rabies (see above)
  • travelling to remote areas where medical care is not readily available.
• Following an animal bite, wounds should be thoroughly cleansed and an urgent medical assessment sought, even if the wound appears trivial. Prompt post-exposure treatment is required, even if pre-exposure vaccine has been received.
• Suitable vaccines and immunoglobulin may be in short supply or unavailable in some countries.

Resources

TETANUS

Tetanus is caused by a toxin released from Clostridium tetani bacteria.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Tetanus bacteria are found worldwide.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.

Risk management

• Travellers should thoroughly clean all wounds and seek appropriate medical attention
• Travellers should have completed a primary vaccination course according to the UK schedule.
• A booster dose should be givenAll travellers in risk categories should receive vaccine to travellers whose last dose of a tetanus-containing vaccine was given more than 10 years ago, and who will not have ready access to medical care; even if they have received five doses previously.

Resources

TICK-BORNE ENCEPHALITIS

Tick-borne encephalitis (TBE) is a viral disease affecting the central nervous system. View a map showing risk areas for countries in Europe here (587KB GIF).

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - There is a risk of TBE in some areas of the country below 1,400m. The areas affected are Baden-Württemberg, Bayern (Bavaria), Hessen, Sachen  Thüringen,  and Rheinland-Pfalz states, and Odenwald region. The transmission season varies, however, ticks are most active during early spring to late autumn (March to November).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - TBE is transmitted to humans via the bite of an infected Ixodes tick. Travellers are at risk via exposure to ticks during outdoor activities in areas of vegetation (gardens, parks, forest fringes, meadows and marshes) below 1,400m. Cases of TBE may also occur following ingestion of unpasteurised milk products.

Risk management

• Travellers should take tick bite avoidance measures during outdoor activities.
• Travellers should check themselves for ticks and be aware of effective tick removal methods.
• Travellers should not eat or drink unpasteurised milk products.
• TBE vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to travellers whose planned activities put them at risk (see above).

Resources

MALARIA

There is no risk of malaria in this country.

ALTITUDE

There is a point of elevation in this country higher than 2,500 metres (m).

Risk assessment

• Travel to destinations of 2,500-3,500 m (8,200-11,500 feet) or higher carries the risk of altitude illness. Important risk factors for altitude illness are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.

Risk management

• The most important prevention measure is adequate acclimatisation.
• Travellers should spend a few days at an intermediate altitude below 3,000 m.
• Ascent above 3,000 m should be gradual with no more than a 300 - 500 m increase in sleeping altitude per day, with a rest day every three days.
• Acetazolamide is recognised for use in the prevention of altitude illness. It should not replace acclimatisation and gradual ascent.
• Travellers who develop symptoms of altitude illness (headache, fatigue, loss of appetite, nausea and sleep disturbance) should avoid further ascent. In the absence of improvement or with progression of symptoms the first response should be to descend.
• Development of more severe forms of altitude illness, high-altitude cerebral oedema (HACE) (confusion, difficulty with balance and coordination) or high-altitude pulmonary oedema (HAPE) (shortness of breath at rest, cough and chest tightness), require immediate descent and emergency medical treatment.

Resources