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Introduction

As a traveler in a new and unknown environment you are exposed to a wide variety of risks. There are many factors that can affect your health - temperature, altitude, humidity changes - and mainly the different spectrum of microorganisms. That is why you should be well aware of all the possible risks and learn how to prevent them effectively when planning your trip.

A visit to a travel medicine specialist should take place at least 4 to 8 weeks before the planned departure, in case of a long stay abroad even sooner. The consultation should not be avoided in the event of last minute traveling either.

During the consultation with the specialist you will be advised of which vaccination is suitable for you, if malaria prophylaxis is inevitable and how to minimize the risk of infection and other kinds of health problems.

It is appropriate to undergo a dental and (for women) gynecological exam before long stay abroad or travel to remote areas.

In case of chronic disease it is necessary to visit the specialist, e.g. diabetologist, allergist or internist and request an advice and prescription of medicines that could be needed in event of deterioration.

Health Risks

Risks Associated with the External Environment

  • travelling

    Deep Vein Thrombosis

    Prolonged sitting can cause a mild leg swelling or eventually can lead to a blood cot formation in deep veins in legs. A very dangerous complication that can occur is transfer of the blood cut by blood flow to the lungs - pulmonary embolism. The main risk factors of thrombosis formation are: dehydration, age over 60, deep vein thrombosis in past, varicose veins, recent surgery or injury, pregnancy, use of hormonal contraception, cardiovascular diseases and cancer. Effective preventive measures from thrombus formation in leg veins during flight is regular stretching and exercise, occasional walk in the airplane gangways, consume of sufficient fluids as well as use of the compression stocks for patients at risk. When at high risk it is necessary to take medicine for reducing blood clotting.

  • swimming - in seas, lakes and rivers

    Swimming in sea can put us in danger represented by various sea animals and corals. The best preventive measure is to avoid them. If you are considering underwater diving, it is necessary to provide insurance on this activity. When diving in malaria area you must not use Lariam as a prophylaxis. Swimming in stagnant and slow flowing waters in tropical areas is not recommended because there is a high chance of schistosomiasis and leptospirosis infection, wild amoebas and various pathogens causing diarrhea.

  • elevation

    75% of people suffer from symptoms of mild altitude sickness when climbing up above 3000 meters asl. Its formation depends on individual predisposition and climb speed. Common symptoms are headache, sickness, loss of appetite, lethargy, shortness of breath and insomnia. They get worse at night and fade slowly during the process of acclimatization in few days. If coordination disorder accompanies the illness and headache is getting stronger, it is advisable to climb down at least 300 meters, where the situation should improve significantly in 24 hours. Hard altitude sickness can cause psychical changes, inability to walk and hard breathing. In this case it is inevitable to climb down immediately at least 600 meters. If a person gets swelling of brain and lugs, it is necessary to evacuate the patient promptly and provide a medical help.

    Prevention:

    Right acclimatization, that means slow climb. If possible, avoid transport to the highs by plane or car; the best way is to start the climb on foot at 3000 meters asl, from 3000 meters asl it is recommended to climb only 300 meters daily. When symptoms of altitude sickness start to occur, slow down the tempo or stay at the place. If the symptoms will not subside, climb down more. It is vital to drink enough fluids and have a high calorie diet. No smoking, no alcohol, tranquilizers or sleeping pills and most importantly, no over estimating your own abilities. It is possible to take acetazolamide as prevention, but it is vital to consult it with your doctor.

  • heat and humidity

    The risk of sunstroke and overheating can be reduced by limiting your activities in the sun, especially if you are staying in hot and wet environment. It is important to drink enough fluids containing needed ions and to not forget to cover your head.

  • UV rays

    In tropical and subtropical areas it is necessary to avoid direct sunlight between the hours of noon until 2pm, to wear a hat, clothes with long sleeves and sunglasses and to use a water-resistant sunscreen with a high sun protection factor. Lying down exposing yourself to sun right after swimming is not recommended. When staying in alpine environment it is necessary to wear a hat and sunglasses with side shields and protect your neck.

  • insects

    Many infections are spread by insects, especially by gnats (malaria, Japanese encephalitis, yellow fever, dengue fever, chikungunya filariasis...) ticks (tick-borne encephalitis, Lyme disease, typhus...), flies (filariasis, leishmaniasis, sleeping sickness), fleas (plague) and bed bugs (Chagas disease). Thus it is important to prevent biting or reduce the risk to minimum. The most important thing is to use repellents, especially those containing DEET, IR353 or Icardin. It is also necessary to use mosquito nets when sleeping, as well as window insect screens and electric or other incest repellent.

  • animals

    Domestic and wild animals can be sources for various infectious diseases. The most dangerous one is rabies, a viral disease that is almost invariably fatal. When travelling to developing countries it is necessary to avoid contact with dogs and cats, bats, jackals, foxes and other wild animals. When injured by animal in areas with rabies incidence it is vital to seek medical help immediately for post-exposure prophylaxis for rabies and tetanus prevention. First aid should consist of prompt cleanse of the wound by soap and water, disinfection and further seek of medical help even in case you were already inoculated. Travellers without previous vaccination must be revaccinated within 24 hours from exposition. In areas where poisonous snakes, spiders and scorpions can be encountered it is necessary to clearly see where you put your feet or hands and it is also vital to avoid blind grass-covered surface and wear boots. It is recommended to sleep under a mosquito net and never on bare ground. At night remember to always take a torch light.

  • accidents

    Accidents and injuries frequently threaten the health of tourist abroad. Majority of deaths are connected especially with these events, therefore it is necessary to secure an adequate insurance before the journey, act wisely and not take unnecessary risk. It is not advisable to drink too much alcohol and take drugs, night walks in dangerous areas are also not recommended. When standing at the traffic lights and crossroads always make sure that all the doors on the vehicle are locked and be well informed about current security situation in the country. In some countries it is not permitted to use cameras near train stations, airports and hydroelectric dams and you can easily end up being arrested on suspicion of spying. A frequent cause of death of tourists are car accidents, therefore be cautious when crossing the road and remember that the car can appear from different side of the road that you are used to. Do not forget that local drivers may not follow the habit of giving priority to pedestrians, nor follow any road traffic laws. Do not travel by crowded ferries, buses and trains; do not jump out of vehicle during the ride. When swimming, do not drink alcohol; never swim alone or during the ebb so to avoid being taken by sea stream.

Risks Associated with Water and Food

  • diarrheal diseases

    Travelers' diarrhea is one of the most frequent health problems, affecting as many as 80% of tourists. Diarrhea can be accompanied by vomit, fever and abdominal pain. In most cases it is a bacterial disease, but can be caused also by viruses and vermins, therefore in countries with lowered hygienic standards it is important to be very particular about hands, food and water hygiene, which means to drink only water, originally packed in bottles. If such water is not accessible, it is necessary to boil, filtrate or disinfect the water with capsules. When it goes to food, we should follow the old colonial era rule: "wash it, peel it, cook it". It is also recommended to avoid the consummation of ice, fresh greens, inadequately cooked meat, eggs and sea creatures as well as drinking raw milk.

  • viral hepatitis (A and E)

    These are viral diseases primarily affecting liver. They are passed via fecal - oral route, by close contact with diseased patient, contaminated food or drinks. The incidence is world-wide. The main symptoms are: lethargy, increased body temperature, abdominal discomfort, yellowing of the skin and sclera. The risk for patients of hepatitis A and E is high especially when travelling in areas with low hygienic standard. Prevention: washing your hands, avoiding potentially contaminated food and drink, vaccination against hepatitis A.

  • intestinal parasitosis

    Travellers in tropical and subtropical areas are exposed to the danger of many parasitic diseases. Intestinal parasites occur especially in areas with low hygiene standard and low sanitary measures which lead to pollution of land, water and food by human and animal excrements. People become infected by ingestion of contaminated food and water but also by walk barefoot, because the larval stages of some parasites are able to actively drill through the skin. Prevention contains very thorough hygiene of hands, water and food. Avoid walking barefoot and swimming in stagnant and slowly flowing waters.

Sexually Transmitted Diseases

The most frequent sexually transmitted diseases are HIV/AIDS, hepatitis B and C, syphilis, gonorrhea, also infections caused by chlamydia, trichomoniasis, and herpes simplex. The infection is mainly transmitted by unprotected sex, in case of HIV, hepatitis B and C and syphilis the transmission is possible via blood /transfusion, contaminated injection, unsterilized tattoo tools, acupuncture and piercing/ and the transmission from mother to child is also possible. Among the most common symptoms of sexual diseases belong: genital ulcer, pain in pelvic area and vaginal or urethral discharge. However, many of the diseases can show no symptoms at all. The incidence of sexually transmitted diseases is worldwide. The risk of infection is particularly high for some travelers, increased by absence of information on risk and preventive measures as well as adventitious sexual intercourse. There is no risk of infection in common social contact at home, work and public transport; nor are these diseases transmitted by insects. Prevention: During vacation avoid adventitious sexual intercourse and use protection. Never use mutual needles and injections; in case of needed parenteral drug administration in health center always make sure that these tools are sterile and originally packed. Vaccination is available only against hepatitis B and HPV.

Advice for Travelers

General Preventive Measures

By following general preventive measures it is possible to significantly reduce the risk of exposition to infectious pathogens. These measures should be followed even in case we have gone through vaccinations and take antimalarials.

Many infections, mainly diarrhea and parasitic diseases, are transmitted via consummation of contaminated food and water. Thus we should drink only water, originally packed in bottles. If such water is not accessible, it is necessary to boil, filtrate or disinfect the water with capsules. When it goes to food, we should follow the old colonial era rule: "wash it, peel it, cook it". It is also recommended to avoid the consummation of ice, fresh greens, inadequately cooked meat, eggs and sea creatures as well as drinking raw milk.

Many infections are spread by insects, especially by gnats, ticks, flies, fleas and bed bugs. Thus it is important to prevent biting or reduce the risk to minimum. The most important thing is to use repellents, especially those containing DEET, IR353 or Icardin. It is also necessary to use mosquito nets when sleeping, as well as window insect screens and electric or other incest repellent.

It is important to avoid swimming in stagnant waters in areas with endemic schistosomiasis and avoid walking barefoot on surfaces /e.g. beaches/ that are contaminated by excrements.

Malaria Prevention

Malaria is common, life-threatening disease that occurs in many tropical and subtropical areas. There are more than 10 000 tourists every year that suffer from malaria. If you get ill from malaria during your journey, it is not always possible to find suitable and reliable health center. If you get ill after return, doctors in developed countries are not always prepared for such disease; this can lead to wrong diagnosis, delay of the treatment and further developing of severe form of malaria and even death.

The risk of infection varies not only from country to country but also among each region. There is lower risk in urban areas and at altitudes above 1500 meters asl and in dry season, though it is not always the case.

General Malaria Preventive Measures:

  • Risk awareness
  • Protection against gnat biting
  • Taking anti-malarial medication
  • Early diagnosis and treatment at the occurrence of fever after more than one week since entering the malarial area

Antimalarials

No antimalarials grant full protection, however they significantly reduces the risk of deadly form of malaria. Even when you take antimalarials it is important not to forget about prevention against gnat biting. The most common used medication in malaria prevention is: Chloroquine (Delage), Lariam (mefloquine), Malarone (Proguanil-Atoquanone), doxycycline (Doxybene, Doxyhexal) and in some cases azithromycin (Sumamed). It is advisable to choose your antimalarials after consultation with your doctor considering your health condition, concomitant illnesses, length of intended stay as well as emerge of resistance in the area you plan to visit. For long time stay - more than 6 months - or in areas with very low risk it is possible to follow the preventive measures and when suspecting malaria to retreat with antimalarials, so called "stand by treatment". For retreatment, combined preparations containing artemisinin are suitable.

Vaccination

Vaccination is the administration of antigenic material (vaccine) into the human organism. The aim of vaccination is to develop the produce of antibodies against microorganisms and at the same time create the so called adaptive immunity to a disease in organism, thus creating in vaccinated individual a long term, optimally a lifelong, protection.
Vaccination before travelling abroad is one of the most effective ways to prevent infection and infectious disease. This way you avoid the hassle and negative experience in visited country. It is important to pay great interest to vaccination, just like sufficient amount of time. Given that some vaccinations have a longer dosing schedule it is suitable to consult the vaccination at least 4 to 8 weeks prior to leaving. The doctor will prepare an individual vaccination plan according to the country, character of the journey and length of the stay as well as according to your health condition.

Common Vaccination

  • Diphtheria

    Diphtheria is transmitted by droplets, in contact with infected person, eventually by contaminated bed linen and clothing. Vaccine contains toxin extracted from bacteria agent. Vaccination against diphtheria is given in childhood, booster is recommended to older individuals travelling to risk areas (the cases of diphtheria occur on the Indian subcontinent, Southeast Asia, Africa and South America, but also in countries of former USSR).

  • Tetanus

    Tetani spores are found in soil, the infection develops after transmission into wounds. Incidence of the disease is worldwide. Vaccination against tetanus is given in childhood, revaccination is recommended every 10 years or after injury.

  • Whooping Cough

    Whooping cough is a highly contagious bacterial disease that affects the respiratory system. It is transmitted by direct contact with ill person and causes cough that lasts for several weeks and is accompanied by cyanosis and vomiting. Among the main complications belong pneumonia, encephalitis and malnutrition. Vaccination against whooping cough is given in childhood; older travelers to endemic areas are sometimes advised to have a revaccination.

  • Hepatitis B

    Hepatitis B is a viral disease transmitted by blood, sexual intercourse and from mother to child. It causes liver inflammation, yellowing of the skin and sclera; chronic infection may lead to cirrhosis and liver cancer. The risk of infection is lower in cases of short journeys, however increases in dependence on sexual behavior /hepatitis B is more infectious than HIV/. In cases of long term stay, vaccination against hepatitis B is recommended because the possibility of treatment at dentist or other health center is higher. Hepatitis B prevalence is high in countries of Sub-Saharan Africa, Southeast Asia, the Amazon region and the Caribbean. In Slovakia the vaccination against hepatitis B is given in childhood since 1998. The vaccine is administered 0.5 to 1 ml intramuscularly, second dose after 28 days and third dose after 6 months. Immunity lasts for 15 years.

  • Haemophilus Infection

    Hamophilus influanzae bacteria in children is common cause of pneumonia, meningitis and other life threatening complications such as epiglottitis, osteomyelitis, arthritis and sepsis. In danger of getting infected are all unvaccinated children under 5 years.

  • Measles

    Measles is a highly contagious disease transmitted by direct contact with ill person. It affected almost the whole pre-adolescence population in the pre-vaccination era. Common complication of the disease is otitis media and pneumonia. Travellers that are not completely vaccinated are endangered by this disease when travelling to endemic areas. Vaccination is given in childhood, by trivalent vaccine (together with vaccination against mumps and rubella).

  • Mumps

    Epidemic parotitis is a viral disease that primarily affects salivary glands. Most often affecting children, it can also cause complications to adults, e.g. orchitis, meningitis. Travellers that are not completely vaccinated are endangered by this disease when travelling to endemic areas. Vaccination is given in childhood by trivalent vaccine (together with vaccination against measles and rubella).

  • Rubella

    Rubella is an infectious disease with mild course, however infection in the first trimester of pregnancy may cause defect or even death of fetus. Thus, when travelling into endemic areas, pregnant women that were not completely vaccinated are especially in danger. Vaccination is given in childhood by trivalent vaccine (together with vaccination against measles and mumps).

  • Poliomyelitis

    The disease is transmitted via fecal-oral route. Vaccination against poliomyelitis (polio) is given in childhood, revaccination is recommended after 10 years for individuals travelling into risk areas that include parts of Africa, Afghanistan and the Indian subcontinent.

  • Tuberculosis

    Risk for travelers is low, increasing in case of a long term stay in areas with high tuberculosis incidence, especially at professional exposition in health centers, refugee camps, prisons, homeless shelters, etc. Vaccination against tuberculosis is given in childhood; this vaccination is supposed to prevent severe forms of disseminated tuberculosis.

Recommended Vaccination

  • Rabies

    In endemic areas travelers should avoid activities that increase the risk of exposition to animas (playing with dogs and cats, running, cycling). Prophylactic vaccination against rabies is recommended especially to those travelling to remote areas where it is not possible to visit the health center promptly. Administered 1 ml intramuscularly on days 0, 7, 21-28. Revaccination is required every 3 years. After being bit or scratched by animal it is necessary to immediately find medical help, even in case you were vaccinated against rabies.

  • Typhoid fever

    The disease is closely associated with low levels of hygiene and sanitation. It is transmitted via fecal-oral route, especially via contaminated food and water. Vaccine contains bacteria surface antigen, it is administered in a single dose 0.5 ml subcutaneously or intramuscularly. Immunity occurs after 2 weeks since vaccination and lasts for around 3 years.

  • Hepatitis A

    The disease is associated with low levels of hygiene and sanitation. It is transmitted by infected food and drink, through contact with people and via fecal-oral route. The vaccine is inactivated and contains antigens. It is administered as a single 0.5 or 1 ml intramuscularly; immunity occurs approximately after two weeks and lasts for a year. When revaccinated after 6 to 12 months since the first dose, immunity lasts for at least 10 years.

  • Hepatitis B

    Hepatitis B is a viral disease transmitted by blood, sexual intercourse and from mother to child. It causes liver inflammation, yellowing of the skin and sclera; chronic infection may lead to cirrhosis and liver cancer. The risk of infection is lower in cases of short journeys, however increases in dependence on sexual behavior /hepatitis B is more infectious than HIV/. In cases of long term stay, vaccination against hepatitis B is recommended because the possibility of treatment at dentist or other health center is higher. Hepatitis B prevalence is high in countries of Sub-Saharan Africa, Southeast Asia, the Amazon region and the Caribbean. In Slovakia the vaccination against hepatitis B is given in childhood since 1998. The vaccine is administered 0.5 to 1 ml intramuscularly, second dose after 28 days and third dose after 6 months. Immunity lasts for 15 years.

  • Cholera

    There is available vaccine (Dukoral) for people travelling to high endemic areas, especially for humanitarian workers and medical personnel in refugee camps. The vaccine is administered orally, for adults and children over 6 years in two doses during the course of at least one week, for children in age from 2 to 6 years there are 3 doses needed. Revaccination is recommended after 2 years.

  • Japanese encephalitis

    It is a rare, but serious viral disease that occurs throughout whole Southeast Asia. It is transmitted by gnats. Currently there is available vaccine IXIARO that is administered in two doses during the course of 28 days. Immunity occurs approximately after two weeks and probably lasts for 3 years. Vaccination is recommended to individuals that plan a long term stay in countryside in endemic areas.

  • Tick-borne encephalitis

    It is a viral disease transmitted by ticks, rarely even via drinking raw milk. Vaccination is recommended to tourists heading into woodland and grassland areas in certain European countries. Countries with the highest incidence are: Austria, Estonia, Lithuania, Czech Republic, Slovakia, Germany, Hungary, Poland, Switzerland, Russia, Ukraine, Belarus, Bulgaria, Romania and Iran. Lower incidence is in Denmark, France and in southern Sweden. Risk for travelers is higher when hiking, camping and working in forested terrain. The highest risk is during spring and summer season. The vaccine (FSME) in administered in three doses: 0, after 1 to 3 months and 5 to 12 months after second dose. Immunity lasts for three years. Further revaccination is recommended.

  • Meningococcal meningitis

    The disease is transmitted by droplets from the respiratory tract and by close contact with ill person or carrier. The vaccine is administered in one dose 0.5 ml subcutaneously or intramuscularly, immunity occurs after two weeks since vaccination and lasts for approximately 5 years. Vaccination against meningitis is recommended when the person is travelling to endemic areas, especially in sub-Saharan Africa. When travelling to Saudi Arabia during the Hajj pilgrimage, vaccination with quadrivalent vaccine (ACYW) is obligatory.

  • Yellow fever

    It is a serious viral disease transmitted by gnats. Yellow fever occurs in tropical areas of Africa and South America. Vaccine (Stamaril) contains a weakened virus and is administered in a single dose of 0.5 ml into the subcutis. Immunity occurs after 10 days since vaccination and lasts for 10 years. The vaccination must be recorded in the International vaccination card. The record about vaccination must be carried - when entering some countries you are obliged to demonstrate this evidence.

Compulsory vaccination

  • Yellow fever

    It is a serious viral disease transmitted by gnats. Yellow fever occurs in tropical areas of Africa and South America. Vaccine (Stamaril) contains a weakened virus and is administered in a single dose of 0.5 ml into the subcutis. Immunity occurs after 10 days since vaccination and lasts for 10 years. The vaccination must be recorded in the International vaccination card. The record about vaccination must be carried - when entering some countries you are obliged to demonstrate this evidence.

  • Meningococcal meningitis

    The disease is transmitted by droplets from the respiratory tract and by close contact with ill person or carrier. The vaccine is administered in one dose 0.5 ml subcutaneously or intramuscularly, immunity occurs after two weeks since vaccination and lasts for approximately 5 years. Vaccination against meningitis is recommended when the person is travelling to endemic areas, especially in sub-Saharan Africa. When travelling to Saudi Arabia during the Hajj pilgrimage, vaccination with quadrivalent vaccine (ACYW) is obligatory.

Travel First Aid Kit

The content of travel first aid kit depends on the length of your stay, intended activities and areas you want to visit. It is important to consider the availability of health care facilities in the country.

Travel first aid kit for short journeys to tropical and subtropical areas should contain:

  • regularly taken medicine
  • suitable dressing material (bandage, gauze, plasters)
  • disinfectants (alcohol swabs, tools for disinfecting hands and wounds)
  • analgesic, antipyretic
  • motion sickness medicine
  • diarrhea medicine, mixture for the rehydration solution
  • sore throat medicine, cough medicine
  • antihistamine - cream, pills
  • antifungal + antibiotic ointment / cream
  • repellent
  • antimalarials
  • water disinfection tablets

Incidence Maps

Diseases

Travelers are exposed to many infectious diseases. The risk of infection varies according to the destination, planned activities, travel itinerary, accommodation standard and behavior of the traveler. Some diseases can be prevented by vaccination, against others, including the most dangerous ones, vaccine does not exist.

  • Anthrax

    is a bacterial disease that primarily affects the cattle. Cutaneous anthrax is typically caused when bacillus anthracis spores enter through a wound during the manipulation with ill animals or during a contact with a soil contaminated by excrements. Untreated infection can spread via lymphatic vessels, which leads to the widening of regional lymph node, spread of blood and even death. Sporadic cases occur worldwide, rare epidemics occur in Central Asia and Africa. The risk for travelers is very low. Prevention: Avoid direct contact with soil and materials from domestic animals.

  • Rabies

    is a viral disease, transmitted mostly by infected saliva that enters the body through a bite from an infected animal. Symptoms of rabies are brain and spinal cord disabilities; in almost all cases the disease leads to death. At first the patient feels headache, lassitude associated with fever and changes in sensitivity around the bite, consequently there occurs excitation, hallucinations, aero-and hydrophobic, delirium, coma, convulsions; death occurs within few days. Less frequent is the paralytic form when the patient feels weakness, strong pain, changes in sensitivity and is paralytic. The disease occurs worldwide. Risk for travelers is higher with exposition to animals - dogs, cats, wild animals, bats. Prevention: Avoid contact with animals, when bit or scratched, immediately wash the wound with disinfectant or soap and find medical help for post-exposure prophylaxis. Travelers with higher risk should be vaccinated before leaving to hyperendemic areas

  • Brucellosis

    is a bacterial disease that primarily affects cattle, pigs, sheep, goats and dogs. It is transmitted to humans by direct contact with animals and via consummation of raw milk and cheese. Occurs worldwide, mainly in developing countries, in the Mediterranean, the Middle East, Central Asia and South America. Risk for travelers is very low, however increases when staying in rural areas. Prevention: Avoid close contact with domestic animals; do not consume raw milk and diary products.

  • Typhoid fever

    is a bacterial disease, transmitted by consuming contaminated water or food; direct transmission via fecal-oral route is very rare. Food can be contaminated by flies. The disease occurs worldwide, especially in connection with low hygienic standard of food preparation. It is a systemic disease. Symptoms are of varied intensity, with fluctuating fever, headache, malaise, anorexia and insomnia. Constipation is usually more common. Without treatment, the fever becomes permanent, liver becomes bigger and the heart rates become slower. Rash appears on the trunk. On the third week there appear complications that can lead to death. From 2 to 5% of patients remain chronic carriers. The risk for travelers is generally low, increases with lowering of the hygienic standards of visited places. Prevention: Drink water from originally packed bottles; be particular about the hand hygiene and consummated food which has to be protected against flies. Do not eat ice and raw vegetable. Vaccination.

  • Dengue

    is a viral disease transmitted by gnats. Occurs in tropical and subtropical areas of Central and South America, South and Southeast Asia but also in Africa and Oceania. Symptoms are fever, exanthema, muscle and joints pain, sometimes accompanied by bleeding. Most of the patients recover after few days; however the mortality can increase to 40% in cases of severe course of the disease accompanied by shock and bleeding and without adequate treating. Risk for travelers in endemic areas is high. Prevention: Protection against gnat bite.

  • Chikungunya

    is a viral disease transmitted by gnats that bite mainly during the day. Occurs in sub-Saharan Africa, Southeast Asia, tropical Indian subcontinent and the Indian Ocean islands. The symptoms are fever, headache, muscle pain, exanthema and joints pain, especially of the hand, wrist and ankles. Patient recovers within few days but the joints pain persists for several months. Infection is also often asymptomatic. Risk for travelers is higher when staying in endemic areas. Prevention: Protection against gnat bite.

  • Cholera

    is a bacterial disease, transmitted mainly by ingestion of contaminated water. Occurs in developing countries without infrastructure, sewerage and drinking water, especially in Africa, Asia, Central and South America. Symptoms are: frequent and liquid bowel movements and vomiting accompanied by dehydration which, when not treated, can end in collapse and even death. Risk for travelers is very low even when epidemics are present in the country. Especially in danger are humanitarian workers, particularly in refugee camps and disaster areas. Prevention: Avoid ingestion of contaminated food and water; it is suitable to have a rehydration solution and antibiotics. Vaccination.

  • Flu

    is a viral disease transmitted by droplets from ill person, especially via coughing and sneezing in crowded rooms without ventilation. Transmission is also possible via contaminated hands. The disease occurs worldwide, especially during winter season. The symptoms are: fever, coughing, headache, muscle pain and weakness. Risk for travelers is high during the epidemic, which can also occur during a long voyage. When traveling to the opposite hemisphere you can encounter a different kind of virus. Prevention: Avoid crowded rooms and events during the flu epidemic, avoid a close contact with ill person, regularly wash your hands, get a vaccination against seasonal and swine flu.

  • Filariasis - Lymphatic, Onchocerciasis

    are parasitic diseases transmitted by gnats and flies, occur in Sub-Saharan Africa, Southeast Asia, the Pacific and South America. It is a chronic disease where adult vermin interlocks the lymph vessels with further swelling of limbs, breast and scrotum. Microfilariae can cause blindness and even brain damage. Risk for travelers is low, increased by long term stay in endemic areas. Prevention: Protection against gnat and fly bite.

  • Giardiasis

    is a parasitic disease occurring mainly after ingestion of contaminated water. The disease incidence is worldwide. It can show no symptoms, which are usually diarrhea, cramps, meteorism and lassitude. Risk for travelers is high especially when swimming in water contaminated by animal excrements and drinking contaminated water. Prevention: Avoid consumption of food without heat treatment and contaminated water. It is suitable to boil the water at least 5 minutes, eventually disinfect with chlorine.

  • Hantavirus disease

    is a viral disease transmitted mainly by rodents. The infection occurs through direct contact with excrements, urine and saliva of the infected rodents, eventually through inhalation of viruses from excrements. The disease occurs worldwide. Symptoms are: fever, lassitude, damage and even defection of kidney and pulmonary edema with symptoms of bleeding. Lethality is from 15 to 50%. Risk for travelers is very low, increased in areas with a high incidence of rodents. Prevention: Avoid contact with rodents and their secretions; protect the food from possible contamination.

  • Haemorrhagic fever

    Haemorrhagic fever is caused by viruses; among the most important ones belong Ebola, Marburg, Lassa, Crimean-Congo haemorrhagic fever, Rift valley fever, dengue, hantavirus disease and yellow fever. (The last three are described in separate chapters.) Some of them are transmitted by gnats (dengue, yellow fever, and Rift valley fever), ticks (Crimean-Congo haemorrhagic fever), rodents (hantaviruses, Lassa) or bats (Ebola, Marburg). These diseases are spread in tropical and subtropical areas, especially in Sub-Saharan Africa, Crimean-Congo haemorrhagic fever in the Central Asia as well. They are acute diseases accompanied by fever, lassitude, headache, muscle pain, vomiting and diarrhea followed by exanthema and bleeding from mucous membranes. Most of cases end in death (50%). Risk for travelers is low, increased for persons visiting rural and forested areas. Prevention: Avoid gnat and tick bite and contact with rodents and bats.

  • Hepatitis A, B, C, D, E

    is a viral disease that primarily affects the liver. Hepatitis A and E is transmitted via fecal-oral route, close contact with ill person and through contaminated food and water. Hepatitis B, C, and D is transmitted through infected body fluids, sexual intercourse, transfusion, use of contaminated needles, procedures invading skin barrier - tattoo, piercing, acupuncture. Transmission from mother to child is also possible. These diseases occur worldwide. The main symptoms are: lassitude, increased body temperature, abdominal discomfort, yellowing of the skin and sclera. Hepatitis B and C can occur without symptoms with later progression to liver cirrhosis and cancer. Risk for travelers for hepatitis A and E is high especially when visiting areas with low hygiene standards, for hepatitis B and C the risk is high when having unprotected sexual intercourse and using unsterilized needles; the risk is also high in health centers with low hygienic standards. Prevention: For hepatitis A and E it is washing hands regularly, avoiding potentially contaminated food and water, vaccination against hepatitis A. For hepatitis B and C it is avoiding unprotected sexual intercourse, using of contaminated needles and vaccination against hepatitis B.

  • HIV

    The disease is transmitted by sexual intercourse, via blood and from mother to child. Occurs almost worldwide, with the highest prevalence in countries of Sub-Saharan Africa. Few weeks after infection the disease acts similarly to flu; this period is followed by few years without any symptoms at all. Right after this period, when the virus weakens the immune system, infection occurs through various opportunistic infections and cancers. The disease is incurable; it can only be suppressed by lifelong use of antiretroviral medicine. Risk for travelers is low, increased with adventitious unprotected sexual intercourse. Prevention: Avoid adventitious unprotected sexual intercourse, use condom, sterilized needles and injections, post-exposure prophylaxis.

  • Japanese encephalitis

    Japanese encephalitis is a viral disease transmitted by gnats of the Culex species. Occurs in Southeast Asia. Most of the diseases run without symptoms, however there can occur headache, in some cases even inflammation of the brain. After severe course of the illness permanent neurological sequelae may remain. About 30% of cases of severe encephalitis end in death. Risk for travelers is low, increased by visits of rural areas during running epidemic. Prevention: Protection against gnat bite, vaccination when staying longer in endemic areas.

  • Tick-borne encephalitis

    is a viral disease transmitted by ticks, eventually through ingestion of raw milk. Occurs in Central and Eastern Europe, from east to Siberia, China, Japan. Its symptoms are similar to flu; 10% of infected people overcome the second phase of fever with inflammation of the brain. In cases of some people, permanent neurological sequelae may remain. Risk for travelers is increased by staying in endemic areas during summer season, especially when camping or hiking.

  • Legionellosis

    is a bacterial disease that occurs after inhalation. Legionella can be often found in air conditioners, humidifiers and bathtubs. Occurs worldwide. Symptoms are: loss of appetite, lassitude, headache and rapid onset of fever, pneumonia, respiratory failure and death. Risk for travelers is low; epidemic sometimes occur when the air conditioner in hotel is contaminated. Prevention: Regular cleaning and disinfection of potential sources.

  • Leishmaniasis

    is a parasitic disease transmitted by flies. Reservoirs are mostly dogs, rodents and other mammals. Occurs in many tropical and subtropical areas. Symptoms are skin changes, e.g. creation of chronic ulcer on the place of bite. The disease can affect internal organs, especially bone marrow, liver and spleen. Risk for travelers to rural and forested areas in endemic countries is increased. Prevention: Protection against fly bite, especially after sunset. It is suitable to use repellents and sleep under a mosquito net.

  • Leptospirosis

    is a bacterial disease. Person can become infected through contact of mucous membrane or wound with contaminated water, moist soil or plants that have been contaminated by rodent urine, eventually through ingestion of food contaminated in such way. The disease occurs worldwide, especially in tropical countries. Symptoms are: sudden onset of fever, headache, muscle pain, cold fever, conjunctival redness and exanthema. There may develop meningitis, hemolytic anemia, jaundice, signs of bleeding or failure of kidney and liver. Risk for travelers is generally very low, increased in areas after floods, when practicing water sports and swimming in fresh waters. Prevention: Avoid swimming and other activities in potentially contaminated waters including water channels, swamps, lakes and rivers.

  • Lyme borreliosis

    is a bacterial disease transmitted by ticks. Endemic foci appears in forested areas of Asia, North, Central and Eastern Europe and the USA. Symptoms are: redness around the bite, fever, shiver and headache and muscle pain. Infliction of meninges of the brain can occur, with further persistence of neurological symptoms. After some time, arthritis can also occur. Risk for travelers is generally very low, increased by camping and hiking in endemic areas. Prevention: Protection against tick bite. Remove the tick after biting as soon as possible.

  • Malaria

    is a common and life threatening parasitic disease transmitted on human by biting of gnat of the Anopheles species. Occurs in many subtropical and tropical areas. Symptoms are: fever, shiver, joints and muscle pain and vomiting as well as diarrhea and abdominal pain, etc. Symptoms occur approximately after 10 or 14 days from infection. Without treatment the disease can lead to failure of individual organs and death. Risk for travelers significantly varies according to visited countries and areas, season and altitude. Prevention: Protection against gnat bite, use of antimalarial prophylaxis, immediate diagnosis and treatment in case of fever that occurs after 7 days from entering a malarious area. Vaccination does not exist.

  • Meningitis

    is an inflammation of the meninges caused by variety of pathogens. Meningitis caused by meningococcal meningitis is especially important for travelers. It is transmitted via droplets from infected person or carrier. Sporadic cases occur worldwide, epidemic occurs particularly in closed, crowded places (dormitories, military barracks). In sub-Saharan Africa huge epidemics arise during the dry seasons (November to June). Risk for travelers is generally low, increased by accumulating of large number of persons, sometimes the epidemic can occur in tourist accommodations. Prevention: Avoid crowded places; in case of incidence of this disease in near area it is necessary to take preventive antibiotics. The vaccine against common types of N. meningitis is available.

  • Plague

    is a disease caused by bacteria, transmitted on human by fleas from infected rodents. In case of pulmonary form, the transmission is also possible by close contact with ill person. Sporadic epidemic occurs worldwide, mainly in Central and Eastern Africa, South America and Asia. The symptoms of plague are mostly enlarged lymph nodes and swelling of the place of bite, sepsis, meningitis as well as affected lungs. Without quick diagnosis and treatment the disease death rate is 50-60%. Risk for travelers is low, increased by staying in rural areas. Prevention: Avoid contact with living and dead rodents. Vaccine is not commercially available, only persons with high exposition risk at work are vaccinated.

  • SARS

    is a viral disease transmitted by close contact with ill person. Its symptoms are fever, lassitude, headache and muscle pain, diarrhea, shiver, cough and hard breathing. From 2002 to 2003 there was an epidemic in China and Hong Kong. Prevention: It is necessary to follow the recommendations of WHO.

  • Sexually transmitted diseases

    The most frequent sexually transmitted diseases are HIV/AIDS, hepatitis B and C, syphilis, gonorrhea, also infections caused by chlamydia, trichomoniasis, and herpes simplex. The infection is mainly transmitted by unprotected sex, in case of HIV, hepatitis B and C and syphilis the transmission is possible via blood /transfusion, contaminated injection, unsterilized tattoo tools, acupuncture and piercing/ and the transmission from mother to child is also possible. Among the most common symptoms of sexual diseases belong: genital ulcer, pain in pelvic area and vaginal or urethral discharge. However, many of the diseases can show no symptoms at all. Course of these diseases can be acute or chronic; they are main causes of sterility, long-term sick leave and even death. They also increase the probability of HIV transmission. Sexually transmitted diseases occur worldwide. The risk of infection is particularly high for some travelers, increased by absence of information on risk and preventive measures as well as adventitious sexual intercourse. There is no risk of infection in common social contact at home, work and public transport; nor are these diseases transmitted by insects. Prevention: During vacation avoid adventitious sexual intercourse and use protection. Never use mutual needles and injections; in case of needed parenteral drug administration in health center always make sure that these tools are sterile and originally packed. Vaccination is available only against hepatitis B and HPV.

  • Schistosomiasis

    Schistosomiasis and bilharsiosis are caused by vermin whose larvae penetrate into skin during swimming in freshwater lakes and slowly flowing rivers. The disease occurs in sub-Saharan Africa, the Arabian Peninsula, Indonesia, Southeast Asia and South America. Its symptoms are: hematuria, diarrhea or liver disease. Treatment consists of taking praziquantel. Prevention: Avoid contact with contaminated water in endemic areas; after accidental exposition it is necessary to thoroughly dry the skin in the sun.

  • Sleeping Sickness

    Sleeping sickness is caused by single-celled parasite and transmitted by tsetse flies. Occurs in several outbreaks of western, central and eastern Africa. Its symptoms are skin changes in the place of bite, headache, enlarged lymph nodes and disturbed sleep. In advanced stage of the disease loss of weight occurs together with neurological changes; without treatment ends in death. Endangered are especially travelers visiting endemic rural areas (safari, hunting, fishing, boating). Prevention: Protection against tsetse fly bite. Clothes of green, grey and khaki color are suitable. Common repellents do not work against tsetse flies.

  • Tuberculosis

    Tuberculosis is caused by mycobacteria and transmitted by close contact with ill person. The disease occurs worldwide. Symptoms are mostly cough, fever, weight loss, night sweats. The treatment lasts for at least 6 months, consists of taking combination of antituberculous. Risk for common travelers is low, increased by long stay in areas of high incidence of the disease. Prevention: BCG vaccine in childhood. Humanitarian and medical personnel with suspected exposure should undergo tuberculin test before departure.

  • Yellow Fever

    is a viral disease transmitted by gnats. Occurs in tropical areas of Africa and South America. Does not occur in Asia. Clinical picture: Biphasic course of the disease is typical; first phase consists of fever rise, headache, muscle pain, cold fever, lack of appetite, vomiting. After few days the second phase occurs; it is characterized by the reappearance of fever, yellowing of the skin and eyes, abdominal pain, vomiting and symptoms of bleeding. The disease can end in death. Risk for travelers: All areas with endemic infection, especially forested and jungle areas. Prevention: Protection against gnat biting during the day and evening, vaccination as a protection against the disease and its spreading to another country.

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