Vaccinating travellers

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Hepatitis A is a common disease in many parts of the world. The virus is transmitted through food, sewage-contaminated water, or the feces-contaminated hands of people who have the disease or are recovering from it. The disease can be subtle, but vaccination is one of the most effective known. One dose is enough to provide short-term protection, at least ten days before entering an area where transmission has stopped. Two doses of the vaccine are required 6–12 months apart to obtain long-term protection. Booster doses are not necessary after these two doses are completed.

Symptoms
Initially, the preceding symptoms of jaundice predominate with flu-like symptoms, upper abdominal discomfort, loss of appetite and nausea, fever up to 39°C, and occasional muscle and joint pain. A few days later, yellowing and darkening of the urine and faeces may occur. Jaundice and itching can last for weeks or months. Not everyone infected develops symptoms, but most people feel tired and have little appetite for weeks or months. Children get symptoms less often than adults, and most children under six are asymptomatic, but they can easily pass the infection on. Hepatitis A always resolves, i.e. the infection never becomes chronic.

The gestation period of hepatitis A, i.e. the time from infection to the onset of symptoms, is usually around four weeks but can be anywhere from two to six weeks.

Diagnosis
Hepatitis A is diagnosed by measuring antibodies in the blood. Results are available within a few days of taking the test.

Treatment
Hepatitis A resolves spontaneously without any treatment.

Prevention
Great care should be taken when choosing food and water in countries lacking sanitation. Hepatitis A can be prevented by vaccination or injecting antibodies into the muscle. The antibodies protect for only 2-3 months. The vaccine is given in two injections 6–12 months apart to persons one year of age and older, and it is believed to protect for at least 20 years. When an infection is known, the person should remember that good hand washing after using the toilet and before handling food is the most effective protection against infecting others.

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Hepatitis B is common in many parts of the world. The virus is transmitted between people through close contact (sexual intercourse, from mother to child during childbirth, or even if an infected person bites another) or through needle injuries, blood transfusions if the blood is not screened for the virus, and similar situations.

What is Hepatitis B?

Hepatitis B means inflammation of the liver caused by the Hepatitis B virus, which is one of many viruses that can cause liver inflammation. The first symptoms of the infection are due to acute hepatitis, which resolves over time, but not everyone develops symptoms. Some infected individuals develop chronic hepatitis, especially if the infection occurs in childhood.

How is Hepatitis B transmitted?

The virus is found in body fluids such as blood, semen, and vaginal fluids/mucus, even before symptoms appear and in asymptomatic individuals. During sexual intercourse, the virus is transmitted through these body fluids via the genitals, mouth, and rectum. The virus can also spread through blood contamination and needle sharing. A child can become infected during childbirth if the mother is infectious.

How can I prevent transmission?

Vaccination against Hepatitis B is an effective way to prevent infection. Hepatitis B vaccination is not part of the routine childhood vaccination schedule in this country, but it can be received at health clinics, hospitals, and places offering travel vaccinations.

Two doses with a minimum of 4 weeks apart are needed for short-term protection (up to 18 months), and a third dose is required 6-12 months after the first dose for long-term protection. No booster shots are needed after completing the recommended 3-dose series.

Correct use of condoms can prevent transmission. People who use injectable drugs should avoid sharing syringes or needles with others.

Is Hepatitis B dangerous?

Acute Hepatitis B can, in rare cases, lead to death. Chronic Hepatitis B can be severe and life-threatening. It may develop into cirrhosis of the liver and liver cancer.

What are the symptoms of Hepatitis B?

Acute Hepatitis B often causes abdominal pain and jaundice (yellowing of the skin). Nausea, fever, and fatigue are also common, along with dark urine and light-colored stools. Some people may also experience joint pain. Hepatitis can also be completely asymptomatic.

When do symptoms appear after exposure?

Symptoms of acute Hepatitis B usually appear 2 to 3 months after exposure.

How is Hepatitis B diagnosed?

Hepatitis B is diagnosed with a blood test, which can be done by any doctor, and the results are typically available within a few days.

Is there treatment for Hepatitis B?

Treatment is available for acute Hepatitis B but is only used in severe cases. Individuals who contract the virus as adults often recover from the infection, while children often develop chronic infections. If Hepatitis B develops into chronic hepatitis, treatment may be available in some cases.

Preventive treatment is available through vaccination, and individuals at risk but not yet infected can be vaccinated. It is recommended that newborns receive the vaccine immediately after birth if their mother has a chronic infection.

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Typhoid fever is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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Yellow fever is a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration are a public health threat.

When yellow fever is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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Meningococcal meningitis, especially of type A, which is not vaccinated against in Iceland, is common in epidemics in the savanna areas of West and Central Africa south of the Sahara during the dry season, from December to June every year. The disease is often fatal, and the course of the disease can be very rapid. There are vaccines against type A only in these countries, but those who provide tourist vaccinations in Iceland can get a vaccination against types A, C, W135, and Y together. There may be a reason for revaccination after 1–5 years if repeated trips are made to the area at the time of the year when the risk is greatest.

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Rabies is a deadly viral infection. The disease is transmitted by bites, scratches, or licks (over wounds or mucous membranes) from animals that carry the disease and are often obviously sick, but not always. It varies from country to country which animals are most likely to infect humans, usually dogs (Europe, Asia, Africa) or bats (America), but all mammals can be infected, and people can be infected by cats, monkeys, or various other forest animals, e.g. foxes, felines or raccoons. Few travellers need a rabies vaccination, but it is essential to respond appropriately to injuries caused by animals. If you are bitten or bitten by an animal abroad, you should:

• Wash the wound thoroughly with soapy water or rinse the wound.

• Contact a doctor. You may need treatment for rabies, and antibiotics are often required after an animal bite.

• Contact the owner of the animal, if possible. Make sure the animal is vaccinated against rabies. The owner must be notified if the animal becomes ill or dies within two weeks.

In rare cases, there may be a reason to get vaccinated in advance, which simplifies the treatment if a bite occurs, e.g. when a trip has been taken to work on the markings of forest animals or the trip is very remote, where the disease is relatively common and it is not possible to get appropriate medical help if something happens, e.g. in Nepal.

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Japanese encephalitis is a mosquito-borne viral infection that can cause severe symptoms. The chances of getting the disease are small, but it is advisable to get vaccinated against it if you stay in the countryside of countries where it is endemic. It occurs in many parts of Asia but is very rare and tends to occur in epidemics, in some places annually, but often irregularly. The spread of the disease is seasonal and follows the prevalence of mosquitoes. In China, Korea and other regions, the disease is most common in summer and autumn. In tropical regions, the risk is related to the rainy season, which can vary from country to country. However, the risk of contracting Japanese encephalitis is very low. There is a vaccine against Japanese encephalitis. Vaccination is primarily recommended for those who intend to stay in rural areas where the disease is endemic for four weeks or longer and when an epidemic is known to be in progress.

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Cholera is an infectious disease spread through contaminated water and food and causes bloody diarrhoea. The risk of infection is very low. Vaccines that have been used against this disease have been ineffective. Cholera vaccination is, therefore, generally not recommended except in exceptional cases, e.g. for those who have stomach ulcers and are on treatment that works against stomach acid. Improved vaccines have been developed but do not protect against all forms of cholera. The World Health Organization does not require vaccination for tourists.

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Recommended travel vaccinations against diphtheria and polio for all travel abroad, for those aged 24 and over who have not received such vaccinations in the last ten years.

Diphtheria is a disease caused by bacteria that is highly contagious and begins in the upper respiratory tract. The disease manifests as a sore throat with irritating mucous membranes in the mouth and nose. The bacterium produces a toxin that is released into the blood and is harmful to the body's tissues, e.g. heart muscle, kidneys, and nervous system. Antibiotics kill the bacteria but do not prevent the toxic effects. Diphtheria can become a severe disease and lead to death, but 40-50% of those who do not receive treatment for the disease die from it.

Epidemiology
Diphtheria was a widespread disease years ago but is rare today due to the powerful and widespread vaccination against it. The last time diphtheria was diagnosed in Iceland was in 1953. The disease is easily transmitted between people, and the experience of many Eastern European countries shows that this disease, like other diseases, can spread if vaccinations are relaxed. Unvaccinated children under the age of 5 and adults over 60 are the most exposed to infection.

Modes of transmission and gestation period
Diphtheria is highly contagious. The bacterium is transmitted between people by droplet or spray transmission from the respiratory system, i.e. by coughing, sneezing, or laughing, which then gets into the mucous membranes of the mouth or nose with the hands. It only takes 2-4 days from infection until the disease symptoms appear. The bacteria can also enter the body through wounds on the skin. There are examples of asymptomatic individuals being carriers without getting sick themselves.

Symptoms
The symptoms of the disease can be individual. The most common symptoms are a severe sore throat with a grey ridge covering the mucous membrane of the mouth and pharynx with associated swallowing and breathing difficulties. Added to this are enlarged lymph nodes in the throat, hoarse and slurred voice, rapid heartbeat, sore nasal mucosa, swollen upper palate, fever, double vision, and disuse.

The disease can become severe. The thick mucus accompanying the disease can cover the airway and prevent the person from breathing. The bacterium then emits a toxin that can be carried through the blood to the various organs, including the kidneys, heart, and nervous system, thus impairing their function, causing permanent damage, or even paralysis.

If the diphtheria bacterium enters the body through the skin, the symptoms are usually milder, but in addition to other symptoms, yellow spots or soreness in the skin may develop.

Diagnosis
Initially, the symptoms of diphtheria resemble a bad sore throat with fever and swollen lymph nodes. But what distinguishes diphtheria from similar diseases is a toxin produced by the bacterium, which forms a thick grey coating that settles on the mucous membranes of the nose, throat, and airways and can cause breathing and swallowing difficulties. The disease can be diagnosed by taking a sample from the throat and putting it in a culture.

Treatment
Those who get sick with diphtheria almost always have to be hospitalised and are kept in isolation. When a diagnosis is made, an antibody against the toxic effects of the bacteria is given, as well as penicillin. Other consequences caused by the poison released by the bacteria, e.g. on the heart muscle and kidney, are treated separately. When the disease is very severe, the patient may need to be put on a ventilator.

Vaccinating everyone in the infected person's immediate environment is necessary to prevent further spread. Once the patient has recovered from the illness in 4-6 weeks, they need vaccination to prevent them from getting the disease again later.

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Travel vaccinations for diphtheria and polio for all trips abroad are recommended for 24-year-olds and older who have not received such vaccinations in the last ten years.

Polio is an infectious disease caused by a virus that can affect the body's nervous system and cause paralysis, leading to death. Those most at risk of contracting the disease are newborns, young children, and unvaccinated individuals. The risk of being paralysed by the disease increases with age.

Epidemiology
Since the vaccination against the disease began in 1955, significant success has been achieved, and the disease has almost been eradicated worldwide. However, polio still threatens young children in poorer countries where access to vaccines is limited.

Transmission and gestation period
The polio virus is highly contagious and can be transmitted to humans by aerosol transmission, i.e., by spray from the respiratory system (e.g., sneezing) and faecal contamination in drinking water and food. The virus can be present for weeks in the stools of infected people. Hygiene is essential to prevent infection, and good hand washing is the most important.

Symptoms
The vast majority of those who get sick, about 90-95%, get mild flu-like symptoms, manifesting as general weakness, fever, decreased appetite, nausea, vomiting, sore throat, constipation, and stomach pain. More severe symptoms include pain and reduced strength in the body's musculoskeletal system, neck stiffness, muscle atrophy, hoarseness, and difficulty breathing and swallowing. In the most severe cases, there will be muscle paralysis, paralysis of the bladder, and symptoms such as restlessness, involuntary drooling, and a distended abdomen.

Diagnosis
In addition to a medical examination, the polio virus can be diagnosed by measuring antibodies against the virus in the blood and cerebrospinal fluid. The virus can also be detected in a stool or urine sample and a throat swab.

Treatment
No treatment or medication can cure the disease. In general, treatment is aimed at reducing symptoms.

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Most people in Iceland have been vaccinated against tetanus in childhood and, therefore, do not generally need to be vaccinated as adults. There is a specific risk of tetanus worldwide if dirt gets into a wound, e.g. when practising extreme sports. Therefore, travellers should be vaccinated if more than ten years have passed since the last vaccination.

Tetanus is a severe infection caused by a bacteria called Clostridium tetani. This bacterium is present in many natural places, such as in soil and livestock droppings. Still, it is found in the intestines of humans and animals (herbivores) without causing any harm. When the bacterium enters a wound, it produces a toxin that affects the human central nervous system, causing stiffness and convulsions that can be life-threatening.

Modes of transmission and gestation period
Infection occurs due to dirt entering puncture wounds or open wounds. The bacterium takes residence in the wound and begins to produce a toxin that travels through the body through the bloodstream, mainly affecting the central nervous system and muscles. From the time of infection, it can take anywhere from one day to one month for symptoms to appear, but it is most common for them to appear after 6-8 days. Contagion does not spread between people.

Symptoms
The first symptoms of infection may be fever, sweating, rapid pulse, irritability, and localised pain in the muscles closest to the wound. Jaw stiffness, contraction of facial muscles, difficulty swallowing, and breathing may also be seen. The spasms and stiffness can spread throughout the body, e.g. to the abdominal and back muscles, and cause respiratory and cardiac arrest.

Diagnosis
The disease is usually diagnosed by history and symptoms. The bacteria can also be detected in a swab from the wound.

Treatment
There is an antidote that works if acted upon quickly enough. Other treatments include wound care, antibiotics, and anticonvulsants. A severe infection caused by tetanus requires hospitalisation.

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Tuberculosis is a severe infectious disease caused by the bacterium Mycobacterium tuberculosis. Mycobacterium bovis, which causes bovine tuberculosis, can also cause human infections. The bacteria are transmitted from one organism to another by airborne respiratory tract infections, which spread through the body through the bloodstream and can nest in various organs. Lung infection is most common, but the bacteria can also spread to other organs such as the kidneys, the central nervous system, and bones. It is estimated that 10% of those who become infected develop a disease with active tuberculosis in the first two years after infection. Those who have been infected but do not develop symptoms of the disease have secret tuberculosis. With the secret of TB, the bacteria is present in the body but does not cause infection, and the person is not infectious.

You can carry the TB bacteria for the rest of your life without the onset of the disease, as your immune system can keep the infection at bay. The bacteria can multiply with a weakened immune system, and the disease can take over. In the case of latent tuberculosis, treatment is given to prevent the bacteria from spreading in the body later.

The epidemiology

TB was most likely introduced to Iceland during the settlement age, but it was in the 1900s that it became prevalent in Iceland. About 150-200 people died annually between 1912-1920. In the 1950s, TB was significantly reduced by introducing anti-tuberculosis drugs. In recent years, cases of TB have been diagnosed in Iceland between 10–20 per year.

The rate of TB increased again in the mid-nineties, mainly due to the spread of HIV and the impact of the AIDS epidemic on the prevalence of TB in poor countries and, therefore, worldwide.

HIV-infected people are at greater risk of active tuberculosis. The HIV weakens the immune system and prevents it from working on the tuberculosis bacteria. Thus, TB and HIV co-infection are life-threatening.

The TB bacterium is widespread worldwide, and it is believed that 1/3 of the world population has secret TB, meaning it is not contagious. Still, when immunosuppressed, the infection can become active.

Transmission routes and incubation periods

Tuberculosis is most commonly transmitted by aerosols and droplets produced by coughing and sneezing of persons with tuberculosis bacteria in the sputum. Tuberculosis in vocal cords, which is rare, is the most contagious. Although TB is an infectious bacterium, it is not spread as quickly as influenza and measles viruses. It is more likely to be transmitted between individuals who are in close contact, such as family members and work colleagues, and infection in tight-knit prisons has also been a problem.

Symptoms

The main symptoms of tuberculosis infection are cough, weight loss, weakness, fever, night sweats, chills, and lack of appetite.

The TB bacteria mainly affects the lungs, causing symptoms such as chronic cough with or without bloody sputum, chest pain, and pain when breathing and coughing. Tuberculosis can also affect other body parts, such as the kidneys, spinal cord, and bone. The symptoms of infection depend on the location in the body. Spinal cord infection causes back pain; kidney infection causes blood in the urine, and bone infection causes musculoskeletal pain.

Diagnosis

The diagnosis of tuberculosis is multifactorial and is based on the disease picture, skin test (PPD), or blood test that measures cellular resistance to tuberculosis bacteria. Sputum samples/other specimens should be obtained from the lower respiratory tract or other infection sites by microscopic examination and tuberculin culture. However, PCR (the DNA of the tuberculosis bacteria) should also be analyzed. Image analysis is also an important research method for the diagnosis of tuberculosis.

Treatment

To eradicate infectious tuberculosis, individuals must undergo continuous multi-drug treatment for at least six months to prevent the bacteria from developing drug resistance. In a standard treatment, four drugs are administered for the first two months and then two drugs for four months. The treatment results are excellent if the patient is adherent and takes medication as directed. A person who has been treated for tuberculosis for two weeks should not be infectious any longer. In multidrug-resistant TB, the treatment is longer and more complex; drugs must be selected for bacterial sensitivity, and, if possible, at least four active drugs must be available for treatment. In the case of latent tuberculosis, treatment is given to prevent the bacteria from spreading in the body later. The standard minimum treatment for latent tuberculosis is one anti-tuberculosis drug for at least six months.

Prevention

Prevention is a crucial priority for TB prevention and control and is good healthcare that provides fast diagnosis and early treatment to prevent infection. The environment of vectors is used to provide preventive management to those who have become infected.

The latter year is mainly responsible for two factors affecting the spread of tuberculosis. On the one hand, HIV/AIDS is common in countries where TB is endemic, but HIV infection increases the risk of TB in individuals at least one hundredfold. However, multidrug-resistant strains of the bacteria have developed; these strains have developed resistance to antibiotics, so the drugs do not work on the disease.

Multidrug-resistant tuberculosis (TB) bacteria are a growing threat worldwide. New anti-tuberculosis drugs have not been introduced for some time, and treatment prospects are much lower for infections caused by multidrug-resistant TB, in addition to which the treatment is many times more expensive. To prevent the development of resistance, physicians and patients must follow minimum standards for treating tuberculosis.

Vaccination

BCG vaccine was introduced in the market in the first half of the 20th century but has not been included in general vaccinations in Iceland. The vaccine is used worldwide and is very effective in preventing life-threatening tuberculosis infection in infants.

Other languages:

Icelandic: Leiðbeiningar fyrir sjúklinga með smitandi berkla utan sjúkrahúss
Polish: Instrukcje dla pacjentów z gruźlicą zakaźną poza szpitalem
Lithuanian: Instrukcijos užkrečiamąja tuberkulioze sergantiems pacientams, kurie gydosi ne
Ukrainian: Інструкція для хворих на заразний туберкульоз поза стаціонаром
Filipino: Mga tagubilin para sa mga pasyenteng may nakakahawang tuberkulosis sa labas ng ospital

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by tuberculosis with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

For further details:

Tuberculosis - Mayo Clinic
What is tuberculosis? - The Icelandic Web of Science (Icelandic)

• Heilsuvera - Travellers

• Fit For Travel

• Vaccination.dk

• CDC Traveler's Health

• International Travel and Health (WHO)

• International Society of Travel Medicine