Health Information for Travelers to Eastern Europe and the Newly Independent States of the Former Soviet Union

Food and waterborne diseases are the number one cause of illness in travelers. Travelers� diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Eastern Europe and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites. All travelers to malaria-risk areas in Eastern Europe, including infants, children, and former residents of Eastern Europe, are at risk for malaria. Parts of the countries of Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan have malaria risk.. Travelers to malaria-risk areas in Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan should take the antimalarial drug chloroquine to prevent malaria.

In Uzbekistan, the risk of malaria is low and varies along its border with Tajikistan; travelers to Uzbekistan or their health care provider should contact CDC (Malaria Hotline, 770-488-7788) for risk and prevention advice.

An outbreak of diphtheria is occurring in all the states of the former Soviet Union. Travelers to these areas should be sure that their diphtheria immunization is up to date. Tick-borne encephalitis, a viral infection of the central nervous system occurs chiefly in Central and Western Europe. Travelers are at risk who visit or work in forested areas during the summer months and who consume un-pasteurized dairy products. Vaccine for this disease is not available in the United States at this time. To prevent tickborne encephalitis, as well as Lyme disease, travelers should take precautions to prevent tick bites.

There is no risk for yellow fever in Eastern Europe and the Newly Independent States of the Former Soviet Union (NIS). A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements. Also, find the nearest authorized U.S. yellow fever vaccine center.

CDC recommends the following vaccines (as appropriate for age)

• Hepatitis A or immune globulin (IG).
• Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
• Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
• Typhoid, particularly if you are visiting developing countries in this region.
• As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults. Hepatitis B vaccine is now recommended for all infants and for 11� to 12-year-olds who did not receive the series as infants.

• Wash hands often with soap and water.
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an �absolute 1-micron or less� filter AND adding iodine tablets to the filtered water. �Absolute 1-micron filters� are found in camping/outdoor supply stores.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• If you are going to visit risk areas for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)  

• Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
• Wear long-sleeved shirts, long pants, and hats.
• Use insect repellents that contain DEET (diethylmethyltoluamide).
• Read and follow the directions and precautions on the product label.
• Apply insect repellent to exposed skin.
• Do not put repellent on wounds or broken skin.
• Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children�s hands or around eyes and mouth.
• For details on how to protect yourself from insects and how to use repellents, see Protection against Mosquitoes and Other Arthropods.
• If you are visiting friends and relatives in your home country in areas where malaria occurs, please read the malaria prevention recommendations for recent immigrants on the CDC malaria site.  

Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases. 

• Don�t eat food purchased from street vendors.
• Don�t drink beverages with ice.
• Don�t eat dairy products unless you know they have been pasteurized.
• Don�t share needles with anyone.
• Don�t handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague). 

• Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects.
• Insect repellent containing DEET.
• Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
• Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Over-the-counter antidiarrheal medicine to take if you have diarrhea.
• Iodine tablets and water filters to purify water if bottled water is not available.
• Sunblock, sunglasses, hat.
• Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s). 

If you have visited a malaria-risk area in Eastern Europe, continue taking your chloroquine for 4 weeks after leaving the risk area. Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.