Eastern Europe and Northern Asia
Travel To Eastern Europe & Northern Asia
* Albania * Armenia * Azerbaijan * Belarus * Bosnia and Herzegovina * Bulgaria * Croatia * Czech Republic * Estonia * Georgia * Hungary * Kazakhstan * Kyrgyzstan * Latvia * Lithuania * Moldova * Poland * Romania * Russia * Serbia and Montenegro * Slovakia * Slovenia * Tajikistan * Turkmenistan * Ukraine * Uzbekistan
Access to clean water and adequate levels of sanitation are limited in many parts of region. Vaccine-preventable diseases remain a problem where levels of immunisation are low. The public health infrastructure has deteriorated in areas of conflict; political instability has threatened health in some areas.
Common infections in travellers include gastrointestinal infections, respiratory infections, and occasionally vector-borne infections. Chronic and latent infections immigrants (and long-term residents) include tuberculosis (including multidrug-resistant TB) and late sequelae of hepatitis B.
Vector-borne infections: Malaria transmission occurs seasonally in focal rural areas of countries in the southernmost part of the region (Armenia, Azerbaijan, Georgia, Tajikistan, Turkmenistan, and Uzbekistan). Tick-borne encephalitis is widespread, occurring in warmer months in the southern part of the nontropical forested region of Europe and Asia. Most intense transmission has been reported in Russia, the Czech Republic, Latvia, Lithuania, Estonia, Hungary, Poland, and Slovenia. Other vector-borne infections include murine typhus, scrub typhus, spotted fever due to Rickettsia sibirica (North Asian spotted fever), rickettsialpox, relapsing fever (more southern parts of region), Crimean-Congo haemorrhagic fever* (in many countries of the region but primarily in persons working with animals or in hospitals), leishmaniasis (cutaneous and visceral; especially in the southern areas of the former Soviet Union), Lyme disease (throughout the former Soviet Union), sandfly fever (in the southern parts of region), West Nile (a large outbreak occurred in Romania in late 1990s), and Japanese encephalitis (transmission occurs in a limited area of far eastern Russia).
Food- and water-borne infections: A high risk of hepatitis A is present in many parts of the region. Sporadic cases of typhoid fever are reported, and outbreaks occur. Outbreaks of hepatitis E have been reported from the southern areas of Russia. Brucellosis is a risk in many areas. Outbreaks of botulism are usually linked to home canned foods. Sporadic cases of fascioliasis occur.
Airborne and person-to-person transmission: The annual incidence rate of tuberculosis per 100,000 population is estimated to be 100-300 in many parts of the region. High rates of drug-resistant TB are found in Estonia, Kazakhstan, Latvia, Lithuania, parts of Russia, and Uzbekistan, where rates of drug resistance in newly diagnosed TB patients are as high as 14%. Cases of diphtheria have declined (after the massive outbreak of the 1990s) with improved rates of immunisation. Transmission of measles is declining.
Sexually transmitted and blood-borne infections: The prevalence of HIV in adults is estimated to be 0.6% in the region. The prevalence of hepatitis B is intermediate (2%-7%) or high (>8%) in most of the region. The prevalence of hepatitis C is 1%-2.4% in much of the area (2.5%-9.9% in Romania).
Zoonotic infections: Rabies is widespread in the region and is increasing in some countries. Tularemia* is widespread and occurs in focal outbreaks. Wild rodent plague* is broadly distributed in southern areas of the former Soviet Union; human cases are rare. Sporadic cases and occasional outbreaks of anthrax* are reported. Q fever* is found, especially in cattle-raising areas. Hantaviruses causing haemorrhagic fever with renal syndrome are found in many countries in the region; infection is sporadic and epidemic. Echinococcosis* occurs sporadically in the area.
Soil- and water-associated infections: Cases of cholera have been reported from Russia in 2002-2003.
Other risks for travellers include motor vehicle accidents and injuries related to ongoing conflicts and alcohol abuse. Nosocomial transmission of infections is a problem in many areas because of inadequate infection control procedures. Screening of blood before transfusion is inadequate in many hospitals.
