An outbreak of diphtheria is occurring in all the states of the former Soviet Union. Although control measures have been implemented, the risk of contracting diphtheria is pervasive in these areas. Travelers to these areas should be sure that their diphtheria immunization is up-to-date.

Tickborne 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 unpasteurized dairy products. Vaccine for this disease is not available in the United States at this time. Prevention includes precautions against tick bite.

The CDC recommends the following vaccines (as appropriate for age):

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

• 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.

To stay healthy, use these suggestions:

• 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.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
 

To avoid getting sick, follow these suggestions:

• Do not eat food purchased from street vendors.
• Do not drink beverages with ice.
• Do not eat dairy products unless you know they have been pasteurized.
• Do not share needles with anyone.
• Do not handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
 

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The material in this article is based on information provided by the CDC (Center for Disease Control of the Department of Health and Human Services, an agency of the United States Government.  All medical advice provided here is for informational purposes only.  Medical treatment should be discussed and prescribed by your physician or other registered medical personnel.