Accidents, especially traffic accidents, but also sports and leisure accidents are responsible for a large proportion of deaths among tourists.

While cardiovascular diseases (heart attacks) predominate among older travelers, accidents dominate among younger people. Accidental deaths are up to 80 times more likely than at home.

Important factors are poor roads, non-existent lighting, vehicles in catastrophic condition and the carelessness of the vacation mood.

Due to the reduced oxygen content of the air at altitude, symptoms of altitude sickness can occur at sea level above 2500 meters. How susceptible or sensitive one is to this is genetically determined and has no connection with physical fitness or training condition.

In addition to the absolute altitude, the speed of the ascent is particularly significant; the body needs time to set adaptation mechanisms in motion. Ideally, one should not increase the sleeping altitude by more than 500 meters per day on a mountain tour.

Symptoms of mild altitude sickness are headache, nausea, dizziness, palpitations.

If the body’s warning signs are ignored, the two dreaded and potentially fatal forms of altitude sickness can develop:
High altitude pulmonary edema (fluid retention in the lungs): Shortness of breath, rattling breathing sound.
High altitude cerebral edema: behavioral changes, incoordination, loss of consciousness, coma.

The most important prevention is good tour planning.

In the absence of personal altitude experience, a test to determine altitude tolerance may be useful.
In this test, oxygen-reduced air is inhaled under defined conditions, simulating an ascent to high altitudes. Based on the behavior of pulse rate and oxygen concentration of the blood, the individual altitude fitness can be classified.

Especially in endurance sports, training through natural or artificial exposure to altitude has been known for a long time. The adaptation of the body to the reduced oxygen supply is supposed to make it more efficient.

The same principle can also be used to prepare for extreme mountain tours or trekking routes with an unfavorable altitude profile. Three to four weeks before the trip, hypoxia training is carried out at least 5 times a week by breathing in oxygen-reduced air. The altitude acclimatization of the body, which otherwise only begins during the tour, is thus anticipated.

Amoebae are single-celled pathogens (protozoa) that are responsible for the dreaded amoebic dysentery.

Infection occurs via contaminated food or water. Symptoms range from completely unnoticed brief colonization of the intestine to severe bloody, potentially fatal diarrhea.

Treatable with specific antibiotics.

Antimalarial drug for prophylaxis and as an emergency drug for self-treatment.

Parasitic disease with worldwide distribution in tropical regions. It has been successfully suppressed in many areas, but the WHO still estimates that 200 million people are infected.

Infection occurs through active penetration of the pathogen through the skin while bathing or wading in fresh water.

Symptoms vary depending on the stage of the disease:

1. rash and itching immediately after penetration (lasting only a short time).
2. acute phase with fever, cough, diarrhea, headache (duration a few days, treatment in mild cases with antipyretic preparations, in severe symptoms with cortisone)
3. Chronic phase: chronic inflammatory processes and microscopic scarring destroy the liver, intestinal wall or urinary tract in the long term.

Treatment: praziquantel is well effective, but cannot repair damage that has already occurred.

Virus from the togavirus family.

Causes a high-fever illness with very severe joint pain. Usually heals within a few days. There are hardly any known complications or deaths.

However, some patients develop joint inflammation that is clinically very reminiscent of rheumatism. The pain can be so severe that the patients are almost unable to move. There are quite a few reports of courses lasting weeks to months.

A therapy is not available, because of the similar complaints – with varying success – rheumatism drugs are used.

Bacterial diarrheal disease that is of little concern to travelers. It is feared in catastrophic hygienic conditions, after natural disasters such as hurricanes and floods, and in refugee camps and slums.

The main symptom is massive fluid loss in the sick. If this loss can be compensated with infusions, the disease is over again after a few days.

Drug for malaria prevention and treatment. No longer effective worldwide due to development of resistance.

Broad-spectrum antibiotic with excellent efficacy against malaria. One of the three currently still effective drugs for the prophylaxis of malaria.

see Traveler’s Diarrhea

Viral disease that is widespread in almost all tropical and subtropical regions and sometimes causes large epidemics. The transmission occurs through mosquitoes.

While the disease is uncomplicated in the majority of infected persons – but with VERY unpleasant symptoms and strong subjective feeling of illness – the hemorrhagic course can lead to organ failure and circulatory shock due to consumption of platelets and bleeding.
If one is infected with dengue a second time, this complication is more common.

Some countries require proof of vaccination upon entry.
This is well known for the yellow fever vaccination, which must be presented as an entry requirement for a whole series of countries. Especially for round trips the corresponding regulations have to be checked.

For entry into Saudi Arabia – but ONLY when visiting the holy cities (Hadj, Umrah) – a meningococcal vaccination is mandatory.
In case of local disease outbreaks, cholera vaccination can also be made compulsory at short notice (hardly ever happens).
The situation regarding the Covid-19 vaccination is still unclear.

Mostly incurable disease. However, the symptoms can at least be alleviated – ask your travel medicine specialists for advice.

The term hepatitis generally refers to an inflammation of the liver, which can occur for a variety of reasons. Mostly, however, one of the viral hepatitides is meant.

The most common are

Hepatitis A: originally a worldwide infection, but with improved hygiene (sewage disposal, drinking water supply) it has become rare in industrialized nations. Infection through contaminated food and water. Acute illness with fever, nausea, diarrhea, yellowing of skin and mucous membranes. Self-healing after a few days. Hardly any complications. No chronic stage.

Hepatitis B: widespread worldwide, but with very variable frequency. Transmission through blood (unsterile needles, syringes, during piercing, tattooing) and unprotected sexual intercourse.
Acute phase with unspecific symptoms of the disease (often just tiredness, fatigue), is often overlooked. Then the disease either cures, or goes into the chronic phase, in which constant inflammation of the liver causes damage to the organ – cirrhosis of the liver, increased risk of liver cancer.

Hepatitis C: also widespread worldwide. Transmission through blood, but rarely through sexual intercourse. Otherwise, the course and symptoms of the infection are similar to those of hepatitis B, but with a higher rate of chronic courses.

Effective and safe vaccinations are available for hepatitis A and B.

Many travelers tend to forget how widespread and unchecked the HIV epidemic remains in many developing countries. Southern Africa, in particular, has dramatic infection rates. In these areas, but also in parts of Asia and in Eastern Europe, many sex workers are infected.

Improved therapy options and new drugs have improved the quality of life of many patients with chronic inflammatory or malignant diseases, so that not only the desire to live but also to travel has returned.

Since not all vaccinations are possible in this situation, and under certain circumstances a titre control after vaccination makes sense, the travel medical consultation should take place in good time before the planned departure. If no booking has been made yet, we are also happy to contribute our expertise in the selection of suitable travel destinations.

Viral disease. In Europe with strongly seasonal occurrence, epidemics in Austria mostly from December to March. In tropical countries no clear “flu season”, cases all year round and sporadic.

Vaccination is recommended in Austria for all who wish to protect themselves, but especially for the elderly, persons with underlying diseases and pregnant women.

The protective effect varies greatly, as it depends on the match between the vaccine composition and the circulating virus strains, which cannot always be ideally predicted.

Due to the incredible number of infectious diseases that can be transmitted by biting, sucking, and stinging insects, insect repellent is of paramount importance when traveling.

Details on strategies and recommended substances can be found here.

Flavirus infection (the virus is related to TBE viruses).

Occurs exclusively in Asia, in tropical and subtropical areas and here mainly in rural regions.

A very large percentage of infections are asymptomatic. However, in about 1% of infected persons, inflammation of the brain occurs with severe symptoms and danger to life.

The disease is not treatable.

In Asia, several vaccines with very different tolerabilities are in use; in Europe, a modern, well-tolerated cell culture vaccine is available.

Physical and psychological complaints triggered by disturbances of the sleep-wake rhythm in the context of air travel over several time zones.

Occurs during flights over >2/3 time zones.

Symptoms: tired during the day, sleepless at night, concentration and motivation problems, reduced physical and mental performance, headaches, irritability, loss of appetite, digestive problems.

How long do the symptoms last?

worldwide spread disease caused by microscopic unicellular parasites. Alternative name: Giardia

Transmission through unhygienically prepared food or contaminated water.

The disease is not dangerous, but causes annoying symptoms that usually last for weeks and are very typical: Nausea, flatulence, alternating diarrhea, foul-smelling gases.

Treatment with special antibiotics

Harmless skin disease caused by larvae of animal hookworms.
The larvae penetrate the skin and cause meandering inflammation. The risk is everywhere where the environment is contaminated with dog and cat feces – not infrequently on popular beaches.

Symptoms: mainly itching

Self-healing, treatment with a special parasite medication can accelerate the process.

Bacterial disease occurring mainly in Europe, North America and some temperate zones of Asia. Transmission to humans occurs through tick bites; in rare cases, non-pasteurized milk (especially goat milk) may also be infectious.

The first stage of the disease, the so-called migratory redness (erythema migrans) usually looks quite typical and allows a “visual diagnosis”. If therapy is given at this stage (several different antibiotics are effective), no problems are to be feared.

If migrans is overlooked or not treated for other reasons, the infection can spread to the nervous system, heart, or joints. At this stage, treatment is more difficult and lengthy.

Despite many years of research, there is still no vaccine available.

Potentially fatal protozoal disease transmitted via mosquito bites. Widespread in tropical and subtropical regions of Africa, Asia and Latin America. Sub-Saharan Africa bears the brunt, both in terms of disease incidence and deaths.

Different prevention strategies are recommended for travelers, depending on the frequency of the disease in the destination country: Mosquito repellent, preventive medication, or emergency self-treatment.

Drug for malaria prophylaxis.

Can no longer be used in parts of Southeast Asia due to resistance; still effective in Africa.

Noticeable neuropsychiatric side effects.

Bacterial meningitis. In Europe and the USA, cases occur mainly in young children and adolescents. Therefore, meningococcal vaccination is included in the childhood vaccination schedule.

For “older” travelers, vaccination is recommended for travel to the meningococcal belt of Africa (see there) or for expected close contact with children and adolescents, e.g. in the context of social projects.

Travelers must receive the quadrivalent vaccine, which contains 4 strains of meningococci, including those that are predominant in the high-risk areas of Africa.

In a group of sub-Saharan countries – from Senegal in the west, through Mali, Niger and Nigeria, Chad, to the west of Ethiopia – large epidemics of bacterial meningitis occur in cyclic waves of 5-10 years.

The availability of low-cost vaccination against the meningococcal strain prevalent there has reduced case numbers in many countries. The political and terrorist unrest of recent years is likely to reverse many of these successes.

In the course of pregnancy, but especially in the last trimester, antibodies from the maternal circulation reach the fetus via the placenta.

After birth, these antibodies protect the newborn for a few weeks until its own immune protection is built up through contact with various pathogens, or until a protective effect is created by the childhood vaccinations of the first year of life.

This refers to the use of a drug either for groups of people, age groups or for diagnoses for which the drug is not approved.

Since approval processes are complex and expensive, manufacturers are often reluctant to have new indications included in the approval.

Particularly in tropical medicine and travel medicine, we often use preparations whose efficacy is well documented and researched, but which are not approved for this indication.

Quite arbitrarily grouped group of pathogens. This includes pathogens as diverse as the causative agent of malaria, sleeping sickness, bilharzia and the various intestinal worms.

Spherical bacteria encased in a capsule that often cause middle ear infections or meningitis in young children and are responsible for severe pneumonia in older adults.

Vaccination against pneumococcus is part of the childhood immunization schedule.
Because of the increasing risk of pneumonia with age, vaccination is then given again starting at age 60.

Despite largely successful eradication efforts by the international community, 2 countries remain polio-endemic, meaning that the virus circulates in the population (Afghanistan, Pakistan). In addition, outbreaks continue to occur in poorly vaccinated societies in areas previously declared polio-free.

When traveling to countries that are vulnerable to polio, it is important to ensure that vaccinations are up to date. Poliomyelitis can be administered either in combination with the standard diphtheria/tetanus/pertussis vaccines or as a single component vaccine.

The term covers all measures that are intended to prevent impairment of health.
This includes brushing teeth to prevent tooth decay as well as taking antimalarial medication to prevent infection.

Especially in the case of malaria prophylaxis, it is important to use the term correctly (which, unfortunately, many doctors do not do).
Malaria prophylaxis means the preventive, continuous intake of medication and mosquito protection.
Taking an emergency medication with you is NOT prophylaxis, but only a life insurance that in case of an emergency of a malaria disease a treatment can be started immediately.

Viral disease. Transmission occurs through the bite or (rarely) also scratch injuries of mammals. In most parts of the world, dog bites are mainly responsible for the infection.

The virus causes an inflammation of the brain, which leads inexorably to death. There is no therapy available.

Even though the disease is very rare in travelers (1-5 cases are registered per year in travelers returning to Europe), it has a special significance due to its merciless course.

In the first 48 hours after a bite, a subsequent vaccination series can still be made, which protects safely. However, the necessary vaccines are not available in many travel countries. Preventive vaccination should be considered for such destinations.

Appointments can be made at Traveldoc by phone, email or online. Of course, you can also come to us without an appointment, but then there may be considerable waiting times – especially during peak travel periods.

However, special concerns such as diving fitness examinations, tropical fitness examinations, health examinations or detailed travel medicine consultations are only possible by appointment.

You should consult your doctor about the sensible stocking of your first-aid kit. In most cases, far too much is packed. The individual preparations and their handling must be familiar to you.

Bacterial pathogens that cause intestinal infections.

Salmonella (S. enteriditis), which is also well known in our latitudes, is responsible for acute diarrhea accompanied by nausea, sometimes fever and vomiting. Often contaminated poultry products or eggs are the cause. The disease is usually harmless and self-healing, but for the elderly, the loss of fluids and circulatory distress can be threatening.

Salmonella typhi, the causative agent of typhoid fever, also belongs to the salmonella family, but can cause a much more severe clinical picture. (see typhoid fever).

Shingles is a reactivation of the varicella-zoster virus, which “lies dormant” in the body, in ganglion cells of the nervous system, after surviving chickenpox (sheep pox, wet pox) in childhood. If the immune system that keeps the virus in check is weakened – by age, illness, immunosuppressive drugs or stress – painful blisters form in the supply area of the nerve that harbored the virus, which crust over and dry up after a few days. The sometimes very severe accompanying nerve pain, which can last for weeks and months in some unfortunate patients, is feared.

For some years now, a very effective vaccine has been available, which is recommended for persons over 60 years of age according to the Austrian vaccination schedule.

African trypanosomiasis. Transmitted by the bite of the TseTse fly. Unfortunately, this insect is not reliably deterred by mosquito repellent products. However, impregnating (safari) clothing with permethrin provides some protection. Choose light-colored clothing, as the flies are attracted to dark colors.

The disease progresses differently as West or East African variant, but in the final stage it is a fatal inflammation of the central nervous system. The loss of consciousness in this stage has given the disease its name.

The two subtypes respond differently to the few available drugs, which also have many side effects. Fortunately, cases of the disease in tourists are extremely rare.

See travel sickness

Suitable clothing can already make an important contribution to protection against negative effects of the sun: hat or cap with a wide brim or umbrella, long pants, light but tightly woven textiles. In Australia, special sun-protective textiles have a long tradition and are also available for beach wear. They are ideal for people who are highly sensitive to the sun or have a history of skin cancer, as well as for children.

Sunscreens protect either
physically, by reflecting the sun’s rays (UVA and UVB) – they contain zinc or titanium oxide
or
chemically, by absorbing the light.

Preparations with sun protection factor <15 are not suitable for the tropics

Most reputable dive centers require “their” divers to provide medical confirmation of fitness to dive.

At Traveldoc this examination includes:

Medical history

• Survey of lifestyle habits (sports, smoking, occupation)
  
• Clinical examination (heart, lungs, throat, abdomen, musculoskeletal system)
  
• Checking the ear canals and eardrum
  
• Vital signs examination (blood pressure, heart rate, heart rhythm, oxygen saturation)
  
• ECG at rest
  
• Pulmonary function test

Viral disease with limited distribution in Europe. The pathogen is transmitted by ticks.

The majority of infected persons only experience non-specific symptoms similar to a “summer flu”. The disease then heals itself. However, a small proportion of sufferers experience spread of the infection into the central nervous system. The inflammation of the brain, meninges and spinal cord can lead to permanent damage such as paralysis, seizures or chronic headaches. Approximately 1% of cases are fatal.

No therapy available, but there are vaccines that work well.

Tetanus is caused by the bacterium Clostidium tetani. Symptoms are not caused by infection, but by the effects of the toxin produced by the bacterium. Spores of C. tetani are found everywhere in the soil, if a wound is contaminated with them, the disease can develop. The toxin, tetanospasmin, causes muscle spasms; entire muscle groups can contract with extreme pain. The spasms of opposing muscles of the back can be so severe that vertebral bodies fracture. Patients are fully conscious during this process.

Due to respiratory impairment and cardiovascular complications, 10-15% of the patients die (with modern intensive care! under the medical possibilities of the developing countries, the mortality is much higher).

Venous thrombosis, i.e. the formation of blood clots in a vein, causes painful swelling of the affected part of the body (usually the leg) and also damages the affected veins. The serious health hazard, however, lies in the possibility that parts of such a clot may become detached and travel with the bloodstream to the lungs, where they can cause life-threatening pulmonary infarctions.

Such thromboses occur, of course, even without any relation to flying/traveling. However, it is known that prolonged immobility – as in bedriddenness or even when a leg is immobilized by a cast – promotes thrombosis.

Because there is little room on long-haul flights to stretch the legs or change position regularly, it has always been feared that such flights could pose a risk for thrombosis. Despite many attempts at clarification and studies, it is still not clear how high this risk actually is.

In such an uncertain situation, the most important thing is to design prevention strategies WITHOUT side effects.

Fortunately, there are many completely harmless ways to do something about thrombosis development.

The most important general measures are:

movement exercises, e.g. foot rocking; isometric exercises

Sufficient fluid intake (restraint with alcohol)

Restraint in the use of sedatives and sleeping pills.

Some people have a slightly increased risk of thrombosis

• Age over 60

• heart failure

• more severe varicose veins,

• “birth control pills, hormone replacement therapy, pregnancy

• Overweight

• known tendency to thrombosis in the family

If 2 or more of these factors are present, you should consider wearing calf stockings during the flight in addition to the measures mentioned above. Such support stockings should correspond to compression class I-II, i.e. exert a pressure of 20-23mm Hg. Nowadays, such products already look very good and are also comfortable to wear.

For people with a very high risk of thrombosis, preventive medical care is recommended

• who has already suffered a thrombosis or embolism in the past

• who suffers from a malignant tumor disease

• who wears a plaster cast on the leg

• who had a major operation shortly before the flight, especially in the pelvic or leg area.

Preventive medication is administered with special heparin preparations that have to be injected under the skin. After a short training session, anyone can do this themselves. Discuss the possibility with your doctor. These modern medications are not without side effects and should not be prescribed lightly and without compelling reason.

Next to mosquitoes, ticks are among the most potent disease vectors. Spread worldwide, they can harbor a wide variety of viruses and bacteria and also pass them on when they suck blood.

Mostly seen as a necessary evil on the way to the vacation destination.

In the case of pre-existing conditions or in special situations such as pregnancy or traveling with small children, special preparations may be necessary.

One of the most common health disorders when traveling. Mostly just annoying and over again after a few days. However, some pathogens can also cause severe courses.

Certain destinations are considered hotspots for diarrhea: South Asia, Egypt, Mexico have a reputation to defend in this regard.

If the symptoms last uncharacteristically long, or if fever or bloody stools occur, you should seek medical help immediately.

also called kinetosis. The symptoms are triggered by movement stimuli and are based on a disturbance of the sense of balance. Commonly seen on water (seasickness) but also when driving a car or bus, less commonly on airplanes.

Symptoms: Nausea, vomiting, dizziness, sweating, headache.

On large cruise ships, the symptoms occur much less frequently, since the huge steamships are relatively still due to stabilizers and above all do not cause the lurching rolling movements of smaller boats.

Typhoid fever is caused by a bacterium of the Salmonella family (Salmonella typhi), but is not a typical diarrheal disease! The main symptoms are fever, loss of appetite, lethargy and intestinal symptoms, which usually manifest themselves in constipation and only very occasionally in diarrhea. Typhoid fever can be life-threatening without treatment.
The disease is widespread worldwide.

Infection occurs through contaminated food, unclean water, or smear infections.

Diagnostic methods for typhoid fever are not available in many developing travel countries, where diagnosis is based on symptoms, which unfortunately leads to very frequent misdiagnosis.

Prevention: there is a vaccination that is well tolerated, but unfortunately does not have a 100% protection rate.

Treatment: the disease is well treatable with antibiotics. However, increasing resistance of salmonellae worldwide is causing problems. Substances that were standard therapy 10 years ago can no longer be used today.

Even though the development of an electronic vaccination certificate is slowly taking shape, the paper vaccination certificate will still be with us. Especially when traveling internationally, the well-known “Yellow Vaccination Card” travels with you. If your travel route requires a yellow fever vaccination, this vaccination must be administered by a certified center and documented in an International Vaccination Certificate.

In many countries, including Austria, the standard vaccinations recommended by the national vaccination committees are summarized in the so-called vaccination schedule. With a few exceptions – in our case mainly TBE – these are diseases that occur worldwide and are significant. These vaccinations are therefore also important for travel.

The demands on vaccines are particularly high, since they are administered to healthy children and adults. The vaccines we use today undergo intensive testing for quality, safety and efficacy. The need for and appropriateness of a vaccine recommendation is also continuously re-evaluated.

In recent years, there have been a number of reports on associations between various vaccinations and diseases that have not yet been researched very much, such as multiple sclerosis, autism or inflammatory brain diseases. So far, no correlations have been proven in serious studies.

Like any effective medication, vaccinations also have possible side effects. These can occur either locally, at the site of vaccination, or more rarely systemically, affecting the whole body.

Local side effects: Redness, mild swelling, tenderness at the site of vaccination.

Systemic side effects: Fever, fatigue, tiredness, aching limbs. They occur very early (a few hours to 2 days after vaccination) and subside within 24-48 hours.

In the case of live vaccinations, the side effects may be similar to the disease against which vaccination was given – of course, in a greatly attenuated and harmless form: thus, in the case of measles vaccination, fever and a skin rash may occur; in the case of mumps, fever and a slight swelling of the parotid glands; in the case of rubella, fever and also a skin rash. They usually do not require treatment.

Ideally, if you have problems, contact the doctor who administered the vaccine. If that is not possible, be sure to take your vaccination record with you for examination.

In any case, please inform the doctor who vaccinated you of any vaccine reaction. This is important information for your medical record and for future vaccinations.

see shingles

Due to the often high germ count in contaminated water, travelers have to make do with bottled water. Those who are concerned about the additional flood of plastic have few practical alternatives.

There is hardly any infrastructure for filling one’s own drinking bottles, but the countless tea stations along Nepal’s trekking routes may show how it could be done.

Of course, you can boil the water yourself if you are traveling with camping equipment.

The alternatives are germ reduction by UV lamps, which are available from various manufacturers – but they only work reliably with clear water, i.e. when there is no suspended matter or turbidity in it.
Filter solutions need to be chosen based on the type of trip. They are reliable against larger pathogens such as protozoa (Giardia!) and usually also quite good against bacteria, but fail with viruses due to their small size.

Because whooping cough causes the most severe infections in infants and young children, it has long been part of childhood vaccinations.

Only in recent years, however, has the frequency of infection in adults been increasingly documented. The symptoms are less typical here and are therefore often not interpreted correctly. As a consequence of these findings, most health authorities have now included pertussis vaccination in adult vaccination schedules. In addition to providing individual protection, this is also intended to limit transmission to children who have not yet been vaccinated.

Viral disease. Exclusively in Africa (south of the Sahara) and South America. The virus is transmitted by mosquitoes.

The disease has a broad spectrum of symptoms: from completely asymptomatic courses to fatal hemorrhagic fever. The associated liver damage with jaundice has given the disease its name.

No therapy available, but there are vaccines that work well.
To prevent introduction of the disease by travelers, many countries require proof of vaccination upon entry.

Viral disease (flavivirus, related to TBE and yellow fever).

For a long time, the disease was considered completely harmless, a little fever and after a few days everything is over again.

During the major epidemic in Brazil in 2015, the enormous number of cases first brought to attention the potential of the virus to cause severe malformations in the child if infected during pregnancy.

During the height of the epidemic, women of childbearing potential were advised against traveling to Zika-endemic areas. In recent years, however, the diseases have almost “disappeared” again. However, attention to Covid-19 may be skewing the numbers.