Within three weeks, mpox cases have increased by +4’758 to cumulative 14’078 confirmed cases (all clades), including 55 deaths. The following countries have reported new cases of clade I between 03 to 24 Nov 2024:
No new clade I cases have been reported within 3 weeks from Congo (22 clade Ia cases), Zimbabwe (2 clade Ib cases), and Zambia (1 clade Ib case).
A significant number of suspected mpox cases, that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and thus never get confirmed.
For updates, details, suspected cases, epidemic curves, see WHO LINK).
Follow local media and local health authority advice. Prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (worldwide) in case of:
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
If you are diagnosed with mpox:
For clinicians:
Further information on evaluation and diagnosis: see CDC LINK.
According to WHO, between 2 to 29 September 2024 (week 36 to 39), 17 countries shared their meningitis epidemiological data.
Epidemic:
Alert:
For previous epidemics and alerts, see EpiNews or news at www.healthytravel.ch.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended:
If no alert or epidemic is reported, vaccination is recommended for travel to the ‘meningitis belt’ during the dry season (typically occurring from December to June) across sub-Saharan Africa if
According to WHO, between 29 to 1 September 2024 (week 31 to 35), 19 countries shared their meningitis epidemiological data.
Epidemic:
Alert:
For previous epidemics and alerts, see EpiNews or news at www.healthytravel.ch.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended:
If no alert or epidemic is reported, vaccination is recommended for travel to the ‘meningitis belt’ during the dry season (typically occurring from December to June) across sub-Saharan Africa if
In 2024, as of 06 October 2024, 16 countries have reported 7’524 confirmed cases (+770 new confirmed cases within 1 week), including 32 deaths. The three countries with the majority of the cases in 2024 (all clades) are Democratic Republic of the Congo (6’169), Burundi, (n = 987), and Nigeria, (n = 84).
(Note: A significant number of suspected mpox cases that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and therefore never got confirmed.)
In 2024, 15 countries have reported both 31’527 suspected and laboratory tested cases (+5’160 within 1 week, all clades), including 998 suspected and confirmed deaths (+2 within 1 week).
According to WHO, in 2024 as of 29 Sept 2024 the cumulative confirmed mpox cases (+ cases since last update 29 Sep 2024) were reported in the below mentioned countries (for updates, details, suspected cases, epidemic curves, see WHO LINK):
Clade Ia and b:
Clade Ib
Clade Ia:
Clade II (a and/or b):
In addition, mpox cases have been reported in Africa in 2024 without specification of the clade:
Epicurve for Ib clade cases as 6 October 2024:
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (worldwide) in case of:
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
If you are diagnosed with mpox:
For clinicians:
Masernausbrüche werden aus mindestens 14 Ländern Afrikas berichtet mit einigen Hundert bis mehreren Tausend Fällen seit Jahresbeginn 2021.
Masern sind eine hoch ansteckende Viruserkrankung, die über die Atemwege übertragen wird. Sie ist in der ganzen Welt verbreitet. Mit einem Impfstoff lässt sich die Krankheit sehr wirksam verhindern.
Folgen für Reisende
Eine Reise bietet eine ideale Gelegenheit, den Schutz vor Masern zu kontrollieren (2x geimpft oder durchgemachte Masern) und wenn nötig den Impfschutz zu aktualisieren.
Referenzen
Hepatitis A occurs all over the world, but the risk of infection is higher in countries with poor hygiene standards. There is an increased risk in most tropical and subtropical countries, as well as in some countries in Eastern Europe and around the Mediterranean.
In recent years, there have also been increasing cases in North America and Europe, including Switzerland, especially among men who have sex with men (MSM). Outbreaks in northern European countries can also occur when unvaccinated children become infected during family visits to tropical and subtropical countries. Upon return, they may transmit the virus within their care facilities.
There is a safe and very effective vaccine that consists of two injections at least 6 months apart. It provides lifelong protection after the second dose. Hepatitis A vaccination can also be given in combination with hepatitis B vaccination (3 doses required).
Vaccination against hepatitis A is recommended for all travellers to risk areas, as well as for persons at increased personal risk: persons with chronic liver disease, men who have sex with men, people who use or inject drug, persons with increased occupational contact with persons from high-risk areas or populations, and others.
In addition to the basic immunisation against polio, a booster vaccination is recommended for
In addition to the basic immunisation against polio, a booster vaccination is recommended for
EKRM_Factsheet_Layperson_EN_Polio.pdf
Regular hand washing after using the bathroom and before eating or preparing food. Avoidance of undercooked or raw food that is potentially contaminated with fecal material.
The most important prevention is vaccination. A very effective and well-tolerated vaccine against polio is available (inactivated (killed) polio vaccine (IPV)), which is part of the basic vaccination schedule during childhood. Combination vaccines (e.g. with diphtheria and tetanus) are also available. After basic vaccination, a booster dose is recommended every 10 years for travel to certain countries (see country page recommendations). WHO recommends a yearly vaccination for residents or long-stay visitors (minimum 4 weeks) in a country with ongoing polio infections or circulating vaccine-derived polio viruses. This recommendation not only targets individual protection, but aims to prevent the international spread of the virus.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
All travellers should have completed a basic immunisation and boosters according to the Swiss vaccination schedule, LINK.
Travellers should be immune to chickenpox. Persons between 13 months and 39 years of age who have not had chickenpox and who have not received 2 doses of chickenpox vaccine should receive a booster vaccination (2 doses with minimum interval of 4 weeks), see Swiss vaccination schedule, LINK.
For administrative reasons, there is the following entry regulation of the country:
Exempt from this entry requirement:
EKRM_Factsheet_Layperson_EN_Yellow-fever.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
For administrative reasons, there is the following entry regulation of the country:
Exempt from this entry requirement:
CDC Map: Yellow fever vaccine recommendations for the Americas
Footnotes
As against all mosquito-borne diseases, prevention from mosquito bites is during day and night (see “Insect and tick bite protection” factsheet). The available vaccine is highly efficacious and provides a long-term protection. It is recommended for people aged 9 months or older who are travelling to yellow fever endemic areas. In addition, providing proof of vaccination may be mandatory for entry into certain countries.
The vaccine is a live-attenuated form of the virus. In immunocompetent persons, protection starts about 10 days after the first vaccination. Reactions to yellow fever vaccine are generally mild and include headache, muscle aches, and low-grade fevers. Side effects can be treated with paracetamol but aspirin and other nonsteroidal anti-inflammatory drugs, for example ibuprofen or naproxen, should be avoided. On extremely rare occasions, people may develop severe, sometimes life-threatening reactions to the yellow fever vaccine – which is why this vaccine is used with caution in immunocompromised individuals, pregnant women and the elderly for safety reasons. Talk to your travel health advisor if you belong to this group.
No treatment against rabies disease exists.
Post-exposure measures:
Stroking cute pets is not a good idea; refrain from touching wild or unfamiliar or dead animals.
All travellers to places where rabies may occur and who are likely to take repeated trips to areas where rabies occurs should have a pre-exposure vaccination. In addition, pre-exposure vaccination is highly recommended for travellers at particular risk:
The shortened vaccination schedule can be proposed to most travellers: 2 shots, the first one at one month before departure if possible (minimum: 8 days before departure). A single third rabies booster vaccination is recommended before the next trip, at least after one year.
“Cook it, boil it, peel it or forget it” – this simple slogan would be sufficient to prevent typhoid fever nearly entirely. However, only few travelers fully adhere to this advice. Nevertheless, the value of food and water hygiene cannot be stressed enough: avoid buying water bottles without proper sealing, avoid drinking tap water from unknown sources, avoid eating cooled / frozen foods (i.e. ice cubes in water or ice cream) and avoid eating raw fruits and vegetables that you yourself have not peeled and washed with clean drinking water.
Two types of vaccines are available:
Prevention: Mosquito bite prevention and chemoprophylaxis.
Discuss with your travel health advisor which prophylactic medication is suitable for you. The travel health advisor will prescribe the appropriate medication and dosage.
There is a seasonal risk in the following regions (see map):
Prevention: Mosquito bite prevention.
Discuss with a travel health advisor whether carrying a stand-by emergency self-treatment against malaria is necessary.
Prevention: Mosquito bite prevention.
EKRM_Factsheet_Layperson_EN_Malaria.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
Prevention: Mosquito bite prevention and chemoprophylaxis.
Discuss with your travel health advisor which prophylactic medication is suitable for you. The travel health advisor will prescribe the appropriate medication and dosage.
There is a seasonal risk in the following regions (see map):
Prevention: Mosquito bite prevention.
Discuss with a travel health advisor whether carrying a stand-by emergency self-treatment against malaria is necessary.
Prevention: Mosquito bite prevention.
Fever during or after a stay in a malaria-endemic area is an emergency! Prompt diagnosis and treatment are required as the health of people with malaria can deteriorate very quickly. That means: if you have fever >37.5° (use a thermometer!) you need to test for malaria within a maximum time-frame of 24 hours, regardless of whether or not you have used prophylactic medication (malaria chemoprophylaxis). Try to reach a doctor or hospital where you can reliably receive such a test. If the first test is negative, it should be repeated on the following day if the fever persists.
Prevention of malaria requires a combination of approaches:
For travellers, there is currently no malaria vaccination available.
EKRM_Factsheet_Layperson_EN_Dengue.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
CDC Map: Distribution of dengue
Dengue fever is the most common insect-borne infectious disease worldwide. There are 4 known serotypes of dengue virus, so it is possible to be infected with dengue more than once. Approximately 1 in 4 infected individuals develop symptoms of dengue, resulting in high fever, muscle and joint pain, and skin rash. In rare cases, most often after a second infection, life-threatening bleeding and shock (severe drop of blood pressure) may occur.
In 3 out of 4 cases, an infection with the virus remains asymptomatic. After a short incubation period (5-8 days), 1 out of 4 infected people present an abrupt onset of fever, headache, joint, limb and muscle pain, as well as nausea and vomiting. Eye movement pain is also typical. A rash usually appears on the 3rd or 4th day of illness. After 4 to 7 days, the fever finally subsides but fatigue may persist for several days or weeks.
In rare cases, severe dengue can occur. Particularly susceptible are local children and seniors as well as people who have experienced a prior dengue infection. Tourists extremely rarely present with severe dengue. In the first days, the disease resembles the course of classic dengue fever, but on the 4th/5th day, and usually after the fever has subsided, the condition worsens. Blood pressure drops, and patients complain of shortness of breath, abdominal discomfort, nosebleeds, and mild skin or mucosal hemorrhages. In the most severe cases, life-threatening shock may occur.
There is no specific treatment for dengue virus infection. Treatment is limited to mitigation and monitoring of symptoms: fever reduction, relief of eye, back, muscle and joint pain, and monitoring of blood clotting and blood volume. Patients with severe symptoms must be hospitalised.
For treatment of fever or pain, paracetamol or acetaminophen are recommended (e.g. Acetalgin® Dafalgan®). Drugs containing the active ingredient acetylsalicylic acid (e.g. Aspirin®, Alcacyl®, Aspégic®) must be avoided.
Effective mosquito protection during the day and especially during twilight hours (i.e. sunset) is the best preventive measure:
For further information, please refer to the factsheet on "Mosquito and tick bite protection".
Note on the dengue vaccine Qdenga®:
Consistent mosquito protection during the day (see above) is still considered the most important preventive measure against dengue!
Of note
EKRM_Factsheet_Layperson_EN_Chikungunya.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
CDC Map: Distribution for Chikungunya
The infection may present with some or all of the following symptoms: sudden onset of high-grade fever, chills, headache, redness of eyes, muscle and joint pain, and rash. The rash usually occurs after the onset of fever and typically involves the trunk and extremities, but can also include the palms, soles of the feet, and the face.
Often fever occurs in two phases of up to one week duration, with an interval of one to two fever-free days in between. The second phase may present with much more intense muscle and joint pain, which can be severe and debilitating. These symptoms are typically bilateral and symmetric and mainly involve hands and feet, but may also involve the larger joints, such as the knees or shoulders.
About 5-10% of infected people continue to experience severe joint pain even after the fever has subsided, in some cases lasting up to several months or, albeit rare, even years.
EKRM_Factsheet_Layperson_EN_Zika.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
The Zika virus was identified in 1947 in monkeys from the Zika forest in Uganda. Virus circulation has long been limited (a few cases each year) in Africa and South-East Asia. In May 2015, the American continent was affected for the first time, with an epidemic in Brazil that rapidly spread to South America, Central America, and the Caribbean. Since then, the disease has been reported in most tropical and subtropical regions.
The risk of infection is currently low in most regions and does not require specific measures. However, epidemics may occasionally reappear. During epidemics, the risk of transmission is high, and specific recommendations for the traveller are necessary.
In case of fever, it is recommended to consult a doctor. The symptoms of a Zika virus infection may seem similar to those of malaria, for which urgent treatment is necessary, or dengue fever. Treatment for Zika aims for reduction of fever and joint pain (paracetamol). Avoid aspirin and anti-inflammatory drugs (e.g. ibuprofen) as long as dengue fever is not excluded. There is no vaccine available.
In case of pregnancy and fever during or upon return from a Zika virus transmission area, blood and/or urine tests are indicated. In case of confirmed infection, the medical management should be discussed with the gynecologist and infectious/travel medicine specialists.
The risk of infection can be reduced by effective protection from mosquito bites during the day and in the early evening (long clothing, mosquito repellents, mosquito net).
When travelling in an area of increased risk (= declared epidemic) and in order to prevent possible sexual transmission of the virus, it is recommended to use a condom / Femidom during the trip and at least 2 months after return.
Due to the risk of fetal malformation, pregnant women are advised against travelling to areas at increased risk (= declared as epidemic) of Zika transmission at any time during pregnancy (in case of essential travel, a consultation with a travel medicine specialist is advised before departure). Women who wish to become pregnant should wait at least 2 months after their return (or that of their partner) from an area at increased risk of Zika transmission.
Wichtig: Eine STI kann auch ohne oder mit nur leichten Symptomen auftreten. Auch wenn Sie sich dessen nicht bewusst sind, können Sie andere anstecken. Deshalb ist es wichtig sich testen zu lassen.
Durch Bakterien oder Parasiten hervorgerufen
Alle diese Krankheiten können geheilt werden. Wichtig ist dabei, frühzeitig zu testen und umgehend zu therapieren, um Komplikationen und v.a. weitere Übertragungen zu vermeiden.
Durch Viren hervorgerufen
There is a risk of arthropod-borne diseases other than malaria, dengue, chikungunya or zika in sub-/tropical regions, and some areas of Southern Europe. These include the following diseases [and their vectors]:
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
EKRM_Factsheet_Layperson_EN_Mosquito-and-tick-bite-protection.pdf
The incubation period (time between infection and onset of symptoms) ranges from a 2 to 21 days (usually 5 to 10 days). The onset of MVD is usually abrupt, with initially non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhoea. As the disease advances, clinical manifestations can become more severe and include liver failure, delirium, shock, bleeding (hemorrhaging), multi-organ dysfunction and death.
In case of symptoms
If think that you have had an exposure at risk and develop fever with nonspecific symptoms such as chills, headache, muscle pain, malaise or abdominal pain:
The risk for travellers is very low if the below precautions are followed, but it is high for family members and caregivers who have contact with sick people.
General precautions during travel to affected areas:
Mpox has been commonly found in West and Central Africa for many years where the suspected reservoir - small mammals - is endemic. There are two types of Monkeypox virus called ‘clades’ that cause the disease mpox - clade I in Central Africa and clade II in West Africa. Since the end of smallpox vaccination campaigns in the early 1980’s, cases of mpox have increased, slowly at first and significantly in the last 5-10 years, especially in the Democratic Republic of Congo (DRC).
In 2022, a new emerging subclade of clade II was responsible for a global epidemic that spread mainly through sexual contact among men who have sex with men. It resulted in the first public health emergency of international concern (PHEIC) declared by the WHO until 2023. Although the clade II epidemic is now under control, this virus variant continues to circulate worldwide.
In 2024, the continued spread of mpox clade I in endemic regions of Central Africa, particularly in the DRC, and the emergence of a new subclade Ib in Eastern DRC and neighboring countries have raised global concern and prompted the WHO to declare a PHEIC for the second time in two years. The current geographical spread of the mpox clade Ib variant occurs via commercial routes through sexual contact (e.g. sex workers), followed by local transmission in households and other settings (which is becoming increasingly important).
Animal to human transmission
Mpox can spread from animal to human when they come into direct contact with an infected animal (rodents or primates).
Human to human transmission
Mpox can be spread from person to person through close physical contact (sexual and non-sexual contact) with someone who has symptoms of mpox. Skin and mucous membrane lesions, body fluids, and scabs are particularly infectious. A person can also become infected by touching or handling clothing, bedding, towels, or objects such as eating utensils/dishes that have been contaminated by contact with a person with symptoms. Household members, family caretakers, and sexual partners of a confirmed case of mpox are at higher risk for infection as are health care workers who treat a case without adequate personal protection.
The incubation period (time between infection and onset of symptoms) ranges from a few days up to 3 weeks. Mpox causes a rash / skin eruption that can be painful associated with swollen lymph nodes and fever. Fever may start already before the rash phase. Other symptoms include muscle aches, back pain, and fatigue. The rash may be localized or generalized, with few or hundreds of skin lesions. It mainly affects the face, the trunk and the palms of hand and soles of the feet. It can also be present in genital areas and on mucous membranes such as in the mouth and throat. Symptoms usually last 2 to 4 weeks and the person remains contagious until all lesions have healed (once the cabs have fallen off).
Complications include secondary bacterial infections, infections of the lung and brain and involvement of other organs, still birth and others. Children, pregnant women, and people with weak immune systems are at higher risk to develop a severe form of mpox.
The majority of person with mpox recovers spontaneously and do not need specific antiviral treatment. Care management consists of relieving pain and other symptoms and preventing complications (e.g., superinfection). Several antiviral treatments are studied in various countries and may be used in trials or in clinical situations according to the recommendations of national medical societies.
In case of symptoms:
General precautions:
Vaccination:
There are several vaccines against mpox (e.g. Jynneos®, manufacture Bavarian Nordic). The Bavarian Nordic vaccine was originally developed to fight against smallpox, but offers a cross-protection against mpox. In Switzerland, the Jynneos® vaccine has been licensed by Swissmedic since 2024. Groups at risk (e.g., men who have sex with men or transgender people with multiple sex partners) are eligible for vaccination since 2022 and this recommendation remains unchanged (see FOPH recommendations). In light of the epidemiological situation in Africa in 2024, the Swiss Expert Committee for Travel Medicine recommends vaccination against mpox for professionals who are / will be in contact with suspect mpox patients or animals in endemic/epidemic regions or who work in a laboratory with the virus (for updates, see news).
The risk to the general population and travelers (tourists) is considered extremely low if the above-mentioned general precautions are followed and vaccination is not recommended.
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