Europe

Western Europe (Andorra, Austria, Azores [Portugal], Belgium, Denmark [including Greenland and Faroe Islands], Finland, France, Germany, Gibraltar, Greece, the Holy See, Iceland, Ireland, Italy, Liechtenstein, Luxembourg Malta, Monaco, the Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland, and the United Kingdom [including Channel Islands and the Isle of Man]) The area encompassed by these countries extends from the broadleaf forests and the plains of the west to the boreal and mixed forests of Scandinavia.

The incidence of communicable diseases in most countries is such that they are unlikely to prove a hazard to international travelers greater than that found in their own country. There are, of course, health risks, but in most areas very few precautions are required.

Of the arthropod-borne diseases. Tickborne encephalitis, for which a vaccine exists, and Lyme disease can occur throughout forested areas where the vector ticks are found infective.

Leishmania and human immunodeficiency virus (HIV) co-infections have been reported from France, Greece, Italy, Portugal, and Spain.

Other diseases. Rabies is endemic in wild animals (particularly foxes) in rural areas of northern Europe.

Other hazards. The extreme cold in winter is a climatic hazard in parts of northern Europe.

— Paul Arguin, Martin Cetron, Phyllis Kozarsky, Stefanie Steele

Eastern Europe and the Newly Independent States of the Former Soviet Union (NIS): (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Macedonia [Former Yugoslav Republic], Moldova, Poland, Romania, Russia, Slovakia, Slovenia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, and Yugoslavia) The area extends from the broadleaf forests in the northwest and the mountains of the Alps to the prairies and, in the south and southeast, the scrub vegetation of the Mediterranean.

Among the arthropod-borne diseases are small foci of malaria in Armenia, Azerbaijan, Georgia, Tajikistan, and Turkmenistan. There is evidence that natural foci of plague exist in Kazakhstan. There are very small foci of cutaneous and visceral leishmaniasis in Azerbaijan and Tajikistan. Sporadic cases of murine and tickborne typhus and mosquito-borne West Nile fever occur in some countries bordering the Mediterranean littoral. Both cutaneous and visceral leishmaniasis and sand fly fever are also reported from this area. Rodent-borne hemorrhagic fever with renal syndrome can occur in the eastern and southern parts of the area. There are very small foci of tickborne typhus in east and central Siberia. Tickborne encephalitis, for which a vaccine exists, and Lyme disease can occur throughout forested areas where the vector ticks are found infective (e.g., in the Baltic states, neighboring forested areas of Russia, and some forested areas in central and eastern Europe).

Foodborne and waterborne diseases, such as bacillary dysentery and other diarrheas, and typhoid fever, are more common in the summer and autumn months, with a high incidence in the southeastern and southwestern parts of the area. Brucellosis can occur in the extreme southwest and southeast and echinococcosis (hydatid disease) in the southeast. Fasciola hepatica infection has been reported from different countries in the area. Hepatitis A occurs in the eastern European countries. The incidence of certain foodborne diseases (e.g., salmonellosis and campylobacteriosis) is increasing significantly in some of these countries.

Other diseases. Hepatitis B is endemic in the southern part of Eastern Europe (Albania, Bulgaria, and Romania). Rabies in animals exists in most countries of southern Europe. In recent years, Belarus, Russia, and Ukraine have experienced extensive epidemics of diphtheria. Diphtheria cases, mostly imported from these three countries, have also been reported from neighboring countries: Estonia, Finland, Latvia, Lithuania, Poland, and Moldova. All countries in southern Europe where poliomyelitis was until recently endemic are conducting eradication activities, and the risk of infection in most countries is very low. However, a large poliomyelitis outbreak occurred in 1996 in Albania; also affecting Greece and Yugoslavia, it had been interrupted by the end of 1996.

— Paul Arguin, Martin Cetron, Phyllis Kozarsky, Stefanie Steele