Make sure you are up-to-date on routine vaccines before every trip, such as:

• measles-mumps-rubella (MMR) vaccine
• diphtheria-tetanus-pertussis vaccine
• varicella (chickenpox) vaccine
• influenza vaccine

Altitude sickness

Parts of this country are at high altitude. Altitude sickness is a risk at altitudes greater than 3000m and can be fatal. Symptoms include breathlessness, lethargy, confusion and coughing due to fluid in the lungs.

The best way to prevent altitude sickness is to ascend slowly, by less than 300m per day once over 3000m. Other tips to prevent altitude sickness include:

• Your doctor can prescribe medications such as acetazolamide to prevent altitude sickness.
• Increase your fluid intake. You may need up to seven litres every day.
• Avoid cigarettes and alcohol.
• Be aware that you are at increased risk of altitude sickness if you have experienced it before.

Lyme disease

Lyme disease is a tick-borne illness caused by the bacterium Borrelia burgdorferi. It is spread by ticks

Prevention includes measures to prevent tick bites such as wearing long pants and using repellents like DEET.

Schistosomiasis

Bilharzia (schistosomiasis) is a common, serious infection caused by a parasite found in rivers, streams and lakes in sub-Saharan Africa, Asia and South America. The parasite infects people by penetrating their skin then developing in the person’s blood stream.

No vaccine is available. To avoid bilharzia:

• avoid paddling, swimming and washing in fresh water – only swim in the sea or chlorinated swimming pools
• take waterproof trousers and boots with you if there’s a chance you’ll need to cross a stream or river
• boil or filter water before drinking – as the parasites could burrow into your lips or mouth if you drink contaminated water
• avoid medicines sold locally that are advertised to treat or prevent schistosomiasis – these are often either fake, substandard, ineffective or not given at the correct dosage
• don’t rely on assurances from hotels, tourist boards or similar that a particular stretch of water is safe – there have been reports of some organisations downplaying the risks

Tick-borne encephalitis (Rickettsia)

Tickborne encephalitis is a viral infection of the central nervous system transmitted by tick bites. It most commonly affects people who visit or work in forests or fields. Infection also can be acquired by consuming unpasteurised dairy products from infected cows, goats or sheep.

An effective vaccine is available but can only be obtained via a Special Access Scheme. It is only recommended for travellers who plan to spend extended periods in affected areas, especially if extensive rural exposure is planned during warmer months