Read below for travel health advice on Czech Republic from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to the Czech Republic will need vaccinations for hepatitis A, as well as medications for travelers' diarrhea. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Tick precautions are recommended for travelers to rural or forested areas. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.
|Hepatitis A||Recommended for all travelers|
|Hepatitis B||Recommended for all travelers|
|Measles, mumps, rubella (MMR)||Two doses recommended for all travelers born after 1956, if not previously given|
|Tetanus-diphtheria||Revaccination recommended every 10 years|
Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.
The following are the recommended vaccinations for Czech Republic:
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.
Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. The vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.
Tick-borne encephalitis vaccine may be considered for long-term travelers who expect to be visiting rural or forested areas in the spring or summer (see "Recent oubtbreaks" below). Two vaccines have been developed: TicoVac, also known as FSME Immun (Baxter AG), which is manufactured in Austria, and Encepur (Chiron Behring), which is made in Germany. The vaccines are approved for use in a number of European countries, but not the United States. A full series consists of three doses over a one-year period, which is not practical for most travelers, though limited data indicate that Encepur may be given in an accelerated schedule for faster immunity. Tick precautions, as discussed below, are strongly advised.
A mumps outbreak was reported from the north Bohemian region in early 2011, causing a total of 996 cases during the first four months of the year (see ProMED-mail). All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.
An outbreak of hepatitis A was reported from the Czech Republic in June 2008, chiefly affecting Prague, Central Bohemia, and the Olomouc region. A total of 1616 cases had been identified by the end of the year (see Eurosurveillance and ProMED-mail, September 23, 2008). A smaller outbreak was reported in November 2011 among the residents of Predndrazi street in the Privoz quarter of Ostrava, caused by blocked sewer pipes. Hepatitis A vaccine is recommended for all travelers to the Czech Republic.
Several outbreaks of H5N1 avian influenza ("bird flu") were reported in June and July, 2007, from poultry farms in the eastern part of the Czech Republic. No human cases were reported. Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The World Health Organization and the Centers for Disease Control do not advise against travel to countries affected by avian influenza, but recommend that travelers to affected areas should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to the Czech Republic should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
An outbreak of listeriosis was reported from the Czech Republic in 2006, resulting in a total of 75 cases, most of them in the last four months of the year. Twelve of the cases were fatal, including two neonates. Cases were reported throughout the country, though more occurred in the east. Preliminary evidence suggested that the outbreak was related to contaminated cheese. For further information, go to Eurosurveillance.
The incidence of tick-borne encephalitis has risen sharply since the late 1990s, notably at altitudes between 700 and 1100 m, due to a rise in the tick population at these elevations (see Eurosurveillance in 2001, 2002, and 2005). The number of cases rose to 1029 for the year 2006, the largest number since notification began, apparently related to unusual weather. The largest number of cases were reported from South Bohemia, Vysocina (situated in south Bohemia and Moravia), and central Bohemia. For the year 2007, the number of cases fell to 542 (see ProMED-mail, November 12, 2006, and Eurosurveillance).
Tick-borne encephalitis is a viral infection of the central nervous system transmitted by tick bites, usually after travel to rural or forested areas in the spring or summer. The infection may also be acquired by ingesting unpasteurized dairy products. The disease typically begins as a flu-like illness, including fever, headache, and vomiting, followed by the development of neurologic symptoms. Neurologic damage may be permanent, causing chronic headaches, difficulty concentrating, muscle weakness or loss of balance. Tick-borne encephalitis vaccine should be considered for long-term travelers who expect to be visiting rural or forested areas in the spring or summer. The vaccine is available in many European countries, but not the United States. Tick precautions are strongly advised, as below.
A small number of cases of bovine spongiform encephalopathy ("mad cow disease") have been identified, including one case in 2009, but transmission to humans has not been reported to date. At present, the risk of acquiring variant CJD from European beef appears to be extraordinarily low, at most about one in 10 billion servings. The Centers for Disease Control does not advise against eating European beef, but suggests that travelers who wish to reduce their risk may either abstain from beef while in Europe or eat only solid pieces of muscle meat, such as steak, rather than products like sausage or chopped meat that might be contaminated. There is no evidence of any risk from pork, lamb, milk or milk products. For recent updates, go to ProMED-mail.
A small Salmonella outbreak, noteworthy for the organism's resistance to most antibiotics, occurred after a family party in South Moravia in June 1998. The predominant symptom was diarrhea. The overall incidence of Salmonella infections has been climbing in the Czech Republic in recent years. (See Weekly Epidemiological Record(PDF) for details.)
Hemorrhagic fever with renal syndrome has been reported. The disease is caused by hantaviruses and acquired by exposure to rodent excreta, often by the aerosol route. See Emerging Infectious Diseases for further information. Most travelers are at extremely low risk.
Lyme disease is prevalent in central Europe, including the Czech Republic. Lyme disease is a tick-borne infection which causes fever, headache, joint pains, body aches, and malaise, usually in association with an expanding red rash, often pale in the center (known as a bull's eye rash). If not treated in its early stages, the illness may be complicated by arthritis, meningitis, encephalitis, Bells palsy, or cardiac involvement. Tick precautions are recommended for travel to rural and forested areas, especially during the warm weather months.
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
Food and water precautions
Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.
All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Insect and Tick Protection
Wear long sleeves, long pants, and boots, with pants tucked in. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing and shoes. Permethrin-treated clothing appears to have little toxicity. Perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
Ambulance and Emergency Services
For an ambulance in the Czech Republic, call 155, but response times may be slow. Many ambulance companies expect payment at the time of delivery. For an extreme emergency in Prague or Brno, call Zachranná Služba (“emergency services”) at 112.
In Prague, there are a number of Western-style medical clinics with English-speaking doctors and dentists. Many expatriates go to Motol Hospital (U Uvalu 84, Prague 5; tel. 224-433-681 for adults and 24-433-690 for children; 24-hour care for major and minor trauma, illness; accepts VISA, Mastercard) or Na Homolce Hospital (Roentgenova 2, Prague 5; tel. 257-272-146 for adults, 257-272-025 for children, 257-272-174 for foreigners clinic; accredited by the Joint Commission International; no 24-hour emergency service, not for major trauma; accepts VISA, Mastercard). For outpatient care, other options include UNICARE Medical Center (Na Dlouhem lanu 11, Prague 6; tel. 235-356-553, weekend tel. 267-750-425, 24 hour on-call service tel. 601-201-040 or 602-201-040; major credit cards accepted) and the Canadian Medical Center (Veleslaviska 1, Prague 6; tel. 235-360-133; after-hours pediatrician 602-335-670; after-hours adult 603-220-207; website www.cmc.praha.cz; major credit cards accepted).
For a guide to other physicians and clinics, as well as a general introduction to health care in the Czech Republic, go to the U.S. Embassy website. Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities. Because euthanasia is not permitted under Czech law, living wills that stipulate that there should be no extraordinary interventions to prolong life cannot be honored in the Czech Republic.
The following pharmacies are open 24 hours a day:
Traveling with children
Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two.
Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.
Travel and pregnancy
International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.
Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary. In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.
Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Adequate fluid intake is essential.
Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Americans living in or visiting the Czech Republic are encouraged to register at the Consular Section of the U.S. Embassy in the Czech Republic and obtain updated information on travel and security within the Czech Republic. Information is also available on the Embassy's web site at http://prague.usembassy.gov/. The U.S. Embassy in Prague is located at Trziste 15, 118 01 Prague, Czech Republic; telephone (420) 257 530 663; for after-hours emergencies only - telephone (420) 257 532 716.
For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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