Read below for travel health advice on Greece from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
No special immunizations or medications are necessary for most trips to Greece. Anti-malarial medications are recommended for travel to the agricultural areas of Evrotas.
Malaria:Prophylaxis with chloroquine, Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for travel to the agricultural areas of Evrotas.
|Hepatitis A||Sometimes recommended for extended travel to rural areas where food hygiene is questionable|
|Measles, mumps, rubella (MMR)||Two doses recommended for all travelers born after 1956, if not previously given|
|Tetanus-diphtheria||Revaccination recommended every 10 years|
|Influenza||Recommended for all travelers from November through April|
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for Greece:
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. Influenza 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.
Hepatitis A vaccine is occasionally recommended for extended travel to rural areas where food hygiene is questionable. 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.
Travelers who require protection against hepatitis A and are less than two years old, are pregnant, or have less than two weeks before departure should receive a single intramuscular dose of gammaglobulin (see hepatitis A for dosage) instead of vaccine.
Yellow fever vaccine is required for all travelers greater than six months of age arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to children less than nine months of age, pregnant women, immunocompromised travelers, or anyone allergic to eggs.
A case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was reported in April 2014 in a Greek national who had returned from Saudi Arabia, where a MERS outbreak was in progress (see Eurosurveillance). There was no evidence of secondary spread. There is no risk for travelers to Greece.
A total of 20 cases of malaria occurred among Greek residents between May and September 2011. The majority occurred in a delimited agricultural area in Evrotas, Laconia district, in the southern part of the country. Other cases occurred in the Evia/Euboea (island east of the Central Greece region), Eastern Attiki, Voitia, and Larissa districts. All were caused by Plasmodium vivax (see Eurosurveillance). Seventeen additional locally-acquired cases were reported between June and December 2012, chiefly from the Attica and Laconia regions, but also from Viotia, Karditsa, and Xanthi. Cases have occurred in the cities of Evrotas, Marathon, Markopoulo, and Selino. All locally-acquired cases were caused by Plasmodium vivax. No cases have been reported in Athens. The Centers for Disease Control recommends that travelers to the agricultural areas of Evrotas take an anti-malarial medication, such as chloroquine, mefloquine (Lariam), atovaquone/proguanil (Malarone), or doxycycline. All travelers to southern Greece should follow insect protection measures, as described below, to reduce the risk of mosquito bites. For further information, go to Eurosurveillance and the U.S. Centers for Disease Control.
Four malaria cases were diagnosed in Evros, northern Greece, in 1994 and 1995. In the summer of 1998, two additional cases were identified in immigrants from southern Albania who had been living for four years in Feres (in the Evros peripheral area, East Macedonia and Thrace, Greece). Between August and October 2009, a cluster of six cases occurred among residents of the Evrotas river basin, Lakonia, southern Greece.
A cluster of 14 cases of Legionnaires' disease was reported among UK tourists who had visited the island of Corfu between August and October 2011. Several different accommodation sites were implicated as the source of infection. Control measures were implemented and no further cases were reported (see Eurosurveillance and ProMED-mail). Legionnaires' disease is a bacterial infection which typically causes pneumonia but may also involve other organ systems. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires' disease is not transmitted from person-to-person. No travel restrictions are recommended for Corfu, but anyone who develops fever, cough, or chest pain after visiting Corfu should seek immediate medical attention.
An outbreak of West Nile virus infections was reported from Greece in August 2010, causing 262 confirmed cases and 35 deaths. Most of the cases were described in Central Macedonia and in the adjacent Thessalia region in northern Greece (see Eurosurveillance and ProMED-mail). An additional 37 cases were reported in July and August 2011, occurring in Central Macedonia and Thessalia, as well as Eastern Attiki and Viotia in Central Greece, which had not reported cases the previous year (see Eurosurveillance). A total of 160 cases were reported nationwide for the first ten months of 2012. The suburbs east and south of Athens and in the north, near the town of Naoussa, were particularly affected. A case was reported in a Belgian traveler who visited Greece in August 2012 (see ProMED-mail).
West Nile virus is carried by Culex mosquitoes, which breed in stagnant water and are most active after dusk. Most infections are mild or asymptomatic, but the virus may infect the central nervous system, leading to fever, headache, confusion, lethargy, coma, and sometimes death. There is no treatment for West Nile virus. Travelers to Central Macedonia in the summer and fall should protect themselves from mosquito bites by keeping themselves covered and by applying 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).
A measles outbreak was reported from Greece in the first half of 2010, causing 126 cases by July, chiefly in the Roma population (see Eurosurveillance). In February 2006, a measles outbreak occurred in northern Greece, causing 171 cases, chiefly in children and young adults. Most of those affected had never been vaccinated against measles, and a majority belonged to Roma (gypsy) or immigrant families (see Eurosurveillance and ProMED-mail, February 8, 2006). All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, consider giving an initial dose of measles vaccine to children between the ages of 6 and 11 months who will be traveling to Greece, especially the northern part of the country. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.
An outbreak of brucellosis was reported from the island of Thassos in June 2008, resulting in 55 human cases (see Eurosurveillance). The outbreak was linked to consumption of locally produced raw cheese (see Eurosurveillance). The symptoms of brucellosis may include fever, malaise, depression, loss of appetite, headache, muscle aches, and back pain. Complications may include arthritis, hepatitis, endocarditis, and meningitis. Infection may be short-lived or last for years. In Greece, the most common sources of infection are sheep and goats. Most cases occur in rural areas on the mainland, typically in those who consume unpasteurized milk or dairy products or those who work with animals, including shepherds, animal husbandry workers, veterinarians. Travelers to Greece are at low risk, but should avoid consuming unpasteurized milk or dairy products.
An outbreak of myocarditis (inflammation of the heart) caused by a Coxsackie virus was reported from Greece in April 2002. In most cases, the initial symptoms were those of an upper respiratory infection, including fever, cough, and malaise, followed by severe muscle aches and chest pain (pleurodynia). Three deaths were reported (two in Crete and one in northern Greece). Another fifty possible cases have been identified, none fatal. As of early May, no further cases were being reported. There is no vaccine for Coxsackie virus infections. In general, the risk of Coxsackie virus infections may be lessened by good personal hygiene, such as careful hand-washing. The World Health Organization and the Centers for Disease Control do not recommend any restrictions on travel to Greece. For further information, go to Eurosurveillance and the World Health Organization.
A single case of bovine spongiform encephalopathy ("mad cow disease") has been identified, 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 travlers 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.
For disease statistics and updates on recent outbreaks, go to the National Centre for Surveillance and Intervention.
Food and water precautions
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, including 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, hats and shoes (rather than sandals). 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, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal 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
(reproduced from the U.S. State Dept. Consular Information Sheet)
People traveling in Greece who do not speak Greek may call 112 if they require emergency services. This is a 24-hour toll-free number. Callers will be able to receive information in English and French (as well as Greek) to request ambulance services, the fire department, the police and the coast guard.
Physicians and hospitals
For an online list of physicians, dentists, and hospitals in Greece, go to the U.S. Embassy website.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Medical facilities are adequate, and some, particularly the private clinics and hospitals in Athens and Thessaloniki, are quite good. Some private hospitals have affiliations with U.S. facilities, and generally their staff doctors have been trained in U.S. or other international teaching institutions.
Public medical clinics, especially on the islands, may lack resources; care there can be inadequate by American standards, and often, little English is spoken. Many patients, Greeks and visitors alike, are transferred from the provinces and islands to Athens hospitals for more sophisticated care. Others may choose to transfer from a public to a private hospital within Athens or Thessaloniki. Americans choosing to do so would arrange for an ambulance belonging to the private hospital to transport them from the public hospital to the private one. The cost of the ambulance for this transfer, as well as all expenses in a private hospital, must be borne by the patient.
Nursing care, particularly in public hospitals, may be less than adequate. For special or through-the-night nursing care, it is suggested that a private nurse be hired or a family member or friend be available to assist. One parent or a private nurse should always plan to stay with a hospitalized child on a 24-hour basis, as even the best hospitals generally maintain only a minimal nursing staff from midnight to dawn on non-emergency floors or wards...
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).
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, and appropriate antibiotics for common childhood infections, such as middle ear infections.
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 Greece are encouraged to register at the consular section of the U.S. Embassy/Consulate General and to obtain updated information on travel and security in Greece. The U.S. Embassy in Athens is located at 91 Vasilissis Sophias Boulevard, tel: (30)(210) 721-2851. The U.S. Consulate General in Thessaloniki is located at Plateia Commercial Center, 43 Tsimiski Street, 7th floor, tel: (30)(2310) 242-905. The Embassy's web site is http://www.usembassy.gr. The e-mail address for the Consular Section is email@example.com. The U.S. Consulate's web site addresses are http://www.usconsulate.gr. The e-mail address for the U.S. Consulate General Thessaloniki is firstname.lastname@example.org.
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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