Read below for travel health advice on Netherlands from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
In general, no special vaccinations or medications are necessary for travel to the Netherlands.
|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 the Netherlands:
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.
Two cases of infection with the Middle East respiratory syndrome coronavirus (MERS-CoV) were reported from the Netherlands in May 2014. Both became ill while in Saudi Arabia, where a MERS epidemic is ongoing. There does not appear to be any significant risk for travelers to the Netherlands.
An outbreak of Q fever was reported in May 2007 from the northeastern region of the province of Noord-Brabant, an agricultural area in the south of the Netherlands known for dairy goats. This was followed by a second, larger outbreak in the same area starting in the spring of 2008. The latter outbreak was more widespread and extended to the adjacent province of Gelderland. More than 1000 human cases of Q fever were reported from the Netherlands in 2008. The numbers appeared to be declining by July 2008, but a sharp increase in human cases was again reported from Noord-Brabant in April-May 2009, resulting in 2357 confirmed human cases for the year, including six deaths. A total of 506 human cases, 11 of them fatal, were reported for the year 2010, followed by an additional eight non-fatal human cases in the first month of 2011. See Eurosurveillance and ProMED-mail (July 25 and 28, 2008; May 8, June 26, September 27, and December 7, 2009; and July 27, 2010) for further information.Most of the cases have been in Noord-Brabant, though cases have also been reported from Gelderland, Limburg, and Utrecht Provinces in the southern part of the country, and elsewhere.
Symptoms of Q fever typically include fever, chills, nausea, headache, and body aches. Complications may include pneumonia, hepatitis, endocarditis (heart valve infection), and infections of the bones and joints. Pneumonia has been the predominant presentation in the Netherlands outbreak. In pregnant women, Q fever may lead to miscarriage. Q fever is primarily a disease of ruminants such as cattle, sheep, and goats, which shed the Q fever bacteria in their body fluids, especially birth products. Humans become infected by inhaling dust or aerosols contaminated by body fluids from infected animals. The disease is not transmitted from person-to-person. Travelers to the Netherlands should avoid farms in the affected areas. If this is not possible, avoid going near areas where animals are kept, such as barns and pens, and avoid direct contact with animals. Travelers should also be sure not to drink unpasteurized milk or eat products made from unpasteurized milk.
A mumps outbreak was reported from the Netherlands in December 2009, causing 172 cases by April. Most of the cases occurred in students aged 18 to 24 years who had been fully vaccinated (see Eurosurveillance). An increased incidence of mumps was also reported from the Netherlands between August 2007 and May 2008, resulting in 89 cases, mostly in those who had declined vaccination for religious reasons (see Eurosurveillance). 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.
A measles outbreak was reported from Utrecht in October 2008, causing 16 cases. An outbreak was reported from the Hague in June 2008, leading to 36 cases as of July, mostly in children. The outbreak involved members of the anthroposophic community, who generally decline measles vaccination (see Eurosurveillance). Between April 1999 and January 2000, a measles outbreak in the Netherlands caused more than 3200 cases, chiefly among young people belonging to a religious community whose members routinely choose not to immunize their children for religious reasons. For further information, go to Eurosurveillance. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to the Netherlands.
An outbreak of psittacosis was reported in November 2007 among those who had visited a bird show in the rural town of Weurt (village of Beuningen). See Eurosurveillance for further information.
Three people in the Netherlands developed infections caused by Vibrio alginolyticus in July 2006 after swimming in the Oosterschelde, a large inlet on the North Sea, at separate but nearby locations. See Eurosurveillance for further information. Vibrio infections were reported among bathers from several other European countries in the summer of 2006, apparently related to an increase in water temperature, which is favorable to the growth of Vibrio species. Those with compromised immune systems or open wounds should avoid swimming in the North Sea until further notice.
An outbreak of Legionnaires' disease was reported from Amsterdam in July 2006, resulting in 27 confirmed cases, one of them fatal. The source was a cooling tower located next to a former Post Office building (Oosterdokskade) in the east-central part of the city. The cooling tower was taken out of operation on July 11. For further information, go to Eurosurveillance and ProMED-mail. In February-March 1999, an outbreak of Legionnaires' disease was reported among visitors to a flower show, causing 188 confirmed and probable cases, including 21 deaths. The source of the outbreak appeared to be a whirlpool spa. For further information, go to Emerging Infectious Diseases. 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.
An increase in the number of cases of Lyme disease has been observed over the last several years. The greatest increase has been reported from the south and northeast of the Netherlands, as well as several locations along the coast in the west. See Eurosurveillance for further information. 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 infection 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.
An outbreak of rubella (German measles) was reported among members of the Gereformeerde Gemeente in Nederland (Netherlands Reformed Community) in the Netherlands, a Christian community, beginning in September 2004. A total of 387 serologically confirmed cases were identified. Most had declined rubella vaccination on the basis of religious beliefs. For further information, go to Eurosurveillance and Health Canada. For a map showing the distribution of cases, go to the Nationale Atlas Volksgezondheid. All travelers to the Netherlands should make sure they have received rubella vaccine, which is one of the routine childhood immunizations.
Three human cases of variant Creutzfeldt-Jakob disease (CJD) have been identified in the Netherlands. See Eurosurveillance for details. The disease is acquired by eating beef from cows with a related infection known as bovine spongiform encephalopathy (mad cow disease). A small number of cases of mad cow disease are sporadically reported from the Netherlands, most recently from a cow in Noord Brabant in October 2010. 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.
An outbreak of H7N7 avian influenza (H7N7) ("bird flu") was reported among Dutch poultry farms in March 2003. Unlike H5N1 avian influenza, which is highly pathogenic, H7N7 avian influenza does not in general pose a major risk to humans. The H7N7 outbreak resulted in 89 symptomatic human cases, mostly conjunctivitis (pink-eye). A smaller number developed flu-like symptoms. One person died from pneumonia. Three cases occurred in people who had had contact with an infected poultry worker but had not themselves been directly exposed to poultry, implying that the infection had spread from person-to-person. Serologic studies performed at a later date suggested that there may have been hundreds of asymptomatic human infections, including many in people who did not have direct poultry contact. The outbreak was terminated by mass slaughter of poultry. For further information, go to Eurosurveillance, the World Health Organization, the Centers for Disease Control, and ProMED-mail (October 15, 2004).
A cluster of five cases of meningococcal disease was reported from the towns of Klundert and Zevenbergen in July 2001. Two were cousins, but no direct relationship could be established between the other cases. See Eurosurveillance for details.
An outbreak of pertussis (whooping cough) was reported in 1996 and 1997. All children traveling to the Netherlands should be up-to-date on routine immunizations, which include pertussis.
For disease statistics and updates on recent outbreaks, go to the Nation Master site.
Insect and Tick Protection
Wear long sleeves, long pants, and boots, with pants tucked in when traveling to rural or forested areas. 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 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.
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 emergencies anywhere in the Netherlands, call 112.
(reproduced from the U.S. Embassy website)
If your situation warrants, you should seek assistance from a hospital. These institutions are staffed and equipped to deal with emergency situations.
Emergency services (including transportation by ambulance) are not free and you will be billed for any services rendered to you.
The Netherlands Association of Hospitals has compiled a list of all Dutch hospitals, which can be searched by city.
For non emergency medical asistance, you are obliged to consult a general practitioner (huisarts) before attempting to obtain non-emergency medical treatment from a specialist. The medical care sector in the Netherlands is based on a referral system which requires patients to see a local huisarts first. Medical specialists will generally only see those patients who have been referred to them by a general practitioner.
If you are staying in a hotel, contact the reception desk and they will direct you to the doctor assigned to that hotel. If you are staying with a friend or family, contact their family doctor.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Good medical facilities are widely available. The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. U.S. medical insurance plans seldom cover health costs incurred outside the United States unless supplemental coverage is purchased. Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. However, many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas including emergency services such as medical evacuations.
When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the U.S. may cost well in excess of $50,000. Uninsured travelers who require medical care overseas often face extreme difficulties, whereas travelers who have purchased overseas medical insurance have, when a medical emergency occurs, found it life-saving. When consulting with your insurer prior to your trip, please ascertain whether payment will be made to the overseas healthcare provider or if you will be reimbursed later for expenses you incur. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.
Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State's Bureau of Consular Affairs brochure, Medical Information for Americans Traveling Abroad, available via the Bureau of Consular Affairs home page or autofax: (202) 647-3000.
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 traveling in the Netherlands are encouraged to register with the Consulate General in Amsterdam through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within the Netherlands. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in The Hague, at Lange Voorhout 102; tel. (31)(70) 310-9209. However, all requests for consular assistance, including registration, should be directed to the Consulate General in Amsterdam at Museumplein 19, tel. (31)(20) 664-5661, (31)(20) 679-0321 or (31)(20) 575-5309. The after-hours emergency telephone number is (31)(70) 310-9499. The U.S. Embassy and Consulate General web site at http://www.usembassy.nl answers many questions of interest to Americans visiting or residing in the Netherlands.
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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