Read below for travel health advice on Ukraine from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to the Ukraine will need vaccinations for hepatitis A and typhoid fever, as well as medications for travelers' diarrhea. All travelers should be up-to-date on tetanus-diphtheria vaccination. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.
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 the Ukraine:
Tetanus - diphtheria vaccine is recommended for all adults who have not received a tetanus-diphtheria immunization within the last 10 years. In the 1990s, a massive diphtheria epidemic occurred in the newly independent states of the former Soviet Union. Cases of diphtheria have been reported among U.S. citizens who have traveled to this area.
Measles vaccine is recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. A measles outbreak was reported from the Ukraine in February 2006 (see "Recent outbreaks" below.) 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 the Ukraine. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.
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.
Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.
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.
Rabies vaccine is recommended only for those at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers living in areas with a high risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions. An increased number of animal rabies cases was reported from the Donetsk region in June 2007.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.
All travelers should be up-to-date on routine immunizations, including
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.
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. 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 measles outbreak was reported from the Ukraine in November 2011, causing more than 10,000 cases in the first six months of 2012, mostly in the western regions of the country bordering on Hungary, Poland, and Slovakia. A previous outbreak began in February 2006, totaling more than 17,000 cases by the end of the year. The outbreak appeared to have started in Kyiv city (also known as Kiev), but cases were ultimately reported from all parts of the country (see Eurosurveillance and ProMED-mail, February 4, 2006). All travelers born after 1956 should make sure they are fully immunized against measles or have a blood test documenting measles immunity, as above.
A rubella (German measles) outbreak was reported from Lviv oblast in January 2011, causing 18 cases for the month, compared to 32 cases for the whole of 2010 (see ProMED-mail). All travelers born after 1956 should be sure to have received two doses of MMR vaccine before departure. Those born before 1957 are presumed to be immune to rubella.
Cases of cholera are reported sporadically from the Ukraine. Four cases were reported from the city of Mariupol (Donetsk region) in June 2011. In August 2010, the bacteria which cause cholera were found in the Dnieper River near Zaporizhzhya. Swimming is prohibited on the central beaches near the Khortytsya island and on the beaches located on the area from the Dniprohes hydroelectric power station to the lower limits of the city (see ProMED-mail). Cholera vaccine is not advised for travel to the Ukraine.
A major outbreak of H1N1 influenza was reported from the Ukraine in October 2009, resulting in 282 deaths by November 14. Most of the cases were reported from the western part of the country, specifically the Ternopil, Lviv, Ivano-Frankivsk, and Chernivtsi regions, but a growing number are being reported from the capital city of Kiev (see ProMED-mail). No travel restrictions are recommended, but travelers to the Ukraine should try to receive the H1N1 vaccine, if available, before departure.
A diphtheria outbreak was reported from Donetsk in July 2008, chiefly involving the city of Makeevka (see ProMED-mail, July 23, 2008). A much larger outbreak occurred in the early 1990s after the break-up of the Soviet Union (see CR Vitek and M Wharton, Emerging Infectious Diseases). All travelers to the Ukraine should make sure they have received tetanus-diphtheria vaccine within the past ten years.
An increased incidence of Lyme disease was reported from the Donetsk region in July 2008 and again in June 2009 (see ProMED-mail, July 23, 2008, and June 6, 2009). Lyme disease is a tick-borne bacterial infection that may be complicated by arthritis, neurological involvement, or (less commonly) cardiac conduction disorders. The disease is reported from many parts of the Ukraine, including Kiev. Travelers to the Ukraine should protect themselves from tick bites, as below.
An outbreak of H5N1 avian influenza ("bird flu") was reported from poultry farms in the Crimea in December 2005, followed by outbreaks in the Kherson region, the Sumy region, and a zoo in Odessa. The most recent poultry outbreaks were reported in January and February 2008 from the Black Sea Crimea peninsula. No human cases have been reported to date.
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 Ukraine 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.
A mumps outbreak was reported in December 2006 from the Perechinskiy district of the Zakarpatye Region of the Ukraine, resulting in more than 200 cases (see ProMED-mail; December 13, 2006). All travelers born after 1956 should make sure they either have received two doses of MMR (measles-mumps-rubella) vaccine, which is one of the routine childhood immunizations, or have a blood test documenting mumps immunity. Children who are 12 months or older should receive a total of 2 doses of MMR vaccine, separated by at least 28 days, before traveling to the Ukraine. Children between the ages of 6 and 11 months should be given a single dose of MMR vaccine before departure.
An increase in the number of hantavirus infections was observed in spring 2005, chiefly from Ardennes and the Aisne administrative departments in northern France, bordering on Belgium, and the département of Jura, bordering on Switzerland. In Europe, hantaviruses cause an illness known as hemorrhagic fever with renal syndrome, characterized by the abrupt onset of fever, chills, weakness, and dizziness, often associated with headache, muscle pains, and back ache. The main complication is kidney failure. Hantaviruses are acquired by exposure to bank voles, which are a type of rodent. Most travelers are at low risk for infection. For further information, go to Eurosurveillance.
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
A small amount of the radiation released from the Chernobyl incident in 1986 reached the Ukraine. According to the U.S. State Department, wild berries, mushrooms, and wild fowl and game should be avoided, since these have been found to contain higher than average levels of radiation.
Tap water is generally safe to drink in major cities, but water quality is variable in rural areas. If in doubt, do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not eat fruits or vegetables unless they have been peeled or cooked. Don't eat wild mushrooms or berries. 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 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
(for travel to rural or forested areas in the spring or summer)
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.
Swimming and bathing precautions
Do not swim in the Dnipro River, due to the risk of exposure to pollutants and radioactive material. Swimming should be limited to chlorinated swimming pools.
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 a public ambulance in Kyiv, call 03. For a private ambulance, call Medicom at 432-8888 or Polyclinic #1 at 294-7002, -7008, or -7009.
Medical care is adequate for routine problems, but not comparable to that found in North America or Western Europe. Medical supplies may be limited. When a patient is hospitalized, family members or friends may be expected to provide bandages, medication, and food. Many expatriates use the American Medical Center (1 Berdichevskaya vul.; tel. 490-7600); LifeLine Medical Clinic (Beresneki Region on Left Bank at St. Andrews School; tel. 553-9787, 553-7416) or Medicom (private hospital; 8 Kondratyuka vul.; tel. 055 for information, 432-9447 for emergency, 432-8888 for office/hospital). For a guide to other physicians, clinics, and hospitals in the Ukraine, go to the U.S. Embassy website. Most 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.
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 Ukraine are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov, and obtain updated information on travel and security within Ukraine. 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 Consular Section of the U.S. Embassy is located at #6 Mykola Pymonenko St., 01901 Kiev, Ukraine. Telephone: (38-044) 490-4422, fax 236-4892. The Embassy is located at #10 Yuriv Kotsyubinsky St. 01901 Kiev, Ukraine. Tel.: (38-044) 490-4000.
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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