* Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling. You are not at increased risk in Northern, Western, and Southern Europe, including the Mediterranean regions of Italy and Greece.

* Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11-12 years who did not receive the series as infants.

* Malaria: if you are traveling to a malaria-risk area in this region, see your health care provider for a prescription antimalarial drug.

* Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.

* Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors

* As needed, booster doses for Tetanus-Diphtheria and Measles. Outbreaks of Diphtheria have been reported in states of the former Soviet Union. Travelers to these areas should be sure that their diphtheria immunization is up to date.

Malaria: (Eastern Europe and Northern Asia)

Malaria is always a serious disease and may be a deadly illness. All travelers to Malaria-risk areas in Eastern Europe, including infants, children, and former residents of Eastern Europe, are at risk for Malaria. Parts of the countries of Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan have Malaria risk. Travelers to Malaria-risk areas in Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan should take antimalarial drugs. In Uzbekistan, the risk of Malaria is low and varies along its border with Tajikistan.

Yellow Fever:

There is no risk for Yellow Fever in Western Europe, Eastern Europe and Northern Asia. A certificate of Yellow Fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa.

Food and Waterborne Diseases:

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' Diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Western Europe and Eastern Europe and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, Cholera, and Parasites), fever (Typhoid Fever and Toxoplasmosis), or liver damage (Hepatitis). The risk of Hepatitis A can be high in parts of the Eastern Europe region.

Other Disease Risks - Eastern Europe and Northern Asia:

Tick-borne Encephalitis, a viral infection of the central nervous system occurs in the southern part of the non-tropical forest belt in Europe and Asia (to Pacific Ocean). Most intense transmission has been reported in Russia, Czech Republic, Latvia, Lithuania, Estonia, Hungary, Poland, and Slovenia. Travelers are at risk who visit or work in forested areas during the summer months and who consume unpasteurized dairy products. Vaccine for this disease is not available in the United States at this time. A number of Rickettsial infections also occur in this region. To prevent tick-borne infections travelers should take precautions to prevent tick bites.

Other Disease Risks - Western Europe:

In 2004-2005 there has been a marked increase in reported cases of Mumps in the United Kingdom. Tick-borne Encephalitis, a viral infection of the central nervous system, occurs in Austria, Germany, Finland, Sweden, Switzerland, Denmark (only on the island of Bornholm); a few cases have also been reported from Italy, Norway, and France. Travelers are at risk who visit or work in forested areas during the summer months and who consume unpasteurized dairy products. The vaccine for this disease is not available in the United States at this time. To prevent Tick-borne Encephalitis, as well as Lyme disease, travelers should take precautions to prevent tick bites.