TBE and Lyme Disease

🔎 What is TBE?

TBE stands for Tick-Borne Encephalitis. It is a viral disease transmitted by ticks that, in severe cases, can lead to meningitis, paralysis, and sensory disturbances. 

🔎 What is the difference between TBE and Lyme disease?

Lyme disease is a bacterial infection, whereas TBE is a viral infection. Both are transmitted by ticks.

In the early stages, both infections can cause flu-like symptoms, though some cases remain asymptomatic. About one in three people with Lyme disease develop a characteristic rash known as erythema migrans. This is a ring-shaped skin redness, at least 5 cm in size, typically paler in the center than at the edges, and slowly expanding outward over several days¹.

There is a vaccine available for TBE, but not for Lyme disease. TBE cannot be treated–the symptoms can only be managed. Lyme disease, on the other hand, can be treated with antibiotics, and early treatment leads to the best outcomes.

Mosquito-Borne Diseases

🔎 Are there mosquitos in Switzerland?

There are mosquitos in Switzerland but they typically do not transmit diseases like Malaria, Dengue or Japanese Encephalitis. However, because of climate change, three different invasive mosquito species, which had previously been alien to Switzerland, have been identified². Of these, the Asian Tiger Mosquito is of greater relevance, as this mosquito species can transmit diseases such as Dengue, Zika and Chikungunya. While still rather rare in Switzerland, its geographic distribution in Europe has clearly increased over the last years. 

🔎 What are the side effects of Tiger Mosquito bites?

Apart form the local reaction to mosquito bites such as local swelling, redness and itching, tiger mosquitoes can spread vector-borne diseases such as Dengue, Zika or Chikungunya. The symptoms depend on the transmitted disease.

🔎 Is mosquito repellent safe during pregnancy?

The EKRM (Expert Committee for Travel Medicine) recommends using mosquito repellents containing DEET (20-30%) or Icaridin during pregnancy. Additionally, permethrin (an insecticide used for treating mosquito nets and clothing, e.g., NOBITE®) is also advised. As a general precaution, hands and other body areas that come into contact with the baby (e.g., chest) should be washed after applying repellents.

In our shop, we offer NOBITE® Extreme (for the skin) and NOBITE® Textile (for clothing) for purchase.

Rabies

🔎 How long before a trip should rabies vaccinations be started?

Ideally, rabies vaccinations should begin at least six weeks before departure. Most travelers require two doses, spaced 28 days apart. If time is short, the interval can be reduced to a minimum of seven days. Since the vaccine takes some time to become effective, the second dose should ideally be administered no later than about two weeks before travel.

🔎 How long does the rabies vaccine remain effective?

Protection begins two weeks after the second dose and should be boosted once after one year. If a person has already received two doses in the past, a single booster shot provides lifelong protection. However, even after completing the primary vaccination series, immediate wound care and additional booster doses are necessary in case of potential rabies exposure³!

🔎 Can mosquitoes transmit rabies?

No, rabies can only be transmitted by mammals.

🔎 When should the rabies vaccine be boosted?

After completing the primary rabies vaccination series with two doses, protection lasts for at least one year. A booster dose, given no earlier than one year after the initial series, is intended to provide lifelong protection. However, even after full vaccination, immediate wound care and additional booster doses are required in case of potential rabies exposure³!

🔎 What should you do after a bite or scratch from a mammal?

In case of potential rabies exposure (such as a bite, scratch, or licking of broken skin by a mammal), the wound must be washed immediately with plenty of water and soap for 10–15 minutes and then disinfected. Vaccination is required in all cases.

• If vaccinated before travel: Two additional vaccine doses are needed, given three days apart.

• If unvaccinated: Four doses are required over several days, along with passive immunization (rabies immunoglobulin).

Whenever possible, a blood test is conducted afterward to verify the immune response. For more details, click here.

Shingles

🔎 Should you get vaccinated against shingles?

The shingles vaccine is recommended for all individuals aged 65 and older. For people with weakened immune systems, vaccination may be advised from age 50 or even as early as 18, depending on the severity of the condition. The vaccine provides highly effective protection against shingles, which is the reactivation of the varicella-zoster virus (the same virus that causes chickenpox). However, individuals who have never had chickenpox and want to protect themselves require a different vaccine.

🔎 Can you get vaccinated against shingles if you’ve never had chickenpox?

Shingles is caused by the reactivation of the varicella-zoster virus (VZV). The initial infection with this virus leads to chickenpox, after which the virus remains dormant in the body and can reactivate later, especially if the immune system is weakened, causing shingles. This means that shingles only occurs in individuals who have previously had a varicella-zoster virus infection. Therefore, the shingles vaccine is only beneficial for those who have had chickenpox before.

Nearly the entire adult population of Switzerland (98%) has had chickenpox at some point, which is why routine testing is not required before receiving the shingles vaccine. However, if there is uncertainty—especially before planned immunosuppression—a blood test may be helpful.

For young, healthy individuals who have never had chickenpox, it is recommended to get the chickenpox vaccine. This consists of two doses, given at least one month apart.

🔎 Can you get shingles more than once?

Yes, it is possible, but shingles usually occurs only once.

🔎 How many doses are needed for shingles protection?

To ensure effective protection, two vaccine doses are required, with a minimum interval of two months between them.

🔎 How much does the shingles vaccine cost in Switzerland?

The shingles vaccine consists of two doses, given at least two months apart. Each dose costs CHF 175, plus additional fees for consultation and administration. If the vaccine is given according to official recommendations, the costs are covered by mandatory health insurance (after deductibles and co-payments).

🔎 What are the side effects of the shingles vaccine?

As with other vaccines, side effects can occur with Shingrix, the shingles vaccine. The most common reactions include pain, redness, or swelling at the injection site, as well as fatigue, chills, fever, headache, gastrointestinal issues, and muscle pain (myalgia)⁴.

HPV

🔎 How much does the HPV vaccine cost in Switzerland?

The HPV vaccine is free of charge for adolescents and young adults as part of the cantonal vaccination programs. It is important that the vaccination schedule is started before the 27th birthday and carried out in the individual's canton of residence. If the vaccination schedule (consisting of three doses) is started after the 27th birthday, the cost per dose is CHF 213.50, in addition to consultation and injection fees.

Japanese Encephalitis

🔎 What are the risk areas for Japanese Encephalitis?

Japanese Encephalitis is primarily found in rural areas of Southeast Asia. However, its distribution extends from Japan through eastern China and India to Indonesia, Papua New Guinea, and Australia in the south. Here you can find a map of the distribution area.

Yellow Fever

🔎 How long before departure should the yellow fever vaccine be given?

Immunity is provided 10 days after the first dose of the yellow fever vaccine.

Vivotif (Typhoid oral vaccination)

🔎 What are the side effects of Vivotif?

Common side effects include gastrointestinal issues such as abdominal pain, nausea, and changes in stool, as well as fever, fatigue, and general discomfort. However, Vivotif® is generally well tolerated.

Diphtheria

🔎 Can you still get diphtheria despite vaccination?

The vaccine works against the diphtheria toxin responsible for severe diseases, not against the bacteria itself. This is one reason why it is still possible to contract the bacteria despite being vaccinated. However, in vaccinated individuals, the infection typically results in mild or no symptoms. The vaccine prevents severe disease by enabling the "trained" immune system to neutralize the toxin early.

Immunity decreases over time. Therefore, after completing the initial vaccination series, the diphtheria vaccine (combined with tetanus) should be boosted every 10-20 years, depending on age. In the event of exposure to a known case of diphtheria or an outbreak, an earlier booster may be required.

Hepatitis

🔎 How long before travel should I start the hepatitis A vaccination?

Depending on the vaccine used, a single dose may be sufficient for protection during travel. Since it takes some time for symptoms to appear after contracting the hepatitis A virus, even "last-minute" vaccinations just before departure can provide adequate protection. However, be cautious—this is usually not the case for vaccines against other diseases. Therefore, it is generally advisable to schedule your consultation well before the trip, not just right before departure.

🔎 How many hepatitis vaccinations are needed?

This depends on the vaccine used. If hepatitis A is administered using the monovalent vaccine, a single dose is sufficient for travel protection. For long-term protection, a second dose is required after 6-12 months. If the combination vaccine with hepatitis B is used, three doses are needed in total, with the first two doses given at least 4 weeks apart before travel.

And a note: individuals who previously received passive immunization with hepatitis A antibodies still need to complete the full vaccination series. Hepatitis A active vaccines have been available in Switzerland only since 1992, with passive vaccines used before then. If you were vaccinated before 1992, you most likely received a passive vaccine.

Travel Diarrhea

🔎 What are the symptoms of travel diarrhea?

The symptoms of travel diarrhea are self-explanatory from the name. It’s important to seek medical attention if you experience fever and/or blood in the stool. Otherwise, it's crucial to focus on maintaining adequate fluid intake and replacing lost electrolytes (salts). This can be done with foods such as bananas, broth, and prezels or alternatively, you can use oral rehydration solutions (ORS).

Tetanus

🔎 What is tetanus?

Tetanus, also known as lockjaw, is a disease caused by the bacterium Clostridium tetani. The bacterium forms spores that are found virtually everywhere in the environment, particularly in soil, road dust, and on objects such as thorns, wood splinters, and nails. If the bacterium enters a wound, it produces the highly dangerous tetanus toxin. This toxin damages the nerve cells that control muscles, leading to the characteristic paralysis and painful muscle spasms, which can spread from the face and jaw muscles throughout the body. Even with the best medical care, one in five to one in two people who develop generalized tetanus will die. Fortunately, there is a very effective vaccine that is administered in Switzerland during childhood. The vaccine should be boosted in adulthood every 10-20 years, depending on age and health status. A booster may also be needed earlier in the case of injuries.

🔎 What is the difference between tetanus and rabies?

Tetanus is often confused with rabies because both diseases cause muscle spasms and have similar-sounding names (in German). However, the causative agents and transmission methods are different. In tetanus, the pathogen is a bacterium (Clostridium tetani) that enters a wound and releases a nerve toxin (tetanus toxin). In rabies, the pathogen is a virus, typically transmitted through a bite or scratch from an infected mammal.

Dengue

🔎 What are the symptoms of Dengue?

Dengue infections often occur without or with only mild symptoms and may go unnoticed. If symptoms do occur, they typically involve Dengue fever. The typical symptoms include fever, headaches, pain behind the eyes, muscle/joint pain, and a red, spotted or patchy rash. In most cases, these symptoms subside on their own, but they can also progress to a more severe form. Severe dengue cases are rare in tourists, but the risk of severe illness increases significantly with a second dengue infection.

🔎 How much does the Qdenga vaccine cost?

The Qdenga® vaccine is used to protect against a second (reinfection) dengue illness. It is recommended for travelers aged 6 and older who have already had a dengue infection and are planning another trip to an area with significant dengue transmission. The vaccination requires two doses, given 3 months apart, and can be started 6 months after the first dengue infection. You can find the price for the Qdenga® vaccine on our price list.

Travel Medicine

🔎 What is a travel medicine consultation?

During a travel medicine consultation at our Travel Clinic UZH, you will discuss your individual travel plans with a specialist, including your travel route and planned activities. Based on your travel plans and personal health history, our staff will provide tailored recommendations and answer any questions you may have. If you choose to proceed with the recommended vaccinations, they can be administered immediately after the consultation. Common travel medications can also be purchased on-site.

🔎 Tropical Institute Appointment and Tropical Institute Zurich Opening Hours

If by "Tropeninstitut" you mean us, the Travel Clinic UZH, appointments can be booked via our website. There, you will also find our opening hours and other useful information for preparing your trip.

Now we’ve covered a whole range of popular topics - but of course, your health questions don’t have to stop here. For more in-depth info, visit our website. And if you’re planning a trip and looking for tailored advice on vaccinations, medications, or health risks at your destination, book an appointment with us. We’re here to help you travel safely and confidently.

References

¹ https://www.infektionsschutz.de/erregersteckbriefe/borreliose/

² https://www.swisstph.ch/en/topics/asian-tiger-mosquito

³ https://www.healthytravel.ch/de/get-file?attachment_id=2702&download_file=RABIES_ECTM_Factsheet_Layperson_DE.pdf

⁴ https://www.swissmedic.ch/swissmedic/de/home/ueber-uns/publikationen/public-summary-swiss-par/public-summary-swiss-par-shingrix.html