Bulgaria: Vaccines and Diseases to Be Aware of

Last updated Jan 2015


Consult your physician to make sure you are up-to-date on routine vaccines and boosters before your trip to Bulgaria. Depending on your specific health situation, your doctor might decide that you need some additional vaccinations.



RECOMMENDED VACCINES FOR BULGARIA


The recommended immunisations for travel to Bulgaria are:

  • Hepatitis A and B
  • ‚ÄčTetanus vaccine or booster 
  • Typhoid fever vaccine or booster
  • *Tick-borne encephalitis (only recommended for travelers planning to spend a lot of time on the field or around domestic animals b/n March and Sept)
  • *Rabbies – The rabbies vaccine is usually only recommended for people closely working with wild or homeless animals or expecting to spend extended time in rural or wild areas, etc. 


     

DISEASES TO BE AWARE OF WHEN TRAVELING TO BULGARIA

Some diseases to be aware of while traveling in Bulgaria:



Hepatitis A

Viral infection that affects the liver. It is transmitted by contaminated food or water. In most cases, a completely recovers within few weeks is expected, though sometimes, recovery might take up to 9 months.

Symptoms: Fever, nausea, fatigue and yellowing of the skin and eyes (jaundice).

What is the risk? Bulgaria has reported several outbreaks in the last years. Travelers who plan to stay or work in areas with poor sanitation might be at risk.  

Vaccine: A vaccine for Hepatitis A (and a combination vaccine for Hepatitis A and B) exists and is usually recommended for travelers to Bulgaria. It is administered in the course of 6 months.

Prevention: Wash hands frequently and follow good food and personal hygiene habits. 



Hepatitis B

Infection caused by the highly contagious hepatitis B virus that affects the liver. It is transmitted by unprotected sex or sharing needles.Most people fully recover but some may remain at much higher risk of cirrhosis and liver cancer at a later stage in life. In very few people the infection leads to liver failure which can be fatal.

Symptoms: Flu-like, mild symptoms, joint pain and others that appear many months after the infection. Often no symptoms appear at all. In a very few people a potentially fatal liver failure can occur.

What is the risk? Bulgaria has a high prevalence of the disease and substantial percentage of the population are carriers of chronic hepatitis B without even knowing it.
The risk is small for most travelers who do not plan to engage in risky behavior. Volunteers at health facilities, childcare facilities, or people relocating to the country permanently are at a higher risk.

Vaccine: A vaccine exists and is recommended, especially to people in the high- risk groups. The vaccine is administered over the course of 6 m but an accelerated schedule is also offered.

Prevention: Refrain from risk behavior like unprotected sex, sharing needles or coming into contact with bodily fluids of any kind.



Hepatitis C

Viral infection that affects the liver. It is transmitted by blood-to-blood contact, usually by sharing needles or contaminated instruments for tattoo or acupuncture. 
Most people infected with the virus develop chronic hepatitis, which if untreated might cause scarring of the liver and significantly increase the risk of cirrhosis and liver cancer later in life.

Symptoms: Most people do not have symptoms. In rare cases flu-like symptoms may appear.

What is the risk? Bulgaria has a high prevalence of the disease and substantial percentage of the population are carriers of chronic hepatitis C without even knowing it.
The risk is small for most travelers which do not plan to engage in risky behavior. Volunteers at health facilities and childcare facilities are at a higher risk.

Vaccine: No vaccine currently exists.

Prevention: Avoid risk behaviors like sharing needles or coming into contact with blood.



Lyme disease 

Lyme disease is a bacterial infection spread by tick bites.  It is notoriously difficult to diagnose due to the unreliability of current testing methods. It is treated with antibiotics.

Symptoms: In early stage the skin around the bite becomes red. In some cases it is accompanied by flu-like symptoms, headache, fatigue, muscle pain, etc. If untreated, in later stages (several weeks or months after the bite) severe headaches, impaired memory, personality change or facial paralysis may occur.

What is the risk? This is the most common tick borne disease in Europe and Bulgaria reports over 500 cases each year. The risk is higher in wooded areas or grassy fields below 1500 m in altitude and in moist areas frequented by domestic animals. The risk increases with the time spent outdoors and between March and September.

Vaccine: No vaccine for Lyme disease is available.

Prevention: Wear loose clothing with smooth weave, tuck your pants in your socks and use insect repellent to minimize the risk of a tick bite. Check your body for ticks daily. If a tick bite is detected, visit a doctor to ensure the proper removal of the tick. The immediate removal of the tick will decrease the risk of infection.



Tick-borne Encephalitis

Viral infection, usually spread by tick bites or less commonly by drinking unpasteurized milk from infected animals. The disease affects the central nervous system. Unlike its Asian counterpart the European subtype is benign and rarely has a lasting consequences; 98% of those affected are expected to fully recover.

What is the risk? Most central European countries, including Bulgaria report several cases each year in the period between March and September. Your risk as a traveler is small but will increase the more time you spend outdoors. Most cases are reported in locals, living in rural areas below 1500 m in altitude and in moist areas frequented by domestic animals.  Rarely the disease infected ticks can be found in large urban parks.

Symptoms: fever, nausea, headache, tiredness, sore muscles. In rare cases a serious illness develops some 20 days after the initial symptoms. 

Vaccine: Vaccine is available but should be administered more than 6 months prior to traveling with subsequent 2 booster doses. Some accelerated vaccine schedules also exist. The vaccine is only recommended if you plan to spend extended time in high-risk areas like forest, fields etc. The vaccine is only available in Europe and Canada.

Prevention: Wear loose clothing with smooth weave, tuck your pants in your socks and use  insect repellent to minimize the risk of a tick bite. Check your body for ticks daily. If a tick bite is detected, visit a doctor to ensure the proper removal of the tick. The immediate removal will decrease the risk of infection.



Typhoid fever 

Caused by bacteria and transmitted by food or water contaminated with human feces. If detected early, the disease is easily treatable with antibiotics and 99% of those affected are expected to fully recover. If untreated, however, the disease might have serious and potentially fatal consequences.

Symptoms: fever that increases every day, abdominal pain, flu-like symptoms

What is the risk? The disease is commonly associated with the developing world, but sporadic cases have been reported in Eastern Europe in recent years. 

Vaccine: A vaccine provides partial protection (50 to 80%) and should be . A booster vaccine might be required every 2 to 5 years.

Prevention: The risk in Bulgaria is low, but increases for travelers to rural and underdeveloped areas of the country and among certain minority groups. Avoid risky foods and drinks. Those might include uncooked foods, peeled fruids, fresh vegetables and non-bottled water. 



Rabies 

Viral infection that targets the brain and the nervous system through contact with the saliva of an infected animal. In most cases the virus is transmitted by biting or less frequently by scratching. Unless treated before first symptoms appear  the disease is 100% fatal.

Symptoms: Fever, fear of water and aggressive behavior. Note that once the symptoms develop the disease is untreatable and is almost always fatal.

What is the risk? Bulgaria has reported only few human fatalities in the last 40 years, but tens of cases of infected animals are detected each year. The animals are predominantly wild foxes living in the northern part of the country as well as few dogs and cats. Rabies can also be transmitted by a bat bite. 
The risk for travelers visiting cities is small but slightly increases if you plan to spend time around wild animals, hiking, exploring caves, etc. 

What to do if bitten? If bitten by a dog, bat, fox or cat, rinse and disinfect the wound without covering it and seek immediate medical care. If it can’t be proven that the animal that bit you has been vaccinated for rabies a 14 day course of treatment will follow. An additional tetanus vaccine will be adminisred.

Vaccine: The pre-exposure vaccine in administred in 3 injections over the course of 3 months. Post-exposure vaccinations are required for treating individuals who have had no previous immunisation. It is usually recommended for people closely working with animals or expecting to spend extended time in rural or wild areas, etc.

Prevention: Avoid being around wild animals and stray dogs and cats. 



Tuberculosis (TB)

A bacterial infection that usually affects the lungs. It is transmitted from person to person most often by coughing or sneezing. It is not highly contagious and is usually spread between people who spend extended time in the same room, like family members or coworkers.
Most people who are exposed successfully fight off the bacteria. In others the disease remains latent. They do not feel sick and do not spread the bacteria to others.  There is  some risk that a latent TB will became active. The risk is higher in the first 2 years after the initial exposure and in cases of compromised immune system due to HIV and AIDS. 

Symptoms develop slowly, months after exposure and include persistent cough and night sweats.

What is the risk? Bulgaria is not considered a high-risk country. It reports just about 30 cases per 100 000 population each year even though over 90% of the population is vaccinated against the disease. The risk is concentrated within certain risk groups like prison population and the Roma minority.

Vaccine: The vaccine has been dropped from the list of routine childhood vaccines in most Western European countries and the US. Consult your physician before traveling to determine if you will need the vaccine.


Tetanus (Lockjaw)

A very rare bacterial infection that can be fatal if not treated. The bacteria enters the body through a puncture wound, animal bite or a wound contaminated with soil, dirt or feces.

Symptoms: stiffness in jaw and muscles

What is the risk? Bulgaria reports less than 5 cases each year and the risk is negligible. Regardless an up-to-date tetanus vaccine is always a good idea for any traveler.

Vaccine: part of routine childhood vaccination in most countries. A booster is usually needed every 10 years. 

Note! Animal bites, wounds contaminated with dirt, soil, saliva and puncture wounds can cause a tetanus inferction. A tetanus immunoglobulin (TIG) shot should be administred no later than 24 h after the incident.



Traveler’s Diarrhea

Caused by a virus or a bacteria in contaminated food, this is a common condition that affects up to 40% of all world travelers. It can be unpleasant and can ruin a trip. It can also have more severe consequences if it persist and leads to dehydration.
Most cases will clear up by themselves with time a proper diet and no additional medication will be necessary. It is important that you drink extra fluids in order to stay hydrated.
If you need to alleviate symptoms quickly, pharmacies in Bulgaria sell Imodium, an over the counter drug that treats and controls diarrhea. 

In cases of dehydration a combination of glucose and sodium chloride called Hydratin Alpha is widely available in pharmacies.
 
Note! The diarrhea can be a symptom of more serious conditions! If your diarrhea persist more than 3 days without a sign of improvement or if it is combined with dehydration or abdominal pain see a doctor. 


The Bulgarian National Center for Infectious and Parasitic Diseases publishes weekly epidemiological bulletin of the cases of contagious diseases reported in the Bulgaria.
 

Last updated Jan 2015
 
   
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