Northern Europe (Belarus, Belgium, Czech Republic, Denmark (with the Faroe Is-lands), Estonia, Finland, Germany, Iceland, Ireland, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Republic of Moldova, Russian Federation, Slovakia, Swe-den, Ukraine and the United Kingdom (with the Channel Islands and the Isle of Man). The area encompassed by these countries extends from the broadleaf forests and the plains of the west to the boreal and mixed forest to be found as far east as the Pacific Ocean.

The incidence of communicable diseases in most countries is such that they are unlikely to prove a hazard to international travelers greater than that found in their own country. There are, of course, health risks but in most areas very few precautions are required.

Of the arthropod-borne diseases, there are very small foci of tick-borne typhus in east and central Siberia. Tick-borne encephalitis, for which a vaccine exists, Lyme disease, and Crimean-Congo hemorrhagic fever may occur throughout northern Europe. Rodent-borne hemorrhaghic fever with renal syndrome is now recognized as occurring at low endemic levels in this area.

The foodborne and waterborne diseases reported, other than the ubiquitous diarrheal diseases are taeniasis (tapeworm) and trichinellosis in parts of northern Europe, diphyl-lobothriasis (fish tapeworm) from the freshwater fish around the Baltic Sea area. Fasciola hepatica infection can occur. Hepatitis A occurs in the Eastern European countries. Cases of cholera have been reported from some countries in the area. The incidence of certain food-borne diseases, e.g., salmonellosis and campylobacteriosis, is increasing significantly in some of these countries.

Other diseases. Poliomyelitis (also a food-borne and water-borne disease) continues to be reported from Belarus, the Republic of Moldova, the Russian Federation and the Ukraine. An outbreak of poliomyelitis in the Netherlands in 1992–93 was confined to a religious group that refuses vaccination. Rabies is endemic in wild animals (particularly foxes) in rural areas of northern Europe except Finland, Iceland, Ireland, Norway, Sweden, and the United Kingdom. In recent years, Belarus, the Russian Federation, and Ukraine have experienced extensive epidemics of diphtheria. Diphtheria cases, mostly imported from these three countries, have also been reported from neighboring countries: Estonia, Finland, Latvia, Lithuania, Poland, and the Republic of Moldova.

A climatic hazard in part of northern Europe is the extreme cold in winter.

Southern Europe (Albania, Andorra, Austria, Bosnia and Herzegovina, Bulgaria, Croatia, France, Gibraltar, Greece, Hungary, Italy, Liechtenstein, Malta, Monaco, Por-tugal (with the Azores and Madeira), Romania, San Marino, Slovenia, Spain (with the Canary Islands), Switzerland, and the Former Yugoslav Republic of Macedonia, and Yugoslavia. The area extends from the broadleaf forests in the north-west and the mountains of the Alps to the prairies and, in the south and south-east, the scrub vegetation of the Mediterranean.

Among the arthropod-borne diseases, sporadic cases of murine and tick-borne typhus and mosquito-borne West Nile fever occur in some countries bordering the Mediterranean littoral. Both cutaneous and visceral leishmaniasis and sandfly fever are also reported from this area. Recently an increasing number of Leishmania/HIV co-infections have been notified from France, Italy, Portugal and Spain. Tickborne encephalitis, for which a vaccine exists, Lyme disease, and rodent-borne hemorrhagic fever with renal syndrome may occur in the eastern and southern parts of the area.

The foodborne and waterborne diseases-bacillary dysentery and other diarrheas, and typhoid fever-are more common in the summer and autumn months, with a high incidence in the southeastern and southwestern parts of the area. Brucellosis can occur in the extreme southwest and southeast and echinococcosis (hydatid disease) in the southeast. Fasciola hepatica infection has been reported from different countries in the area. Cases of cholera have been reported from some countries in the area. The incidence of certain food-borne diseases, e.g., salmonellosis and campylobacteriosis, is increasing significantly in some of these countries.

Other diseases. Poliomyelitis (also a food-borne and water-borne disease) remains en-demic in Romania and Yugoslavia. Hepatitis B is endemic in the southern part of eastern Europe (Albania, Bulgaria and Romania). [Rabies in animals exists in most countries of southern Europe except Gibraltar, Greece, Malta, Monaco, mainland Spain]* and Portugal.

* Editor’s note: CDC addition.