Medical Recommendations for Visitors to Uzhhorod, Ukraine

(Compiled by Mark E. Rampton, M.D., Corvallis Family Medicine, PC, Corvallis, Oregon Updated April 2019)

These are medical recommendation for anyone who is planning a trip to Corvallis, Oregon’s sister city – Uzhhorod, Ukraine. You will want to plan ahead to insure a safe and healthy trip. This document provides some preventative strategies, and I suggest that you talk with your personal physician for specifics regarding your individual situation.

A trip to Ukraine may give rise to numerous health-related issues, such as jet lag, safety of public water, care of minor and not-so-minor illnesses or injuries, and the advisability of taking along an antibiotic, just in case. The most challenging issue is prevention of infectious diseases, from diarrhea to diphtheria, so I have devoted most of this page to prevention through immunization, and caution against exposure.

Required Vaccinations: None

Recommended Vaccinations:

  1. Diphtheria/Pertussis/Tetanus – due to an epidemic of diphtheria in all areas of the former Soviet Union, travelers to Ukraine should be up-to-date on this immunization. Routine schedule is every 10 years, however, if you are going to Ukraine, I recommend a booster if it has been over 5 years since last vaccination.
  2. Poliomyelitis – if you completed the primary series (given before entry to kindergarten) you do not need to be revaccinated, unless going to a country where there has been a recent outbreak (not Ukraine).
  3. Measles – if you were born after 1957, and were not vaccinated with MMR, you should receive this now.
  4. Hepatitis A – endemic in all parts of the world, especially in developing nations, hepatitis A is one of the most preventable diseases affecting travelers. A single vaccination (Havrix or Vaqta) gives immunity within 15 days of administration. For lasting immunity, it is recommended that a booster be given at 6 to 12 months after the primary. I recommend vaccination rather than immune globulin, unless you require a more immediate protection.
  5. Hepatitis B – formerly called “serum hepatitis”, hepatitis B remains a worldwide problem, especially in Africa and eastern Asia. This vaccination is optional for travelers to Ukraine, but recommend for those involved in healthcare.
  6. Influenza or “flu” – this an annual immunization, since immunity is short-lived, and the strains vary year to year. This vaccine is now recommended for all adults.

Optional Vaccinations:

  1. Typhoid Fever – there have been cases of typhoid fever in western Ukraine in recent years, caused by ingestion of the water-born Salmonella Typhi organism. By proper precautions, one can greatly reduce the risk of this gastrointestinal infection (see below under heading “Notes on Prevention” for details). I am recommending this immunization only if you will be spending some of your time in a rural or primitive setting in Ukraine. For those who desire this added protection, they can take the oral form, available as four doses, taken on an empty stomach every other day. No antibiotics should be taken for two weeks after the first dose. This vaccine is generally well tolerated, and a booster is recommended after five years. Alternately, an injectable typhoid vaccine, Typhim Vi, can be given as a single dose. This vaccine is generally well tolerated with minimal side effects.
  2. Pneumococcus (pneumonia) – this is recommended for adults with chronic illnesses, esp. lung diseases and all adults over the age of 65 years.

Tuberculosis:

I recommend that everyone who travels to Ukraine have a PPD skin test prior the trip and a repeat test approximately 2 months after return.

Additional Notes on Prevention, Antibiotics and Special Considerations

Prevention:

Prevention of ingested pathogens (salmonella, shigella, campylobacter, pathogenic E. coli, etc.) can be accomplished in most cases by following these guidelines. Avoid drinking unpurified water, including the municipal water, and avoid ice cubes or chips in your beverages. For brushing your teeth, use only purified water. During bathing, do not allow water from the bath or shower to enter your mouth. Avoid any unpeeled fruit, and eat only vegetables which have been cooked or served in a vinegar or salty solution (a common dish in Ukraine is sliced cucumbers in a mild vinegar solution). Water purification can be accomplished by either using tablets, or a compact filtration system. Bottled drinking water is readily available for sale in any grocery store in Uzhhorod.

Antibiotics:

I am frequently asked by patients who are planning foreign travel to prescribe antibiotics for them to have “just in case”. In general, it is wise to carry an antibiotic for bowel infections, but they are rarely necessary for other infections (respiratory, etc). Traveler’s diarrhea is a common ailment in persons traveling from the U.S. to Ukraine. The major sources of these enteric pathogens include unpeeled fruits, uncooked/untreated vegetables, and municipal or well water. Traveler’s diarrhea caused by bacteria typically occurs during the 1st or 2nd week of a trip: 20% lasts under 24 hours; 60% lasts 2 – 7 days; and 15% lasts over 8 days. Symptoms usually include abdominal cramps, diarrhea, and vomiting. A more severe infection will include fever and bloody diarrhea. Prevention, as mentioned above, can be summarized: “Boil it, cook it, peel it, or forget it”. Trying to prevent infection by taking an antibiotic during your trip is discouraged, since there is a chance that the antibiotic will cause a problem. When necessary, I recommend the following dosage for antiobiotics:

One of the following – (a) Trimethiprim /Sulfamethoxisole DS twice/day. (b) Cipro 500 twice/day, or Levaquin 500/day

Treatment of Diarrhea (Check with your physician if you have special needs):

Mild Diarrhea (loose stools, mild symptoms): alter diet toward clear liquids (avoid all fresh milk products) and toward easily digested foods (avoid spicy, rich or fatty foods). Antidiarrheal meds, such as Loperimide, Imodium AD or Pepto-Bismol may be used, but are usually unnecessary.

Moderate Diarrhea (3 – 5 loose or watery stools/day, moderate abdominal symptoms): alter diet to only clear liquids (no dairy) and easily digested food (bananas, rice or rice water, applesauce, low-fat crackers or dry toast). Use Loperimide, 2.5 mg, one after each stool, and if symptoms last 3 days, begin 3-day antibiotic regimen (see below).

Severe Diarrhea (3 or more watery stools/day, severe abdominal cramps, possibly bloody stools): clear liquids only (water, dilute soda pop, and in severe cases use oral rehydration solution), avoid solid foods, Loperimide 2.5 mg every 1 – 4 hours depending on the presence of diarrhea, and 4-day antibiotic regimen, taking a double dose on day 1, and regular dose on days 2 – 4.

Pregnant or Immunosuppressed individuals:

In the case of patients who are pregnant, or are on immuno-suppressant medications, they should avoid live virus vaccines, such as typhoid, yellow fever, measles, mumps, rubella, and oral polio. There is evidence that patients who are taking gastric acid inhibitors (Tagamet, Pepcid, Zantac, Prilosec, Previcid, etc.) are at greater risk to develop a case of infectious diarrhea.