Travel vaccinations for Bulgaria

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong. All travellers should take care with personal, food and water hygiene. As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch. Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil. Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. This country is considered to have an intermediate or high prevalence of hepatitis B. Travellers should avoid contact with blood or body fluids. This includes: Avoiding unprotected sexual intercourse. Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used). Not sharing needles or other injection equipment. Following universal precautions if working in a healthcare or other higher risk setting. A sterile medical equipment kit may be helpful when travelling to resource poor areas. Vaccination could be considered for all travellers and is recommended for those whose activities or medical history put them at increased risk. This includes: Those who may have unprotected sex. Those who may be exposed to contaminated needles through injecting drug use. Those who may be exposed to blood or body fluids through their work (e.g. health and aid workers). Those at high risk of requiring medical or dental procedures or hospitalisation e.g. those with pre-existing medical conditions, those who may require travelling for medical care abroad, or those travelling to visit families or relatives. Long-stay travellers. Those who are participating in contact sports. Families adopting children from this country.

Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection. Rabies symptoms can take some time to develop, but when they do the condition is almost always fatal. The risk of exposure is increased by certain activities and length of stay (see below). Children are at increased risk as they are less likely to avoid contact with animals and to report a bite, scratch or lick. Most travellers to this country are considered to be at low risk for rabies. However some animals may pose a greater risk of rabies for travellers, e.g. foxes. Bats may carry rabies-like viruses in this country. Travellers should avoid contact with wild animals. Rabies is preventable with prompt post-exposure treatment. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Although rabies has not been reported in domestic animals, it is still sensible to seek prompt medical advice if bitten or scratched by all animals. Post-exposure treatment and advice should be in accordance with national guidelines. Pre-exposure vaccines could be considered for those who are at increased risk of exposure to wild animals especially foxes and bats.

Tick-borne encephalitis (TBE) is a viral infection spread by the bite of infected ticks. Occasionally cases of TBE occur after consumption of raw (unpasteurised) milk or dairy products from infected animals (e.g. cows, goats and sheep). Travellers are at increased risk of exposure during outdoor activities in areas of vegetation such as gardens, parks, meadows, woods, forest fringes and glades. This includes urban parks and woodland areas in cities. Ticks are usually most active between early spring and late autumn. There is a risk of TBE in some areas of this country. The transmission season varies, however, ticks are most active during early spring to late autumn. All travellers should avoid tick bites during outdoor activities, apply insect repellent frequently and follow tick bite avoidance advice. Travellers should check their skin and clothes regularly for ticks and remove them as soon as possible with a recommended technique. Wearing light coloured clothes makes it easier to spot ticks. Travellers should not eat or drink any unpasteurised milk products. Vaccination is recommended for those visiting affected areas whose activities put them at increased risk including: Living in TBE risk areas. Working in forestry, woodcutting, farming and the military. Visiting forested areas and urban parks, e.g. camping, fieldwork, hiking and hunting. Laboratory workers who may be exposed to TBE.

Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection. Travellers who will have access to safe food and water are likely to be at low risk. Those at increased risk include travellers visiting friends and relatives, frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work. Typhoid fever is known or presumed to occur in this country. All travellers should take care with personal, food and water hygiene. Vaccination could be considered for those whose activities put them at increased risk (see above). Oral and injectable typhoid vaccinations are available.