Bhutan

Pregnant women

In general, most women can travel safely while pregnant, providing they take precautions. However, several diseases may have more severe consequences in pregnancy, with risk to both mother and unborn baby. Traveling while pregnant, especially to tropical areas or places with basic facilities, may therefore pose some risks and you should consult healthcare professionals for pretravel advice.  

Most vaccines are safe during pregnancy, but healthcare professionals need to assess the risk of infection versus the risk of vaccination on a case-by-case basis. 

Preventing gatrointestinal infections is particularly important during pregnancy. Diarrhoea can trigger contractions, and some microorganisms can harm the foetus, although the likelihood is small. Listeria and toxoplasma represent particular risks for pregnant women and unborn babies. Hepatitis A and E can be transmitted through contaminated water and food. Pregnant women are more susceptible to a severe course of the variant of hepatitis E that is often found in low-income countries in Africa and Asia. There is a vaccine for hepatitis A but not for hepatitis E. Pregnant women should be especially careful with food hygiene abroad.
Avoid raw meat, raw fish, unpasteurised dairy products, and always wash or peel raw vegetables, fruits, and berries.

Mosquito-borne diseases: Several mosquito-borne diseases can pose a risk to both mother and foetus, most important are Zika virus and malaria. Even other mosquito-borne diseases can occasionally cause early labour or low birth weight. Therefore, pregnant women must be meticulous about protecting themselves from mosquitoes, especially in subtropical and tropical areas.
Pregnant women are advised to postpone non-essential travel to malaria-endemic areas or areas with zikavirus outbreaks.

Children 

Children can be more vulnerable to infectious diseases. The same precautions apply to children as to adults. Generally, children should have started their routine vaccination programs before traveling abroad. Protect children traveling to tropical and subtropical regions against mosquito bites. Small children have increased risk of severe malaria. 

Medication

If you use medicines, make sure you bring enough for the entire stay. Drug shortages or alternative brand names can make it difficult to obtain the medications you need abroad.

Place essential medicines in your carry-on luggage. You may be asked to present a prescription or medical certificate (in English) at customs, stating that you need the medicine. If you have a chronic illness or disability, consult your doctor before travelling.

Travel Pharmacy

In addition to regular medication, it's wise to consider bringing:

• Antiseptic for wounds
• Plasters
• Painkillers
• Nasal drops
• Motion sickness medications
• Anti-diarrhoeal medications

Blood clots

Air pressure in the cabin during a long flight may cause problems for some. People who may be at higher risk of blood clots include those who have had blood clots previously, are pregnant, or who use birth control pills. Advice to prevent blood clots:  

• Move your legs regularly
• Walk around the plane at regular intervals
• Wear compression stockings
• Drink plenty of non-alcoholic beverages

If you have a severe disease/condition, consult your doctor when planning a long flight.

Medical tourism comes with certain challenges and risks and is generally not recommended. However, you must seek medical help if you have a medical emergency during your trip.

Resistant bacteria are more common in many areas outside the Nordic countries and the risk of being infected/colonised with such bacteria is higher in healthcare facilities. The risk is greatest if you are admitted to hospital, but there is also an increased risk associated with surgical procedures or other out-patient treatments, i.e. cosmetic clinics, dental care, or general practitioner practices.

Antibiotic use contributes to bacterial resistance. Avoid buying over-the-counter antibiotics. If you have purchased such medication, contact your general practitioner for further guidance when you return. Return any unused antibiotics to a pharmacy for safe disposal (do not dispose in household waste or down the toilet).

Food and Water

Preventing travellers' diarrhoea depends mainly upon practising good hand hygiene and food and water precautions: Always wash your hands thoroughly after using the toilet and before eating. You can also use alcohol-based hand sanitiser if water and soap are unavailable. 
 
The quality of water and sanitation varies around the world. Reduce the risk of infection by following simple precautions. Recently prepared, thoroughly cooked food that is served piping hot, fruit you can peel yourself, and pasteurised dairy products are good options for travellers. 

• Drink safe water (bottled or boiled), avoid tap water
• Avoid unpasteurized milk products
• Avoid uncooked meats, fish and seafood
• Avoid raw vegetables and fruits unless you can peel them 

Diarrhea and Vomiting

Traveler’s diarrhea is unpleasant but usually harmless. Follow these guidelines:

• Drink plenty of fluids, i.e. boiled water, mineral water, or glucose-electrolyte powder dissolved in bottled or boiled water.
• If you are nauseous, sip small amounts frequently
• Small children are more susceptible to dehydration than adults. Pay attention to the child's general condition and contact a doctor if you are concerned  
• Seek medical advice if you develop bloody diarrhoea or diarrhoea with high fever.
• Anti-diarrhoeal medications can relieve diarrhoea but should be used with caution. Do not use if you have a fever and do not give them to children under 12 years of age.
• Practise good hand hygiene to reduce the chance of transmitting infection to others.
• If you use birth control pills or other medication, be aware that their effectiveness may be reduced during bouts of diarrhoea or vomiting.

Many diseases are transmitted through insect bites. In tropical and subtropical regions, you are often exposed to various mosquito-borne diseases, such as malaria, dengue fever, zika fever, chikungunya fever, West Nile fever, japanese encephalitis and yellow fever. You should always protect yourself against mosquito bites round the clock when travelling to such areas. 
 
Even in temperate regions like Europe, America, and Australia, diseases transmitted by ticks, mosquitoes and other insects occur. Ticks can transmit Lyme disease or TBE (tick-borne encephalitis) among others, while West Nile fever can be transmitted through mosquito bites. Therefore, protection against bites is important even outside tropical regions. If you are bitten by a tick, remove it as quickly as possible to reduce the risk of infection. 

Ticks and tick bites

How to prevent insect bites:

• Wear clothes that cover your skin, and use insect repellent on exposed body  
  parts.
• Use insect repellent. The most effective ones contain DEET (diethyltoluamide) in concentrations between 20-50%. Adults should apply to children, making sure children do not get it on their hands or near their eyes/mouth. Avoid applying it on wounds/skin defects. Reapply every 6 hours.
• Use an impregnated mosquito net over/around the bed, both indoors and outdoors.
• Mosquitoes are attracted to light at dusk. Therefore, do not turn on the light until doors and windows are closed. Rooms with air conditioning are mostly mosquito-free.
• You can effectively protect infants who do not move around on their own by hanging impregnated mosquito nets over cribs, prams, playpens, etc. Line baby baskets with mosquito-proof fabric. 

Other Preventive Measures

In some cases malaria prevention medicines are recommended. If you have been given malaria tablets, it is essential to use them as prescribed by the doctor, even after returning home. Small children and pregnant women have higher risk of severe malaria.  

The Norwegian Institute of Public Health (NIPH) recommends pregnant women to postpone non-essential travel to malaria areas or areas with Zika outbreaks.  

Some of the insect-/tickborne diseases can be prevented by vaccines.. Your health care provider can give more information and individual assessment based on your travel itinerary, medical history etc.

Animals can transmit various diseases to humans in different ways. Therefore, it is generally best to avoid contact with animals during your trip. Even apparently healthy animals can sometimes transmit severe diseases, so resist the urge to pet them. Children, in particular, should be helped to avoid contact with animals. 
 
Animal bites can cause infections. If you are bitten, you should consult a doctor for assessment as soon as possible. Infections after bites are usually caused by bacteria from the animal's mouth or your own skin flora.

• Rodents like mice and rats can spread diseases through bites, scratches, urine, faeces, or via fleas. Avoid areas with many rodents and refrain from touching items that might be contaminated by them. 
• In many countries there are outbreaks of avian influenza (bird 'flu) among wild birds and in poultry farms. There are also sporadic cases among other mammals. In addition, there have been some more extensive outbreaks with likely transmission between mammals (marine mammals in South America, cattle in North America, mink in Finland). Avoid contact with sick or dead mammals. Avoid direct contact with birds (both poultry and wild birds) and places where these are kept or sold. Do not touch surfaces soiled by droppings and secretions from birds.
• Bats can transmit potentially serious diseases. Protect yourself by avoiding areas with high density of bats such as bat caves. 
• In many places monkeys are common. However, they can carry numerous diseases, so avoid contact with them. 
• The MERS coronavirus, which causes MERS (Middle East Respiratory Syndrome) in humans, is endemic in dromedaries in several countries in the Middle East and Africa. To prevent infection from dromedaries to humans, it is recommended to avoid contact with dromedaries and avoid consumption of unpasteurised or uncooked animal products, such as milk, meat, blood or urine from dromedaries.
• Rabies is a rare but lethal disease found among mammals worldwide, with higher risk in Africa and Asia. Humans can be infected, primarily through dog bites. The virus is transmitted through bites or if the animal's saliva enters wounds, mucous membranes, or skin abrasions. If bitten, scratched, or licked on wounds or mucous membranes, wash thoroughly and immediately seek medical attention. The doctor can assess the risk of rabies and administer vaccinations promptly if necessary. There is an effective rabies vaccine available, and you can get vaccinated against rabies before traveling. If bitten and there's a risk of rabies exposure, you will need additional vaccine doses
  • Areas with and without Risk of Classic Rabies Transmission
• Bites from snakes, scorpions, spiders and others can also pose health risks. If exposed to such bites, you should see a doctor for evaluation.

Sunbathing and Heat

Protect your skin from sunburn, using a combination of shade, clothing and sunscreen. Use sunscreen with a high SPF and reapply it several times throughout the day. Children's skin is especially vulnerable to the sun. Infants and toddlers should be kept in the shade or wear clothing that covers larger parts of their bodies. 

Prevent overheating. Stay in the shade and cover your head. This is particularly important for children. 
When you sweat, you lose a lot of fluid and salt. Avoid dehydration by drinking plenty of water and consider eating salty foods unless you have salt restrictions. If you produce the usual amount of urine, and it has a normal colour, your fluid intake is adequate. 

Swimming and water safety

Try to avoid walking barefoot. Several diseases can be transmitted from soil and sand, especially in tropical areas. 

Water can be contaminated by sewage near inhabited areas. Swimming pools with treated water are normally safe.

Check for undertows and rip currents before swimming. Follow local advice and warning

Schistosomiasis (also known as bilharzia or snail fever) is caused by a parasite found in freshwater, that can penetrate the skin. It is most common in but not limited to Sub-Saharan Africa, where most lakes, rivers, and streams can be potential sources of infection. The parasites also exist in parts of the Middle East, South America, and Asia. 

Adventure travel can pose a risk of infection. Local information claiming a freshwater source is free from schistosomiasis is not always reliable. Avoid swimming in freshwater in these areas. 

Vibrio bacteria can be found in brackish and saltwater, especially in subtropical and tropical regions, and can cause severe wound infections. 

The risk of transmission of a sexually transmitted infection (STI) from casual and/or unprotected sex is high worldwide.

The most common STIs are chlamydia and gonorrhoea, but also syphilis, HIV, viral hepatitis, and other diseases transmitted through intimate contact (i.e. Mpox, meningococcal disease, gastroenteritis).

Antibiotic resistance makes infections hard to treat, and is particularly common for gonorrhoea. Do not buy over-the-counter antibiotics and start treatment without consulting a doctor. It may complicate treatment of your infection while contributing to the global resistance problems.

The highest prevalence of HIV, syphilis and hepatitis viruses are found in Africa and certain Asian countries, but Southern and Eastern Europe also have higher prevalence than Norway. Sex workers are generally at higher risk for STIs.

Preventive measures 

Condoms provide good protection when used correctly during vaginal, anal, or oral sex. The quality of condoms may vary so you should bring your own condoms from home. 

• Sexually Transmitted Infections - Yellow Book 2024 (cdc.gov)

If you become ill and need medical attention after returning from a trip abroad, you must inform the doctor where you have been. This is particularly important if you have been to malaria risk areas or have received medical or dental care abroad. The doctor needs this information to find the correct diagnosis and provide the right treatment.

Traveler's diarrhoea can sometimes continue for a few days after you return home. Maintain strict hand hygiene, always washing your hands after using the toilet and before handling food.