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Netherlands



Capital: The Hague

Time Zone: +1 hours. GMT +2 hour for daylight savings time.
Tel. Country Code: 31
USADirect Tel.: 800
Electrical Standards: Electrical current is 230/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Netherlands

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Netherlands


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• U.S. Embassy
The Hague. Lange Voorhout 102
Tel: [70] 624-911
http://thehague.usembassy.gov/
http://amsterdam.usconsulate.gov/

• Embassy of Canada
Sophialaan 7, 2514 JP
The Hague
Tel: [31] (70) 311-1600
E-Mail: hague@international.gc.ca
Website: http://www.canada.nl

• The British Embassy
Lange Voorhout 10
The Hague
Tel: [31 (70) 4270 427
Email: library@fco.gov.uk
Website: http://www.britain.nl

• British Consulate Amsterdam
Koningslaan 44
Amsterdam
Tel: [31] (20) 676 4343
Website: http://www.britain.nl

Entry Requirements

HIV Test: Not required.

Required Vaccinations: None required.

Passport Information

Passport/Visa: The Netherlands is a highly developed, stable democracy. Tourist facilities are available throughout the Kingdom. Read the Department of State Background notes on The Netherlands for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. Visas are not required for U.S. citizens for tourist visits of up to 90 days. That period begins when you enter any of the Schengen group of countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden. Effective December 21, 2007, the following countries will be included in the Schengen group: the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, and Slovenia. To be admitted into the Netherlands, travelers must have a passport with a validity that exceeds their intended stay by at least 90 days, a return airline ticket, and enough money to finance the planned stay. For further information on entry requirements, contact the Embassy of the Netherlands at 4200 Linnean Ave. NW, Washington, DC 20008, telephone (202) 244-5300, or one of the Dutch consulates in Chicago, Houston, Los Angeles, New York or Miami. Additional information is available on the Netherlands• National Bureau for Tourism•s internet web site at http://www.goholland.com. Visit the Embassy of the Netherlands web site at http://www.netherlands-embassy.org/homepage.asp for the most current visa information. 

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from acupuncture, body piercing and tattooing; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Hospitals / Doctors

Medical care of high quality is available in the Netherlands; all physicians are fluent in English. Travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers• diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country•the equivalent drugs may not be available.
• Travelers are advised to obtain travel insurance that provides for medical evacuation in the event of serious illness or injury.

The emergency number for the Dutch police, rescue, and fire departments is 1-1-2.

Hospitals with emergency services include:

• Onze-Lieve-Vrouww Gasthuis
Oosterpark 9
Amsterdam
Tel: (020) 599-9111
Website: www.olvg.nl

• Academisch Medisch Centrum (AMC)
Meibergdreef 9
Amsterdam
Tel: (020)-566-3333
Website: www.amc.uva.nl

Other medical facilities and travel medicine specialist in The Netherlands include:

• VU University Medical Center
De Boelelaan 1117
Amsterdam
Tel: [31] (20) 444 4444
Emergency: (20) 444 3636
Emergency Department Cardiology: (20) 444 4800
English Website: http://www.english.vumc.nl:80/patientcare/

• Dr. Ruben Coevorden
Medisch Centrum Buitenveldert
Amsterdam
Tel: [31] 20 644 1627
Specialty: General Practice

• Dr. J. Wetsteyn
Clinic for Tropical and Travel Medicine
Academic Medical Center
Amsterdam
Tel: [31] (20) 5663 330/566 7431
E-mail: j.c.wetsteyn@amc.uva.nl
Website: http://www.tropencentrum.nl
Infectious diseases; travel medicine
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center
Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Dr. P.P.A.M. van Thiel
Center for Tropical and Travel Medicine
Academic Medical Center
Meibergdreef 9 A01-330
Amsterdam
Tel: [31] (20) 5666526
Fax: [31] (20) 5669061
E-mail: trop.amc@amc.uva.nl
Website: http://www.tropencentrum.nl
Travel medicine; infectious diseases
Languages: Principal - Dutch, English; Other - German, French
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center
Post-Travel Medical Consultation, On-Site Diagnostic Laboratory

• Dr. Peter A.M. de Beer
Medical Services for the Tropics-Travel Clinics
Becanusstraat 13-B11
Maastricht
Tel: [31] (46) 4789544
E-mail: mstropics@planet.nl
Website: http://www.tropenkliniek.nl
Travel medicine; infectious diseases
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Academish Ziekenhuis
Rotterdam
General medical/surgical facility; all major medical specialties.

• Academish Zeikenhuis
Utrecht
All medical specialties including Ob/Gy; pediatrics;
24-hour emergency service; hemodialysis; trauma team.

Havenziekenhuis en Instituut Voor
Tropische Zietken
Haringvliet
Rotterdam
Tel: [31] 10 404 3300
Website: http://www.havenziekenhuis.nl/

Destination Health Info for Travelers

AIDS/HIV: Heterosexual contact has been the most frequent transmission mode in the West since 1999, especially in immigrants from sub-Saharan Africa and their sexual contacts. It is responsible for the largest proportion of diagnosed HIV infections in every country except Germany, Greece and the Netherlands, in which men who have sex with men (MSM) form the largest transmission group. The prevalence of HIV adults in The Netherlands is estimated at 0.2 percent. This is well below France (0.4%), Italy (0.5%) and Spain (0.6%). (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Anisakiasis: Anisakiasis is a parasitic disease of fish transmitted by eating raw, smoked, undercooked, or lightly pickled saltwater fish, especially salmon, herring, mackerel, gefiltefish, whitefish, cod, and sole. The parasite is the larval form of a marine roundworm, which may be present in the muscles and organs of the fish just mentioned. The worm is harmless when cooked to an internal temperature of 140 degrees F or frozen (rapid freeze) to -40 degrees or to -4 degrees for three to five days. If salmon is to be eaten raw or cold-smoked, it should have been frozen properly beforehand.
The worm attaches to the lining of the stomach or intestine. Symptoms include nausea and vomiting, or abdominal pain that mimics appendicitis. The treatment is surgical excision of the worm from the intestinal tract.
• Diphyllobothriasis (fish tapeworm disease) This is an infection caused by a fish tapeworm called Diphyllobothrium latum and occurs among people who eat raw, smoked, pickled, or undercooked freshwater fish. These include Eskimos, fishermen, devotees of sushi bars (salmon), and people who taste raw fish (such as whitefish) while cooking. Symptoms are uncommon but may include primarily abdominal cramps and diarrhea, but fatigue and, rarely, anemia from vitamin B12 deficiency can also occur because fish tapeworms consume this important vitamin. Treatment (adults and children) is with a single dose of praziquantel, 10 mg/kg.
• Travelers to the Netherlands and other Scandinavian countries should be aware of the potential risk (not clearly defined) of eating raw, undercooked, salted, or smoked fish.

NOTE: In the EU, conditions concerning control of parasites are laid down in Council Directive no. 91/493/EEC (EC, 1991a). All fish and fish products must be subject to a visual inspection during processing for the purpose of detecting and removing any visible parasite. Further, all fish that are to be consumed raw or almost raw must be subjected to a freezing process (-20 degrees for at least 24 hrs). This also applies to fish products that are heated (e.g. hot smoked) to a temperature of less than 60°C. As far as salted fish is concerned, the process must be sufficient to destroy the larvae of nematodes. The US regulations stipulate that the freezing process to destroy parasites should be -20°C for 7 days or -35°C for 15 h (FDA, 2001a).
• The best prevention and control of anisakiasis is eating well-cooked or well-frozen fish only. A number of well-known fish products can be unsafe. This applies to all lightly preserved fish products (< 5% NaCl in water phase) such as cold smoked fish, gravad fish, matjes herring, lightly salted caviar, ceviche and several other local traditional products. A short period of freezing - either of the raw material or the final product - must be included in the processing as a mean to control parasites.

Avian Influenza A (Bird Flu): An outbreak of H7N7 avian influenza (H7N7) was reported among Dutch poultry farms in March 2003. Unlike H5N1 avian influenza, which is highly pathogenic, H7N7 avian influenza does not in general pose a major risk to humans. However, while avian influenza strains normally infect exclusively poultry, Dutch authorities have reported that the H7N7 strain has now jumped the species barrier, causing one death and more than 80 cases of mild disease in humans, mostly conjunctivitis (pink eye).
Note:
• H5N1 avian influenza A is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:

1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.
The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.

Food-Borne Disease: Between 14 September and 20 October 2007, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 simultaneously occurred in the Netherlands and Iceland. A total of 50 laboratory-confirmed cases were reported with a STEC O157 infection caused by the same clone. The most probable cause of this international outbreak was contaminated lettuce, shredded and pre-packed in a Dutch food processing plant.
Read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19065

Food-Borne Disease: Salmonellosis: A large, countrywide outbreak due to multi-resistant Salmonella typhimurium is ongoing in the Netherlands, with 152 cases as of October 2008. Pork products are the suspected cause. Earlier this year two other oubtreaks due to S. typhimurium were linked to a particular brand of cream cheese and to a local butcher. (Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19026)
• Salmonella typhimurium is a particular strain of Salmonella enterica. Up to 2000 salmonella strains have been described, the best known being Salmonella typhi, the cause of typhoid fever. Strains such as Typhimurium (now endemic in the Netherlands and other European countries) can lead to a form of human bacterial gastroenteritis, sometimes referred to as salmonellosis.
• Salmonellosis is the second most common food-borne infection in the European Union (EU). Symptoms include nausea and vomiting, abdominal cramps, diarrhea, and fever starting 12 to 72 hours after infection and may last for up to 7 days. Severe cases should be hospitalised. Salmonella infections can lead to septicemia and sometimes death. Salmonella bacteria are readily transmitted through the feces of people or animals. Humans generally become infected by eating contaminated, insufficiently cooked food or consuming contaminated dairy products.
• Salmonella gastroenteritis is usually a self-limiting disease. Fluid and electrolyte replacement are the mainstays of treatment. Because antibiotics do not appear to shorten the duration of symptoms, they are not routinely used to treat uncomplicated nontyphoidal gastroenteritis. Current recommendations are that antibiotics (fluoroquinolnes or azithromycin preferred) should be reserved for patients with severe disease or patients who are at a high risk of invasive disease.
Note: Obviously, people with acute gastroenteritis (i.e., travelers’ diarrhea) will not know the bacteriological cause of their symptoms and may have empirically started antibiotic self-treatment for their symptoms. Such treatment may limit the severity of their illness. (Read more: http://www.emedicine.com/MED/topic2058.htm)

Hepatitis: Although there is a low risk of hepatitis A in the Netherlands, sporadic outbreaks are reported. Between 31 December 2009 and 10 February 2010, 13 patients were infected by an identical hepatitis A virus strain not previously detected in the Netherlands. They had not been abroad and the cases were widely distributed throughout the country. Semi-dried tomatoes in oil were identified as the likely source of the outbreak.
Hepatitis A is a preventable disease and all travelers, not previously immunized, should consider receiving the hepatitis A vaccine. Even in so-called low-risk, developed countries, sporadic outbreaks of hepatitis A occur.
Hepatitis A virus is transmitted through contaminated food and water. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E may be endemic but levels are unclear. Seroprevalence appears to be 2% or less in the population. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals (e.g., swine) may also harbor a hepatitis E virus. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate 1s estimated at <2% in the general population. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at a low level with a prevalence of 0.1% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Legionnaires' Disease: An outbreak of legionellosis was reported in Amsterdam in July 2006, with 23 confirmed case, of whom one died. Most patients were inhabitants of Amsterdam city centre. A cooling tower located next to a former Post Office building in the east-central part of city was as the probable source of infection. (Source: ProMED-mail 13 and 14 July 2006)

Further information: In the Netherlands, the first large LD outbreak occurred in 1999; it affected 188 patients of whom 23 died. This epidemic was caused by aerosol transmission from a display whirlpool at a flower show, and was not recognized as an LD outbreak until 14 days after the first patient was diagnosed with pneumonia of unknown origin. The source was identified within a week after the epidemic was detected as an LD outbreak; 10 days after the show had ended, when already 71 patients had been admitted to various hospitals throughout the country. The 1999 outbreak was evaluated extensively and this has led to changes in prevention policies, legislation and outbreak management strategies.

Legionnaires’ disease (LD) is an acute pneumonia caused by infection with bacteria of the genus Legionella. Inhalation of aerosolized water containing the bacteria is the primary mode of acquisition. Although cases of LD are often sporadic, large outbreaks can be caused by communal sources, such as“hot tubs” or “spa pools” and hospital or hotel showers. Wet cooling towers can emit contaminated aerosols, with dispersal over long distances, sometimes causing major outbreaks.
Read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18983

Q Fever: The Netherlands has reported a large outbreak of Q fever. As of June 10, 2009 1,133 human cases have been reported. Most of these cases have been in Noord (North) Brabant Province in the southern part of the country, although cases also have been reported in Limburg, Utrecht, and Gelderland. This is the third outbreak of Q fever in the Netherlands in recent years; 190 cases were reported in 2007 and 1,000 cases in 2008.
Read more: http://wwwn.cdc.gov/travel/content/id/1769.aspx

Q fever is a disease that it is passed from infected animals to humans. Humans become infected by inhaling dust or aerosols contaminated by body fluids from infected animals. The risk of Q fever infection is generally low; however, if you are traveling to the Netherlands, follow these recommendations to help stay healthy.
Recommendations for U.S. Travelers:
• Avoid farms in the affected areas. If you cannot avoid visiting farms, avoid going near areas where goats, sheep, or cattle are kept. Not all animals infected with Q fever look sick, so it is best to avoid direct contact with any animal, especially animals that may be giving birth to young, since birth products may be especially infectious. Breathing in soil and dust contaminated by animals can make you sick.
• Eat only pasteurized milk and dairy products. Do not drink raw milk or eat raw milk products.
• Practice good hand hygiene and wash your hands often with soap and water, especially if you have been near animals. If soap and water are not available, use an alcohol-based hand gel with at least 60% alcohol.

Rabies: The Netherlands is currently reported to be free of canine rabies. All wild animal bites, however, especially from a racoon dog or fox, should be vigorously cleansed with soap and water and medically evaluated for possible post-exposure treatment.
• Rabies is still present in Europe. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory.
Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=575

Swimmer's Ear (otitis externa): Large outbreaks occurred in the 1990s associated with swimming in recreational freshwater lakes during hot summer months. The infection is caused by pseudomonas bacteria infecting the external ear canal. Prevent/treat with Vosol solution.

Tick-Borne Diseases: An increase in the number of cases of Lyme disease has been observed over the last several years. The greatest increase has been reported from the south and northeast of the Netherlands, as well as several locations along the coast in the west. Lyme disease is transmitted by Ixodes ticks that are found in wooded, brushy areas, although transmission can also occur in backyards.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease in someone who has just been bitten by an infected tick. (http://content.nejm.org/cgi/content/abstract/345/2/79).

A case of human granulocyctic ehrlichiosis (human granulocytic anaplasmosis) was reported in 1998 from the Gelderland region. These data demonstrate that human granulocytic ehrlichiosis occurs in western Europe and should be considered in the differential diagnosis when evaluating persons who are at risk for tick-borne diseases. Reference: NEJM: http://content.nejm.org/cgi/content/full/340/15/1214-a

Travelers' Diarrhea: Low risk. Tap water is safe throughout The Netherlands. Outside of hotels and resorts, we recommend that you filter or purify all drinking water or drink only bottled water or other bottled beverages. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetable. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.