Time Zone: +1 hour. (GMT +2 from the last Sunday in March to the last Sunday in October)
Tel. Country Code: 46
USADirect Tel.: 20
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Sweden
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 Sweden
• U.S. Embassy
Dag Hammerskjoldsvag 31
Tel:  (8) 783-5300 or 8-783-5310
• Canadian Embassy
Tel:  (8) 453-3000
• British Embassy
Tel:  (8) 671 3000
ENTRY REQUIREMENTS: A valid passport is required. Since March 2001, Sweden entry visas are governed by the rules in the Schengen Agreement. U.S. citizens can stay without a visa for tourist/business for up to 90 days. That period begins when you enter any of the Schengen countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden. Contact the Swedish Embassy at 901 30th Street, NW, Washington, DC 20007, tel: (202) 467-2600 (mailing address 2900 K Street, NW, Washington, DC), or the Swedish Consulate General in New York at (212) 583-2550, web site: www.swedenabroad.com for the most current visa information. Swedish immigration authorities (Migrationsverket) also maintain a home page at www.migrationsverket.se.
HIV Test: Not required.
Required Vaccinations: None required.
Sweden is a highly developed stable democracy with a modern economy. English is widely spoken.
Vaccinations: Recommended and Routine
Hepatitis A: There is a low risk of hepatitis A in Sweden, but this is a preventable disease and all travelers, not previously immunized, should consider receiving hepatitis A vaccine.
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 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. The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated. MMR protection is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine. Immunity against measles is particularly important for adults at high risk for measles exposure, including college students and health care workers. People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
In January 2006, a measles outbreak was described in the Scandinavian region of Øresund, resulting in 18 cases as of late March (nine in Denmark and nine in Sweden). All the Swedish patients resided in the western part of Skane.
Hospitals / Doctors
Medical care of high quality is widely available. The Swedish medical system is a state-run system so instead of visiting a local private general practitioner, travelers can visit a local medical center or clinic, called an Akutmottagning or Vardcentral. Patients should be prepared to present their passports. In case of a medical emergency, use the emergency telephone number 112 (equivalent to 911 in the U.S.) to contact the appropriate emergency service.
All 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 readily available.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. If you are visiting remote areas, you should consider the relative inaccessibility of the emergency services. The countrywide telephone number for emergencies in Sweden is 112.
Destination Health Info for Travelers
AIDS/HIV: The most noticeable trend in 2007 was a sharp increase in the number of people reported as having been infected with HIV in Sweden. During 2007, 65 cases of acquired immunodeficiency syndrome (AIDS) were reported in Sweden, compared to an average of 48 cases during the last five-year period. The three major routes of transmission of HIV are: heterosexuals, men who have sex with men (MSM) and injecting drug users (IDUs).
The recent increase in HIV/AIDS occurred in all transmission groups, but primarily among MSM and IDUs. There has also ben an increase in the number of cases acquired through heterosexual contact. Almost half of these cases were foreign nationals born in countries with a high prevalence of HIV, who constitute about one percent of the population in Sweden. This shows that, even after they having moved to Sweden, people originating from countries with a high HIV prevalence have a higher risk of being infected through heterosexual contact than people born in Sweden. (Eurosurveillance 2008: Volume 13/Issue 13)
The prevalence of HIV adults in Sweden 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.
Avian Influenza A (Bird Flu): The Swedish authorities have confirmed that there have been outbreaks of avian Influenza (“bird flu”) in ducks and wild birds at various locations in Sweden. No domestic birds have been identified as having the virus. No human infections or deaths have been reported.
• Avian influenza A (H5N1) 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 influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against “bird flu.” Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). 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 cases.
Hepatitis: There is a low risk of hepatitis A in Sweden, but this is a preventable disease and all travelers, not previously immunized, should consider receiving hepatitis A vaccine. Sporadic outbreaks of hepatitis A do occur in developed countries. 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 is endemic at a low level. In persons younger than 40 years, the percentage of seropositive individuals is about 2.5%, whereas the seroprevalence rate of anti-HEV antibodies is 7.4% in subjects older than 40 years. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) 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 in the general population is estimated at <2%. 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 (prevalence <0.01%) 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.
Note: the Swedish hepatitis C epidemic is highly related to the increase of intravenous drug use in the late 1960s and 1970s, with a high proportion of people now chronically infected for more than 25 years, resulting in an increase of severe liver complications in form of cirrhosis and hepatocellular carcinoma. Furthermore the unchanged number of notifications of newly infected younger people indicates an ongoing HCV epidemic. (Eurosurveillance, Volume 13, Issue 21, 22 May 2008)
Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.
Lyme Disease: This disease is frequently rep[orted in southern Sweden. Ten to 30% of ticks in endemic areas are infected. The greatest risk of transmission occurs May through November in the forests of the southern coastal areas below 1,500 meters elevation and the Aland Islands.
• 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 if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Other Diseases/Hazards: Hemorrhagic fever with renal syndrome (human cases usually in young adults exposed to dried or aerosolized rodent excreta)
• Karelian fever (mosquito-transmitted; endemic in rural areas of southern and coastal provinces)
• Tularemia (see below)
Rabies: No cases of rabies have been confirmed in humans or any animal species, including bats, in recent years. Rabies in Europe occurs primarily in wild animals, especially foxes, in many rural areas. There is no risk of rabies in Sweden, Finland, Iceland, Ireland, the United Kingdom, Gibraltar, Malta, Monaco, Portugal, and Spain.
• Although Sweden is reported to be rabies-free, all unprovoked dog or wild animal bites should be medically evaluated for possible post-exposure treatment.
Seafood-Related Illness: 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 (“lutefish”), 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.
• 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, 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 Sweden and other Scandinavian countries should be aware of the potential risks (not clearly defined) of eating raw, undercooked, salted, or smoked fish, including raw cod (“lutefish”).
Tick-Borne Encephalitis (TBE): You should be aware of the risk of tick-borne encephalitis (TBE) in coastal areas, especially the Stockholm Archipelago. Risk is present from the forested areas around Uppsala down to Kristianstad, including the islands of Gotland and Oland, and in the wooded areas around Goteborg and Stockholm. Sporadic cases occur in the rest of Sweden every year. A recent study shows a distinct migration of the TBE virus to the western parts of the country. In addition, there are indications that climate warming has allowed the Ixodes ricinus ticks (the ticks that transmit TBE) to expand their distribution toward the north and become more abundant in Central Sweden.
In the five-year period between 2003 and 2007, the average number of cases of TBE was 150 annually. Occurrence has been highest in 2007, with 190 reported cases. Except for Hungary, this makes Sweden the only European country where no significant reduction in the number of cases is observed from 2006 to 2007.
Source: Eurosurveilance 2008: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916
• A TBE vaccine is available in Canada and Europe, but is recommended only for those who will have prolonged or intense exposure (e.g., hiking or camping for 2-3 weeks or more) in rural endemic areas.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
Travelers' Diarrhea: Campylobacteriosis is the most common reported bacterial gastrointestinal disease in Sweden. Food-borne outbreaks of campylobacter-caused diarrhea are rather rare except for small, family outbreaks. Water-borne outbreaks of campylobacteriosis, however, have affected several thousand persons in the past. (Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18847)
• A quinolone antibiotic, or azithromycin, is recommended for the treatment of acute diarrhea. Diarrhea not responding to antibiotics, or chronic diarrhea, may be due to a parasitic disease, such as giardiasis or cryptosporidiosis.
In September 2008, 21 cases of cryptosporidiosis occurred among guests and staff at a wedding reception in a hotel restaurant in Stockholm county, Sweden. Three patients were hospitalised due to dehydration. The most probable source of the outbreak was béarnaise sauce containing chopped fresh parsley.
• Cryptosporidiosis has since the 1980s been increasingly recognised as a common cause of gastrointestinal infection in humans worldwide. The two most common causes of human cryptosporidiosis are Cryptosporidium hominis, which is considered to be pathogenic primarily to humans, and Cryptosporidium parvum, which is zoonotic. Humans become infected when they ingest Cryptosporidium oocysts in contaminated food or water. Ingesting as few as 9-100 oocysts can cause an infection.
• Outbreaks of cryptosporidiosis are mostly associated with water, both drinking water and recreational water use, partly due to the resistance of the oocysts to chlorination at the levels used for water disinfection. In Sweden, outbreaks of cryptosporidiosis are rare. However, in August 2002 there was a swimming pool-associated outbreak in Stockholm county, affecting approximately 800-1,000 people and with a secondary attack rate of 8-10%.
• Worldwide, food-borne outbreaks of cryptosporidiosis occur less frequently. In a few reports, the source of infection were fruits or vegetables that had been in contact with contaminated water or manure, as well as unpasteurised apple juice. Only rarely has an outbreak of cryptosporidiosis been linked to a food handler.
Source: Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19071
Tularemia: Sweden has had reported cases of tularemia (also known as “rabbit fever”) since 1931, with outbreaks of variable magnitude, but with no cyclical patterns or trends. An outbreak of tularemia was reported in the summer of 2006 in central Sweden. Outbreak were also reported in 2000 and another in 2003, chiefly from the counties of Stockholm, Sodermanland, Vastmanland, Varmland, and Orebro.
• In Sweden, tularemia appears to be primarily transmitted by mosquitoes and ticks. In general, humans most often contract tularemia by tick bite or through handling an infected animal. (Hunters are at particular risk when skinning an infected animals, such as wild rabbit or deer.) Infected cats have also transmitted the disease. Ingesting infected water, soil, or food can also cause (rarely) infection. Most common symptoms are an infected ulcer, enlarged lymph nodes, and fever.