Time Zone: +1 hour. (GMT +2 from last Sunday in March to Saturday before last Sunday in October).
Tel. Country Code: 41
USADirect Tel.: 800
Electrical Standards: Electrical current is 230/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug S.
Travel Advisory - Switzerland
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 Switzerland
• U.S. Embassy
Tel:  (31) 357-7011 or  357-7218
• Canadian Embassy
Tel:  (31) 357-3200
Fax:  (31) 357-3210
• British Embassy
Tel:  (31) 359 7700
Fax:  (31) 359 7765
• British Consulate-General
Avenue Louis Casai 58
Tel:  (22) 918 24 00
Fax:  (22) 918 23 22
ENTRY/EXIT REQUIREMENTS: A passport is required for travel to both Switzerland and Liechtenstein. A visa is not required for stays up to 90 days in either country. For more information on entry requirements for both countries, travelers may contact the Embassy of Switzerland at 2900 Cathedral Avenue NW, Washington, DC 20008, telephone (202) 745-7900, or the nearest Swiss Consulate General in Atlanta, Chicago, Los Angeles, New York, or San Francisco. Visit the of Swiss Embassy website at http://www.eda.admin.ch/eda/en/home/reps/nameri/vusa/wasemb.html for the most current visa information.
HIV Test: Not required.
Required Vaccinations: None required.
Switzerland is a highly developed democracy. Liechtenstein is a democratically run constitutional monarchy.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for travelers >1 year of age not previously immunized against hepatitis A who want extra protection.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
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.
NOTE: There has been a significant number of cases of measles reported in Switzerland since January 2007. The outbreak had originally been confined largely to the Swiss German region near Lucerne but has now spread to other cantons. Measles is a potentially serious infectious disease, particularly for children, and the Department of Health and Ageing advises that travellers to Switzerland should ensure they are protected against measles prior to travel and should consult their doctor.
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.
Hospitals / Doctors
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 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. Coverage is especially important if you will be climbing or skiing.
Good medical care is widely available and most doctors are English-speaking.
In Geneva, telephone 144 for any medical problem. The Emergency Center can summon an ambulance, if necessary, or send a doctor. The emergency center can also give a referral to the closest 24-hour walk-in clinic (walk-in clinics are called Permanence Médicale).
• SOS Medécins Cité Calvin
Rue Louis-Favre 43
Tel:  (22) 748-4950
Provides 24-hour hotel/house calls.
• PMC International
(Permanence Médicale Genéve Suisse)
Tel:  (22) 595 11 91
PMC is an independent health services provider conveniently located in downtown Geneva, in close proximity of the railway station (with five-minute train connexions from the international aeroport) and of all major transport means. PMC International offers a multidisciplinary team with a range of investigation tools for up-to-date medical evaluation, plus a wide network of connexions with other local physicians and health institutions. Frequently used by travelers and expatriates.
• Permanence Médicale de Vermont
9A, Rue de Vermont
Tel: 41] (22) 734-5150
• Permanence Médicale de Plainpalais
Rue de Carouge 17-19
Tel:  (22) 329 56 56
• Permanence Médicale de Cornavin
Rue du Jura 1-3
Tel:  (22) 595 11 11
• Hôpitaux Universitaires de Genéve (HUG)
24 Rue Micheli-du-Crest
Tel:  (22) 372 33 11
Major university teaching hospital; all specialties.
• Clinic Sonnenhof
Tel:  (31) 358 11 11
All specialties. 24-hour emergency services.
• Im Park Clinic
Tel:  (1) 209 21 11
This is one of 13 private Swiss clinics managed by Im Park.
Other facilities are listed on their website.
Destination Health Info for Travelers
AIDS/HIV: The numbers of new HIV diagnoses declined for all transmission groups during most of the 1990s, but this trend was reversed in 2001, and an overall increase of 25% was seen between 2001 and 2002. The two transmission groups most affected by this increase were men who have sex with men (MSM) and heterosexuals originating from sub-Saharan Africa. Between 2002 and 2004, the situation appeared to stabilise in both groups. In 2005, a disturbing new trend appeared in MSM. A similar increase of new HIV diagnoses in MSM has recently been reported in Germany ...read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2850
According to UNAIDS estimates, the largest numbers of people living with HIV in Western Europe in 2007 were in Italy, Spain and France. In Spain, the prevalence of HIV in the adult population is estimated to be 0.6%. In Switzerland and France, the prevalence is estimated to be 0.4%. (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 the body fluids or blood of another person. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Acute Mountain Sickness (AMS): There are dozens of peaks >4,000 meters (13,000 ft) elevation in the Swiss Alps. The highest is Monte Rosa (4,633 m/15,203 ft) in the Valais. Many of the mountain huts on the most popular climbing/trekking routes are over 3,000 m elevation.
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you do not have a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 - 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75% effective. It may also reduce the risk of HAPE.
• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE)—recognized by confusion, difficulty with balance and coordination, staggering gait. Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also will prevent HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent.
Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
• High-Altitude Illness (NEJM) http://content.nejm.org/cgi/content/extract/345/2/107
Avian Influenza A (Bird Flu): In February 2006, the Swiss authorities confirmed outbreaks of Avian Influenza (Bird Flu) in the Lake Geneva and Lake Constance areas, however, no new cases have been found since the end of March 2006. There have been no reported cases in Liechtenstein. No human infections or deaths have been reported in either country.
• H5N1 avian influenza 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 â€œbird flu.â€�
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: Salmonellosis: An increased number of Salmonella typhimurium cases were reported in Switzerland between May and June 2008. Investigations involved 72 cases. Bacteria affecting one third of the cases were also found in animal samples, pork in particular. These investigations revealed that the strain isolated from pork samples was imported from other European countries. The contaminated meat was processed into products used for barbecue such as pork sausages. The hypothesis that such products contributed to the outbreak is supported by the fact that younger people were overrepresented among the infected persons. In this age group barbecue parties during the summer months are very popular and frequently practiced. (Eurosurveillance October 2008: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19020)
• Salmonella typhimurium is a 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 Switzerland 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; symptoms 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: There is very low incidence of hepatitis A in Switzerland, but nonimmune travelers should consider hepatitis A vaccine for added protection. Outbreaks of this disease occasionally occur, even 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 low but undetermined levels. Sporadic cases may go unrecognized. 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 <1%. 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 with a prevalence of 0.2% 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.
Lyme Disease: The incidence of Lyme disease in Switzerland is among the highest in Europe, but the risk to the average tourist is low. Risk occurs primarily from May through October in wooded, forested areas below 1,500 meters elevation in an area extending from Lake Geneva in the west to Lake Bodensee in the northeast. Risk may be elevated on the northern Swiss plateau.
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: Brucellosis (low risk; consumption of contaminated foods and occupational contact remain the major sources of infection)
• Boutonneuse fever (tick-borne; may occur in southern areas; also called Mediterranean spotted fever)
• Hemorrhagic fever with renal syndrome (Hantaviruses, including the Puumala virus serotype, are human pathogens that are prevalent worldwide. In western and central Europe, the predominant serotype is Puumala, which causes hemorrhagic fever with renal syndrome (HFRS). Puumala virus is spread by rodents and is transmitted to humans by inhalation or ingestion of food contaminated with rodent excreta. The most common symptoms are fever, nausea, vomiting, headache, stomachache, back pain, tenderness in the kidney area, diarrhea or constipation, and sore throat. HFRS infection may also lead to neurologic symptoms including encephalitis, radiculitis, seizures, and cerebral hemorrhage. Renal failure may require dialysis)
• Listeriosis (may be transmitted by contaminated soft cheeses)
• Leptospirosis (wild and domestic animals can harbor leptospira bacteria)
• Echinococcosis (fox tapeworm disease; risk known to occur in 21 of 26 cantons, especially in the northwest part of Switzerland; endemic Echinococcus multilocularis infections in red foxes occur also in the following countries of Central Europe: Belgium (southern parts), Luxembourg, France (Massif Central and eastern parts), Liechtenstein, Austria (6 of 9 provinces), Germany, and Poland. Mortality is >90% in untreated cases of human alveolar echinococcosis)
• Legionellosis (sporadic cases)
• Human alveolar echinococcosis (Most cases originate from rural communities in regions from eastern France to western Austria. Those at risk include people engaged in part-time farming, gardening, forestry, or hunting. Transmission to humans occurs when eggs of the tapeworm, excreted by the final hosts (usually foxes), are accidentally ingested. The larva’s primary target organ is the liver, where it proliferates slowly, but the larva also spreads into extrahepatic structures and even metastasizes to distant organs. If untreated, the fatality rate exceeded 90% within 10 years. (http://www.cdc.gov/ncidod/EID/vol9no3/02-0341.htm)
Rabies: Switzerland is reported to be rabies-free. All unprovoked dog or wild animal bites, however, should be medically evaluated for possible post-exposure treatment. Any exposure to a bat bite should be promptly evaluated.
(See Eurosurveillance: http://www.eurosurveillance.org/ew/2003/030814.asp)
Tick-Borne Encephalitis (TBE): Transmission of TBE occurs from May through October, below 1,400 meters (4,600 feet) elevation, in brushy and/or wooded areas of central and northern Switzerland. In the five-year period between 2003 and 2007, a mean of 165 cases were reported annually. In 2006, 259 cases were reported, the highest number in recorded history in Switzerland. There are two high-risk regions, the larger one covering the midland, with the exception of the far-western part, and the smaller one located in the upper Rhine valley, including the principality of Liechtenstein. A focus of ticks infected with the TBE virus (TBEV) is located on a much-used forest path near Vaduz, the capital of the principality. The canton Zürich has become the most dangerous region for TBE in Switzerland, followed by Thurgau, St. Gallen, Aargau, and Bern. The TBE risk areas in the northeast of Switzerland remain stable, however, new risk areas in the western part of the country (Neuchâtel) have been identified.
Source: Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916
• Travelers to rural areas should use measures to prevent tick bites.
• A vaccine is available in Canada and Europe. Vaccination against TBE is recommended only for persons who have higher-than-average exposure to ticks. Such persons include foresters and agricultural workers, as well as some hikers and campers.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
Travelers' Diarrhea: 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.
Typhoid Fever: Outbreaks of typhoid fever have previously occurred in Zurich (contaminated restaurant food) and Zermatt (breakdown in the sewage system). No recent cases of typhoid fever have been reported from this country. Typhoid vaccination is not recommended for travel to Switzerland.