Diseases and vaccines

Vaccination is available for all for a fee.

What is hepatitis A?

A liver infection or jaundice which is caused by being infected with the hepatitis A virus (HAV) which multiplies in the liver tissue and damages the liver. There is no medicinal product which can be used to treat hepatitis A.

How does it spread?

The hepatitis A virus spreads by the faecal-oral route either directly from one individual to another (for example via children in nappies at kindergartens), or via contaminated food or water. Hepatitis A may also be contracted via anal sex and, in rare cases, via blood.

HAV is a stable virus which can remain viable for days in food products and in saline water. For example, several outbreaks have been caused by confectionery products or other dishes which do not require heat-treatment and which have been made and contaminated by individuals who carry the virus. Outbreaks have also been caused by eating raw oysters, crustaceans, molluscs, or shellfish, as they may come in contact with the virus via sewage water in coastal areas in the vicinity of cities. Ice which has been made from contaminated water and is served in drinks, for example, may also carry the infection.

Symptoms

A significant peculiarity of hepatitis A is that the disease may be suffered with concealed symptoms or with no visible symptoms (especially in children).

Different phases of the disease can be identified:

• The incubation period for the disease usually lasts between twenty-eight and thirty days. No visible symptoms are experienced in this period, but the virus is multiplying actively in the body. If the body initially came in contact with a higher amount of the virus, this phase is shorter.
• The preliminary symptoms phase usually lasts from five to seven days and results in the development of jaundice. The patient may experience fever, anorexia, muscular pain, vomiting, weakness, and other symptoms.
• Jaundice (icterus) is characterised by the dark, yellowish-brown colour of the urine due to the bilirubin concentration. After a few days, the patient will turn yellow almost all over. Medical assistance is usually sought in this phase. The patient will remain infectious for about a week in this period.
• The recuperation period lasts up to a few months.

The symptoms may appear within fifteen to fifty days after coming in contact with the virus. An infected individual is infectious from two to three weeks before developing the first symptoms and in the first and second week after falling ill.

People usually recover within a few months and without complications. In between three to twenty percent of all cases, acute episodes of hepatitis A may recur. This will occur between four to fifteen weeks after the symptoms disappear.

Having had hepatitis A will ensure life-long immunity.

How is it diagnosed?

A diagnosis is based on clinical symptoms and epidemiological information (such as the patient having visited a place with a higher HAV prevalence).

Who is most at risk?

• travellers in countries with a higher HAV prevalence
• individuals who are working with people who originate from countries with a higher HAV prevalence
• injecting drug addicts
• men who have sexual relations with other men
• family members and/or carers of those individuals who have fallen ill
• individuals who work with children (kindergarten and school teachers)
• organ (liver) transplant patients
• individuals who suffer from chronic liver diseases (chronic hepatitis, cirrhosis, etc)
• employees of wastewater treatment plants

How does one avoid falling ill?

Hepatitis A is a disease which can be prevented by following the normal hygiene rules (such as in terms of washing one’s hands before preparing food or eating).

It is advisable to be vaccinated against hepatitis A before travelling to a number of countries. 

While travelling, avoid drinking water which may not be clean (including drinks which contain ice), or eating semi-cooked crustaceans, or uncooked and unpeeled fruit and vegetables.

Two doses of the vaccine are injected with an interval of between six to eighteen months. Between Ninety-four to one hundred percent of all individuals who have been vaccinated develop immunity within one month after receiving the first dose. The second dose will guarantee immunity for all individuals who have been vaccinated. Immunity lasts for at least twenty years.

There is no vaccine for immunising children under one year of age.

Information about the vaccine(s) which is/are used in Estonia can be found on the website of the State Agency of Medicines.

Vaccination is free of charge based on the national immunisation schedule.

What is hepatitis B virus?

Hepatitis B is a liver infection which is caused by the hepatitis B virus (HBV). Chronic hepatitis B may result in liver necrosis or liver cancer.

How does it spread?

Hepatitis B virus is highly infectious and may spread via:

• blood transfusions, reusing syringes, tattooing, piercing, puncture wounds, using everyday products which have been contaminated with blood as a result of microtraumas (toothbrushes, shaving machines, and the like)

• from the mother to the neonate

• sexually

HBV is very resilient, remaining viable at a temperature of -15ºC for up to fifteen years and at temperatures of 30-32ºC for up to six months. The virus also tolerates brief boiling. Strong disinfectants must be used to destroy HBV.

Infected individuals may be infectious for several weeks before developing any symptoms, as well as during the illness itself. Anyone who is suffering from chronic hepatitis B is also infectious.

Symptoms

As is the case with hepatitis A, a significant peculiarity of hepatitis B is that the disease may progress with no visible symptoms. Almost a third of all adults experience the disease asymptomatically, which is followed by a high risk of remaining a chronic carrier of the virus.

The incubation period for hepatitis B may range from between thirty to eighty days (remaining between sixty and ninety days on average). The acute phase of the disease consists of three stages:

• The preliminary symptoms phase which lasts from two to seven days on average. The symptoms may include tiredness, a lack of appetite, fever, bloating, and pain the liver area. At the end of this phase, the individual’s urine becomes dark and the colour of their excrements becomes light.

• The symptomatic period which lasts for four to eight weeks and may involve a yellowing of the skin and mucosae (in twenty-five percent of cases), plus itchiness of the shin. Only the symptoms are treated in the acute phase.

• The recuperation period lasts for two to six months, after which the individual’s condition will return to normal.

Hepatitis B may result in a chronic liver infection. The younger the individual who falls ill, the greater the risk. While five to ten percent of adults who have suffered from the acute form of the disease develop the chronic form, this risk is considerably higher in children (up to ninety percent of all infected neonates develop a life-long chronic liver disease).

The aim of the treatment for chronic hepatitis B is to reduce the extent of the liver infection or liver damage. Full elimination of the virus is no longer possible.

How is it diagnosed?

Hepatitis B is diagnosed through blood samples and the symptoms of the disease.

How does one avoid falling ill?

• Avoid using hygiene products, especially toothbrushes, razors, or manicure instruments which are not your own.

• Use condoms in sexual relations.

• Avoid contact with medical instruments or instruments that are used to provide beauty services where they may not have been disinfected or sterilised.

• Anyone who comes into contact with blood and other bodily fluids ay work (healthcare workers, members of the rescue services, police officers, prison employees, members of the Defence Forces, etc) must carefully follow all hygiene rules.

• Avoid reusing syringes and needles.

Falling ill can be prevented through vaccination, which provides long-term and efficient protection.

Who is most at risk?

• Neonates whose mothers carry the hepatitis B virus

• Sexual partners of infected individuals

• Individuals who change their sexual partners frequently

• Men who have sexual relations with other men

• Injecting drug addicts

• Family members and other close contacts of individuals who are suffering from chronic hepatitis B

• Care home patients and employees

• Providers of healthcare services who come into contact with blood and other bodily fluids

• Patients who receive haemodialysis or peritoneal dialysis

• Individuals who are travelling in countries in which hepatitis B is more prevalent

• Users of services which involve puncturing of the skin (such as tattooing and piercing)

Vaccination is free of charge based on the national immunisation schedule.

What is diphtheria?

Diphtheria is a serious bacterial disease, which manifests in the form of a pharyngitis, laryngitis, and rhinitis. The disease may be fatal.

How does it spread?

Diphtheria spreads through direct contact from one individual to another, as well as in the form of a droplet infection via coughing or sneezing. The disease usually involves the upper respiratory tract or skin, as well as the ocular or genital mucosa on rarer occasions.

Individuals of any age may become infected with diphtheria. The pathogen usually enters the body through the mucosa of the upper respiratory tract and multiplies there. The infected tissue secretes a purulent fluid which will form a film-like plaque.

If diphtheria is suspected, the individual must be hospitalised immediately and the condition of those individuals who have come into contact with them must be monitored.

Without being treated, an infected individual may spread the disease for between two to three weeks.

Symptoms

The disease begins with tonsillitis with plaque, which may spread to the rest of the respiratory tract. The plaque is of a greyish or whitish colour, or dark due to haemorrhaging, and will spread over the edges of the tonsils. The spread of the plaque into the throat, trachea, or bronchi may cause a blockage of the respiratory tract. Children are most at risk, as they may develop swelling of the throat which may result in suffocation.

Complications may involve the kidneys, heart, and nervous system. Paralysis of the soft palate muscles or pneumonia may also be suffered.

Diphtheria is characterised by:

• swollen lymph nodes
• throat pain
• loss of voice
• a cough
• shortness of breath
• swallowing difficulties

The incubation period usually lasts between two to five days.

An infected individual usually ceases to be infectious 24 hours after starting treatment with antibiotics.

Having had diphtheria does not ensure immunity.

How is it diagnosed?

The disease is usually identified based on external symptoms. If diphtheria is suspected, a nasopharyngeal sample is collected with a cotton swab which is used to run an analysis for the pathogen. Diphtheria can also be diagnosed by testing for the antibodies in a blood sample.

How does one avoid falling ill?

The easiest way is to get vaccinated. It is important to keep in mind the fact that those who have received the vaccination in their childhood must be immunised again at an interval of ten years in order to be able to preserve their immunity.

Vaccination is available for all for a fee.

What is influenza?

Influenza is a viral disease. It is characterised by a sudden beginning of the disease and a high fever (with a temperature of at least 38°C), as well as a cough, headache, throat pain, muscular pain, or breathing difficulties.

How does it spread?

The virus usually spreads via the droplets which are released by sneezing, blowing one’s nose, or coughing. If hands are not washed, the virus can spread to numerous people via objects such as door and other handles, phones, or computer keyboards.

Symptoms

The average incubation period for influenza ranges from between three to seven days. An infected individual usually becomes infectious before they develop any symptoms and will remain infectious for up to seven days (or, in the case of small children, for up to twenty-one days).

Influenza is characterised by a sudden beginning of the disease, a high fever (with a temperature of at least 38°C), plus either a cough, headache, throat pain, muscular pain, or breathing difficulties. Diarrhoea may also be experienced.

The most feared complications which may accompany influenza include sinusitis, pharyngitis, otitis media, bronchitis, and pneumonia. Influenza complications may also be fatal.

How is it diagnosed?

The disease is usually identified based on external symptoms and/or a nasopharyngeal sample is collected with a cotton swab and is analysed for the pathogen. If necessary, more specific rapid tests may also be used.

How does one avoid falling ill?

• Avoiding close contacts with infected individuals helps.
• Germs are often spread by touching objects which are covered with germs and then one’s eyes, nose, or mouth.
• A healthy lifestyle and getting enough sleep protect one from falling ill. Physical activity, avoiding stress, and consuming healthy food and drinks also help.

How does one avoid infecting others?

• If possible, stay home and avoid contact with other people.
• When you sneeze or cough, cover your mouth and nose with a disposable tissue and immediately throw the tissue into a waste container. If there is no other option, cover your nose and mouth with your sleeve.
• Wash your hands frequently.

The best protection is guaranteed by vaccination in October before the beginning of the flu season. In the case of healthy individuals, the influenza vaccine will become efficient between ten to fourteen days after having picked up the infection and will remain effective for up to one year. If there are no contraindications, anyone who is at least six months old can be vaccinated.

Individuals who are included in the following risk groups should consider vaccination more seriously than others:

• at least 65 years old individuals.
• children aged 0-5.
• individuals who are suffering from anaemia or a chronic lung, heart, kidney, or digestive system disease (primarily diabetes).
• children and youngsters from the age of six months to seventeen years who are receiving long-term aspirin treatment.
• individuals with immunodeficiency, including those who are receiving treatment which reduces the functioning of the immune system, as well as HIV-positive individuals.
• pregnant women in any stage of pregnancy.
• pregnant women if the second or third trimester of their pregnancy falls on a period in which influenza cases are more prevalent.
• care home patients and patients with chronic diseases who are receiving long-term hospital treatment.
• individuals who are at risk due to their occupation (healthcare workers, care home workers, bird farm workers, etc).
• individuals who may spread influenza to at-risk individuals.

Vaccination is contraindicated in the case of individuals with hypersensitivity to egg protein or other ingredients of the vaccine, as well as when suffering from an acute disease which comes with a fever.

Information about the vaccine(s) which is/are used in Estonia can be found on the website of the State Agency of Medicine.

HPV is a virus that spreads from person to person; according to various studies, high-risk strains of HPV cause more than 85% of cervical cancer cases. Four out of five people contract HPV during their lifetime.

How is vaccination carried out?

In Estonia, girls aged 12–14 years are vaccinated against HPV, on the basis of the national immunisation schedule. The vaccination usually takes place at school as it is voluntary and in case of minors, a parent shall make the vaccination decision.

Safety of the vaccine

HPV vaccines have been in use since 2006. In clinical studies, the effects of HPV vaccines on hundreds of thousands of patients have been studied. The results of those studies confirm that the vaccine is effective and safe.

At what age are people vaccinated?

It is recommended that girls are vaccinated when they are about 12 years old, prior to coming into contact with the virus.

How can you protect yourself from HPV?

• Avoid promiscuous sexual intercourse.
• Use a condom.
• Don’t smoke.
• Go for regular health checkups.
• Get vaccinated.

Vaccination does not replace the regular Pap smear test used for cervical screening – women should visit their gynecologist regularly even after getting vaccinated. In order to ensure thorough protection, the current screening recommendations apply to women who have been vaccinated against HPV as well.

However, screening does not enable the detection of rapidly growing cervical cancer in teenagers and young women. Therefore, cervical cancer prevention programmes for teenagers should focus primarily on HPV vaccination , which is very effective when done prior to the person becoming sexually active.

Is the human papillomavirus (HPV) dangerous?

12 types of HPV are currently known to cause cancer of the cervix, anus, vulva, vagina, penis and throat. All those HPV types are very contagious. In most cases, contraction of those types of HPV has no symptoms, so that the infected person will have no idea of the infection. In most cases, the infection persists for 1–2 years and then disappears by itself.

However, one in ten cases of the infection lasts longer and can cause precancerous formations. If those are not discovered on time, those may develop into cancer.

How does the vaccine work?

The HPV vaccine Gardasil 9 contains nine proteins that are similar to those of the human papillomavirus. Those are not live virus cells, nor can they bring about an infection; however, when the vaccine is injected to the body, the organism reacts to the proteins just as it would react the real virus. The body will produce antibodies against those particles, thereby creating a defence system that can ward off the real HPV virus when the body comes into contact with that. This is what helps prevent diseases caused by dangerous strains of HPV, such as cancer of the cervix, vagina, vulva, anus, penis, oral cavity, as well as pre-cancerous conditions.  The vaccine also protects from the occurrence of genital warts (condyloma acuminatum). The vaccine does not contain live virus and cannot therefore cause an infection and is not dangerous.

Vaccination is free for children based on the vaccination schedule.

What is measles?

Measles is a highly infectious viral infectious disease which comes with a rash and has spread around the world. Measles may have a severe form, which often causes complications such as pneumonia, otitis media, or encephalitis. 

How does it spread?

The virus spreads in the form of a droplet infection when an infected individual coughs or sneezes.

An infected individual is infectious from four to five days before and up to five days after developing the rash. The disease is most common in children under the age of seven. Malnutrition may be a risk factor of the disease.

The disease is destroyed within thirty minutes on the outside of the body and in daylight.

Symptoms

The incubation time for measles is between seven to eighteen days (ten days, on average).

The symptoms include an elevated fever, a general feeling of being unwell, a cough, head cold, conjunctivitis, and sensitivity to light. On the second day after developing the first symptoms, whitish spots with a bright red contour (so-called Koplik’s spots) appear on the mucosa of the cheeks above the teeth. A few days later a rash develops on the skin. The rash first develops behind the ears and spreads to the face and neck, then to the body and hands on the second day, and to the palms and soles of the feet on the third day. The rash is initially pink, then intensively red, remains for four to five days, and then disappears in the same order in which it appeared. In the period between the sixth and tenth day, skin which has the rash on it turns brown and starts shedding. The fever remains until the rash has disappeared.

Measles complications often include pneumonia, otitis media, or encephalitis.

How is it diagnosed?

Measles is diagnosed based on the symptoms, plus epidemiological information (having been in a measles distribution area), and based on laboratory tests.

How does one avoid falling ill?

Timely vaccination helps to prevent measles. The vaccine against measles which is used in Estonia also protects from mumps and rubella.

Measles is highly infectious. Contact with an infected individual must be avoided during the entire period in which they remain infectious. Any family members who have not yet had the disease and have not been vaccinated against measles should be isolated from the individual who has fallen ill and will need to be vaccinated as soon as possible.

Infants whose mothers have had measles remain immune for six to nine months after birth.

Having had measles provides life-long immunity.

Vaccination is free based on the national immunisation schedule.

What is mumps?

Mumps is an acute viral infectious disease, which manifests in the form of a fever and a painful swelling primarily in the parotid glands, but occasionally also in the other salivary glands (submandibular and sublingual glands). 

How does it spread?

Mumps spreads as a droplet infection (such as when coughing or sneezing), and via close contact with an infected individual.

The incubation period last from between eleven to twenty-one days. An individual with mumps is infectious within the last two days of the incubation period and between six to nine days after falling ill, irrespective of the form of the disease.

All age groups are susceptible to the virus, although it is most common in children and youngsters in the spring and winter seasons. Infants whose mothers have had mumps remain immune for up to one year. Having mumps ensures permanent immunity.

The virus dies quickly outside of the body.

Symptoms

Mumps comes in different forms. The most common form is unilateral or bilateral parotitis. At the start the individual who has fallen ill suffers a headache, feels unwell, and lacks an appetite for the first day or two. Next, a fever of 38-39°C develops, the parotid gland swells and becomes painful on one side and often also on the other side after one or two days. The skin over the swollen gland will not turn red but will be smooth and shiny. The swollen gland will usually be soft and dough-like to the touch. As the skin is stretched, it is difficult to chew and swallow. Other glands (gonads, pancreas, thyroid, etc) may also be damaged.

One of the significant peculiarities of mumps is the fact that the disease can be had asymptomatically, that is without developing any symptoms.

How is it diagnosed?

In most cases, mumps is diagnosed through the characteristic symptoms. Laboratory tests may also be carried out if necessary.

How does one avoid falling ill?

The primary measure for the prevention of mumps is vaccination based on the national immunisation schedule. The vaccine which is used in Estonia also provides protection against rubella and measles.

Anyone who has been infected with mumps should avoid contact with others. Patients are usually treated at home, but may be hospitalised if necessary. In the case of being treated at home, the patient may be released from isolation nine days after falling ill. Children under ten years of age who have not had mumps and who have not been vaccinated should be isolated from any children’s groups for twenty-one days after coming into contact with an infected individual.

Any objects which have been contaminated with the nasopharyngeal secretions of an infected individual must be sanitised.

Vaccination is available for a fee.

What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a viral infectious disease which spreads via ticks. The disease may take a serious course, involving the central nervous system and causing complications (such as balance and coordination issues, paralysis of the extremities, etc).

How does it spread?

Humans are infected if they are bitten by a tick which is carrying the virus. As the virus is spread by ticks, prevalence of the disease is characterised by the geographical spread of ticks and their seasonal activity from April to October.

Symptoms

Tick-borne encephalitis is an infectious disease of the central nervous system which often consists of two phases. In the first phase, the infected individual may develop flu-like symptoms within one to two weeks: a fever with headaches and muscular pain. Those complaints usually last for up to one week and then disappear.

In one third of cases, the virus may find its way into the infected individual’s brain and cause meningitis or meningoencephalitis. The symptoms become more severe, including a high fever, severe headache, nuchal rigidity, vomiting, drowsiness, and a general feeling of being unwell. Most of those who fall ill will recover, but some complications may remain, such as balance and coordination issues, paralysis of the extremities, headache, focussing and memory issues, etc. The disease may also be fatal.

How is it diagnosed?

Tick-borne encephalitis is diagnosed through the symptoms of the disease, known tick bites, and also laboratory testing.

How does one avoid falling ill?

In order to avoid being bitten by ticks:

• it would be a good idea to wear light colours and long sleeves in order to spot any ticks as soon as possible, as well as tucking your trouser legs into your socks and/or wellingtons.
• use a tick repellent.
• having been to an area where there is a risk of coming into contact with ticks, inspect your entire body, including the area behind the ears, under the armpits, and other areas of the body in the case of children.

Children as well as adults can be protected from tick-borne encephalitis by means of vaccination. The vaccination consists of three injections of which the first two are given within an interval of one to three months and the third up to three years later. Two shots provide a good levelof immunity, but it will only last for one season. The third injection will extend the period of immunity. In Estonia, which is a distribution area for ticks, people should get immunised against tick-borne encephalitis every three to five years.

Children of at least one year of age can be vaccinated.  

There is no specific treatment against tick-borne encephalitis. Only the symptoms are treated. Anyone who has had the disease will develop life-long immunity.

Information about the vaccine(s) which is/are used in Estonia can be found on the website of the  State Agency of Medicines.

Vaccination is available for a fee.

What is chickenpox?

Chickenpox is a wide-spread viral infectious disease which is characterised by a blister-like rash.

How does it spread?

Chickenpox spreads from person to person in the form of a droplet infection, with any contact with the secretions that leak from the blisters also being hazardous. The infection usually spreads to those individuals who are in the same room as an infected individual, but may also travel longer distances such as, for example, to the next room or office or to stairwells. Once there is one case in the family, any other family members who have not yet had the disease are also very likely to fall ill. Children up to ten years of age are most susceptible.

An infected individual is infectious from one to two days before developing the blister-like rash until shedding the chickenpox scabs within five to six days. Anyone who is suffering from shingles may also spread the disease as the symptoms of the two diseases are identical. The cases mostly occur in winter and spring.

The virus lives and multiplies in the human body and is able to remain viable in droplets of saliva outside of the body for ten to fifteen minutes. It is destroyed quickly by direct sunlight.

Anyone who has had chickenpox will develop life-long immunity.

Symptoms

The incubation period for chickenpox is between seven to twenty-one days (fourteen to sixteen days on average). The disease begins with catarrhal symptoms which last one to two days (such as in the form of a mild head cold or a sore throat), as well as a fever. Then a papular, bullous rash develops.

Elements of the rash may differ and could appear simultaneously all over the body. The rash is usually milder in children. For example, small children may only have a few small spots. Chickenpox is much more serious in adults who may develop over 500 blisters.

The rash usually spreads under hair on the scalp, on the neck and face, and asymmetrically all over the body. The blisters may appear on the mucosa of the eye, mouth, or genitals.

The chickenpox rash is extremely itchy and uncomfortable, and will cause sleep issues.

Complications of the disease may include skin inflammation, pneumonia, and encephalitis in more serious cases.

How is it diagnosed?

Chickenpox is diagnosed through a clinical diagnosis which is based on the symptoms.

How does one avoid falling ill?

Chickenpox is a vaccine-preventable infectious disease. In order to prevent the spread of the disease, the infected individual must be isolated from others until shedding the scabs, for at least nine days after developing symptoms.

If the exact date upon which an individual fell ill is known, the family physician will allow close contacts - that is, any children who have come into contact with the infected individual - to return to school after the first ten incubation days and will keep them in isolation until the eleventh day or up to the twenty-first day.

There is a vaccine against chickenpox. Children under one year of age and pregnant women are not vaccinated.

Information about the vaccine(s) which is/are used in Estonia can be found on the website of the State Agency of Medicines.