All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for Austria:

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.

Tick-borne encephalitis vaccine may be considered for long-term travelers who expect to be visiting rural or forested areas in the spring or summer. In Austria, most cases occur in Steiermark (Styria) and Kärnten (Carinthia) in the south. In 2003, the disease was described in the areas around Mattsee, Wallersee and Thalgau north of the city of Salzburg. In 2005-2006, new risk areas were identified upstream from the valleys of Inn and Isel and in Ziller valley and Vorarlberg, near Feldkirch (see Eurosurveillance). Two vaccines have been developed: TicoVac, also known as FSME Immun (Baxter AG), which is manufactured in Austria, and Encepur (Chiron Behring), which is made in Germany. The vaccines are approved for use in a number of European countries, but not the United States. A full series consists of three doses over a one-year period, which is not practical for most travelers, though limited data indicate that Encepur may be given in an accelerated schedule for faster immunity. Tick precautions, as discussed below, are strongly advised.

A measles outbreak was reported from the Salzburg area in April 2008, resulting in more than 200 cases as of April 14. The outbreak was linked to an anthroposophic school in Salzburg, most of whose students had not been vaccinated against measles (see Eurosurveillance and ProMED-mail; April 4, 2008). All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Austria.

A mumps outbreak was reported in May-June 2006 from lower Drave (Drau, Drava) valley in Carinthia, chiefly affecting the provinces of Kärnten (known in English as Carinthia, located in southern Austria), Niederösterreich and Wien (both in northeast Austria). The outbreak apparently began at an Easter festival in Feistritz on the Drave. A total 214 cases were identified, mostly in those between 18 and 30 years old. Nearly half of those affected had never been vaccinated. For further information, go to Eurosurveillance and ProMED-mail (June 8, 2006). Mumps is a viral infection which is spread by direct contact with or inhalation of oral or nasal secretions from an infected person. The infection may be complicated by meningitis, deafness, pancreatitis, or inflammation of the testicles or ovaries. All travelers born after 1956 should either make sure they have received two doses of MMR or mumps vaccine or have a blood test proving mumps immunity. Those born before 1957 are presumed to be immune. Although mumps immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of MMR vaccine before traveling to Austria.

Two cases of bovine spongiform encephalopathy ("mad cow disease") have been identified over a four-year period, but transmission to humans has not been reported to date. At present, the risk of acquiring variant CJD from European beef appears to be extraordinarily low, at most about one in 10 billion servings. The Centers for Disease Control does not advise against eating European beef, but suggests that travelers who wish to reduce their risk may either abstain from beef while in Europe or eat only solid pieces of muscle meat, such as steak, rather than products like sausage or chopped meat that might be contaminated. There is no evidence of any risk from pork, lamb, milk or milk products. For recent updates, go to ProMED-mail.

• Lyme disease (tick-borne infection which causes fever, headache, joint pains, body aches, and malaise, usually in association with an expanding red rash, often pale in the center; may be complicated by arthritis, meningitis, encephalitis, Bells palsy, or cardiac involvement if not treated in early stages; tick precautions recommended for travel to rural and forested areas, especially during warm weather months)
• Visceral leishmaniasis (eastern Austria)
• Alveolar echinococcosis (reported from rural areas in the western part of the country; see Emerging Infectious Diseases for details)
• HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

Wear long sleeves, long pants, and boots, with pants tucked in when traveling to rural or forested areas. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing and shoes. Permethrin-treated clothing appears to have little toxicity. Perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity. Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

For an ambulance anywhere in Austria, call 144.

For an on-line list of hospitals and English-speaking physicians in Austria, go to the United States Embassy website.

Excellent medical care is widely available. The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and if it will cover emergency expenses such as a medical evacuation. U.S. medical insurance plans seldom cover health costs incurred outside the United States unless supplemental coverage is purchased. Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. However, many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency services such as medical evacuations...

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of MMR vaccine. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

U.S. citizens are encouraged to register at the Consular Section of the U.S. Embassy in Vienna or at the Consular Agency in Salzburg and obtain updated information on travel and security within Austria. The U.S. Embassy in Vienna is located at Boltzmanngasse 16 in the Ninth District. The Consular Section of the U.S. Embassy is located in the Marriott Building, on the fourth floor of Gartenbaupromenade 2, in the First District. The telephone number for both the Embassy and the Consular Section is (43)(1) 31-339. There is also a Consular Agency in Salzburg at Alter Markt 1, Telephone (43) (662) 84-87-76, open Monday, Wednesday, and Thursday from 9:00 A.M. to 12:00 noon. U.S. citizens in Salzburg who require assistance outside of these hours may contact the U.S. Embassy in Vienna. The Embassy also maintains a website, at http://www.usembassy-vienna.at with security updates and other information helpful to American citizens.

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.