Northern Europe This section includes general information about health hazards as reported by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The region includes Belarus, Belgium, Czech Republic, Denmark (with the Faroe Islands), Estonia, Finland, Germany, Iceland, Ireland, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Republic of Moldova, Russian Federation, Slovakia, Sweden, Ukraine, and the United Kingdom (with the Channel Islands and the Isle of Man). The area encompassed by these countries extends from the broadleaf forests and the plains of the west to the boreal and mixed forest to be found as far east as the Pacific Ocean. The incidence of communicable diseases in most countries is such that they are unlikely to prove a hazard to international travelers greater than that found in their own country. There are health risks, but in most areas very few precautions are required. Of the arthropod-borne diseases, there are very small foci of tick-borne typhus in east and central Siberia. Tickborne encephalitis and Lyme disease may occur throughout forested areas where vector ticks are found. Rodent-borne hemorrhagic fever with renal syndrome is now recognized as occurring at low endemic levels in this area. The foodborne and waterborne diseases reported, other than the ubiquitous diarrheal diseases, are taeniasis (tapeworm) and trichinellosis in parts of northern Europe, and diphyllobothriasis (fish tapeworm) from the freshwater fish around the Baltic Sea area. Fasciola hepatica infection can occur. Hepatitis A occurs in eastern European countries. Cases of cholera have been reported from some countries in the area. The incidence of certain food-borne diseases, e.g., salmonellosis and campylobacteriosis, is increasing significantly in some of these countries. Poliomyelitis continues to be reported from Belarus, the Republic of Moldova, the Russian Federation, and the Ukraine. An outbreak of poliomyelitis in the Netherlands in 1992-93 was confined to a religious group that refuses vaccination. Rabies is endemic in wild animals (particularly foxes) in rural areas of northern Europe. In recent years, Belarus, the Russian Federation, and Ukraine have experienced entensive epidemics of diphtheria. Diphtheria cases, mostly imported from these three countries, have also been reported from neighboring countries: Estonia, Finland, Latvia, Lithuania, Poland, and the Republic of Moldova. A climatic hazard in part of northern Europe is the extreme cold in winter.