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Main messages

Infectious diseases

Immunisation

Ensure that all patients, especially children, are up-to-date with the UK immunisation schedule. See Immunisation collection with complete schedules.

Tuberculosis

The incidence of TB in Estonia is low (<40 cases/100,000), and there is also a high burden of MDR-TB, so:

• routine screening is not required
• consider testing for TB (including children) if the patient shows signs and symptoms
• seek advice, if you are a local TB service, from the before treating patients from Estonia for TB
• be aware that TB is a notifiable disease

Sexually transmitted infections and HIV

Take a sexual history, and:

• screen for STIs and HIV according to risk as specified in the UK national standards and guidelines
• test all sexually active patients under the age of 25 for chlamydia

Estonia has a low rate of HIV (<1%), so offer and recommend an HIV test if the patient:

• falls into a high risk group
• is newly registering in a high prevalence area

Be advised that national guidelines do not recommend routine consideration of HIV testing of infants and children who have recently arrived in the UK.

Hepatitis B

Estonia has an intermediate prevalence of hepatitis B, so:

• consider screening for hepatitis B, particularly those who have recently arrived
• offer screening for hepatitis B to all pregnant women during each pregnancy
• immunise appropriately babies born to mothers who are hepatitis B positive, and follow-up accordingly
• be aware that the UK has a universal infant immunisation programme for hepatitis B聽and a selective immunisation programme for higher risk groups

Hepatitis C

Estonia has a higher prevalence of hepatitis C than the UK, so if other risk factors apply.

Travel plans and advice

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin, and see , or the Health Protection Scotland websites ( and , for travel advice.

Typhoid

There is a risk of typhoid infection in Estonia, so:

• ensure that travellers to Estonia are offered typhoid immunisation and advice on prevention of enteric fever
• remember enteric fever in the differential diagnosis of illness in patients with a recent history of travel to-or-from Estonia

Women鈥檚 health

Reproductive health indicators

Reproductive health indicator	UK	Estonia
Number of children per woman鹿	2	2
Breast examination or mammograph虏	75%	39%
Cervical cancer screening鲁	70%	53%

鹿 lifetime average; 虏women aged 50 to 69 years;鲁women aged 20 to 69 years

No data are available on:

• contraceptive use

Nutritional and metabolic concerns

Anaemia

There is a moderate risk of in adults (estimated prevalence in non-pregnant women is 20 to 40%) and pre-school children (estimated prevalence is 20 to 40%), so:

• be alert to the possibility of anaemia in recently arrived migrants, particularly women and pre-school children
• test as clinically indicated

Vitamin D

Consider the possibility of vitamin D deficiency in people who may be at risk due to:

• covering their body for cultural or religious reasons (lack of sunlight)
• skin colour
• diet (vegan or vegetarian)

Vitamin A

There may be a risk of vitamin A deficiency in Estonia.

Iodine

People from Estonia may be at risk of mild iodine deficiency due to inadequate intake.

Country profile

Health indicators and health care

has a summary of health indicators and health care in Estonia.

Culture, politics and history

and provide background information on the culture, politics and history of Estonia.

Languages

Language	Population (%)
Estonian (official)	68.5%
Russian	29.6%
Ukrainian	0.6%
Other	1.2%
Unspecified	0.1%

Source: .

Religions

Religion	Population (%)
Lutheran	9.9%
Orthodox	16.2%
Other Christian	2.2%
Other	0.9%
None	54.1%
Unspecified	16.7%

鹿including Methodist, Seventh-Day Adventist, Roman Catholic, Pentecostal

Source: .

Migration to the UK

There were almost 8,000 people from Estonia living in England and Wales at the time of the 2011 Census.

Source: .