AIDS/HIV: The incidence of HIV/AIDS in the general population is low but increasing. UNAIDS reports the prevalence of HIV is <0.1% but the actual prevalence in the general population cannot be verified and may be higher. Central Asia, including Afghanistan, is experiencing a rapid increase in HIV cases, largely driven by injecting drug users (IDU). Afghanistan is the largest global producer of opium; recent UNODC reports estimate there are 50,000 heroin users in the country. Among male IDU in Afghanistan, high-risk behaviors are common, including sharing syringes (50%), paid sex with a women (76%), and sex with men or boys (28%). More than half had been incarcerated in prison, 21 percent of them, more than once. (Source: Physcom.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 fluid of another person or their blood. 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.
- MEDICAL INSURANCE: 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.
Avian Influenza A (Bird Flu): As of March 2007, outbreaks in birds were confirmed in Jalalabad, Batikot, Rodat and Khojani in Nangrahar; The 8th district in Kabul and Khaskunar and Chowki in Kuknar. No human fatalities have been reported.
- Avian influenza A (H5N1) 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 influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against “bird flu.” Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). 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 cases.
Cholera: A cholera outbreak in October 2008 affecting over 1100 people with at least 17 deaths was reported in the northern, eastern and southeastern regions of the country. The affected provinces included Laghman, Nooristan, Nangarhar, Samangan, Faryab and Nimruz. (Source: ProMED-mail October 2008).
Although this disease is active in this country with sporadic cases and outbreaks reported, cholera is an uncommon in travelers from developed countries. The cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
- The main symptom of more severe cholera is copious watery diarrhea.
- Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
- A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Crime/Security/Civil Unrest: There is a high level of serious crime in Afghanistan, including in the capital, Kabul. Armed robbery, rape and carjacking are common and the level of gun ownership is high. You should stay indoors after dark.
Local Travel: Due to a deterioration in security in the provinces surrounding Kabul, travel by road from Kabul by foreigners has been restricted by the Afghan government to those with armed security. You are advised to consult a reputable security company about appropriate security arrangements, including at home and at work and for all travel. Fully implementing security advice will help to mitigate, but not eliminate, the very high threat of attack.
Travel outside Kabul should only be to properly secured workplaces. You should avoid unnecessary road travel in Kabul City. If travelling by road, you should only travel in secure transport with close protection, using reputable local drivers and guides. You should consider permanent armed protection, though even these precautions cannot guarantee personal safety.
- Kabul International Airport may close at short notice. You should check with your airline before going to the airport.
- Car-jacking is a problem. Banditry in rural areas by armed groups is common.
- Unexploded landmines and other ordnance are a danger throughout Afghanistan.
For the latest update, go to the Australian government site Smartraveller:
Crimean-Congo Hemorrhagic Fever (CCHF): According to ProMED, A U.S. soldier stationed near Kabul died of CCHF in September 2009 after sustaining a tick bite. He is the first case of CCHF reported in U.S. troops in Afghanistan. An outbreak of Crimean-Congo hemorrhagic fever affecting 5 people including 2 deaths was reported in Herat in September 2008.
• CCHF is caused by a virus that is transmitted by tick bites or by exposure to blood or secretions from infected animals or humans. Anyone who has visited this country and is suffering from a fever, headache, chills, muscle aches, vomiting, red rash (which does not fade when pressed under glass), bleeding on the roof of the mouth, or any other unexplained symptoms should seek medical advice immediately. Risk is seasonal, associated with periods of high tick activity (usually March through September, but seasonal patterns may occur) and increases in tick and rodent host populations.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. 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 with frequent outbreaks. Cases reported from Farashghan village of Dawlatshah district and from Laghman province in the eastern part of Afghanistan in 2006 and 2007. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. 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.
- Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. 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 at high level with a prevalence of 38% in injecting drug users. The prevalence in the general population is elevated, but not clearly determined. 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.
Insect-Bite Prevention: You should exercise insect-bite prevention measures. For maximum protection, apply a DEET-containing repellent to exposed skin (30% concentration recommended), apply permethrin spray or solution to your clothing and gear, and sleep under a permethrin-treated bednet (if available).
- Until now, DEET-based repellents have been the gold standard of protection against disease-transmitting insect bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% protection by using a properly-applied skin repellent and wearing permethrin-treated clothing.
Japanese Encephalitis (JE): Low risk; historically, this disease has occurred along the eastern borders. Travelers to rural areas should prevent mosquito bites.
Leishmaniasis: Cutaneous leishmaniasis occurs in rural and semi-rural areas, especially the northern Afghan plains and the outskirts of Kabul. Other risk areas include Qandahar in the south and Herat in the west. Sporadic cases of visceral leishmaniasis are reported, including some in US military personnel.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
- All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.
Malaria: Transmission occurs from April to December at altitudes below 2,000 meters (6,500 feet). Chloroquine-resistant falciparum malaria is reported, especially along the border with Pakistan. Atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine is recommended for prophylaxis.
A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Afghanistan page on the Destinations menu.
Animated malaria map: http://www.map.ox.ac.uk/MAP-movie-limits.mov
Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
- You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
- Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Other Diseases/Hazards: HIV/AIDS (increasing incidence, primarily related to injecting drug use)
- Anthrax (18 cases of suspected anthrax have been reported, including eight deaths, from the Nimruz region All victims had eaten meat from an infected camel)
- Brucellosis (Humans acquire infection by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material.)
- Crimean-Congo hemorrhagic fever
- Leptospirosis (endemic in the northern and eastern plains)
- Louse-borne typhus
- Sandfly fever
- Siberian tick typhus
- Scrub typhus
- Tick-borne relapsing fever
- Intestinal helminthic infections
Poliomyelitis (Polio): This disease is active in this country. WHO encourages residents and long-term visitors (of over 4 weeks) of those infected countries which are not exporting wild poliovirus, i.e. Afghanistan, Iraq, Equatorial Guinea, Ethiopia, Israel, Somalia and Nigeria, to have polio vaccination 4 weeks to 12 months prior to their international travel.
- All travelers to Afghanistan should be fully immunized. A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
- As of 2014, if you will be in Afghanistan for more than 4 weeks, the government of Afghanistan may require you to show proof of polio vaccination when you are exiting the country. To meet this requirement, you should receive a polio vaccine between 4 weeks and 12 months before the date you are leaving Afghanistan. Talk to your doctor about whether this requirement applies to you. Travel Medicine, Inc. can immunize agianst polio with a booster shot (if needed), and also provide you with proof of vaccination, also if needed.
Rabies: Human cases of rabies occur sporadically in this country. No one should pet or pick up stray animals. All children should be warned to avoid contact with unknown animals. Pre-exposure rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
- Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.
Travelers' Diarrhea: High risk throughout this country. Dysentery from shigellosis is a major problem. We recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
- Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
- 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.
Tuberculosis: Tuberculosis (TB) is a major public health problem in this country. Tuberculosis is highly endemic in Afghanistan with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: A typhoid epidemic epidemic broke out in Charsada district in the central Ghor Province in February 2007, claiming a number of lives. A map of Afghanistan showing the west-central Ghor Province can be found at: http://www.un.org/Depts/Cartographic/map/profile/afghanis.pdf
Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people traveling to or working in Central Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.
Time Zone: +4:30 hours. No daylight saving time in 2008.
Tel. Country Code: 93
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Plug Adaptors D, F.
Travel Advisory - Afghanistan
Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.
Dr. Rose Recommends for Travel to Afghanistan
HIV Test: Not required.
Required Vaccinations: Afghanistan requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination.
Passport/Visa: A passport and valid visa are required to enter and exit Afghanistan. Afghan entry visas are not available at Kabul International Airport. American citizens who arrive without a visa are subject to confiscation of their passport and face heavy fines and difficulties in retrieving their passport and obtaining a visa, as well as possible deportation from the country. Americans arriving in the country via military air usually have considerable difficulties if they choose to depart Afghanistan on commercial air, because their passports do not receive stamps showing they entered the country legally. Those coming on military air should move quickly after arrival to legalize their status if there is any chance they will depart the country on anything other than military air. See our Foreign Entry Requirements brochure for more information on Afghanistan and other countries.
Travelers can visit the Embassy of Afghanistan website at www.embassyofAfghanistan.org for the most current visa information. The Consular office of the Embassy of Afghanistan is located at 2233 Wisconsin Avenue, NW, Suite 216, Washington, DC 20007, phone number 202-298-9125.
HIV Test: Not required.
Required Vaccinations: Afghanistan requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination.
Vaccinations: Recommended and Routine
Afghanistan requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination.
Cholera: Cholera vaccine (not available in the U.S.) is recommended for persons at high risk (e.g., relief workers, health-care professionals working in refugee camps) who work and live in highly endemic areas under less than adequate sanitary conditions. Not recommended otherwise.
Hepatitis A: Recommended for all travelers >1 year of age not immunized or immune against hepatitis A.
Hepatitis B: Recommended for all travelers who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes; from unscreened blood transfusions. Recommended for any traveler requesting protection against hepatitis B.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.
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: Outbreaks of pertussis and diphtheria are reported in this country.
Typhoid: Typhoid vaccine is recommended for all travelers.
Hospitals / Doctors
With only 8 physicians per 100,000 people, many districts in Afghanistan do not have a doctor at all. Especially in rural areas, it is not atypical for the formal training of a medical officer who serves as many as 25 villages to consist of no more than a few months of medical education completed decades ago.
Currently, the majority of health care in Afghanistan is provided through nongovernmental organizations. It is estimated that more than 80 percent of functional health care facilities have some form of support from such organizations, often including the supply of medicines and other basic materials. In the south and east, these groups, e.g., Doctors without Borders, must operate with extreme caution, if they can work at all, because aid workers are perceived as supporters of the coalition political agenda and, as such, have become targets of anti-coalition forces. The inability to deliver aid means that millions of Afghan civilians are beyond the reach of humanitarian assistance, including basic health care services.
- 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; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. 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.
- Travelers are advised to obtain travel insurance that provides for medical evacuation to a medical center in India or another country in the event of serious illness or injury.
Note: Medical evacuation capability from Afghanistan is extremely limited. Even air ambulance companies that claim worldwide capability may not agree to come to Afghanistan. travelers with medevac insurance should confirm with the insurance provider their availability of service to this country.
Well-equipped medical facilities are few and far between throughout Afghanistan and Afghan public hospitals should be avoided. Some Western-style private clinics that have recently opened in Kabul include:
- DK-German Medical Diagnostic Center
Street 66 / House 138 / District 4
Zone 1 / Kabul
Tel:  079-913-6210
- CURE International Hospital
Tel:  079-883-830
CURE has three fully equipped operating rooms for general surgery, obstetrics, gynecology and orthopedics. CURE provides general practice and OB/GYN care and specializes in the orthopedic rehabilitation of children with disabilities.