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American Samoa



Capital: Pago Pago

Time Zone: -11 hours. No daylight saving time in 2008.
Tel. Country Code: 684
USADirect Tel.: 633
Electrical Standards: Electrical current 120/60 and 220/50 (voltz/hz). American Style Adaptor Plug. Grounding Adaptor Plugs A, D, E.

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Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• American Samoa is an unincorporated Territory of the United States. Neither Canada, Australia, nor the United Kingdom has an embassy in American Samoa.

There is no resident Canadian diplomatic mission in American Samoa. In the case of emergency you should contact the Canadian Consulate-General in Los Angeles.

• Consulate General of Canada
550 South Hope Street, 9th Floor
Los Angeles, California
Tel: [1] (213) 346-2700
Emergency toll-free to Ottawa: 1-888-949-9993
Fax: [1] (213) 620-8827
E-Mail: lngls@international.gc.ca
Website: http://www.losangeles.gc.ca

There is no resident British diplomatic mission in American Samoa. In the case of emergency you should contact the British Consulate-General in Los Angeles.

• British Consulate-General
11766 Wilshire Boulevard, Suite 1200
Los Angeles, California
Telephone: [1] (310) 481 0031
Email: consular.losangeles@fco.gov.uk
Website: http://www.britainusa.com/la

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from travelers over 1 year of age coming from infected or endemic areas.


Passport Information

Passport/Visa: To enter the Territory, a U.S. citizen or national must have in his or her possession: (1) a valid U.S. passport or certified birth certificate demonstrating his or her U.S. nationality and (2) a ticket for onward passage out of American Samoa or proof of employment in American Samoa. The requirements for an aliens entry into American Samoa mirror those for a U.S. citizen or national. In addition to a ticket for onward passage out of American Samoa, an alien must have in his or her possession a valid passport containing a photograph or fingerprint of the holder and authorizing him or her (1) to return to the country from where he or she came or (2) to enter some other country.
Whether a U.S. citizen or national or an alien, once lawfully admitted, a tourist or business person may stay in American Samoa for up to thirty days. With the approval of the Attorney General of American Samoa, a tourist or businessperson may stay in American Samoa for thirty days beyond the initial thirty-day period.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized.

Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

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.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.

Hospitals / Doctors

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. 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 - the equivalent drugs may not be available or may be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Medical facilities are basic and therefore medical evacuation by air ambulance to Hawaii, New Zealand or Australia may be necessary.

• LBJ Medical Center
Pago Pago
Tutuila
Tel: 633-1222
Emergency Tel: 633-5555
This 140-bed hospital is the primary medical facility in American Samoa, providing 24-hour emergency care and a range of medical and surgical services.

• Pacific Underwater Construction, LLC., in Pago Pago operates a hyperbaric chamber. It is used mainly for surface decompression for construction divers doing deep-water work, but can also be used to treat decompression sickness in divers.
Tel: [684] 252-1946
Fax: [684] 633-5599
E-mail: pucllc@pucllc.com
Website: http://www.pucllc.com/chamber.htm

Destination Health Info for Travelers

AIDS/HIV: It is estimated that 0.4% of the adult population of Oceania is living with HIV/AIDS, but no statistics are currently available for American Samoa.
• 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.

Dengue Fever: Multiple cases of dengue (78 confirmed), with at east one fatality, were reported through September 2007. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Oceania. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.

A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf

Filariasis: Sporadic cases and outbreaks are reported, but incidence is unclear. American Samoa began a territory-wide mass drug administration (MDA) program with diethylcarbamazine and albendazole in 2000 after baseline surveys indicated that 16.5% of residents were infected with Wuchereria bancrofti. In 2006, after a total of 5 years of MDA and 3 years of improved MDA participation, the antigenemia prevalence dropped from 11.5% (2001) to 0.95% (2006) (P < 0.0001).
• Travelers are at low risk but should take protective measures against mosquito bites.

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through 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 may be endemic but levels are unclear. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 8% or higher. 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 with a prevalence of 0.2% of the adult population. 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 world• s population. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over the age of 6 months who have not received a flu shot in the previous 12 months.

Insect-Bite Prevention: There is the risk of insect-transmitted diseases in this country. You should take measures to prevent insect-bites, depending on your itinerary and planned activities. 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 recently, DEET-based repellents have been the gold standard against mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% bite protection by using a properly-applied DEET or picaridin skin repellent and wearing permethrin-treated clothing.

Malaria: There is no risk of malaria in this country.

Marine Hazards: Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking.
Swimming-related hazards include sharks, jellyfish, including the Indo-Pacific man-of-war, stonefish, scorpion fish, stingrays, sea snakes, spiny sea urchins, sharp coral and poisonous cone shells. Swimmers should take sensible precautions to avoid these hazards. Stonefish, scorpion fish and stingrays congregate in shallow water along the ocean floor and can be difficult to see. Wearing booties may help protect you, but should not be relied upon as complete protection, as many of the spines are sufficiently rigid and long to penetrate wetsuits, booties, and gloves.
• The jellyfish population appears to be increasing, due in part to overfishing of jellyfish predators, rising water temperatures, and pollution. Jellyfish travel in groups, so looking before you leap into water may be protective.
Treatment guidelines for jellyfish stings: http://www.emedicine.com/derm/topic199.htm
• To avoid a shark attack, swim or dive with a group. Avoid swimming during hours of darkness or twilight, in fog, or in murky waters. Avoid swimming in the vicinity of sea lions, harbor seals or elephant seals. Avoid swimming near the mouths of rivers where sharks hunt for fish. When diving, minimize time spent at the surface. Wearing a wetsuit and fins or lying on a surfboard creates the silhouette of a seal to a shark below you. Shallow water is not a deterrent to sharks; attacks have occurred in less than 5 ft/1.5 m of water.

The most serious hazards:
Sea snake venom is highly toxic and the mortality has been reported to be 25% in untreated cases. In severe envenomations, symptoms can occur within 5 minutes, but typically evolve over 8 hours. It is possible that the victim may not have been aware of the bite, since there is little or no pain on envenomation.
Symptoms often include anxiety, muscle aching, salivation and a sensation of tongue swelling, followed by nausea, vomiting, muscle spasms, ascending paralysis, ocular palsy and sometimes loss of vision. Respiratory collapse may ensue, and the need for endotracheal intubation and mechanical ventilation should be anticipated. Sea snake antivenom (older name: antivenin) should be administered in all actual and suspected cases.
• A sea snake bite is always a medical emergency, even if the victim does not appear ill.
• You must get the victim to an emergency department, as fast as possible.
• En route, attempt to keep the bite site in a resting position, while keeping the victim as still as possible.
• Apply a broad pressure bandage over the bite about as tight as an elastic wrap to a sprained ankle. This is intended to slow the spread of the venom through the lymphatic system. Apply a splint to the limb. Make sure that arterial circulation is not cut off, by making sure fingers or toes stay pink and warm.
• Never cut open a sea snake bite and try to suck venom from the victim.
• Sea snake toxin is not inactivated by changes in temperature or pH. Application of ice, hot packs, or vinegar only wastes time.
Read more: http://emedicine.medscape.com/article/771804-overview

The box jellyfish is the most dangerous jellyfish in the world. Box jellyfish belong to the class Cubozoa, and are not a true jellyfish (Scyphozoa), although they show many similar characteristics. When people talk about the extremely dangerous Australian box jellyfish they refer to the species Chironex fleckeri. Chironex fleckeri (sometimes simply called “the box Jellyfish”), is the best-known species of box jellyfish, and is only one of a category which actually contains about 19 different species. The name sea wasp is also applied to some species of Cubozoans, including the aforementioned Chironex fleckeri.
The other species that is known to have caused deaths is Carukia barnesi, commonly called Irukandji. This tiny jellyfish is only about thumbnail size.
Chironex fleckeri is present in the waters of Australia, the Indo-Pacific region, including Vietnam, Papua New Guinea, the Phillipines, and Hawaii. It amy be present in American Samoa. Their exact distribution has not been fully determined.

• Box jellyfish stings are extremely painful, potentially lethal and require treatment with antivenom. Cardio-respiratory arrest may occur within 20 minutes of envenomation. Four other varieties of jellyfish (jimble, Carukia, mauve stinger, and hairy stinger) should also be avoided.
Box jellyfish treatment and antivenom information:
http://emedicine.medscape.com/article/1087794-overview
http://www.toxinology.com/generic_static_files/cslavh_antivenom_boxjelly.html

The stonefish is a rather unattractive squat fish with a mostly rough “skin” that assists its superb camouflage as it sits on old coral or debris. There is a series of erectile dorsal spines, which, with the associated venom glands, provides the creature means of envenoming potential predators. Stonefish are mostly encountered in shallow water, where they may be stepped on by accident, or picked up by the unwary. Instant and severe pain is a constant feature of stings, followed by local swelling, which may be marked, tenderness and a blue discoloration of skin surrounding the sting site. Dizziness, nausea, hypotension, collapse, cyanosis and pulmonary edema have been described, though are by no means common. Tissue ischemia at the sting site is possible.
• Antivenom: Stonefish antivenom should only be given if there is clear evidence of envenomation. It should be given only IM, not IV.
• The use of stonefish antivenom in stings by other species of scorpionfish is not clearly recommended, but there is limited evidence that it may be beneficial (e.g. possibly bullrout stings, Notesthes robusta). The potential risks of immediate and delayed adverse reactions to antivenom should be carefully considered before using this antivenom for other than stonefish stings.

Emergency treatment guidelines for marine stings are here:
http://www.jcu.edu.au/interest/stingers/first%20aid%201treatment.htm#firstaidtop

Source:
Clinical Toxicology Resources
University of Adelaide
Website: http://www.toxinology.com/index.cfm

Reviewer: Paul S. Auerbach, MD, FACEP
Author: Wilderness Medicine and Field Guide to Wilderness Medicine
http://www.travmed.com/catalog/index.php?cPath=172

Other Diseases/Hazards: An outbreak of leptospirosis was reported in 2004, apparently from contamination of streams by urine from nearby pig farms. Ross River virus, transmitted by mosquitoes, has been reported.

Rabies: American Samoa is currently considered rabies-free. All animal bites, however, should be medically evaluated. Prompt medical evaluation and treatment of any animal bite is essential, regardless of your rabies vaccination status.

Travelers' Diarrhea: Low to moderate risk. In urban and resort areas the hotels and restaurants generally serve reliable food and potable water. Elsewhere, travelers should observe all food and drink safety precautions. 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.

Typhoid Fever: Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working in the Oceania, 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.