Time Zone: +4 hours. GMT +5 from March 30 to October 26.
Tel. Country Code: 374
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). Eurpean Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Armenia
Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.
Dr. Rose Recommends for Travel to Armenia
• U.S. Embassy
1 American Avenue
Tel.  (10) 46-47-00
Fax:  (10) 46-47-42
• Canadian Embassy
25 Demirjian Street
Tel. & Fax:  (1) 567-903; Mobile:  (9) 401-238
• British Embassy
34 Baghramyan Avenue
Tel:  (10) 264 301
FaX:  (10) 264 318
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: A passport and visa are required. For stays longer than 21 days, but not exceeding 90 days, an official invitation from a qualifying entity in Armenia is required. U.S. citizens may purchase visas for a stay of up to 21 days online at http://www.armeniaforeignministry.am/ for the fee of USD 60 or upon arrival at the port of entry for the fee of $30 US. Visas for up to 120 days may be purchased at the Armenian Embassy in Washington, D.C. or the Consulate General in Los Angeles for the fee of USD 61.
For further information on entry requirements, contact the Armenian Embassy at 2225 R St. NW, Washington, DC 20008, tel. (202) 319-1976 and (202) 319-2983; the Armenian Consulate General in Los Angeles at 50 N. La Cienega Blvd., Suite 210, Beverly Hills, CA 90211, tel. (310) 657-7320, or visit the Embassy of Armenia•s web site at http://www.armeniaemb.org for the most current visa information.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
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; from acupuncture, tattooing or body piercing; 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.
Rabies: 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.
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.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all unvaccinated travelers.
Hospitals / Doctors
Medical care in Armenia is below Western standards. Hospital accommodations are inadequate and advanced technology is lacking.
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 - the equivalent drugs may not be available; or 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. Serious illness or injury may require medical evacuation to Western Europe.
For a guide to other physicians, dentists, hospitals, and emergency services in Armenia, go to the U.S. Embassy website (http://yerevan.usembassy.gov/consular/physicians.php).
Facilities offering adequate care include:
• European Medical Center
3/1 Vazgen Sargsyan
Tel: (10) 540-003, 540-540
By appointment or walk-in; major credit cards accepted.
• Malatia Medical Centre
28A Varoughan Street
Tel: (10) 773 079 or (10) 773 458
• The 4th Yerevan City Polyclinic has been designated by the Armenian government to serve foreign travelers.
13 Moskovyan Street
Tel: (2) 580-395
Destination Health Info for Travelers
AIDS/HIV: The incidence of HIV/AIDS is increasing in Armenia. The reasons include 1) an increase in IV drug abuse, 2) an increase in commercial sex, 3) an increase in sexually transmitted diseases, 4) decreased availability of sterile needles and syringes, and 5) Inadequate public health prevention programs. (In 2006, there was no registered opioid substitution program for injecting drug users in Armenia.)
From 1988 to 1 December 2007, 528 HIV cases had been registered in the Republic of Armenia. Males constitute 75% of cases. The majority of the HIV-positive individuals (72.3%) belong to the 20-39 age group.
• The main modes of HIV transmission are through injecting drug use (47.9%) and heterosexual practices (45.1%). There are also registered cases of mother-to-child HIV transmission (1.9 %) as well as through blood transfusions (1.5%) and homosexual practices (0.4 % to 3.2%). Note: Under-reporting/under-registration, which is true for both straight and gay people, is higher for homosexuals (MSM - Men having sex with men).
The majority of all the HIV-infected males (64.7%) are individuals who practice injecting drug usage, whereas the majority of women (98.4%) were infected through sexual contacts, either as commercial sex workers or with significant others who are injecting drug users.
HIV prevalence among injecting drug users is about 15% and less than 3% among female sex workers.
• 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 fluids 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.
Cholera: Sporadic cases of cholera may occur in this country, but cholera is a rare disease in travelers from developed countries. Cholera vaccine is usually recommended only for people, such as 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 donâ€™t 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)
Food & Water Safety: All water should be regarded as being a potential health risk. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled. Milk is pasteurized and dairy products should be safe for consumption, however, the incidence of communicable diseases among livestock is increasing because of a breakdown in vaccination programs.
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 and sporadic cases and outbreaks occur. Hepatitis E accounts for up to 18% of acute hepatitis in the south. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. 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 in the general 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 population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.
Leishmaniasis: Risk for cutaneous leishmaniasis primarily limited to southern regions, including portions of Georgia Republic and the southern Ukraine, below 1,300 meters elevation. Visceral leishmaniasis is confined to areas along the southeastern coast of the Black Sea, the southeastern and southwestern coasts of the Caspian Sea and the border areas of Georgia and Azerbaijan.
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.
Lyme Disease: Occurs focally in rural forested areas. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Malaria: Transmission currently is limited to the warmer months of June through September. Risk (exclusively P. vivax) exists in focal areas on the western border with Turkey. Risk is primarily in the Ararat Valley, with most cases in the Masis district and with minimal risk in the Artashat and Ararat districts. No risk exists in typical tourist destinations.
• Prophylaxis with chloroquine is recommended in risk areas.
A malaria map is located on the Fit for Travel website, 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 Armenia page on the Destinations menu or A-Z Index.
• Malaria is transmitted via the bite of an infected 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 remain the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
Mediterranean Spotted (Boutonneuse) Fever: Reported most commonly in the Black Sea coastal areas of the Caucasus, Transcaucasus, and the Crimea, and along the Caspian Sea coastline. Mediterranean spotted fever, also known as boutonneuse fever, is transmitted by dog ticks and has a characteristic rash and a distinct mark, i.e., a tache noire (black spot) at the site of the tick bite. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
The etiologic agent for this infection is Rickettsia conorii, which also is the agent for the same disease also called Marseilles fever, Kenya tick typhus, African tick typhus, Indian tick typhus, and Israeli tick typhus.
• To prevent infection, you should take precautions to avoid contact with ticks.
• The preferred drug is doxycycline (100 mg PO q12h).
• Other effective treatments include the following:
Ciprofloxacin (200 mg IV q12h or 750 mg PO q12h)
Levofloxacin (500 mg PO qd)
Chloramphenicol (50-60 mg/kg/d PO q6h in 4 divided doses)
Azithromycin (500 mg PO qd) and clarithromycin (500 mg PO bid)
Other Diseases/Hazards: Anthrax (sporadic human cases occur, related to exposure to livestock in rural areas, especially southern areas)
• Brucellosis (unpasteurized goat cheese and all other unpasteurized dairy products should be avoided)
• Echinococcosis (in southern and northeastern areas,
• North Asian tick typhus (also called Siberian tick typhus; risk elevated May to June)
• Plague (flea-borne; usually occurs as isolated cases or small outbreaks in semi-arid areas of the southern republics of Azerbaijan, Armenia, and Georgia)
• Tick-borne relapsing fever
• Tularemia (rabbit fever; risk may be elevated in the north)
• Tuberculosis (40% rise in cases since 1995; incidence in Moscow has doubled since 1991)
• Helminthic infections (roundworm, hookworm, and whipworm infections and strongyloidiasis)
Tick-Borne Encephalitis (TBE): Tick-borne encephalitis, which may occur in Armenia, is transmitted from the Baltics to the Crimea. Peak transmission period is April through October. Risk is present primarily in rural brushy and forested areas below 1,500 meters elevation. Co-infection with Lyme disease is increasing.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
More information on TBE at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/TBE.htm
Travelers' Diarrhea: Moderate risk countrywide. Outside of hotels and resorts, 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 (TB): Tuberculosis is highly endemic in Armenia 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: Typhoid vaccine is recommended by the CDC for all unvaccinated people traveling to or working in Armenia and 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.