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Bangladesh



Capital: Dhaka

Time Zone: +8 hours.
Tel. Country Code: 880
USADirect Tel.: 157
Electrical Standards: Electrical current is 220/50 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plugs C, D, F.


Travel Advisory - Bangladesh

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 Bangladesh


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies


• U.S. Embassy
Diplomatic Enclave
Madani Avenue, Baridhara
Dhaka
Tel: [880] (2) 882-4700 through 22
Fax: [880] (2) 882-4449
Website: www.usembassy-dhaka.org/state/embassy.htm

• Canadian Embassy
House CWN 16/A
Road 48, Gulshan
Dhaka
Tel: [880] (2) 988-7091 through 988-7097
Fax: [880] (2) 882-3043
E-mail: dhaka@dfait-maeci.gc.ca
Website: www.dfait-maeci.gc.ca/dhaka

Entry Requirements



HIV Test: Not required.

Required Vaccinations: Required for all travelers >1 year of age arriving from or transiting through a yellow-fever-infected area in Africa or the Americas. Not recommended otherwise.

Passport Information

Passport/Visa: A passport, visa and onward/return ticket are required. All travelers to Bangladesh, including American citizens, must have a valid visa in their valid passport prior to arrival. A valid visa in an expired or cancelled U.S. passport is not acceptable. If you are issued a NEW U.S. passport, you must have your Bangladeshi visa transferred to that passport. Note that airport visas (landing permits) are no longer available upon arrival by air carrier. Americans should not plan to enter Bangladesh on a landing permit. 

New visa rules, introduced in October 2006, require foreign nationals who come to Bangladesh to work or for long-term visits to have the appropriate work permits and clearances on arrival. There are increased financial penalties for overstaying visas. Additionally, those who overstay for more than 90 days face the possibility of being charged with violating the Foreigners Act of 1946. 
For further information on these rules, please check with the nearest Bangladeshi Embassy or Consulate (U.S. addresses listed below) before traveling, or visit the Bangadeshi Immigration Police website, which provides further details on rules relating to Foreigner Registrations. This website can be accessed at: http://www.immi.gov.bd

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age.

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.

Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.

Polio: 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).

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: Imunizations 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.

Yellow Fever: A yellow fever vaccination certificate is required from travellers over 1 year of age coming from countries with risk of yellow fever transmission.

Hospitals / Doctors

Medical care in Bangladesh is well below Western standards. The standard of medical facilities in Dhaka is poor and is very limited outside the capital, Dhaka. 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 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. Serious illness or injury may require medical evacuation for treatment in a more advanced medical facility in India or another country.

For a list of other physicians and dentists in Bangladesh, go to the U.S. Embassy website at http://dhaka.usembassy.gov/medical_assistance.html.

Apollo Hospital
81, Block: E
Bashundhara R/A
Dhaka
Tel: [88] (02) 989-6623
Website: http://www.apollodhaka.com
24-hour emergency services. This facility is part of a large hospital chain based in India.

Destination Health Info for Travelers

AIDS/HIV: When HIV is transmitted through unprotected sex in Asia, it is often from commercial sex. More people in Asia engage in sex work (either as a client or a worker), than any other type of behavior that can carry a high risk of HIV infection.
• Injecting drug use (IDU) is a major driving factor in the spread of HIV throughout Asia. There is often an overlap between communities of IDUs and communities of sex workers in Asia, as those who sell sex may do it to fund a drug habit, or they may have become involved in sex work first before turning to drug use.
• Sex between men accounted for some of the earliest recorded cases of HIV in Asia, and transmission through this route is still a prominent feature of many countries’ epidemics. Most men who have sex with men (MSM) in Asia do not identify themselves as gay because of cultural norms that discourage homosexuality; in some cases they may even be heads of families, with children. This means that MSM can serve as a “bridge” for HIV to spread into the broader population. HIV outbreaks are becoming evident among MSM in Bangladesh, Cambodia, China, India, Nepal, Pakistan, Thailand and Vietnam. (Source: www.Avert.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 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.

Animal Hazards: Animal hazards include snakes (kraits, cobras, vipers), centipedes, scorpions, black widow spiders, brown recluse spiders, and large leeches (not poisonous, but can cause slow-healing ulcers). Other possible hazards include crocodiles, pythons, poisonous frogs and toads, lizards, tigers, leopards, and bears (sloth, Himalayan black, and Malayan sun).

Avian Influenza A (Bird Flu): The World Health Organization (WHO) has confirmed a human case of avian influenza in Bangladesh. Avian Influenza was also confirmed in Meherpur district, Khulna Division. (Source: ProMED-mail 15 February 2008)
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.
� More information here: http://content.nejm.org/cgi/content/full/358/3/261
� The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm

Cholera: As of April 2008, there were more than 3,000 cases of diarrhea from cholera reported in Barisal Province. The capital, Dhaka also had hundreds of diarrheal patients over the last week. Although this disease is reported active in this country, most travelers are at low risk for infection. 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)

Dengue Fever: Year-round risk, countrywide. Increased incidence of dengue occurs during the monsoon season, June through September. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in throughout much of Asia. 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: Bancroftian filariasis is reported, with 10% of the population infected. The prevalence
is highest in the northern and central districts. Travelers should take measures to prevent mosquito bites.

Food & Water Safety: All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is unpasteurised and should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid all dairy products. Travelers should eat only well-cooked meat and fish, preferably served hot. Salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

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 but the prevalence is unclear. Outbreaks have been reported (http://www.ajtmh.org/cgi/content/abstract/57/4/449); sporadic cases occur but 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.
• 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 with a prevalence of 2.4% 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 year-round in the tropics. The flu vaccine is recommended for all travelers >1 year of age who have not had a flu shot in the previous 12 months.

Japanese Encephalitis (JE): The risk of infection is greatest from June through October, countrywide, in rural agricultural areas. Sporadic cases of JE occur year-round. Vaccination against Japanese encephalitis is recommended for travelers who will be staying in rural-agricultural endemic areas more than several weeks. In addition, all travelers should take measures to prevent mosquito bites, especially in the evening. JE vaccine is not routinely recommended for travel exclusively to urban areas or if planning only short visits to the usual rural tourist sites.

Leishmaniasis: Visceral leishmaniasis (kala-azar) is transmitted year-round, countrywide, including urban areas, with an increased incidence in the central delta districts of Mymensingh and Pabna. 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: Risk is present year-round throughout this country. There is risk of malaria in all urban areas except Dhaka. Elevated risk occurs in the forested areas and foothills of the southeast and east bordering India and Burma. Falciparum malaria accounts for 50%–75% of malaria cases in this country, vivax the remainder. Chloroquine-resistant falciparum malaria is confirmed in the eastern and northeastern regions.
• Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine (G6-PD test required) is recommended.

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 Bangladesh page on the Destinations menu or A-Z Index.

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.



Meningitis (Meningococcal): An outbreak of meningococcal meningitis was reported in February 2009 from the Chittagong Hill Tracts in Bangladesh.Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported.

Other Diseases/Hazards: Echinococcosis, influenza (transmitted year-round; vaccination recommended), filariasis, melioidosis (pneumonia or wound infections from a soil bacterium known as Burkholderia pseudomallei, which gains entrance to the body through cuts or other breaks in the skin), sandfly fever (endemic countrywide at low levels), scrub typhus, tuberculosis (a major health problem), typhoid fever, and intestinal worms (whipworms, roundworms, hookworms) are reported.

Poliomyelitis (Polio): The first cases of polio in Bangladesh since 2000 were reported in March 2006. Polio remains persistent in the Indian subcontinent and in Bangladesh. All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio 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.

Rabies: Over 2,000 human rabies deaths occur annually. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. Rabies vaccination may be required. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. 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. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.

Travelers' Diarrhea: High risk. Water supplies in Bangladesh are obtained from ditches, ponds, and streams in rural areas and from canals and ponds in urban areas of the country. Generally, water sources are contaminated with human and animal waste. In addition, the mineral content of the water (especially wellwater) is high. 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.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• 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 is highly endemic in Bangladesh 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 fever is the most serious of the Salmonella infections. 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 Indian subcontinent, 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.