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Belarus



Capital: Minsk

Time Zone: +2 hours. (GMT +3 from last Sunday in March to last Sunday in October).
Tel. Country Code: 375
USADirect Tel.: 0
Electrical Standards: Electrical current 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Belarus

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 Belarus


Resource Links

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

Embassies

• U.S. Embassy
46 Starovilenskaya
Minsk
Tel: [375] (17) 210-1283
Email: ConsularMinsk@state.gov
Website: http://minsk.usembassy.gov/html/consular_services.html

• Canadian diplomatic and consular affairs are handled by the British Embassy in Warsaw. Canadian citizens can receive consular services by calling the British Embassy in Warsaw, Poland at [48] (22) 584 3344, Monday to Friday, from 08:30 to 16:30 or after hours at the toll-free number 00-800-111-4319.
E-mail: wsaw-cs@international.gc.ca

• British Embassy
37 Karl Marx Street
Minsk
Tel: [375] (17) 2105920/1
Fax: [375] (17) 2202306 General
Email: britinfo@nsys.by
Website: www.britain.by

Entry Requirements

HIV Test: Required for all persons staying >3 months.

Required Vaccinations: None required.

Passport Information

Passport/Visa: A passport and visa are required. Travelers must obtain a visa in order to visit or transit through Belarus. Travelers who do not have a visa cannot register at hotels. U.S. citizens visiting or residing in Belarus are required to register with the local office of visas and registration (OVIR) within three working days after arrival. Failure to do so can result in fines and visits from local law enforcement authorities. U.S. citizens staying in hotels are automatically registered at check-in. Visa validity dates are strictly enforced; travelers should request sufficient time to allow for delays in arrival and departure, and should carefully review the beginning and ending dates of their visas before traveling. A valid visa is necessary to depart Belarus.
Visit the Embassy of Belarus web site at http://www.belarusembassy.org/ for the most current visa information or contact the Embassy of Belarus at 1619 New Hampshire Avenue, N.W., Washington, DC 20009, tel. 202-986-1606, fax: 202-986-1805, consul@belarusembassy.org.

HIV Test: Required for all persons staying >3 months.

Required Vaccinations: None required.

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 travelers who might be exposed to blood or body fluids from unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for any traveler requesting protection from 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.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

A measles outbreak was reported from Belarus in July 2006 in the city of Minsk, Minsk region, and Grodno region.


Tick-bore encephalitis: Tick-borne encephalitis vaccine may be considered for long-term travelers who expect to be visiting rural or forested areas in the spring or summer.

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

Hospitals / Doctors

Medical care is substandard throughout Belarus, including Minsk. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered.
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; may be of dubious origin; may be counterfeit, or 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 Vienna or London.

The U.S. Embassy maintains a listing of physicians and clinics at:
http://belarus.usembassy.gov/doctors.html

Most travelers to Belarus go to one of the newer, private clinics, all of which provide a range of specialty services and are relatively well-equipped:

• Richard J. Cervin, M.D.
General Practice and Private Clinic
Gedimino 1 A-19 (2nd Floor)
Vilnius, Lithuania
Tel: [370] (5) 261-3534
www.clinic.lt
English-speaking, Western-trained general practitioner. Services include physical examinations tailored for business executives, families and individuals. Specialists include General and Family Medicine, Pediatrics, Immunizations, Gynecology, Ear, Nose and Throat, Dermatology, and Psychiatry.
Laboratory services include blood and specimen testing, ECGs, ultrasounds, CAT Scans, MRI, endoscopy and laporoscopy arranged.
Note: Vilnuis is about two hours away from Minsk by car; Americans do not need visas to enter Lithuania, but will need a valid Belarusian visa to return.

• Lode
Ulitsa Kiseleva 12
Minsk
Tel: 003 (from Minsk) or [375] (17) 284-7220; branches in Brest and Grodno.
Website http://www.lode.by/english
LODE is one of the first non-state medical centers in Belarus. It was founded in 1992. Over the years, the center has expanded its services to the community by the addition of specialties and departments.
Today, the medical center LODE has 3 departments in Minsk. Among them there are two dental departments and a multi-specialty clinic, where patients can consult various specialists, who are the most experienced and highly qualified physicians. There are medical branches in Brest and Grodno.
LODE has a staff of more than 300 specialists using up-to-date equipment and technology. The only medical organization in Belarus authorized by the U.S. Embassy Minsk to do medicals for immigrant visas.

• Nordin Medical Center
Surganova 47B
Tel: [375] 237-7456 or 237-7458
Website: www.nordin.belinfomed.com
New Medical Center with specialists in all major areas and up to date equipment. There is also a swimming pool and a fitness center.

• Baltic American Medical & Surgical Clinic
Vilnius University Antakalnio Hospital
124 Antakalno St.
Vilnius, Lithuania
(370 (2) 34-2020 or 76-7942
www.bak.lt
The clinic is a Lithuanian-American Joint Venture located in leased facilities within the Vilnius University Antakalno Hospital. Vilnuis is about two hours away from Minsk by car; Americans do not need visas to enter Lithuania, but will need a valid Belarusian visa to return.

Destination Health Info for Travelers

AIDS/HIV: Belarus has the second highest incidence of HIV/AIDS in the Europe and Central Asia region. Injecting drug use still accounts for the largest proportion of newly reported HIV/AIDS infections, but sexual transmission is slowly gaining ground. Other factors include: (1) an increase in commercial sex, (2) an increase in other sexually transmitted diseases, (3) decreased availability of sterile needles and syringes, and (4) insufficient funding and expertise in public health education and prevention programs. Source: www.avert.org/ecstatee.htm
• 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 another person’s body fluids or 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.
• 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.

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.

Arboviral Diseases: Karelian fever (mosquito-borne; most cases occur July–September in the Karelian region); Tahjna virus fever (mosquito-borne; occurs sporadically from the Baltic region north to the Kolsky Peninsula); sandfly fever (sandfly-borne; limited to Moldova and the Crimea); dengue fever (mosquito-borne; cases previously reported from extreme southern regions); West Nile fever (mosquito-borne; virus reportedly circulates in the Volga Delta region from May–September); Sindbis virus fever (detected in the Volga Delta, July–August).
• 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.

Avian Influenza A (Bird Flu): There have been no reported cases of Avian Influenza (Bird Flu) in Belarus during the current series of outbreaks. But the World Health Organisation (WHO) has confirmed cases elsewhere in the region.
• H5N1 avian influenza 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 H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.

The usual vaccines against influenza are not protective against “bird flu.” Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. 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 H5N1 cases.

Cholera: Sporadic cases of cholera may occur in this country. Cholera is an extremely rare disease in travelers from developed countries. 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)

Crimean-Congo Hemorrhagic Fever: Reported mostly from southern areas, but outbreaks have occurred in some areas of Rostov Oblast (near the sea of Azov), April through November. Risk areas are rural steppe, savannah, semi-desert, and foothill/low mountain habitats below 2,000 meters elevation.

Diphtheria: Epidemic diphtheria occurred in the 1990s and 70% of cases occurred in persons older than 15 years of age. All travelers, especially adults, should be fully immunized against this disease. (The CDC estimates that 20% to 60% of Americans older than 20 years lack sufficient immunity to diphtheria.) Diphtheria vaccine in the United States is administered in combination with the tetanus toxoid vaccine (Td vaccine) or the Tdap vaccine (ADACEL).

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 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 as high as 7% but is 12% or more in injecting drug users (IDUs). 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 1.4% 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 from November through March. The flu vaccine is recommended for all travelers >age 6 months who have not had a flu shot in the previous 12 months.

Lyme Disease: Lyme disease occurs focally in rural forested areas with the peak transmission season March to November.
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: There is no risk of malaria in Belarus.

Other Diseases/Hazards: Anthrax (sporadic human cases occur, related to exposure to livestock in rural areas, especially southern areas)
• Brucellosis (from unpasteurized dairy products)
• Echinococcosis
• Legionellosis
• Leptospirosis
• Opisthorchiasis (acquired from consumption of raw freshwater fish; reported from western European Russia)
• Rabies
• Rickettsialpox
• Tick-borne relapsing fever
• Trichinosis (greatest risk in western Belarus and the Ukraine)
• Tularemia (“rabbit fever”; risk may be elevated in the north)
• Tuberculosis (40% rise in cases since 1991)

Rabies: Two cases of human rabies were reported in 2006: one from a cat bite and the other from a raccoon dog. Rabies is also reported in foxes, wolves and raccoons. 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.
• All bites or scratches should be thoroughly cleaned with large amounts of soap and water. Prompt medical evaluation of any animal bite is essential, regardless of your vaccination status.

Tick-Borne Encephalitis (TBE): Tick-borne encephalitis is transmitted from the Baltics to the Crimea by Ixodid ticks. Although Belarus is believed to be a country with risk areas and a high TBE virus prevalence in ticks, information on clinical cases is scarce. 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 occurs.
Vaccination: No TBE vaccines are licensed or available in the United States. Two equivalent, safe, and effective inactivated TBE vaccines are available in Europe and Canada, in adult and pediatric formulations: FSME-IMMUN (Baxter Vaccine AG, Vienna, Austria) and Encepur (Chiron Vaccines, Marburg, Germany). The standard vaccination schedule consists of 3 doses given at 0, 1-3 months, and at 9-12 months. An 2-dose accelerated schedule is possible (0, 21 days), with 85% protection resulting. The European vaccine (FSME-IMMUN-Baxter) is available in health clinics in Germany, Austria, Slovakia, Czech Republic and Poland, as well as Canada, but the traveler would have to initiate the vaccine after arriving in the area and hiking/camping delayed for 3 weeks before adequate protection to kick in. This makes administration of vaccine impractical for the average traveler. Tick-bite protection is therefore essential. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas during the peak transmission season, March to November, 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 gearTick-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
Information on TBE at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/TBE.htm
Additional source: Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916

Travelers' Diarrhea: High risk outside of major hotels. All water supplies in Belarus are suspect, including municipal tap water, which may be untreated and grossly contaminated. 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 (TB): Eastern Europe - particularly the former Soviet republics - have experienced sharp increases in the number of TB cases reported. The increase in drug resistance to anti-TB medication has contributed to this striking increase. Multidrug-resistant TB (MDR-TB), or the more serious extensively drug resistant TB (XDR-TB), may develop in people when TB infections, in response to non-compliance with required drug and treatment schedules, stop responding to the most common (or all) anti-TB drugs.
• Tuberculosis is highly endemic in Belarus 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 eastern and central Europe, 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.