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Benin



Capital: Porto-Novo

Time Zone: GMT +2 hours.
Tel. Country Code: 229
USADirect Tel.: 102
Electrical Standards: Electrical current 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, F.


Travel Advisory - Benin

Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.

Dr. Rose Recommends for Travel to Benin


Resource Links

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

Embassies


• U.S. Embassy
Rue Caporal Anani Bernard
Cotonou
Tel: [229] 21-30-06-50, 21-30-05-13, and 21-30-17-92.
After-hours emergency involving an American Citizen:
Tel: [229] 21 30 06 50.
Website: http://cotonou.usembassy.gov/

• OXFAM-Quebec
The Canadian Consulate is headed by an honorary Consul. Only limited consular services are provided.

Haie Vive, Avenue Amelco
Cotonou
Tel: [229] 21-30-21-45
Fax: [229] 21-30-21-36
E-Mail: oxfam_be@intnet.bj

• The UK has no resident representation in Benin. The British Ambassador in Abuja, Nigeria, is accredited to Benin on a non-residential basis. Any commercial, political, or visa enquiries should be made directly to the British High Commission in Nigeria.

• British High Commission
Dangote House
Aguyi Ironsi Street
Wuse
Abuja
Nigeria
Tel: [234] (9) 413 2010/2011/3885-7

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from all countries.

Passport Information

Passport/Visa: Benin is a developing country in West Africa. Its political capital is Porto Novo; however, its administrative capital, Cotonou, is the largest city in Benin and the site of most government, commercial, and tourist activity. 
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visas are not routinely available at the airport. Visitors to Benin should also carry the WHO Yellow Card (Carte Jaune) indicating that they have been vaccinated for yellow fever. Contact the Embassy of Benin for the most current visa information. The Embassy is located at: 2124 Kalorama Road, NW, Washington, DC 20008; Tel: 202-232-6656.

Vaccinations: Recommended and Routine

A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from all countries.

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.

Meningococcal (Meningitis): Quadrivalent conjugate meningitis vaccine is recommended for all travelers.

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: 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 is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers.

Yellow Fever: Travelers >1 year of age entering the country are required to present a certificate of immunization against yellow fever.

Hospitals / Doctors

Medical facilities are limited, especially outside the major towns, and medical care is well below Western standards. 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; may be counterfeit; or of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that can't be treated locally, medical evacuation (to London, Paris or Johannesburg) may be required

The U.S. Embassy maintains a listing of physicians and medical facilities at:
http://cotonou.usembassy.gov/localdoctors.html
The website also lists referral numbers for SAMU (Service Aide Medicale Urgence, Emergency Medical Assistance Service) which is a French hospital-based emergency medical service.

• Centre National Hospitalier Universitaire (CNHU)
Cotonou (350 beds)
Tel: [229] 30 01 53 or [229] 30 14 78
Website: http://cotonou.unice.fr/cnhu
General medical/surgical facility; teaching hospital.

• Clinique Polyvalente Mahouna
Anne Hekpazo
Cotonou
Tel: [229] (21) 30 14 35

• Clinique Atinkanmey
Cotonou
Tel: [229] (21) 31.22.76
Fax: [229] 31 22 78

• Polyclinique les Cocotiers
Ali Assani
Cotonou
Tel: [229] 30 16 81

• Clinique Louis Pasteur
Porto Novo
Tel: [229] (20) 21 22 22

• Hopital Saint Jean de Dieu
Tanguieta
Tel: [229] 21 83 00 11, [229] 21 83 00 10

Destination Health Info for Travelers

A Country Profile: Benin (formerly Dahomey) is a small West African nation of 6.6 million people. Ruled by military leaders for many years, Benin is striving towards a model democracy and held a presidential election in 2006. It currently enjoys economic growth of about 5 percent per annum, despite economic reliance on subsistence agriculture and a cash crop of cotton. Benin has a small oil industry, and no significant manufacturing.
The malaria burden is very high; the malaria death rate for children ages 0-4 is 960 per 100,000. Overall about 1.9 percent of the adult population is HIV positive, but it is over 40 percent among high-risk urban populations. The tuberculosis death rate is 32 per 100,000. Benin does use the DOTS treatment program for tuberculosis, and an estimated 77 percent of TB cases in Benin are covered under DOTS.

Sources: United Nations Statistics Division, Mbendi Country Profile, Synergy Project, BBC country profile

AIDS/HIV: HIV prevalence estimated at over 10% of the sexually active urban population. Some 80% of HIV infections in Benin are transmitted by heterosexual sex. Factors contributing to this include sexual promiscuity, a lack of information about sexual health and HIV, low levels of condom use and high levels of sexually transmitted infections (STIs) such as chlamydia and gonorrhea, which make it easier for the virus to be transmitted. Blood transfusions, mother-to-child transmission, homosexual sex and injecting drug use are other routes of HIV transmission. Source www.Avert.org
• 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.

African Sleeping Sickness (Trypanosomiasis): Sporadic cases were reported in the 1980s, and the disease may still be active. Tsetse fly vectors are found in the northern areas, particularly in Atakora Province and Pendjari National Park. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so you should wear protective clothing during the day and sleep under a bed net.
Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats.
Read more: http://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php

Avian Influenza A (Bird Flu): Two outbreaks have been reported in poultry from traditionally reared flocks. Outbreaks in Porto Novo and Dangbo started in December 2007, but no human cases have occurred.
• 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: This disease is reported active at this time. A cholera outbreak was reported in September 2008 from Malanville and Karimana in northeastern Benin, close to Niger. Cholera, however, is an uncommon 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)

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 sterilized. 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. 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.

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 levels are unclear. Sporadic cases as well as epidemics are reported in West Africa. 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 >10%. 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 1.5% 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.

Malaria: Risk is present throughout this country, including urban areas. Increased transmission occurs during and after the rainy seasons, April through October. Falciparum malaria accounts for >85% of cases. Chloroquine-resistant falciparum malaria is common. Mefloquine resistance has been reported from the southern provinces of Zou and the Cotonou region.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine is recommended.

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 Benin 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: ProMED reports 68 cases of meningococcal meningitis with 16 deaths as of early 2007. Benin lies within the sub-Saharan meningitis belt, and there is a high incidence of Group A meningococcal meningitis. Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported. The risk is greatest in the dry season, but these may vary within a country and from year to year. The dry season in West Africa is usually between November-May/June.

Other Diseases/Hazards: African trypanosomiasis
• African tick typhus
• Brucellosis (from consumption of raw dairy products)
• Bancroftian filariasis (mosquito-borne)
• Dengue (low risk; cases not officially reported from Benin but virus may occur in neighboring Nigeria)
• Chikungunya fever (outbreaks are common and often occur after the rainy seasons when day-biting Aedes aegypti mosquitoes breed more actively)
• Dracunculiasis (highest rate in Zou Province)
• Lassa fever (may occur)
• Leishmaniasis (low apparent risk; sporadic cases have previously been reported)
• Loiasis (deer fly-borne; most risk in southern rain forests and swamps)
• Mansonellosis
• Onchocerciasis (black-fly-borne; transmitted near fast-flowing rivers; high incidence in coastal areas)
• Paragonimiasis (low risk)
• Rabies (transmitted primarily by stray dogs)
• Toxoplasmosis
• Animal hazards include snakes (boomslangs, cobras, vipers), centipedes, scorpions, and brown and black widow spiders.

Schistosomiasis: Urinary schistosomiasis is focally distributed. The highest rate of disease is found in Mono Province, followed by Atakora and Borgou Provinces. Lowest rate in Oueme Province. Intestinal schistosomiasis reported in Borgou, Zou, and Atlantique Provinces.
• Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Tick-Borne Diseases: African tick typhus, also known as Mediterranean spotted fever and boutonneuse fever, is transmitted by dog ticks. The etiologic agent for this infection is Rickettsia conorii.
• African tick-bite fever (ATBF), a recently rediscovered rickettsiosis of the spotted fever group, is very similar to African tick typhus, and is caused by Rickettsia africae, transmitted by cattle ticks. ATBF is highly prevalent in Africa. The symptoms of tick typhus of both types include fever, severe headache, myalgia, and inoculation eschars (which appear as black crusts surrounded by a red halo at the site of the tick bite.
• All tick-transmitted disease of the spotted fever type respond well to treatment with doxycycline or tetracycline.

Travelers' Diarrhea: High risk outside of first-class hotels. Although larger cities have piped water systems, all water supplies should be considered contaminated. Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. Outbreaks of diarrheal diseases are common during the rainy season. 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 an important public health problem in this country. Tuberculosis is highly endemic in Benin 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 people traveling to or working in sub-Saharan Africa, 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.

Yellow Fever: A valid yellow fever vaccination certificate is required for all travelers >1 year of age to enter this country.