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Bosnia and Herzegovina



Capital: Sarajevo

Time Zone: +1 hour. GMT +2 from the last Sunday in March to last Sunday in October.
Tel. Country Code: 387
Electrical Standards: Electrical current 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Bosnia and Herzegovina

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 Bosnia and Herzegovina


Resource Links

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

Embassies

• U.S. Embassy
Lipasina 43
Sarajevo
Tel: [387] 33-445-700
Website: www.usis.com.ba

• Canadian Embassy
Logavina 7
Sarajevo
Tel: [387] (33) 447-900
E-mail: sjevo@dfait-maeci.gc.ca

• British Embassy
Tina Ujevica 8
HMA, Chancery/Management
Petrakijina 11
Sarajevo
Telephone: [387] 33 204 781/2/3 (Commercial/DfID/Consular/Visa)
E-mail: ConsularEnquiries.sarajevo@fco.gov.uk
Website: www.britishembassy.gov.uk/bih

Entry Requirements

HIV Test: Not required.


Required Vaccinations: None required.

Passport Information

Passport/Visa: A passport is required for travel to Bosnia and Herzegovina. American citizens do not require a visa for tourist stays up to three months. Unless the traveler is staying at a hotel, all foreigners must register with the local police within 24 hours of arrival. U.S. citizens planning to remain in Bosnia and Herzegovina for more than three months must obtain a visa prior to travel, or apply for a temporary residence permit from the local police station having jurisdiction over their place of residence. A residence permit costs $50 dollars for a period of three to twelve months. For additional information concerning longer stays, employments, and other types of visas, please contact the Embassy of Bosnia and Herzegovina, at 2109 E. Street, N.W., Washington , DC 20037 , telephone 202-337-6473. See our Foreign Entry Requirements brochure for more information on Bosnia and Herzegovina and other countries. Visit the Embassy of Bosnia and Herzegovina web site at http://www.bhembassy.org for the most current visa information.

Vaccinations: Recommended and Routine

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

Hepatitis B: Recommended for all non-immune travelers who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for any traveler requesting protection against hepatitis B.

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

Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. 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 in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.


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

Hospitals / Doctors

Medical care is substandard throughout the country, including major cities. Hospital accommodations are inadequate 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; 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, every effort should be made to arrange medical evacuation to Western Europe.

The U.S. Embassy has a link to medical information at: http://sarajevo.usembassy.gov/medical_information.html

• Kosevo Hospital
University of Sarajevo
Tel: 033-297-000
Emergency Tel: 061-147-069
Website: http://www.iisd.org/50comm/commdb/list/c45.htm
This is the main healthcare facility in Sarajevo.

other facilities:

• Pediatric Clinic
Kosevo Hospital
Bolnika 25
Sarajevo
Tel: 033-297-000

• Institute of Emergency Medical Care
Kolodvorska 14
Sarajevo
Tel: 124 or 611-111

• University Children’s Hospital
Bolnicka 25
Sarajevo
Tel: [387] (71) 472 406

University Clinical Center of Tuzla
Tuzla
Tel: [387] (75) 238 359

Destination Health Info for Travelers

AIDS/HIV: In most countries the HIV epidemic is driven by behaviors (e.g., multiple sexual partners, commercial sex, injecting drug use) that expose individuals to the risk of infection. In Bosnia-Herzegovena, the epidemic is predominantly urban, young, male, injecting drug users and their sexual partners and other transmission groups that account primarily for the rise in HIV/AIDS in this country. Central Europe, however, has been relatively spared by the HIV epidemic, with the incidence of both AIDS cases and newly diagnosed HIV infections remaining low. The prevalence of adults living with HIV in Bosnia-Herzegovena is estimated at 0.2%. (Source: 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 the body fluids or blood of another person. 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.

Avian Influenza A (Bird Flu): The Bosnian government confirmed on 22 February 2006 that the H5N1 form of avian influenza had been found in two dead swans on the shores of Lake Plitvice in Jajce, 90 kms north east of Sarajevo. The Bosnian authorities have taken measures to contain the outbreak including the culling of over 4,000 poultry in 12 villages within three kilometers (1.8 miles) of the lake. No human infections or deaths have been reported in Bosnia and Herzegovina.
• 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.


Crimean-Congo Hemorrhagic Fever: Crimean Congo hemorrhagic fever (CCHF) is endemic. CCHF is caused by a virus and is transmitted by tick bite or by exposure to blood or secretions from infected animals or humans. Anyone who has visited this country and is suffering from a fever, headache, chills, muscle aches, vomiting, red rash (which does not fade when pressed under glass), bleeding on the roof of the mouth, or any other unexplained symptoms should seek medical advice immediately. Risk is seasonal, associated with periods of high tick activity (usually March through September, but seasonal patterns may occur) and increases in tick and rodent host populations.
• Studies have found up to 12% of the population is seropositive in some foci of the former Yugoslavia, with higher rates reported in domestic livestock. A major outbreak occurred in neighboring Serbia (Kosovo and Montenegro areas), affecting up to 55 people (10 deaths) in 1995.

Ehrlichiosis: Cases of human granulocytic ehrlichiosis (HGE) have been reported from neighboring Slovenia. Infection with Ehrlichia phagocytophila, the agent of HGE, occurs in areas endemic for Borrelia burgdorferi, the cause of Lyme disease.
• 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.

Hemorrhagic Fever with Renal Syndrome (HFRS): Cases of Hantavirus illness are reported in the Balkans. Travelers should avoid contact with rodent urine or rodent feces, which transmit the virus. The disease is caused by hantaviruses and acquired by exposure to rodent excreta, often by the aerosol route. Transmission typically increases during wartime, when people are forced to live in substandard, rodent-infested dwellings.

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.
• Hepatitis B is moderately endemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 2% to 7%. 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 but levels are unclear. 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.



Lyme Disease: Risk of transmission occurs country-wide in rural brushy, wooded, and forested areas up to 1,500 meters elevation. The ticks that transmit Lyme disease are most abundant and active April through September. 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 this country.

Other Diseases/Hazards: Brucellosis (An increased number of cases of brucellosis was reported in 2008, Humans acquire infection by ingestion of milk and unpasteurized dairy products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material.
• An outbreak of Q fever was reported among UN workers in Bosnia in early 2002, apparently related to a sheep farm near the office where they worked. All recovered after treatment with antibiotics. Another outbreak was reported in the area of Banja Luka in May 2004.
• An outbreak of hemorrhagic fever with renal syndrome was reported in 1995, resulting in almost 400 cases, including at least 5 deaths. The disease is caused by hantaviruses and acquired by exposure to rodent excreta, often by the aerosol route. Transmission typically increases during wartime, when people are forced to live in substandard, rodent-infested dwellings.

Road Safety: Bosnia-Herzegovina is among the rare countries in Europe that has fewer than ten kilometers of four lane highway. The existing, two-lane roads between major cities are quite narrow at places, lack guardrails, and are full of curves. Travel by road should be considered risky, as roads are not well maintained, particularly in winter. Driving in winter is hazardous due to fog, heavy snow, and ice. Overland travel should be undertaken with a four-wheel drive vehicle equipped with spare parts, tires, and fuel, as well as food, water, blankets, torches, and a medical kit.

Tick-Borne Encephalitis (TBE): Sporadic cases occur in rural brushy and forested areas country-wide at elevations up to 1,500 meters. Increased risk is associated with periods of high tick activity (usually March through September, peaking in June, with over one-third of all cases historically reported during July), and increases in tick and rodent host populations. Vaccination against TBE should be considered by those camping near forests for extended periods, for those engaged in extended hiking and camping in wooded areas, and for forest workers. 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 generally impractical for the average traveler. Tick-bite protection is therefore essential.
• 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.

Travelers' Diarrhea: 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): Tuberculosis is highly endemic in Bosnia-Herzegovina 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 the Balkans, 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.