Central African Republic
Time Zone: +1 hour. No daylight saving time in 2008.
Tel. Country Code: 236
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Central African Republic
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 Central African Republic
• U.S. Embassy
Avenue David Dacko
• Canadian Embassy
• British High Commission
Avenue Winston Churchill
Tel:  2222 05 45
Fax:  2222 01 48
HIV Test: Not required.
Required Vaccinations: Yellow fever vaccination is required for travelers >1 year of age arriving from ALL COUNTRIES.
Passport/Visa: The Central African Republic (CAR) is a developing African nation that has experienced several periods of political instability since independence from France in 1960. The capital is Bangui. While the country's Dzanga-Sangha National Park, a primeval rain forest in the southwest region of the country, is an attractive site for ecotourism, facilities for tourism elsewhere are very limited.
A valid passport, visa, and evidence of yellow fever vaccination are required for entry. Travelers should obtain the latest information and details from the Embassy of the Central African Republic, 1618 22nd Street, N.W., Washington, D.C. 20008, telephone (202) 483-7800/7801, fax (202) 332-9893. Overseas, inquiries should be made to the nearest Central African Republic embassy or consulate. NOTE: In any country where there is no Central African Republic diplomatic mission, the French Embassy has authorization to issue a visa for entry into the Central African Republic.
The U.S. Embassy in the CAR is located at Avenue David Dacko, B.P. 924, Bangui; tel. (21) (236) 61-02-00; fax (21) (236) 61-44-94. For additional information on safety and security in the CAR, contact the Consular Section of the U.S. Embassy in Yaounde, Cameroon at telephone (237) 220-1500, fax (237) 220-1572; web site: http://yaounde.usembassy.gov/. Americans may also obtain updated information from the American Embassy in N'djamena, Chad at telephone (235) 51-70-09, 51-92-33 or 51-90-52; fax (235) 51-56-54; web site http://ndjamena.usembassy.gov/
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 with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for any traveler requesting protection against hepatitis B infection.
Influenza: Influenza vaccine is advised for all travelers over 6 months of age who have not had a flu shot in the previous 12 months.
Meningococcal (Meningitis): Vaccination with a quadrivalent vaccine (Menactra or Menomune in the US) is advised for those travelers anticipating close contact with the indigenous population.
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: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites, especially bites from dogs. 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 exposure, but does not eliminate the need for treatment with two extra booster doses of 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.
Yellow Fever: Yellow fever vaccination is recommended for all travelers >9 months of age.
• Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES.
Hospitals / Doctors
Medical facilities are extremely limited and strikes by government workers have affected medical services and hospitals. You should ensure that you are covered for medical evacuation by air ambulance.
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 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. 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 Europe.
There are three general hospitals in Bangui, a pediatrics hospital and a few private hospitals, but they are under-equipped and dilapidated. There is no medical emergency service.
• The Pasteur Institute in Bangui offers a large range of good quality analyses:
Tel:  618 996
• Dr. Chouaib Private hospital
Tel:  611 568
• National University Hospital Center
General medical/surgical facility; some French military medical officers on staff.
• American Lutheran Church Missionary Hospital
General medical services.
Destination Health Info for Travelers
A Country Profile: The Central African Republic (CAR) is a landlocked nation of 3.8 million people located in central Africa. Challenges facing CAR include political instability, extremely limited financial resources, low literacy levels, and a high disease burden. Border tensions with Chad are an additional concern; Chadian military forces in the past have launched cross-border raids into CAR. Political instability makes development and implementation of national health care policies difficult. CAR’s military mutinied three times in 1996, resulting in considerable political turmoil. UN peacekeepers maintained stability in the country from 1998-2000. Since the removal of UN peacekeepers the national government there have been two further unsuccessful coup attempts.
• CAR is challenged by a high disease burden. The HIV prevalence rate in CAR is about 13 percent. Malaria is endemic throughout the country, and the WHO estimated in 2000 that malaria is responsible for 777 deaths per 100,000 children in CAR aged 0-4. In the same year WHO estimated tuberculosis mortality in CAR at 65 per 100,000.
• Doctors Without Borders/ Médecins Sans Frontières (MSF) is providing some medical services in the CAR.
AIDS/HIV: Heterosexual contact is the predominate mode of transmission of HIV in sub-Saharan Africa. People in sub-Saharan Africa do not have many more lifetime partners than people in other parts of the world. However, researchers have found that in some areas it is not uncommon for people to have two or more regular sex partners at the same time. Someone is most likely to transmit HIV during the period shortly after they are infected, when they have very high levels of virus in their body. Therefore someone who has two or more concurrent partners is more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. This too may help to explain why HIV is more widespread in Africa.
Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).
West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Cote dIvoire (7.1%) and Gabon (7.9%). Until recently the national HIV prevalence rate has remained relatively low in Nigeria, the most populous country in sub-Saharan Africa. The rate has grown slowly from below 2% in 1993 to 3.9% in 2006. (Source: www.Avert.org)
• Adult HIV prevalence in the CAR is relatively high compared to other countries in West Africa. The adult (15-49) prevalence rate is 10.7%. (Source: Avert.org)
More statistics are available at: http://www.avert.org/subaadults.htm
• 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.
African Sleeping Sickness (Trypanosomiasis): About 150 cases are reported annually. Risk areas include the Ouham Valley in the northwest, the Nola vicinity (extreme southwest near the Cameroon border), and the southeast. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at 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 travelers should wear protective clothing 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: hthttp://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php
Animal Hazards: Animal hazards include snakes (boomslang, viper, cobra), centipedes, scorpions, and spiders (black widow, brown recluse).
Cholera: This disease is reported active in this country, but the threat to tourists is very low. 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)
Crime/Personal Security: We strongly advise you not to travel to the Central African Republic at this time, with the exception of the capital Bangui, due to the activities of rebel groups and rogue security and military forces, and high levels of serious crime and lawlessness. Following a military coup against the government in March 2003, the security situation continues to be dangerous. If you are in the Central African Republic, you should consider leaving unless you have compelling reasons to stay.
The security situation is particularly dangerous in the border areas with Chad, Sudan, the Democratic Republic of the Congo and Cameroon. Violence has intensified in the northwestern provinces of Ouham and Ouham-Pende. Rebel groups remain active in the west, southeast, north and northeast of the country and many areas outside the capital are lawless. Foreigners, including aid workers, have been killed.
Bangui: We advise you to reconsider your need to travel to the capital Bangui at this time due to the tense and unstable security situation. Skirmishes between government forces and opposition groups have occurred in the capital. Tensions are high due to the inability of the government to pay its civil servants. If you do decide to travel to Bangui, you should exercise extreme caution.
You should avoid all large gatherings, protests and demonstrations as they may turn violent.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through 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; up to 20% of cases of acute infectious hepatitis are antibody positive for the hepatitis E virus (HEV). Transmission of 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 elevated 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 moderately high prevalence of 4.5% 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.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.
Insects: All travelers should take measures to prevent both daytime and nighttime insect bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear (tents, backpacks), and use of a permthrin-treated bednet at night while sleeping.
Leishmaniasis: Sporadic cases of cutaneous leishmaniasis reported in the northwest and southwest. Visceral leishmaniasis may occur in the southwest. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• 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.
Loiasis: Highly endemic focus in southwestern rain forest and swamp forest areas. Travelers should take measures to prevent insect (deer fly) bites.
Malaria: Risk is present year-round throughout this country, including urban areas. Chloroquine-resistant falciparum malaria accounts for most cases.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline 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 Central African Republic 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: The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported on February 2008 that meningitis was spreading across three northwestern districts and was threatening up to one million people. The districts affected include Ouham, Ouham Pende and Nana-Grebizi.
Central African Republic lies within the sub-Saharan meningitis belt. Extensive outbreaks of Group A disease have occurred in previous years.
• Quadrivalent meningitis vaccine is recommended for all travelers during dry season, December to June, especially if they anticipate close contact with the local populace. The vaccine is also recommended for all healthcare workers and all other travelers into epidemic regions at any time of year.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651
Other Diseases/Hazards: African tick-bite fever (http://www.ncbi.nlm.nih.gov/pubmed/12954562; contracted from rodent-borne ticks and cattle ticks)
• Brucellosis (usualy from the consumption of unpasteurized dairy products)
• Filariasis (mosquito-borne)
• Chikungunya fever
• Crimean-Congo hemorrhagic fever
• Lassa fever (low risk; current endemic status unclear),
• Rabies (transmitted primarily by dogs in urban and rural areas)
Rabies: Sporadic cases of human rabies are reported countrywide. Although rabies is rare among tourists—there is risk. Pre-exposure rabies vaccine is recommended for: Travel longer than 3 months; for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care. Children are considered at higher risk because they tend to play with animals and may not report bites.
• All animal bites or scratches, especially from a dog, should be thouroghly cleansed with soap and water and examined as soon as possible by a qualified health care provider, regardless of your vaccination status. In the case of possible rabies exposure, pre-exposure vaccination only eliminates the need for rabies immune globulin; it does not eliminate the need for two additional booster doses of vaccine.
Schistosomiasis: Widespread throughout most of the country. The highest infection rates are reported in the northwest. Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. 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, or streams. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: An outbreak of Shigellosis was reported in the northern part of Central African Republic in 2005. All water, including piped water from municipal treatment facilities, is considered contaminated. utside 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 dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. 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 Central African Republic 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 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 yellow fever vaccination certificate is required of all travelers >1 year of age entering this country.