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Chad



Capital: Ndjamena

Time Zone: +1 hour. No daylight saving time in 2008.
Tel. Country Code: 235
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, F.

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Resource Links

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

Embassies

• U.S. Embassy
Avenue Felix Eboue
N’Djamena
Tel: [235] 51 62-18/32-69
Web: http://ndjamena.usembassy.gov/

• Canadian Embassy (Cameroon)
Tel. [237] 221-090
Internet: http://www.dfait-maeci.gc.ca/world/embassies/cameroon/menu-en.asp

• British High Commission
Avenue Winston Churchill
Yaounde
Cameroon
Tel:
[237] 2222 05 45
[237] 2222 07 96
Email: BHC.yaounde@fco.gov.uk
Web: www.britcam.org

Entry Requirements

HIV Test: Not required.

Required Vaccinations: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES.

Passport Information

Passport/Visa: Chad is a developing country in north central Africa with one of the lowest per capita incomes in the world. Chad faces challenges in the areas of political stability and economic development. Years of war, drought, and lack of economic growth have severely damaged the country’s institutions and its infrastructure. Facilities for tourism are limited. The capital is N’Djamena. French and Arabic are the primary languages. 
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. Visitors must check in with the National Police and obtain a registration stamp within 72 hours of arrival. Further entry information may be obtained from the Embassy of the Republic of Chad, 2002 R St. N.W., Washington D.C. 20009, Tel: (202) 462-4009. Overseas, inquiries should be made at the nearest Chadian embassy or consulate.

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

Meningococcal (Meningitis): Vaccination with a quadrivalent vaccine (Menactra or Menomune) 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 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. 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.

Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES. Vaccination is recommended for all travelers >9 months of age.

Hospitals / Doctors

Medical facilities in Chad are extremely limited. 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 of dubious origin; may be counterfeit, or of unreliable quality. • Travelers are advised to obtain travel insurance that provides for medical evacuation to more advanced medical facility in Europe in the event of serious illness or injury. In case of a serious emergency, the French embassy medico-social center and the French medical service from the Kossei base, both in N’Djamena, can exceptionally intervene. Other facilities include: • International SOS La Centre Medical International Route de l’Aéroport N’Djamena Tel: [235] 52-25-01 Fax: [235] 52-25-03 Website: http://www.internationalsos.com/en/europeafricaregion_chad.htm The clinic offers an international standard of medical services to expatriates living in the area, including comprehensive family-centered care and emergency medical assistance on a 24-hour basis, 365 days a year. Other services include general practice medicine, basic pediatric and obstetric care, vaccinations, travel health advice and first aid training. • Europ Assistance IHS Clinic Quartier de la cuvette St Martin rue 3209 Tel: [235] 620-12-95 • N’Djamena General Hospital Tel: [235] 5-90-37 or 51-40-40 General medical services; some specialties. Travelers can contact the U.S. Embassy for physician referrals. A listing of physicians (likely out-dated) is online at: http://ndjamena.usembassy.gov/medical_information.html

Destination Health Info for Travelers

A Country Profile: As a result of prolonged political insecurity, Chad is one of the poorest nations in Africa. Between 1960 and 1990 Chad was torn by ethnic conflict and repeated Libyan incursions. After several years of peace, ethnic tensions flared up again in a northern rebellion in 1998. Relations with the Central African Republic (CAR) are currently tense, and Chadian military forces launched cross-border raids in 2002. Chad received an influx of refugees fleeing a civil war in the Darfur region of neighboring Sudan, and Sudanese rebel groups continue to launch raids across the border.
Chad is landlocked and very arid, with only 3 percent of its land arable. Much of the northern part of the country is a part of the Sahara Desert, and the majority of the population lives in the southwestern quarter of Chad. Oil resources in southern Chad are currently being developed.
The malaria death rate for children ages 0-4 in Chad is 1008 per 100,000. Fewer than one percent of children sleep under treated bednets. The tuberculosis death rate for the country is 52 per 100,000.
• Doctors Without Borders/ Médecins Sans Frontières (MSF) has been working in Chad since 1981:
http://www.doctorswithoutborders.org/news/chad.cfm

AIDS/HIV: HIV prevalence in the 15-49 age range is estimated at 3.5%. The determinants of this country situation include low condom use, multiple sexual partners, poverty, low education status of women and girls, socio political insecurity, conflict and limited access to AIDS services. The security situation continues to deteriorate in the eastern and southern parts of the country. This sociopolitical insecurity has weakened the country capacity to respond effectively to the epidemic with more then 270 000 refugees and 100 000 internally displaced persons.
• 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): Low risk. Sporadic cases reported in the Logone and Chari River valleys of the southwest, primarily in the prefectures of Logone Oriental (Gore Sub-Prefecture), Logone Occidental (Moundou Sub-Prefecture), and Moyen-Chari (Moissala Sub-Prefecture). 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 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 (adders, vipers, cobras), scorpions, and black widow spiders. Crocodiles and hippos inhabit Lake Chad.

Cholera: According to international health authorities, more than 2,500 cases of cholera have been reported in Chad since July 2010, primarily in rural areas near the borders of Cameroon and Nigeria, where ongoing outbreaks have been reported since May. Risk to travelers is minimal. Extreme care in hygiene and food habits is essential for travel to risk areas. Sporadic cases continue to occur. 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)

Filariasis: Mosquito-borne; sporadic cases are reported in rural areas of southern Chad.

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. An outbreak in 2004 in Goz Amer and Goz Beidatotal affected over 900 people and caused 30 deaths. 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 hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 15% or higher. 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 4.8% 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.

Leishmaniasis: Sporadic cases are reported and foci of infection probably occur throughout most of Chad. Visceral leishmaniasis occurs in the N’Djamena and Lake Chad areas, with foci extending eastward throughout southern Chad. Cutaneous leishmaniasis occurs in Chari-Baguirmi Prefecture (which also includes N’Djamena), along the Chari River in southcentral Chad, and in the northern and northeastern sub-desert and desert areas. Transmission occurs primarily from April through November.
The parasites that causes leishmaniasis are transmitted by the bite of female phlebotomine sand fly. Sand flies bite in the evening and at night. Contrary to what their name suggests, sand flies are not found on beaches. They are usually found in forests, the cracks of stone or mud walls, or animal burrows. All travelers should take measures to prevent sand fly bites in the risk areas outlines above.
• 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: Deer fly-borne: Risk of transmission may occur in southwestern swamp forest areas.

Malaria: Risk is present year-round throughout this country, including urban areas. Malaria is moderately to highly endemic in southern and southwestern Chad during and immediately following the rainy season, June through November. There is lower risk of malaria in the drier northern Sahara Desert. P. falciparum accounts for approximately 85% to 90% of
cases, followed by P. malariae and P. ovale. Chloroquine-resistant falciparum malaria is widespread.
• 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 Chad page on the Destinations menu.

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: So far in 2010, more than 1,500 cases of meningococcal meningitis have been reported in the southern regions of Logone Oriental, Mandoul, and Tandjile. The districts of Bebidja, Bediondo, Mbere, Dobo, Dono Manga, Goundi, and Lai are most heavily affected. Serogroups A and W135 are most prevalent.
Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working closely with local people during the dry season (December through June). Vaccination should be considered for all travelers venturing into endemic 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



Onchocerciasis: Black-fly borne; moderate to highly endemic along most rivers.

Other Diseases/Hazards: Anthrax (usually from contact with freshly slaughtered animals)
• Brucellosis (usually from consumption of unpasteurized dairy products)
• Dracunculiasis (low levels in southern areas)
• Relapsing fever (louse-borne and tick-borne)
• Typhus (flea-borne and louse-borne)

Poliomyelitis (Polio): This disease is active. Multiple cases of polio were reported in 2007, which were the first since 2005. All travelers to Chad should be fully immunized against this disease. 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: Sporadic cases of human rabies are reported countrywide. Rabies is a public health problem in most rural and urban areas. 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: Transmission of urinary schistosomiasis occurs year-round along Lake Chad and is endemic throughout the southern half of Chad, particularly in prefectures bordering Cameroon and Central African Republic. Intestinal schistosomiasis is transmitted primarily along the Logone and Chari River Basins.
• 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: The capital city and some other major urban areas are supplied with well water which, although treated, is consistently 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 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 a major health problem in this country. 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 with an infected individual. 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 is the most serious of the Salmonella infections. Typhoid vaccine is recommended 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.

Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES. Vaccination should be administered at least 10 days prior to arrival in order for the certificate of vaccination to be valid.
• Vaccination is recommended for all travelers >9 months of age.
• No confirmed cases reported recently, but the southern part of this country is within the Yellow Fever Endemic Zone.