Time Zone: +1 local time (GMT +2 from last Sunday in March to the last Sunday in October).
Tel. Country Code: 385
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Croatia
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 Croatia
• U.S. Embassy
ul. Thomasa Jeffersona 2
Tel:  (1) 661-2200
The Embassy is located in the southern outskirts of Zagreb near the airport. For emergencies on weekends, holidays and after hours, an embassy duty officer can be reached at Tel:  (1) 661-2400 or  (91) 455-2247.
• Canadian Embassy
Prilaz Gjure Dezelica 4
Tel:  1-488-1200, 488-1211
Fax:  1-488-1230
• British Embassy
Ivana Lucica 4
Tel:  (1) 6009 100 (Switchboard)
 (1) 6009 122 (Visa & Consular)
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Croatia is a moderately developed nation in transition to a market economy. Facilities for tourism are available throughout the country, and the Adriatic coast is an increasingly popular tourist destination.
ENTRY/EXIT REQUIREMENTS: A passport is required for travel to Croatia. A visa is not required for U.S. passport holders for tourist or business trips of fewer than 90 days within a six- month period. For further information on entry requirements for Croatia, including information regarding requirements for residency and work permits, travelers may contact the Embassy of Croatia at 2343 Massachusetts Ave., N.W., Washington, D.C. 20008, tel. (202) 588-5899, the Croatian Consulates in New York City, Chicago, and Los Angeles or the Croatian Ministry of Internal Affairs/Office for Foreigners, Tel:  (1) 4563-111 or www.mup.hr
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.
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.
An outbreak of measles, involving 49 cases from Zagreb and Slavonski Brod, with onset of symptoms between April and June 2008, has been reported by Eurosurveillance in January 2009. With this outbreak, Croatia joins some other European countries that have recently experienced a resurgence of this disease.
Note: Measles, mumps, rubella (MMR) immunity is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Hospitals / Doctors
Health facilities in Croatia, although generally of western caliber, are under severe budgetary strains. 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 labelled 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 or of uncertain quality. Travelers are also advised to obtain travel insurance that provides for medical evacuation to more advanced medical facility in Western Europe in the event of serious illness or injury.
Health facilities in Croatia are generally of good quality, but are not well-funded. Hospitals in Zagreb include:
• KBC Hospital
Tel:  238-8888
Includes Women’s Health Clinic
Tel:  460-4646
• Orthopedic Institute
Tel:  236-2330
• Clinic for Dental Medicine
Tel:  480-2111
Tel:  461-0011
Primary trauma hospital
Travel Medicine & Infectious Disease
• Nebojsa Nikolic, MD
Medical Centre for General Medicine
and Occupational Health and Travel Clinic
Riva Boduli 1
Tel:  (51) 213-605; Fax:
 (51) 313324
Languages: Principal - Croat, English; Other - Italian, French
Pre-Travel Vaccination, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.
Destination Health Info for Travelers
AIDS/HIV: In the Balkans, 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 Croatia, the epidemic is predominantly urban, young, male, injecting drug users and their sexual partners and other transmission groups 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 Croatia is estimated at 0.1%. (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 personâ€™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.
• 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 (Bird Flu): In May 2006 the Croatian authorities confirmed that the avian influenza virus has been found in dead migratory birds in Viroviticko Podravska county (Zdenci municipality); Splitska Dalmatinska (Trogir), Vukovarsko Srijemska counties (Baranja) and near the Sava River in the outskirts of Zagreb. No human infections or deaths have been reported.
• H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.
The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.
Hemorrhagic Fever with Renal Syndrome (HFRS): An outbreak of hemorrhagic fever with renal syndrome was reported in May 2002. Outbreaks of hemorrhagic fever with renal syndrome, a viral illnes often transmitted by infective, aerosolized rodent excreta, occur periodically in Croatia, Travelers should avoid contact with rodent urine or rodent feces, which transmit the virus.
Hepatitis: All travelers not previously immunized against hepatitis A should receive the vaccine. 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 at a low level with sero-positivity rates of about 1% in the general population. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 3% 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, with a prevalence of 1.4% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Lyme Disease: The risk of Lyme disease occurs countrywide through the warmer months. 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 Croatia.
Mediterranean Spotted (Boutonneuse) Fever: Mediterranean spotted fever, also known as boutonneuse fever, is transmitted by the dog tick Rhipicephalus sanguineus and has a characteristic rash and a distinct mark, ie, a tache noire (black spot) at the site of the tick bite. The etiologic agent for this infection is Rickettsia conorii, which also is the agent for Marseilles fever, Kenya tick typhus, South African tick bite fever, Indian tick typhus, and Israeli tick typhus.
• Peak transmission period is July through September. Disease may be acquired in and around tick-infested houses and terrain, but more than 95% of cases are associated with contact with tick-carrying dogs.
• Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin (spray or solution) to clothing and gear.
Other Diseases/Hazards: Brucellosis (from unpateurized dairy products and under cooked meat), echinococcosis, trichinosis (from udercooked pork; Two outbreaks of trichinellosis were reported from East Croatia in February 2003).
Rabies: Rabies occurs primarily in wild animals, especially foxes, in many rural areas of Europe. Human cases are infrequent. Pre-exposure rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.
Tick-Borne Encephalitis (TBE): The tick vector for this disease is distributed in brushy and forested areas at elevations up to 1,500 meters. Peak transmission from April to October. In Croatia, the only natural focus of the disease is in the northern part of the country, between the rivers Sava and Drava. Between 1998 and 2007, the annual number of cases ranged from 12 to 38. In the five-year period between 2003 and 2007, a mean of 27 cases were reported annually.
(Source: Eurosurveillance 2008: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916)
The TBE vaccine (available in Canada and Europe), is recommended only for people at significant risk of exposure to tick-bites, for example campers and hikers on extended trips, or forestry workers. The risk to the average tourist is very low.
• 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.
Travelers' Diarrhea: Outside of hotels and resorts, we recommend that you 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 (TB): Tuberculosis is highly endemic in Croatia 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.