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Cuba



Capital: Havana

Time Zone: –5 local time (GMT-4 from the second Sunday in March to the last Sunday in October).
Tel. Country Code: 53
USADirect Tel.: 2935
Electrical Standards: Electrical current is 110/60 and 220/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plugs A, D, I.


Travel Advisory - Cuba

Travelers to Central and South America and the Caribbean need to protect themselves against mosquito-transmitted viruses, such as dengue and Zika, as well as nighttime biting mosquitoes in countries where there is  the threat of malaria. 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 Cuba


Resource Links

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

Embassies


The U.S. Interests Section is located in Havana at Calzada between L and M Streets, Vedado; telephone (537) 833-3551 through 833-3559. Hours are Monday through Thursday, 8:00 a.m. to 4:30 p.m., and Friday, 8:00 a.m. to 3:30 p.m. For emergency assistance after hours and on weekends, individuals should call (537) 833-3026 or (535) 280-5791 and request to speak with the duty officer.

• Embassy of Canada
Miramar
Havana
Tel: [53] (7) 204-2516
Fax: [53] (7) 204-2044
E-Mail: havan-cs@international.gc.ca
Website: http://havana.gc.ca

• British Embassy
Calle 34 No. 702/4
Miramar
Tel: [53] (7) 204 1771
Fax: [53] (7) 204 8104 Consular
Email: embrit@ceniai.inf.cu
Website: http://www.britishembassy.gov.uk/cuba

Entry Requirements

HIV Test: Not required.

Required Vaccinations: None required.

Passport Information

Passport/Visa: The United States does not have full diplomatic relations with Cuba, but provides consular and other services through the U.S. Interests Section in Havana. The U.S. Interests Section operates under the legal protection of the Swiss government but is not co-located with the Swiss Embassy.

Entry requirements for Americans: US citizens must be licensed by the Department of Treasury in order to travel to Cuba, but travel to the country is strictly controlled and only select categories of travelers are licensable. Tourist travel is officially impossible due to the US Embargo and travel for business reasons is heavily restricted. US citizens who are licensed require a passport valid for at least three months and a visa for entry. Additional U.S. State Dept. information is here: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1097.html

The United States enforces restrictions on travel to Cuba. The embargo applies to all United States citizens and permanent residents wherever they are located, and all people and organisations physically in the United States. If you plan to travel to Cuba, make sure you are familiar with the sanctions. For further details, also see the Office of Foreign Assets Control website: http://www.ustreas.gov/offices/enforcement/ofac/programs/cuba/cuba.shtml

Entry requirements for Canadians: Canadian citizens must have a valid passport. A visa is also required if the visitor does not have a Tourist Card.

Entry requirements for UK nationals: British nationals must have a valid passport. A visa is also required if the visitor does not have a Tourist Card.

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.

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, such as business travelers and cruise passengers.

Hospitals / Doctors

Cuba‘s medical services are good but below Western standards. The Cuban government has established a for-profit health system for foreigners called Servimed (tel. 07/24-01-41 or 42), which is entirely separate from the free, not-for-profit system that takes care of Cuban citizens. There are more than 40 Servimed health centers across the island, offering primary care as well as a variety of specialty and high-tech services. If you’re staying in a hotel or other accommodation, the usual way to access the system is to ask the manager for a physician referral. Many of the physicians are well-trained, but supplies and bed space are often inadequate. (Source: MD Travel Health)

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.
• 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. Serious illness or injury may require air ambulance evacuation to Miami.

• A listing of hospals in Cuba is available at: http://www.hospitalsworldwide.com/hospitals.php?country=Cuba

Destination Health Info for Travelers

AIDS/HIV: The Caribbean has a well-established HIV epidemic and the incidence of HIV/AIDS in the region is now second only to sub-Saharan Africa, making the region the second most affected in the world. The predominant route of HIV transmission in the Caribbean is heterosexual contact. Much of this transmission is associated with commercial sex, but the virus is also spreading in the general population. The contribution by men having sex with men is significant but not well documented, due to a general atmosphere of homophobia making data gathering difficult.
At one extreme, Haiti has the highest HIV prevalence in the entire western hemisphere (3.8%); at the other, Cuba has one of the lowest (0.1%). The Bahamas (3.3%), Trinidad and Tobago (2.6%) and Guyana (2.4%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. The overall prevalence of HIV in the Caribbean is estimated to be between 1.1% and 2.2%. (Source: www.Avert.org)

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 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.

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.

Cholera: This disease may be sporadically active in this country but the incidence is unclear. Cholera is rarely a threat to tourists. 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)


Dengue Fever: In 2006, 10,000 cases of dengue fever were reported in the neighborhoods of the capital of Cuba, among which 25 were fatal. Dengue fever is widespread in this country and cyclical epidemics occur. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring throughout the Caribbean. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases. Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours.
• You should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to your clothing and gear. There is no vaccination or medication to prevent or treat dengue.

A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf



Fascioliasis (liver fluke disease): Human fascioliasis is endemic, with Cuba having the highest infectivity rates in the Caribbean. Visitors should avoid aquatic vegetables, such as watercress, and thoroughly cook goat and sheep livers prior to consumption.

Food & Water Safety: Main water sources are chlorinated and, while relatively safe, may cause mild abdominal upsets. Bottled water is available and is advised. Milk is pasteurised and dairy products are safe for consumption. Local meat, poultry, seafoods and fruit are generally considered safe to eat.

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 at a low level. A recent study found a seroprevalence of 5.3%. 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 <2%. 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 at a low level with a prevalence of 0.8% 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 monts.

Leptospirosis: More than 300 cases are reported annually. Transmission of disease occurs primarily in low-lying, poorly drained areas where animal urine-infected water accumulates. Holguin Province is reportedly a high-risk area, especially September–October, during the rainy season. Leptospirosis poses a risk to travelers engaged in recreational freshwater activities. Such activities may include whitewater rafting, kayaking, adventure racing, or hiking.

Malaria: There is no risk of malaria in Cuba.

Marine Hazards: Swimming related hazards include jellyfish, spiny sea urchins, and coral.
• Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking.
• Scuba Diving-Hyperbaric Chamber Referral: Divers Alert Network (DAN) maintains an up-to-date list of all functioning hyperbaric chambers in North America and the Caribbean. DAN does not publish this list, since at any one time a given chamber may be non-functioning, or its operator(s) may be away or otherwise unavailable. Through Duke University, DAN operates a 24-hour emergency phone line for anyone (members and non-members) to call and ask for diving accident assistance. Dive medicine physicians at Duke University Medical Center carry beepers, so someone is always on call to answer questions and, if necessary, make referral to the closest functioning hyperbaric chamber. In a diving emergency, or for the location of the nearest decompression chamber, call 919-684-8111.

Other Diseases/Hazards: Abdominal angiostrongyliasis, brucellosis, cutaneous larva migrans (caused by animal hookworm parasites in dog and cat feces; often acquired by walking barefoot on beaches), eastern equine encephalitis, toxocariasis (visceral larval migrans; caused by the dog or cat roundworm), histoplasmosis, toxoplasmosis, and tick-borne rickettsioses (may occur).

Rabies: Rabies occurs sporadically in free roaming dogs and is occasionally transmitted humans. 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.
• All dog and other animal bites should be medically evaluated for possible post-exposure treatment. Pre-exposure vaccination eliminates the need for rabies immune globulin (RIG), but does not eliminate the need for two additional booster doses of vaccine. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.

Travelers' Diarrhea: Moderate risk. 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.

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 the Caribbean, 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: There is no risk of yellow fever in Cuba.