DEMOCRATIC REPUBLIC OF CONGO (FORMERLY ZAIRE)
Time Zone: +1 in the west (Kinshasa) and GMT +2 in the east.
Tel. Country Code: 243
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
TRAVEL ADVISORY - DEMOCRATIC REPUBLIC OF CONGO (FORMERLY ZAIRE)
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.
• U.S. Embassy
310 Avenue des Aviateurs
Tel:  (81) 225-5872
Entrance to the Consular Section of the Embassy is on Avenue Dumi, opposite the Ste. Anne residence. The Consular Section of the Embassy may be reached at Tel: 243-081-884-6859 or 243-081-884-4609.
• Canadian Embassy
Tel.  (12) 27551
• British Embassy
83 Avenue du Roi Baudouin
Telephone:  ( 81) 715 0761
(243) (81) 715 0724 - For genuine emergencies only
A passport, visa and evidence of yellow fever vaccination are required for entry. Some travelers arriving in the DRC without proper proof of yellow fever vaccination have been temporarily detained, had their passports confiscated, or been required to pay a fine. Visas must be obtained from an embassy of the DRC prior to arrival. Dual nationals arriving in the DRC should carefully consider which passport they use to enter the DRC. For departure from the DRC, airlines will require a valid visa for all destination countries before they will issue a ticket or allow a passenger to board. Airlines also require that the passenger have the correct entry stamp in the passport they wish to use to exit the country. Passengers who are unable to leave the country on the passport they used to enter the DRC may not be able to continue on their travel itinerary. Additional information about visas may be obtained from the Embassy of the Democratic Republic of the Congo, 1726 M Street NW, Washington, DC 20036, Tel:a (202) 234-7690, or the DRC's Permanent Mission to the UN, 866 United Nations Plaza, Room 511, New York, NY 10017 Tel: 212-319-8061, Fax: 212-319-8232
Web site: http://www.un.int/drcongo. Overseas, inquiries should be made at the nearest Congolese embassy or consulate.
HIV Test: Not required.
Required Vaccinations: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES.
The Democratic Republic of the Congo (Congo-Kinshasa) located in central Africa, is the third largest country on the continent. The capital is Kinshasa. French is the official language. Years of civil war and corruption have badly damaged the country's infrastructure.
• A visa is required. Travelers should contact the Embassy of the Democratic Republic of Congo for further information.
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, from contact with skin sores of an infected person. 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): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating close contact with the indigenous population, especially during the dry season, December to June.
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 should be adminisered 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.
HOSPITALS / DOCTORS
In the DRC, medical facilities are severely limited. Outside Kinshasa, western standard medical facilities are practically non-existent. The public hospitals are dilapidated, their equipment is obsolete and they usually do not have medications and necessary supplies. 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, and bring drugs for malaria prophylaxis. 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.
• Travelers are also advised to obtain comprehensive travel insurance that provides for medical evacuation to more advanced medical facility in South Africa, or elsewhere, in the event of serious illness or injury.
Note: There is a risk of exposure to unsafe blood and blood products in the DRC. Travelers may need to specifically request the use of sterilized equipment. You should consider bringing with you a supply of sterile needles and syringes, such as a Steri-Kit®.
The U.S. Embassy policy is to stabilize and medevac in emergent cases, usually to South Africa. The best-equipped medical facilities in Kinshasa are the Clinic Privée d‘Urgences (CPU) and the Centre Medicale de Kinshasa (CMK).
• Kinshasa Medical Center (CMK)
168 avenue Wagenia et rue du Commerce
Tel:  89 895-0300
• Private Emergency Center (Centre Privé d‘Urgences-CPU)
in the same building as the Kinshasa Medical center
Tel:  89 895-0305
The Centre Prive d’Urgence (CPU) clinic in Kinshasa is able to cope with basic health problems, to stabilize a patient after most serious accidents, and arrange medical evacuation to Europe or South Africa.
• Doctor Lelo Clinic
15 avenue Kasaï Barumbu
Tel:  (99) 824-5339
• Monkole Medical Center
4804 avenue Ngafani
Tel:  892-4426
The center is managed by a French NGO.
DESTINATION HEALTH INFO FOR TRAVELERS
A Country Profile: Formerly known as Zaire, the Democratic Republic of the Congo (DRC) is Africa’s third largest nation in land-mass (after Algeria and Sudan), and with a population of 50 million is the continent’s fourth most populous nation (after Nigeria, Egypt and Ethiopia). The DRC has been known for its vast mineral and other natural resources since the colonial period.
In 1994 ethnic conflict in the bordering nations of Rwanda and Burundi ignited a civil war that toppled DRC’s dictator Mobutu Sese Seko in 1997. In 1998 the civil war became an international war between the DRC and Rwanda, with troops from Uganda, Angola, Namibia and Zimbabwe also taking part in the fighting. In 2001 Mobutu’s successor, Laurent Kabila, was assassinated and replaced as the president of the DRC by his son (Joseph Kabila), who signed a peace agreement with Rwanda in July, 2002. The International Rescue Committee estimated in 2001 that in eastern DRC 3.5 million people had died since 1998; 2.5 million of these deaths were directly or indirectly due to the fighting. United Nations peacekeeping forces have been introduced into eastern DRC, but continued fighting in the region is still preventing delivery of humanitarian aid in the summer of 2004.
Disease surveillance and other aspects of the DRC’s health infrastructure have been disrupted by the war, making precise estimates of disease prevalence difficult. With that caveat, the best estimate (UNAIDS, 2002) is that 1.3 million Congolese are living with HIV/AIDS, and the adult HIV-prevalence rate is 4.9 percent. The 2004 annual report on global TB control estimated that HIV-tuberculosis coinfection exists at a rate of 24 percent. The WHO estimated the malaria death rate for children under five at one percent annually, and a tuberculosis death rate of 90 per 100,000 for all ages (WHO 2004).
• Doctors Without Borders/ Médecins Sans Frontières (MSF) has been in the DRC since 1985.
AIDS/HIV: Heterosexual contact is the predominate mode of transmission. HIV prevalence is high; ten to 25% of the adult population is HIV-positive.
• 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. Note: There is a risk of exposure to unsafe blood and blood products in the DRC. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes, if these are even available. You should consider bringing with you a supply of sterile needles and syringes, such as a Steri-Kit®.
• 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.
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.
Health insurance is essential.
African Sleeping Sickness (Trypanosomiasis): Most cases are reported from Equateur and Bandundu. Risk surged during the 1990s due to decreased tsetse fly control programs associated with civil unrest. Areas of disease risk (gambiense disease) include the western border region, the extreme northeast, and the southwest (including Bas Zaire Region), extending in a band across southcentral areas of this country. High transmission levels exist along the Congo River and the Bandundu and Equateur regions. Foci of the Rhodesian form of sleeping sickness may occur in eastern Democrtaic Republic of Congo.
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 (vipers, cobras), centipedes, scorpions, and black widow spiders.
Cholera: According to health officials in the Democratic Republic of Congo, nearly 3,000 cases of cholera have been reported from the southeastern province of Katanga so far in 2008. Outbreaks have also been reported in Eastern (Orientale), North and South Kivu, and Kasai Provinces. The threat to tourists, however, is low; most travelers are at low risk for infection. 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.
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)
Ebola Virus Hemorrhagic Fever: An outbreak of the Ebola virus began in September 2007, in West Kasai province (southern DRC). That outbreak has now ended. However, a new case of haemorrhagic fever was reported in the Boende health zone of Tshuapa District in June 2008.
. Ebola is transmitted through close personal contact with severely ill patients and direct contact with infected blood, secretions, and organs. However, travelers should take precautions against the virus, which include careful hand-washing, avoiding contact with potentially-infected patients and avoiding any contact with ill or dead animals.
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 and sporadic cases as well as outbreaks occur. In July 2007, an outbreak of hepatitis E that killed 13 people was reported in Equateur Province. 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%. 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 high level with a prevalence of 6.4% 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.
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, and use of a permthrin-treated bednet at night while sleeping.
Leishmaniasis: Risk undetermined, but probably low. Sporadic cases of visceral leishmaniasis have been diagnosed in the northwest, on the fringe of the equatorial forest, and in the southeast, in the savanna belt. No cases of cutaneous leishmaniasis have recently been re-ported.
• 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.
Coexistence of leishmaniasis with human immunodeficiency virus (HIV) infection is a serious concern. Leishmaniasis is spreading in several areas of the world because of the rapidly spreading epidemic of acquired immunodeficiency syndrome (AIDS).
Malaria: Risk is present year-round countrywide under 1,800 meters elevation, including urban areas. Falciparum malaria accounts for >95% of cases. P. malariae species is the next most common cause of malaria.
• 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 Democratic Republic of Congo 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.
Marburg Virus Hemorrhagic Fever: In 1998, an outbreak occurred in Durba, Democratic Republic of the Congo. Control measures are not available since the mechansism of spread has not been identified. The risk to travelers is low.
• Marburg virus is indigenous to Africa. While the geographic area to which it is native is unknown, this area appears to include at least parts of Uganda and Western Kenya, and perhaps Zimbabwe. As with Ebola virus, the actual animal host for Marburg virus also remains a mystery. Just how the animal host first transmits Marburg virus to humans is unknown. However, as with some other viruses which cause viral hemorrhagic fever, humans who become ill with Marburg hemorrhagic fever may spread the virus to other people. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease.
Meningitis (Meningococcal): As of March 2007, over 730 cases of meningococcal meningitis, primarily serogroup A, were reported from Eastern (Orientale) Province and elsewhere. Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported. The risk is greatest in the dry season, but these may vary within a country and from year to year. The dry season in West Africa is usually between November-May/June.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651
Onchocerciasis: Widespread risk, especially along fast-flowing rivers in the regions of Haut-Zaire, Kasai-Oriental, Kasai-Occidental, central and southern Equator, the forest zone of Maniema in Kivu, and western Bas-Zaire. Travelers to these regions should take measures to prevent insect (blackfly) bites.
Other Diseases/Hazards: African tick typhus (risk elevated in eastern areas)
• Brucellosis (from consumption of raw dairy products)
• Chikungunya fever
• Crimean-Congo hemorrhagic fever (tick-borne; sporadic cases occur)
• Filariasis (mosquito-borne)
• Loiasis (deer fly–borne)
• Monkeypox (usually results from contact with infected squirrels or primates, but can also be spread from person to person)
Plague: An outbreak of suspected pneumonic plague was reported in September 2006 from four health zones in Haut-Uele district, Oriental province, in the northeastern part of the country. As of early November, a total of 1174 suspected cases and 50 deaths had been described. Widespread enzootic foci presumably occur in rural and urban areas, particularly in northeastern areas. Travelers should avoid close contact with rodents. Tetracycline or doxycycline are effective prophylactic antibiotics.
Poliomyelitis (Polio): Numerous cases of polio were reported from Equateur and Bandundu Provinces during 2007. Polio outbreaks are also reported in several previously polio-free countries in Central, Eastern, and Western Africa beginning in 2003.
• Polio remains persistent in sub-Saharan Africa. All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio 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.
Rabies: Sporadic cases of human rabies are reported from Kinshasa and Lisala, and also countrywide. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. Access to rabies vaccine or rabies immune globulin may require emergency evacuation. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals.
• 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.
Schistosomiasis: High risk. Intestinal schistosomiasis occurs primarily in four geographical regions: the northern border along the Kibali-Uele Rivers and tributaries; the eastern border from Lake Mobuto to Lake Tanganyika; the Lualaba basin of Shaba region; and the area between Kinshasa and the Atlantic coast. High-risk area of urinary schistosomiasis occurs in the extreme southeast tip of Congo.
• 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: High risk. Diarrheal diseases are common. In urban areas, about 50% of the population has access to potable water. Piped water supplies may be 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 is highly endemic in the DRC 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: A large outbreak occurred in the Democratic Republic of the Congo in 2004-2005. Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC 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, 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: This disease is considered active and outbreaks of yellow fever can occur at any time. 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.