Time Zone: +2 hours.
Tel. Country Code: 253
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Health Services
Foreign Commonweatlh Office
• The U.S. Embassy is located at Plateau du Serpent, Boulevard Marechal Joffre, Djibouti City. The mailing address is Ambassade Americaine, B.P. 185, Djibouti, Republique de Djibouti. The telephone number is (253) 35-39-95. The fax number is (253) 35-39-40. Normal working hours are Sunday through Thursday, 8:00 a.m. to 4:30 p.m.
• Consulate of Canada
Tel:  (3) 35-38-59 or 35-59-50
HIV Test: Not required.
Required Vaccinations: Yellow fever vaccine is required for all travelers >1 year of age arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise.
Passport/Visa: Djibouti is a developing African country located at the juncture of the Red Sea and the Indian Ocean. It is a multi-party democracy with a legal system based on French civil law (Djibouti was a French colony until 1977), though modified by traditional practices and Islamic (Sharia) law. Although exact statistics are unavailable, unemployment is estimated at greater than 50% of the working-age population. Over two-thirds of the country’s 650,000 residents live in the capital, also called Djibouti. Modern tourist facilities and communications links are found in the city of Djibouti, but limited outside the capital.
ENTRY/EXIT REQUIREMENTS: A passport, visa, and evidence of yellow fever vaccination are required. Travelers may obtain the latest information on entry requirements from the Embassy of the Republic of Djibouti, 1156 15th Street, N.W., Washington, D.C. 20005, telephone (202) 331-0270, or at the Djibouti Mission to the United Nations, 866 United Nations Plaza, Suite 4011, New York, N.Y. 10017, telephone (212) 753-3163. Overseas, inquiries may be made at the nearest Djiboutian embassy or consulate. In countries where there is no Djiboutian diplomatic representation, travelers may sometimes obtain visas at the French Embassy. See our Foreign Entry Requirements brochure for more information on Djibouti and other countries. Visit the Embassy of Djibouti web site at www.embassy.org/embassies/dj.html for the most current visa 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. 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.
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.
Hospitals / Doctors
Adequate medical facilities in the capital of Djibouti are limited and medicines are often unavailable. Medicines that are available are extremely expensive. Medical services in some outlying areas may be completely nonexistent.
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.
• Travelers are advised to obtain travel insurance that provides for medical evacuation to more advanced medical facility in another country in the event of serious illness or injury.
• Peltier Hospital, Djibouti City (700 beds); limited emergency and surgical facilities; old and poorly maintained buildings.
Destination Health Info for Travelers
AIDS/HIV: HIV prevalence is increasing. Street prostitute seropositivity now 43%, up from 3% in 1997. All travelers are cautioned against unsafe sex, unsterile medical or dental injections, and blood transfusions.
Avian Influenza (Bird Flu): The first human case of H5N1 avian influenza was reported from Djibouti in May 2006. A poultry outbreak was reported from Djibouti at about the same time, but no human or poultry cases have been reported since then.
Cholera: This disease is active, with intermittent outbreaks, the last reported in January 2007 from Yoboki village near the border with Ethiopia. The risk of cholera, however, is extremely low for travelers from developed countries, and vaccination is not recommended. 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: Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in this country and is a common cause of fever in travelers returned from this region. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. This illness may be confused with malaria. All travelers should take measures to prevent daytime mosquito bites.
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 but the levels are unclear. Sporadic cases may occur but go 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 >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 at high but undetermined level 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.
Leishmaniasis: Presumably occurs, but recognized foci of disease have not been reported.
Malaria: Present year-round, countrywide, including urban areas. Higher malaria risk occurs from November through March, which is a relatively cool period with some rainfall. There is only minimal risk of malaria in Djibouti City. Major outbreaks, however, have occurred in the Ambouli suburb of Djibouti City, as well as in the Dikhil and Ali Sabih Districts and villages south of Djibouti City. Falciparum malaria causes 80% of cases, with vivax malaria accounting for the remainder.
• Prophylaxis with Malarone, mefloquine, doxycycline, or primaquine is currently recommended when traveling to malarious areas.
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.
Other Diseases/Hazards: African tick typhus
• Crimean-Congo hemorrhagic fever (tick-borne; presumably enzootic)
• Dengue fever (probably active)
• Meningitis (cyclic outbreaks of meningococcal disease occur)
• Sand fly fever
• West Nile Fever
Poliomyelitis (Polio): Immunization is recommended, due to the persistence of polio in sub-Saharan Africa. 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: Presumed to occur, but incidence is unclear. Stray dogs, jackals, foxes, and hyenas are most likely carriers of the disease.
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.
• Regardless of your vaccination status, all animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.
Schistosomiasis: Schistosoma mansoni (intestinal) and Schistosoma haematobium (urinary) are present in this country. Schistosomiasis is transmitted through exposure to freshwater streams, rivers or lakes during activities such as wading, swimming, bathing or washing clothes. Schistosoma larvae are released from infected freshwater snails and penetrate intact skin to establish infection.
• Travelers should avoid wading, swimming, or bathing in fresh water.
Travelers' Diarrhea: Djibouti has limited urban, and no rural, water treatment and distribution systems. Rural inhabitants obtain water from untreated sources. All water is potentially 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.
Typhoid Fever: Vaccine is recommended for all unvaccinated people traveling to or working in Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Since typhoid vaccines are not 100% effective, food safety precautions still need to be observed.