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Travel Advisory - Egypt
There is a low risk of malaria in North Africa and the Middle East, but other insect-transmitted diseases, such as leishmaniasis and viral infections, are potential threats. Safe water precautions, safe needle, and insect-bite prevention measures are important.
Dr. Rose Recommends for Travel to Egypt
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The U.S. Embassy is located at 5 Tawfik Diab Street, Garden City, Cairo, telephone  (2) 2797-2301. Walk-in working hours are 8:00 a.m. to 11:00 a.m. Sunday through Thursday. Phone inquiries are between 1:00 p.m. and 4:30 p.m. The latest Embassy warden message can be heard on  (2) 2797-3000.
For emergencies, contact the U.S. Citizens Services
Egyptian Entry Requirements for US Citizens: Passport & visa required. By air, renewable 30-day tourist visa obtained at airport. Arriving overland, by sea, or those previously experiencing difficulty with visa status, must obtain visa prior to arrival.
Evidence of an AIDS test is required for everyone staying over 30 days for the purpose of studying or working in Egypt. Visit the Egyptian Ministry of Foreign Affairs website at http://www.mfa.gov.eg for the most current visa information.
EENTRY/EXIT REQUIREMENTS: A passport and visa are required.
Proof of yellow fever immunization is required if arriving from an infected area. Evidence of an AIDS test is required for everyone staying over 30 days for the purpose of studying or working in Egypt. Visit the Egyptian Ministry of Foreign Affairs website at http://www.mfa.gov.eg for the most current visa information.
Vaccinations: Recommended and Routine
A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from yellow fever–infected areas.
Hospitals / Doctors
Facilities have many Western trained medical professionals. Most medical facilities are adequate for nonemergencies in tourist areas. Emergency & intensive care facilities are limited, but some in Cairo are of high quality.
Facilities outside of Cairo fall short of Western standards. Most Nile cruise boats do not have ship‘s doctor, but some employ medical practitioner with equivalent of US BA degree.
Hospitals in Luxor & Aswan are adequate but extremely limited at other ports. • 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.
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. In the event of a serious illness or injury that can\'t be treated adequately in this country, you should be evacuated by air ambulance to a hospital in Europe.
Private civilian hospital; quality of care probably Egypt’s best; most major specialties; ambulance service. Offers specialist intensive care, coronary care and neurological critical care beds as well as neo-natal intensive care unit for babies.
The IMC is an advanced facility with 800 beds, 63 ICU beds, 24 operating rooms.
Advanced health care faciluty. All specialties.
Located next to the Cairo Tower
24-hour trauma and emergency services: high-quality care.
Destination Health Info for Travelers
AIDS/HIV: The prevalence of HIV in the Middler East and North Africa is estimated at 0.4%. As in other regions, known high-risk groups in the Middle East and North Africa include men who have sex with men, female sex workers and their clients, injecting drug users and prisoners. The prevalence HIV/AIDS is thought to be <1.0% in the 15 to 49 age group.
• The development of 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.
Health insurance is essential.
Animal Hazards: Animal hazards include snakes (cobras, vipers), scorpions, and black widow spiders are found in this country.
Burrowing asps, vipers, cobras, and black snakes are present country-wide; some have lethal venom, while others can spit venom causing blindness. If bitten, seek urgent medical attention, and wash venom from eyes immediately!
Prevention – Do not handle any snake. Never walk barefoot.
Large Reptiles: Nile crocodiles are considered maneaters; monitor lizards are aggressive and have powerful bites.
Prevention – Use caution around river shorelines.
Scorpions and Spiders: Scorpions are numerous country-wide; some have potentially lethal venom. Yellow sac, widow, and recluse spider bites can be very painful and cause serious skin damage.
Prevention – Shake out boots/bedding/clothing prior to use; never walk barefoot; avoid sleeping on the ground; use caution if entering an abandoned building.
Centipedes, Millipedes, Solifugids, Bees, Ants, Wasps, Blister/Bombadier/Rove Beetles, and Urticating
Catepillars: None with deadly venom but some with stinging hairs; others can inflict painful bites, stings, or secrete fluids that can blister the skin.
Marine Animals: Venomous rays, fish, starfish, shellfish, jellyfish, anemones, sea nettles/urchins in coastal waters.
Prevention – Swim at approved beaches.
Hazardous Plants: Thorny plants that can puncture skin, produce rashes, and/or cause infections are numerous countr-wide; burning some plants can cause skin rashes and lung damage; some plants cause abnormal behavior/poisoning if chewed/eaten.
Arboviral Fevers: West Nile fever, Rift Valley fever, and sandfly fever are regularly reported. The highest transmission rates are June to October with more risk in the Nile River Delta and Nile Valley, with risk increasing from north to the south. There appears to be negligible risk of dengue fever in Egypt.
• All travelers to this country, particularly to the Nile Valley and Nile Delta, should take measures to prevent insect (mosquito and sandfly) 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.
Avian Influenza (Bird Flu): Since the H5N1 strain of bird flu was 1st detected in Egypt in February 2006, the country has had the largest number of human bird flu cases outside the Asian continent. Of the 51 cases confirmed to date in Egypt, 23 have been fatal. Most have occurred in the Delta region. All human cases had a history of close contact with dead or diseased poultry. (Source: ProMED-mail 16 December 2008)
• 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.
Update on Avian Influenza A: http://content.nejm.org/cgi/content/full/358/3/261
The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm
Cholera: This disease is not officially reported active at this time, but sporadic cases may occur. Cholera is a rare disease in travelers from developed countries. Cholera vaccine is usually 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.
Crime/Security/Civil Unrest: Sinai:You should reconsider your need to travel to the Sinai at this time because of the very high threat of terrorist attack, including kidnapping. If you are considering travel to the Sinai, you should be aware that Israeli authorities regularly warn Israeli citizens that they have received information suggesting that terrorist elements may be intending to either kidnap or attack Israeli tourists on the Sinai beaches.
Civil Unrest/Political Tension: Domestic and international political developments and events may prompt large demonstrations in Egypt. These demonstrations could turn violent and should be avoided. You should keep abreast of political events in Egypt and the region. Recent unrest in Egypt over the rising price of bread has resulted in several violent protests.
Crime: The crime rate in Egypt is low. While incidents of violence are rare, purse snatching, pick-pocketing and petty theft do occur. Valuables such as cash, jewellery and electronic items should not be left unsecured in hotel rooms or unattended in public places.
• Foreigners have been kidnapped in remote parts of Egypt. In September 2008, 11 European tourists and their Egyptian tour guides were kidnapped for ransom by armed assailants in the Gilf al-Kebir plateau, a remote area of southwestern Egypt, close to the Libyan and Sudanese borders.
• When using taxis, you should be aware that taxi drivers have assaulted passengers in the past, including foreigners.
Women travelling on their own, particularly when using taxis, may be physically and verbally harassed or assaulted.
Local Travel: Local driving practices and poor road conditions attribute to a high rate of road accidents in Egypt.
Road travel, particularly outside the major cities, can be dangerous as cars, buses and trucks frequently drive at high speed and without headlights illuminated at night. Two major bus crashes in January 2006, in which Australians were killed and injured, highlight the risks. Accidents in which many tourists were killed and injured have occurred in the Sinai in 2008. For further advice, see the bulletin on Overseas Road Safety from Smartraveller: (http://www.smartraveller.gov.au/zw-cgi/view/TravelBulletins/Overseas_Road_Safety).
The Cairo Metro (subway) system is reliable, but the maintenance and safety standards of other methods of public transport are poor.
• There are landmines in some desert and coastal areas. Talk to local authorities for advice on landmine locations.
Tourists traveling the frontiers, including the borders with Libya, Sudan, and Israel and parts of the Sinai off the main, paved roads, must obtain permission from the Travel Permits Department of the Ministry of the Interior. Standards differ from Australia and tourists should ensure that such expeditions are well equipped with adequate food, medical supplies and emergency communications.
• The border between Egypt and the Gaza Strip has been officially closed since June 2007. Travellers should refer to the travel advice for Israel, the Gaza Strip and the West Bank which strongly advises Australians not to travel to the Gaza Strip.
Filariasis: Reported primarily from the eastern Nile Delta, including Ad Daqahliyah, Al Qalyubiyah, and Ash Sharqiyah Governorates, and possibly Asyu’t Governorate. Travelers are advised to take measures to prevent mosquito bites.
Food & Water Safety: Main water suppliesare are normally chlorinated, and while relatively safe may cause mild abdominal upsets. Bottled water is advised for consumption. Milk is unpasteurised and should not be consumed. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid dairy products which are likely to have been made from unboiled milk. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled. Drinking water outside main cities and towns carries a greater risk and should always be sterilized.
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 with up to 30% of cases of acute viral hepatitis caused by the hepatitis E virus (HEV). Both sporadic cases and outbreaks occur (http://www.ajtmh.org/cgi/content/abstract/48/3/372). Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. 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.
• The hepatitis C virus is hyperendemic in Egypt with seroprevalence rates up to 67% in older villagers, 12%–15% in others. Travelers should be advised to avoid blood transfusion in this country. 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.
Insect-Bite Prevention: There is the risk of insect-transmitted diseases in this country. You should take measures to prevent insect-bites, depending on your itinerary and planned activities. For maximum protection, apply a DEET-containing repellent to exposed skin (30% concentration recommended), apply permethrin spray or solution to your clothing and gear, and sleep under a permethrin-treated bednet (if available).
• Until recently, DEET-based repellents have been the gold standard against mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% bite protection by using a properly-applied DEET or picaridin skin repellent and wearing permethrin-treated clothing.
Intestinal Helminthic Infections: Fascioliasis (liver fluke disease) is common in Cairo and the Nile Delta. Aquatic plants (e.g., wild watercress) are a source of infection, but the disease can also be transmitted by undercooked sheep and goat livers. Fascioliasis is suspected in travelers suffering from fever, an enlarged liver, and eosinophilia. Travelers should avoid eating watercress salad and undercooked sheep and goat livers.
• Eating Fessikh (salted raw fish) puts the traveler at risk for acquiring heterophyiasis, an intestinal infection of tiny flukes. Ascariasis (roundworm infection), ancylostomiasis (hookworm disease), trichuriasis (whipworm infection), and taeniasis (pork tapeworm disease) are common in rural areas of the Nile River Delta and Nile River Valley.
Leishmaniasis: Cutaneous leishmaniasis is focally distributed countrywide in rural and periurban areas, including Cairo. Primary risk areas include the Nile River Delta, the Suez Canal Zone, and the Sinai Peninsula (primarily northeastern Sinai). Visceral leishmaniasis possibly occurs near Alexandria. The parasites that cause leishmaniasis are transmitted by the bite of the 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. 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.
Malaria: Very limited risk of vixax and falciparum malaria in El Faiyûm area only (50 miles southwest of Cairo), June - October. No indigenous cases reported since 1998. No risk in tourist areas, including Nile River cruises. Because the risk of malaria is so limited, drug prophylaxis is not recommended. Travelers should, instead, protect themselves against mosquito bites.
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 Egypt 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 a malaria endemic area of this country.
Meningitis: Significant outbreaks of meningococcal meningitis have occurred in Egypt, involving primarily Group A disease, but serogroups B and C also reported. Up to 2,000 cases officially are reported annually with most risk in the Al-Jizah and Al-Sharqiyah Governorates. Vaccination with a quadrivalent meningitis vaccine is recommended for travelers expecting to have close contact with the indigenous population.
Other Diseases/Hazards: Anthrax (cutaneous form; usually from exposure to infected, freshly slaughtered animals)
• Mediterranean spotted fever (low risk; transmitted by ticks; also known as boutonneuse fever and African tick typhus; reported from Ghiza and the Sharqiya and Aswan Governorates)
• Brucellosis (usually from ingestion of unpasteurized goat/sheep milk and cheese)
• Echinococcosis (humans acquire infection by accidental ingestion of E. granulosus eggs voided in the feces of infected dogs and the disease is common in parts of the world where there is close contact between the intermediate and definitive hosts, usually sheep and dogs, respectively.)
• Filariasis (prevalent mainly in the Nile Delta region of the country; transmitted by mosquitoes; mass drug treatment eradication programs have reduced incidence)
• Leptospirosis (an overlooked cause of acute febrile hepatitis)
• Murine typhus (flea-borne)
Poliomyelitis (Polio): Poliomyelitis has been reported in this country since 2003 and is one of the few countries in the world that still reports active cases. 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: Primarily a risk in urban areas, including Cairo. Stray dogs are the primary source of human exposure, but jackals are also a reservoir of infection. 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.
• 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: This disease is widespread in Egypt and is a major public health problem. Urinary and intestinal schistosomiasis are found in the Nile River Delta, throughout the Nile Valley (particularly in the canals and irrigation ditches in rural farming areas), and along the Suez Canal. Areas above the Aswan Dam are heavily infected. There is no risk of schistosomiasis from the beaches on the Mediterranean and Red Sea coasts, which are also generally unpolluted.
• 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 freshwater streams, rivers or lakes during activities such as 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 outside of first-class hotels. 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 milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
• 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.
Amebiasis: a high incidence is reported from the Nile River Delta and along the Nile River). Cryptosporidiosis is a common cause of diarrhea in children. Giardiasis is endemic.
• In April 2007, 60 cases of acute diarrhea, several with high fever, were reported in Greek tourists. The outbreak was thought to be due to food poisoning from a meal consumed locally in the Cairo area. No cause has been established. Travelers should be aware of the risk of food- and water-borne illness, observe safe food and drink guidelines, and carry stand-by antibiotics for treating acute diarrhea. Cases with fever and bloody diarrhea may require medical consultation and possible hospitalization.
Tuberculosis: Tuberculosis is highly endemic in Egypt 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 fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people traveling to or working in Egypt, 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.