Time Zone: -6 hours.
Tel. Country Code: 503
USADirect Tel.: 800
Electrical Standards: Electrical current is 115/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plugs A, D.
Travel Advisory - El Salvador
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 El Salvador
• Consular Section of the U.S. Embassy
Final Boulevard Santa Elena Sur
Urbanizacion Santa Elena
Tel:  2278-4444
• Embassy of Canada
Centro Financiero Gigante, Torre A, Lobby 2
Alameda Roosevelt y 63 Avenida Sur
Colonia Escalon, San Salvador
Tel:  2279-4655/ 4657/ 4659
British diplomatic affairs are handled through the British Embassy in Guatemala.
• British Embassy
Edificio Torre Internacional, Nivel 11
16 Calle 0-55, Zona 10
Tel:  2367 5425,6,7,8,9
HIV Test: Not required.
Required Vaccinations: There is no risk of yellow fever in this country, however, there is a certificate of vaccination requirement for travelers >6 months of age arriving from a yellow fever endemic zone country.
Passport/Visa: El Salvador is a democratic country with a developing economy. Tourism facilities are not fully developed. The capital is San Salvador, accessible by El Salvador's International Airport at Comalapa. Although the American dollar and Colon are legal tender in El Salvador, in practice the Colon has fallen out of use, and Americans traveling with U.S. dollars should not exchange them for Colones. Read the Department of State Background Notes on El Salvador for additional information.
ENTRY/EXIT REQUIREMENTS: To enter the country, U.S. citizens must present a current U.S. passport and either a Salvadoran visa or a one-entry tourist card. The tourist card may be obtained from immigration officials for a ten-dollar fee upon arrival in country. U.S. travelers who plan to remain in El Salvador for more than thirty days can apply in advance for a multiple-entry visa, issued free of charge, from the Embassy of El Salvador in Washington, DC or from a Salvadoran consulate in Boston, Chicago, Dallas, Houston, Las Vegas, Long Island, Los Angeles, Miami, New York City, San Francisco, or Washington, DC. Travelers may contact the Embassy of El Salvador at 1400 16th Street NW, Washington, DC 20036, tel. (202) 265-9671, 265-9672; fax (202) 232-3763; e-mail: email@example.com or visit the Embassy's Internet web site at http://www.elsalvador.org.
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 travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes (increased risk in lesser-developed countries); from contact with open skin sores of an another person. Recommended for any traveler requesting protection against hepatitis B virus.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Rabies: 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.
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.
Yellow Fever: Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever.
Hospitals / Doctors
There are few private hospitals with an environment that would be acceptable to visiting Americans. The Embassy recommends that these hospitals be used only for emergency care, to stabilize a condition prior to returning to the U.S. for definitive evaluation and treatment.
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.
For emergencies, many travelers go to:
• Hospital Centro de Emergencias
Colonia Médica, Diagonal Dr. Luis E. Vasquez, No 250
Tel:  2530-3333, 2226-0003 2225-9303, 2225-4651
24-hour emergency room and a broad range of specialty services. Modern facility with advanced technology.
For an online list of other physicians, dentists, laboratories and hospitals in El Salvador, go to the U.S. Embassy website at http://elsalvador.usembassy.gov/consular/english/acs/doctorslist.html.
Policlinica Salvadorena Hospital
some specialties; emergency services; ICU; CCU.
Destination Health Info for Travelers
AIDS/HIV: Although HIV prevalence (the percentage of a population living with HIV) in Latin American countries is relatively low compared to the rates found in many parts of Africa, the number of people affected is still substantial. What is more, the situation is likely to get worse in many Latin American countries. No country in the region has experienced a significant drop in HIV prevalence, and it is projected that the total number of people living with HIV in Latin America will increase in coming years.
The most severe epidemics are found in smaller countries such as Honduras and Belize, which have HIV prevalence rates of 1.5% and 2.5% respectively. The majority of countries in the region have prevalence rates of less than 1%, but the prevalence among specific groups, such as men who have sex with men and sex workers, is often very high.
El Salvador is proportionally more affected by HIV/AIDS than other countries in Central America, except for Honduras and Belize, with 0.9% of the adult population living with HIV. (Source: 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 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.
Chagas’ Disease: This disease is focally endemic throughout the country. Prevalence is estimated to be 5-10% of the population. The risk of transmission occurs primarily in those rural-agricultural areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take precautions against nighttime bites, which typically occur on the face of the sleeping victim.
• Other methods of transmission are possible, from; consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; from blood transfusions; from fetal transmission.
Cholera: This disease is sporadically active in this country, but the threat to tourists is very low. Cholera is an extremely rare disease in travelers from developed countries. 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: Year-round risk, elevated June through December. In 2007 there was an increase in the number of reported cases of dengue in urban areas at lower elevations in the vicinity of San Salvador and in the eastern regions bordering Honduras. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Latin America. 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. All travelers are at risk and 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 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
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 may be endemic, but levels are unclear. Transmission of HEV occurs primarily through contaminated drinking water. 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 at low levels, with a prevalence of 0.2% in the general population.
Insect-Bite Prevention: There is the risk of insect-transmitted diseases in this country. You should take measures to prevent insect-bites, especially in rural areas. 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.
Leishmaniasis: Cutaneous leishmaniasis is reported from the Rio Lempa valley. Most risk occurs in forested rural areas. There is risk of visceral leishmaniasis in the warm, dry valleys
near the Honduran border. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• 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.
Malaria: There is a low risk of malaria in rural areas below 600 meters elevation in Santa Ana, Ahuachap•n and La Uni•n provinces in western El Salvador. Risk is is minimal in northern and central zones. There is no risk of malaria in urban areas. Vivax malaria accounts for 98% of cases. Chloroquine prophylaxis is recommended for travel in rural areas.
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 El Salvador page on the Destinations menu.
• Malaria is transmitted via the bite of an infected 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.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
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.
Other Diseases/Hazards: Anthrax
• Relapsing fever (tick-borne)
• Strongyloidiasis and other helminthic infections.
are reported. Hazardous animals include venomous snakes, scorpions, spiders, and biting bats.
Rabies: About 10–12 human deaths annually are reported. Rabid vampire bats are common, but dogs are the primary source of human 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, regardless of your vaccination status. 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.
Travelers' Diarrhea: Water is not generally safe to drink outside the better hotels in the main towns but bottled water is widely and cheaply available. 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 milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetablesâ€”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 travelersâ€™ diarrhea.
• A quinolone antibiotic, azithromycin, or rifaximin (Xifaxin), 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 El Salvador 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 (except foe short-term travelers) for all unvaccinated people traveling to or working in Central America, 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.