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Estonia



Capital: Tallinn

Time Zone: +2 hours time (GMT +3 from the last Sunday in March to the last Sunday in October).
Tel. Country Code: 372
USADirect Tel.: 800
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Estonia

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Estonia


Resource Links

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

Embassies


• U.S. Embassy
Kentmanni 20
Tallinn
Tel: [372] 668-8100
Fax: 372-668-8267
Website: www.usemb.ee

• Canadian Embassy
Toom Kooli 13
2nd Floor
Tallinn
Tel: [372] 627-3310-11
Fax: [627] 3312
E-mail: canembt@zzz.ee

• British Embassy
Wismari 6
Tallinn 10136
Tel: [372] 6674700
Email: information@britishembassy.ee
Website: www.britishembassy.gov.uk/estonia

Entry Requirements

HIV Test: Test required for persons seeking residency permits; U.S. tests results accepted.

Required Vaccinations: None required.

Passport Information

Passport/Visa: Estonia is a stable democracy with a rapidly developing economy. Tourist facilities in Tallinn are comparable to other western European cities, but some amenities may be lacking in rural areas. Some goods and services may not be available outside of major cities

ENTRY/EXIT REQUIREMENTS: A valid passport is required. American citizens do not need a visa to travel to Estonia for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the "Schengen group" countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden . Multiple visits to Schengen countries may not exceed 90 days in any 6 month period. For further information concerning entry requirements and residency permits, contact the Estonian Embassy, located at 2131 Massachusetts Ave., NW, Washington, DC 20008, telephone (202) 588-0101, or the Consulate General of Estonia in New York City, telephone (212) 883-0636. Visit the Embassy of Estonia web site at http://www.estemb.org 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 at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and 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.

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.

Hospitals / Doctors

The healthcare facilities in Estonia are very good. There are two main hospitals in the city, North-Estonian Regional Hospital (former Mustamae Hospital) and East Tallinn Central Hospital. There are members of the medical staff in both hospitals that speak English.

The U.S. Embassy maintains a list of medical facilities at: http://estonia.usembassy.gov/doctors.php

Countrywide emergency telephone number for ambulance: 112

• Tallinn Central Hospital
Ravi Strut 18
Tallinn
Tel: [372] (2) 620-7000
Public hospital with 24-hour emergency services and other specialties.

• North-Estonian Regional Hospital (former Mustamae Hospital)
Sutiste str. 19
Tallinn
Information tel: [372] 617 1300 (7:00am-7:00pm)
Reception Tel: [372] 617-1400.
Trauma center: [372] 617-1093
Emergencies: [372] 617-1500 (24h)
Website: http://www.regionaalhaigla.ee/?op=body&id=186

• Medicover Center Tallin
Mustamae tee 5
Tel: [372] 625-9583, (372) 625-9579
Website: http://www.medicover.com/pl/en/ or
http://www.tallinn-life.com/services/services_details/41-Medicover
Private clinic used by expatriates.

• Medicover (based in Poland) has 4 clinics throughout Estonia
Website: http://www.medicover.com/ee/en/en/Default.aspx?TabId=84

• Tallinn Hospital for Children
Tervise str. 28
Tallinn
Info tel: [372] 697-4113
Outpatient treatment: [372] 697-4222; [372] 697-4218
Trauma section: [372] 697-4194
Reception: [372] 697-4141
Website: http://www.lastehaigla.ee
Inpatient and outpatient departments of pediatrics, ear-nose and throat diseases, traumatology and orthopedics, surgery, hemato-oncology. All the doctors are English-speaking.

Destination Health Info for Travelers

AIDS/HIV: UNAIDS estimates that HIV prevalence among adults exceeds 1% in Estonia, Ukraine, Moldova and Russia. UNAIDS estimates an HIV prevalence of 0.2% among adults in Lithuania.
Injecting drug use has become unusually widespread amongst young people, especially young men. Given the high odds of transmission through needle sharing, the fact that the young people are also sexually active, the lack of motivated HIV prevention work and the high levels of sexually transmitted infections in the wider population, an HIV & AIDS epidemic may be unavoidable. (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 of another person or their 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. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• 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.


Diphtheria: Diphtheria is endemic. All travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tadp vaccine) should be given to those who have not received a dose within the previous 10 years.

Hemorrhagic Fever with Renal Syndrome (HFRS): Cases of Hantavirus illness are reported in The Baltics and in Eastern Europe. A milder form of HFRS (caused by Puumala virus) occurs in Scandinavia, other European countries, and European Russia. Travelers should avoid contact with rodent urine or rodent feces, which transmit the virus.

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. 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 4% 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 a moderate level, with a prevalence of 1.5% to 2% 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 world’s population. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.


Influenza: Influenza is transmitted from November to March. The flu vaccine is recommended for all travelers over age 6 months.

Lyme Disease: Risk of transmission occurs, April through September, on the island of Saaremaa, along the Finnish Gulf coast in Harjumaa and Western Virumaa, and in Parnumaa and Eastern Virumaa counties. During the first 5 months of 2007, 106 cases were reported in Estonia, of which 40 (38%) were in Saaremaa. In 2006, 486 cases were reported.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).

Other Diseases/Hazards: Raw cod (lutefish) in Scandinavia and Baltics region may contain the fish tapeworm. Travelers should avoid raw, smoked, or undercooked seafood.

Rabies: Occurs primarily in wild animals, especially foxes, in many rural areas of Europe. Human cases are infrequent, but are reported in Estonia. All animal bites should be medically evaluated.
Pre-exposure 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 if exposure occurs. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.


Tick-Borne Encephalitis (TBE): There is a risk of TBE throughout the country below 1,400 meters elevation. The areas most affected are Parnumaa and Laanemaand counties, the island of Saaremaa in western Estonia, Ida-Virumaa county in north eastern Estonia, and Polvamaa and Tartumaa counties in south eastern Estonia. Most risk occurs from early spring to late autumn (March to November) when ticks are most active.
• TBE vaccine is recommended for: stays of over 3 weeks if hiking, camping, or engaging in similar outdoor activities in rural wooded areas throughout the country (including island of Saaremaa) especially in northern areas around Tallinn and in the South-East (Polvamaa, Tartumaa) along the Latvian border. Infections can occur in parks within Tallinn. The TBE vaccine is only available in Europe and by special release in Canada.
• Travelers engaging in outdoor activities in rural areas, such as campers and hikers, are advised to take measures to prevent tick bites during the peak transmission season. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.


Travelers' Diarrhea: Tap water is not suitable for drinking. 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.

Salmonellosis is the most common food-borne disease in Estonia. In 2007, 428 cases were reported. In May 2008, 94 cases of salmonellosis were reported in a kindergarten, over 90% due to salomonella enteritidis. The source may have been frozen whole hens imported from Lithuania.

Tuberculosis: Tuberculosis is highly endemic in Estonia 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 by the CDC for all unvaccinated people traveling to or working in the Eastern Europe, 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.