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Ethiopia



Capital: Addis Ababa

Time Zone: +3 hours.
Tel. Country Code: 251
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs F, I.


Travel Advisory - Ethiopia

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.

Dr. Rose Recommends for Travel to Ethiopia


Resource Links

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

Embassies

U.S. Embassy
Addis Ababa



U,S. Citizen Service provides emergency help and other services.



List of physicians and private hospitals

Entry Requirements

HIV Test: Not required.

Required Vaccinations: Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever.

Passport Information

Passport/Visa: The Federal Democratic Republic of Ethiopia is a developing country in East Africa and is comprised of nine states and two city administrations (Addis Ababa and Dire Dawa). The capital is Addis Ababa. Tourism facilities can be found in the most populous regions of Ethiopia, but infrastructure is basic.


ENTRY/EXIT REQUIREMENTS:
 It is not advisable that U.S. citizens arrive without a visa to Ethiopia. However, U.S. citizens may obtain a one-month or three month, single-entry tourist visa or a 10-day business visa upon arrival at the international airport in Ethiopia. This service is only available at Bole International Airport, Ethiopia’s main airport in Addis Ababa. The visa fee is payable only in Ethiopian currency. To avoid possible confusion or delays, travelers should obtain a valid Ethiopian visa at the nearest Ethiopian Embassy prior to arrival, and must do so if entering across any land port of entry. 

Prior to travel, individuals intending prolonged stays should direct their questions to the Ethiopian Embassy, 3506 International Dr., N.W., Washington, D.C. 20008; telephone (202) 364-1200. 

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 infected blood or body fluids from unprotected sex; 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 open skin sores. 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 meningitis vaccine is recommended for those travelers anticipating close contact with the indigenous population.

Polio: 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: 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.

Yellow Fever: Vaccination is recommended for all travelers >9 months of age. Yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any area where yellow fever is active or any country in the yellow fever endemic zones. Vaccination should be administered at least 10 days prior to arrival in order for the certificate of vaccination to be valid.



Hospitals / Doctors

Medical facilities are extremely limited. Although physicians are generally well-trained, even the best hospitals in Addis Ababa suffer from inadequate facilities, antiquated equipment & shortages of supplies/medicine. There are a number of hospitals in Addis Ababa but only private hospitals offer a reasonable standard of basic care for minor health problems. Elsewhere medical facilities (including dentistry) are extremely poor. The British Embassy has its own clinic, which tourists may consult in an emergency only.
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; may be of dubious origin; may be counterfeit, or of unreliable quality.
• 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, the traveler should be flown by air ambulance to Nairobi, Kenya, Western Europe or another country with more advanced medical facilities.

The U. S. Embassy has a list of English-speaking doctors at: http://addisababa.usembassy.gov/medical_information.html#top

Addis Ababa
• Dr. Tofik Idris (English-speaking)
Council for the French Embassy
Tel: [251] (11/011)* 465 1666 or 0911 408 302 (portable)

• Swedish Clinic
Tel: [251] (11/011)* 371 0768, 011-371 3363

• British Embassy Clinic
Fikre Mariam Abatechan Street
Addis Ababa
Tel: [251] (1) 15 79 54
[251] (1) 18 93 11

• Noble Higher Clinic
Addis Ababa
Tel: [251] (1) 125 363

• Sun Shine Clinic
Addis Ababa
Tel: [251] (1) 600092

• St Gabriel Hospital
Tel: [251] (11/011)* 661 3622

• Hayat Hospital
Tel: [251] (11/011)* 662 4488

* from abroad, dial + 251 11 then the number you are trying to reach; from Ethiopia, dial 011 then the number you are trying to reach.

Destination Health Info for Travelers

AIDS/HIV: Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. (Source: Avert.org)
Recently, Ethiopia has experienced a marked increase in HIV/AIDS infection rates among women. The HIV prevalence rate among sexually active women now stands at 5%. The over-all HIV prevalence rate in the adult population (15-49) is 0.9 % to 3.5%.
• 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.
• 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. 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.

African Sleeping Sickness (Trypanosomiasis): Areas of transmission of the Rhodesian form of sleeping sickness occur in southwestern Ethiopia in Gamo, Gofa, Ilubabor, Kefa, and Welega Administrative Divisions. Gambien sleeping sickness may occur in areas adjacent to southern Sudan. 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, mambas), centipedes, scorpions, and black widow spiders.

Arboviral Fevers: Dengue fever most likely occurs in the coastal regions. Sandfly fever, West Nile fever, Chikungunya fever, Sindbis fever, and Rift Valley fever are also reported, but levels are unclear.
• All travelers should exercise insect-bite prevention measures. These 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): While there have been confirmed cases of avian influenza in neighbouring Djibouti and Sudan, Ethiopia has not yet have a confirmed case of the disease.

Cholera: A cholera outbreak was reported in January 2009 from Humbo district of Welayita zone in SNNPR. This disease is reported active in this country, with multiple outbreaks of watery diarrhea thought to be due to cholera. Between April 2006 and 21 February 2007, 60,000 cases and more than 680 deaths reported in a suspected cholera outbreak. Eight of Ethiopia’s 11 regions have been affected. The International Red Cross has reported, through October 2007, an outbreak of acute watery diarrheal syndrome (likely to be cholera) from Ethiopia, with 1,000 cases reported across the Horn of Africa each week.
Although this disease is active in this country, most travelers are at low risk. 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.
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)

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 >20% of non-pregnant women seropositive for antibodies to the hepatitis E virus (HEV). Sporadic cases and outbreaks occur. 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 also 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.
• The overall hepatitis B carrier rate in the general population is estimated at 11% or higher. 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 with a prevalence of 2.0% 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 from November through March in areas north of the Tropic of Cancer and throughout the year in areas south of that. 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: Widespread incidence, with focal distribution countrywide. Cutaneous leishmaniasis occurs in most areas of the Ethiopian highland plateau (elevation 1,500–2,700 meters), including Addis Ababa. Areas of risk for visceral leishmaniasis (kala-azar) include the northwestern, southwestern, and southern lowlands, and the northeastern low-lying arid areas along the Red Sea coast. During 2006 Médecins Sans Frontières (MSF) treated 657 patients for kala-azar, of which 8.3 per cent died.
• 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: Transmission occurs year-round in most lowlands and urban areas below 1,500 to 2,000 meters elevation, especially in areas near or around lakes, swamps, streams, and irrigation ditches. Recent outbreaks reported from the Harerge Administrative Division, including the Ogaden Region. Risk is elevated during and immediately following the rainy season (from June through September). There is no malaria in Addis Ababa (elevation 2,450 meters) or the Ethiopian highlands.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended.

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 Ethiopia page on the Destinations menu or A-Z Index.

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.
• 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.

Note: In Ethiopia, malaria is caused by both Plasmodium falciparum and Plasmodium vivax. Drug resistance of P. falciparum to sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) is frequent and intense in some areas. These data point to an extraordinarily high frequency of drug-resistance mutations in both P. falciparum and P. vivax in southern Ethiopia, and strongly support that both SP (sulfadoxine-pyrimethamine) and CQ (chloroquine) are inadequate drugs for this region.

Meningitis: Risk is elevated in central and northern areas. In 2002, the Ethiopian Ministry of Health has reported a total of 1,332 cases of meningococcal disease group A infections, including 85 deaths mainly in Southern Nations, Nationalities and Peoples Region (SNNPR). Sporadic outbreaks occur annually.
• Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.

Onchocerciasis: Blackfly-borne; occurs primarily along rivers in the Angered Valley and Humera area in Gonder, western Gojam, and most of Kefa, Ilubabor, and Welega Administrative Divisions; additional foci may occur in lowland areas of Gonder, Gama, Gofa, and Western Shewa and Sidamo Administrative Divisions.

Other Diseases/Hazards: African tick typhus
• Anthrax (in Gonder region)
• Brucellosis
• Echinococcosis (high prevalence among nomadic pastoralists in the southwest)
• Filariasis (endemic focus of Bancroftian filariasis at Gambela)
• Leptospirosis
• Relapsing fever (tick-borne and louse-borne; epidemics of louse-borne disease reported in prisoner-of-war transit camps in Bahr Dar and Mekele)
• Toxoplasmosis
• Typhus (louse-borne and flea-borne; endemic in highlands), and intestinal helminthic infections (very common).

Poliomyelitis (Polio): A polio outbreak was reported Ethiopia in December 2004, involving the Tigray and Amhara regions in the northern part of the country. These were the first polio cases reported from Ethiopia since 2001.
• 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: Higher than average risk. There is a large stray dog population, especially in Addis Ababa and other urban areas, that is primarily responsible for disease transmission. Travelers should seek immediate treatment of any animal bite, especially if from a dog. 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. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.

Road Safety: While travel on paved & unpaved roads is generally safe, land mines & other anti-personnel devices are encountered on dirt roads targeted during civil war. Before any off-road travel, inquire with local authorities to ensure that area has been cleared. Excessive speed, unpredictable local driving habits, & lack of basic safety equipment on many vehicles are daily hazards. Road travel after dark outside Addis Ababa & other cities is dangerous due to broken down vehicles left on road & possibility of armed robbery in some locations.

Schistosomiasis: Peak transmission occurs during the dry season. Intestinal schistosomiasis is widely distributed in highland areas, primarily occurring in agricultural communities along streams between 1,300 and 2,000 meters elevation. Limited areas of urinary schistosomiasis are confined to warmer lowland areas (below 800 meters elevation), including the middle and lower Awash Valley, the lower Wabi Shebele Valley near the Somali border, and near Kurmuk, Welega Administrative Division, near the Sudan border.
• 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, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: High risk. Most rural water supplies consist of unprotected wells, streams, or natural springs. Large-scale international aid has improved rural wells and reservoirs. In urban areas, piped water is commonly available at public distribution points. Piped water supplies may be contaminated. Since August 2007 there have been approximately 60,000 reported cases of Acute Watery Diarrhea resulting in about 600 deaths.
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 vegetables—these may transmit intestinal parasites, as well as bacteria). 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 Ethiopia 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 Cambodia, 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: There is risk of yellow fever in this country, but recent cases have not been reported. Yellow fever vaccination is recommended by the CDC for all travelers >9 months of age. Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever.