Time Zone: +1 hour. (GMT +2 between last Sunday in March and last Sunday in October).
Tel. Country Code: 33
USADirect Tel.: 0
Electrical Standards: Electrical current is 230/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
TRAVEL ADVISORY - FRANCE
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.
• US Embassy
2, Avenue Gabriel
Tel:  (1) 43 12 22 22
Fax:  (1) 42 66 97 83
Consulates: Marseilles: 12, Blvd Paul Peytal; Tel: 4-91-54 92 00; Fax:4-91-55-09-47.
Strasbourg: 15 Avenue d’Alsace; Tel: 3-88-35-31-04; Fax:3-88-24-06-95.
• Canadian Embassy
35, avenue Montaigne
Tel:  (1) 44.43.29.00
• British Embassy
35 rue du Faubourg St Honore
Tel:  91) 44 51 31 00
HIV Test: Not required for tourists.
Required Vaccinations: None required.
Passport/Visa: France is a developed and stable democracy with a modern economy. Monaco is a developed constitutional monarchy. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: A passport is required to enter France and Monaco. A visa is not required for tourist/business stays up to 90 days in France and Monaco. Anyone intending to stay more than 90 days must obtain the appropriate visa issued by one of the French Consulates in the U.S., prior to departure for France. This also applies to anyone considering marriage in France. The 90-day period begins when you enter any of the Schengen group of countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden.
For further information concerning entry requirements for France, travelers may contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC 20007, tel. (202) 944-6000, or the French Consulates General in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, or San Francisco. For further information on entry requirements to Monaco, travelers may contact the Embassy of the Principality of Monaco. 2314 Wyoming Avenue, N.W., Washington, DC 20008. Tel: 202-234-1530.
VACCINATIONS: RECOMMENDED AND ROUTINE
Hepatitis A: Should be considered 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; from acupuncture, tattooing or body piercing; 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.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is given.
• Since the beginning of 2008, France has been facing an increase of measles incidence. Measles outbreaks were reported from Reims, Cote dOr, Bourgogne, Nord Pas de Calais and a holiday camp at Faye dAnjou in 2008.
Measles, mumps, rubella (MMR) immunity is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
HOSPITALS / DOCTORS
Medical care comparable to that found in the United States is widely available.
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. 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 the equivalent 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. Recommended for climbers and skiers.
Medical facilities used by travelers include:
• American Hospital of Paris
63 boulevard Victor Hugo
Tel: +33 1 46 41 25 25
All specialties; bilingual staff; most have had additional training in the United States; large corporate and international clientele; the hospital has angioplasty, stenting, and coronary artery bypass grafting surgery (CABG) capability; obstetrics, 24-hour emergency room with English-speaking doctors.
• SOS Medécins France
Tel: 36 24 et 01 47 07 77 77
24-hour house/hotel calls; serves primarily western Paris area (7th, 8th, 9th, 14th, 15th, 16th, 17th, arrondissements)
• Urgences Médicales de Paris
(Medical Emergencies in Paris)
Tel. (01) 53 94 94 94
Serves primarily the central Paris area.
• Outside Paris: If you have a medical problem, dial 15 on any telephone in France (including Paris) and this countrywide assistance service (similar to the 911 service in the USA, but more comprehensive) will evaluate your problem; if necessary, they will dispatch a physician, or doctor-staffed ambulance, to your hotel or residence.
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: In high-income nations, HIV infections have historically been concentrated principally among injecting drug users and gay men. These groups are still at high risk, but heterosexual contact accounts for a growing proportion of cases, especially in the immigrant population from sub-Saharan Africa. According to UNAIDS estimates, the largest numbers of people living with HIV in Western Europe in 2007 were in Italy, Spain and France. In France, the prevalence of HIV in the adult population is estimated to be 0.4%. (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 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.
To reduce the incidence of HIV in injecting drug users (IDUs), France switched to a harm reduction policy in 1994, establishing a needle-exchange program, and provided access to opioid substitution treatment in specialized centers, and buprenorphine in primary care. The HIV prevalence in IDUs decreased from 40% to 11% and heroin overdose deaths, as well as heroin-associated crime, both decreased by 80%. (Lancet Aug 9, 2008)
A drug to prevent AIDS. In a major advance, the drug Truvada© is now available for pre-exposure prophylaxis in adults and adolescents (≥35 kg) who are at risk for HIV. The drug is taken once daily. Its use should be combined with safe sex practices.
Acute Mountain Sickness (AMS)/Altitude Illness: Mont Blanc (4,810 meters/15,780 ft), the highest mountain in the Alps and Western Europe, lies between the regions of Aosta Valley, Italy, and Haute-Savoie, France. Many of the mountain huts on the most popular climbing/trekking routes in the French Alps are over 3,000 meters elevation. Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 meters (8,000 ft), especially if you have not had a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 – 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 60% effective. It may also reduce the risk of HAPE.
• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue the ascend if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE, the most severe form of AMS, is recognized by confusion, difficulty with balance and coordination, staggering gait). Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also improve symptoms of HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent .
Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
Food-Borne Disease: Salmonellosis: An unusually high number of cases of Salmonella typhimurium were reported in France in June 2008. Contamination of a food product distributed nationally was suggested as the cause of the outbreak but investigations did not reveal any specific food source. Cases with the same bacterial strain have also been detected in Switzerland, where pork sausages seem to be the likely source. (Eurosurveillance. October 2008: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19022)
• Salmonella typhimurium is a particular strain of Salmonella enterica. Up to 2000 salmonella strains have been described, the best known being Salmonella typhi, the cause of typhoid fever. Strains such as Typhimurium (now endemic in France and other European countries) can lead to a form of human bacterial gastroenteritis, sometimes referred to as salmonellosis.
• Salmonellosis is the second most common food-borne infection in the European Union (EU). Symptoms include nausea and vomiting, abdominal cramps, diarrhea, and fever starting 12 to 72 hours after infection; symptoms may last for up to 7 days. Severe cases should be hospitalised. Salmonella infections can lead to septicemia and sometimes death. Salmonella bacteria are readily transmitted through the feces of people or animals. Humans generally become infected by eating contaminated, insufficiently cooked food or consuming contaminated dairy products.
• Salmonella gastroenteritis is usually a self-limiting disease. Fluid and electrolyte replacement are the mainstays of treatment. Because antibiotics do not appear to shorten the duration of symptoms, they are not routinely used to treat uncomplicated nontyphoidal gastroenteritis. Current recommendations are that antibiotics (fluoroquinolnes or azithromycin preferred) should be reserved for patients with severe disease or patients who are at a high risk of invasive disease.
Note: Obviously, people with acute gastroenteritis (i.e., travelers’ diarrhea) will not know the bacteriological cause of their symptoms and may have empirically started antibiotic self-treatment for their symptoms. Such treatment may limit the severity of their illness. (Read more: http://www.emedicine.com/MED/topic2058.htm)
Hepatitis: In 2007, 111 cases of oyster-transmitted hepatitis A were identified in the Côtes d’Armor district of northwestern France. There is a generally low risk of hepatitis A in France, but all travelers not previously immunized against hepatitis A should consider vaccination against this disease for maximum health protection. 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 levels are unclear. Sporadic cases may occur and go undiagnosed or underreported. In one study, there was a prevalence of anti-HEV antibodies in the general population of 3.20%, which is similar to that of other industrialized countries. In another report, out of a total of 431 consecutive patients from the Midi Pyrenees area with acute hepatitis with unknown etiology, 10.7% had anti-HEV antibodies. 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at <1%. 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 1.1% 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. The flu vaccine is recommended for all travelers over age 6 months.
Legionnaires’ Disease: An outbreak of Legionnaires disease was reported from Paris in 2006, resulting in 26 cases, two of them fatal. The source of the outbreak was not determined. Outbreaks of Legionnaires disease are periodically reported from France.
Leishmaniasis: Low risk, but visceral and cutaneous leishmaniasis do occur in rural areas of southern France, primarily in the departments of Bouche-de-Rhone, Provence, and Alpes-Maritimes, and on Corsica. Transmission occurs between May and November, peaking in July and August. 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.
Listeriosis: Outbreaks of listeriosis, caused by consumption of unpasteurized dairy products, especially soft cheeses, such as Brie, are reported, with some fatalities. Young children, pregnant women, and travelers with compromised immunity should consider avoiding soft cheese products.
Lyme Disease: Risk of transmission occurs throughout the country in wooded, brushy areas or in broadleaf (oak) forests. Risk is elevated in eastern France. 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)
Mediterranean Spotted (Boutonneuse) Fever: Occurs in southern France in regions below 1,000 meters elevation. This is a tick-transmitted spotted fever rickettsial infection caused by Rickettsia conorii. Peak transmission occurs July through September. The primary endemic areas are the southern Mediterranean coast (especially the vicinity of Marseille) and the island of Corsica. Disease may be acquired in and around tick-infested houses and terrain, but more than 95% of cases are associated with contact with tick-carrying dogs.
Other Diseases/Hazards: Brucellosis (sheep and goats are the most common sources of infection; humans acquire infection by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, especially goats, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material)
• Fascioliasis (liver fluke disease; cases reported from Orne and Manche Departments in Normandy)
• Leptospirosis (eastern and central France; two cases of leptospirosis were reported in October 2006 in travelers who had spent a fishing holiday at a resort in the Picardie region of northern France)
• Legionellosis-sporadic outbreaks
• Hemorrhagic fever with renal syndrome (chiefly in the northeast, caused by hantaviruses; related to contact with rodent excreta; hemorrhagic fever with renal syndrome is characterized by the abrupt onset of fever, chills, weakness, and dizziness, often associated with headache, muscle pains, and back ache. The main complication is kidney failure, sometimes requiring dialysis. Hantaviruses are acquired by exposure to rodent excreta, usually by inhalation. Most travelers are at low risk for infection)
• Human alveolar echinococcosis (cases reported from the Franche-Comte region; the red fox is the definitive host)
• Tick-borne meningoencephalitis (due to Rickettsia slovaca; reported in central France/Pyrennes mountains)
• Toxoplasmosis (highly prevlent; prevalent; from ingesting undercooked beef)
• Trichinosis (three small outbreaks of trichinellosis were reported in 2006 [one in the Midi-Pyrénées region and two in the Provence-Alpes-Côte-d’Azur region]. All were attributed to the consumption of wild boar meat which had not been properly inspected or fully cooked; outbreaks associated with consumption of poorly cooked horsemeat have also occurred)
• Tularemia (transmitted to humans by direct handling of infectious carcasses, ingestion of contaminated food or water, and inhalation of infectious dusts or aerosols; reported from eastern and central France)
• Pork and beef tapeworm disease
• Tick-borne encephalitis (slight risk in the Alsace Region. This disease is present from Europe all the way to Asia).
• West Nile virus (small number of human cases reported from the Var in southeastern France in 2003).
Rabies: Although the incidence of human rabies is very low in Europe, there are increasing reports of cases in returned travelers who sustained dog bites in countries where rabies is endemic. In 2003 a three-year-old who had probably been infected when playing with dogs during a visit to Gabon died in France. In 2004, an Austrian tourist died after being bitten by a dog in Morocco, and a German woman died after a dog bite in India. In 2005, a British man died who had been bitten by a dog while on holiday in Goa, India. In 2007, a German national died on his return to Germany after being bitten by a stray dog in Morocco. All the deceased had not been vaccinated.
The regions of Europe considered “rabies-free” face a risk from the illegal importation of potentially infected animals, primarily pet animals. In February 2008 a dog that had never left France was diagnosed with rabies. The likely source of the infection was a dog that contracted rabies from another dog that had been illegally introduced from Morocco in late 2007. In the recent case of a dog introduced from Gambia to France via Belgium, the requirements for the introduction of pet animals from endemic countries were not complied with by the dog’s owner. Although the dog was certified as primo-vaccinated before entry into Belgium, it had neither undergone the required antibody titration test demonstrating a protective immunity, nor the mandatory three-month waiting period before movement to exclude any possible pre-vaccination exposure to the virus.
Rabies is still present in Europe. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory.
France is reported to be free of canine rabies (except in the case of illegally imported animals). All wild animal bites, however, especially from a racoon dog or fox, should be vigorously cleansed with soap and water and medically evaluated for possible post-exposure treatment.
Travelers’ Diarrhea: Low risk. The domestic water supplies in urban areas are generally safe for drinking. Acute diarrhea should be treated with a quinolone antibiotic, or azithromycin, combined with loperamide (Imodium). Giardiasis is reported. Persistent diarrhea may be caused by a parasitic disease such as giardiasis or cryptosporidiosis.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic (e.g., Cipro), 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.