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Georgia



Capital: Tbilisi

Time Zone: +4 hours. No daylight saving time.
Tel. Country Code: 995
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Georgia

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 Georgia


Resource Links

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

Embassies

• U.S. Embassy in Tbilisi is located at 11 George Balanchine Street. Office hours from American Citizens Services are from 2 to 5 pm on weekdays; no appointment is necessary. The telephone number is [995] (32) 27-70-00, which can also be reached after hours, and the fax number is: [995] (32) 53-23-10. U.S. Embassy website: http://georgia.usembassy.gov/.

Canadian diplomatic relations with Georgia are maintained through the Canadian embassy and consulate in Turkey.

• Consulate of Canada
Istiklal Caddesi No. 189/5
Beyoglu
Istanbul
Tel: [90] (212) 251-9838
Emergency toll-free to Ottawa: 00800-14-220-0149
Fax: [90] (212) 251-9888
E-Mail: zeyda@mymerhaba.com
Website: http://www.dfait-maeci.gc.ca/canada-europa/turkey

• British Embassy
GMT Plaza

4 Freedom Square

Tbilisi
Tel: [995] 32 274775 (Consular Enquiries)
Fax: [995] 32 274779 (Consular Section) .
Website: http://www.britishembassy.gov.uk/georgia

Entry Requirements

HIV Test: please call us for more info.

Required Vaccinations: please call us for more info.

Passport Information

Passport/Visa: A passport is required. U.S. citizens visiting for 90 days or less do not need a visa to enter Georgia. Armenian and Azerbaijani visas are no longer valid for transit through Georgia. For further information, please contact the Embassy of Georgia at 2209 Massachusetts Avenue, NW, Washington DC, 20008 tel. (202) 387-2390, fax: (202) 393-4537. Visit the Embassy of Georgia website at http://embassy.mfa.gov.ge/index.php?lang_id=GEO&sec_id=2〈_id=ENG for the most current visa information.

Vaccinations: Recommended and Routine

Please call us for more info.

Hospitals / Doctors

Medical care in Georgia is limited. There is a severe shortage of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
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 or may be 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. Serious illness or injury may require medical evacuation to Vienna or London.

• Frontline Medical Services
Arakishvili Street, 2
Tbilisi
Tel: [995] 32 25 19 48
[995] 32 25 19 51:
Fax: [995] 32 25 19 52

• Dr. Zurab Chkonia
Deputy Director MEDEX 3
Abashidze Street
(near UN building)
Tblisi
Tel: [995] 32 252 2280
Specialist in General Practice.

Destination Health Info for Travelers

AIDS/HIV: AIDS cases are increasing due to: 1) an increase in IV drug abuse, 2) an increase in commercial sex, 3) an increase in sexually transmitted diseases, 4) decreased availability of sterile needles and syringes, and 5) inadequate public health prevention programs. The UNAIDS/WHO Working Group estimates that 0.2% of the adultl population over age 15 is living with HIV.
• 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.
Note: There is a risk of exposure to unsafe blood and blood products in Georgia. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics.
• 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.

Acute Mountain Sickness (AMS)/Altitude Illness: Mountains are the dominant geographic feature of Georgia. The Greater Caucasus Mountain range, also known as the Major Caucasus mountains, includes Southwestern Russia and northern parts of Georgia and Azerbaijan. The Likhi Range divides the country into eastern and western halves. The highest mountain in Georgia is Mount Shkhara at 5,201 meters (17,059 ft), and the second highest is Mount Janga (Jangi-Tau) at 5,051 meters (16,572 ft) above sea level.
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you do not have 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 75% 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 to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) 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)—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 will prevent 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.
Further advice:
http://www.ismmed.org
http://www.altitudemedicine.org
http://www.basecampmd.com/expguide/highalt.shtml
http://wwwn.cdc.gov/travel/yellowBookCh6-AltitudeIllness.aspx


Arboviral Diseases: Karelian fever (mosquito-borne; most cases occur July–September in the Karelian region)
• Tahjna virus fever (mosquito-borne; occurs sporadically from the Baltic region north to the Kolsky Peninsula)
• Sand fly fever (sandfly-borne; limited to Moldova and the Crimea)
• Dengue fever (mosquito-borne; cases previously reported from extreme southern regions)
• West Nile fever (mosquito-borne; virus reportedly circulates in the Volga Delta region from May–September)
• Sindbis virus fever (detected in the Volga Delta, July–August)

Avian Influenza A (Bird Flu): The World Health Organisation (WHO) has confirmed that there have been outbreaks of Avian Influenza (Bird Flu) in wild swans in the Adjara region of Georgia, 300km from Tbilisi. No human infections or deaths have been reported.
• Avian influenza A (H5N1) 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 influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.

The usual vaccines against influenza are not protective against bird flu. Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). 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 cases.
• More information here: 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 currently reported active in Dagestan, a republic within the Russian Federation. Travelers to this area are advised to avoid street vendor food and consume only bottled, boiled, or chemically treated water. 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)

Crimean-Congo Hemorrhagic Fever: Reported mostly from southern areas, but outbreaks have occurred in some areas of Rostov Oblast (near the sea of Azov), April through November. Risk areas are rural steppe, savannah, semi-desert, and foothill/low mountain habitats below 2,000 meters elevation.
• CCHF is caused by a virus and is transmitted by tick bite or by exposure to blood or secretions from infected animals or humans. Anyone who has visited this country and is suffering from a fever, headache, chills, muscle aches, vomiting, red rash (which does not fade when pressed under glass), bleeding on the roof of the mouth, or any other unexplained symptoms should seek medical advice immediately. Risk is seasonal, associated with periods of high tick activity (usually March through September, but seasonal patterns may occur) and increases in tick and rodent host populations.


Diphtheria: An epidemic diphtheria began in 1990 in the Russian Federation has spread extensively, involving all countries of the former Soviet Union. Seventy percent of cases have occurred in persons older than 15 years. All travelers to Georgia, especially adults, should be fully immunized against this disease. (The CDC estimates that 20% to 60% of Americans older than 20 years lack sufficient immunity to diphtheria.) Diphtheria vaccine in the United States is widely available and is administered in combination with the tetanus toxoid vaccine (Td vaccine).

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 may be endemic but levels are unclear. Sporadic cases may be underdiagnosed or underreported. 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.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. 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 estimated between 1% to 2% of 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.

Leishmaniasis: Risk for cutaneous leishmaniasis primarily limited to southern regions, including portions of Georgia Republic and the southern Ukraine, below 1,300 meters elevation.
Visceral leishmaniasis is confined to areas along the southeastern coast of the Black Sea,
the southeastern and southwestern coasts of the Caspian Sea and the border areas of Georgia and Azerbaijan. Travelers to these regions should take measures to prevent sandfly bites.

Lyme Disease: Occurs focally in rural forested areas with the highest incidence in the Ural Mountains area. Risk presumably also occurs in the northwest and central areas. Lyme disease is transmitted by Ixodes ticks that are found in wooded, brushy areas, although transmission can also occur in backyards of homes in endemic areas. 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).

Malaria: There is a very low risk of malaria in the rural southeast of Georgia from July to October. There is no risk in Tbilisi. Transmission currently is limited to the warmer months of May through September. All cases appear to be vivax malaria. Chloroquine prophylaxis is recommended in endemic areas.

A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), 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 Georgia page on the Destinations menu or A-Z Index.

• 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. DEET-based repellents remain the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.

Mediterranean Spotted (Boutonneuse) Fever: Tick-borne; reported most commonly in the Black Sea coastal areas of the Caucasus, Transcaucasus, and the Crimea, and along the Caspian Sea coastline.

Mushroom Poisoning: As of 1 Nov 2008, there are about 100 people in hospitals in Georgia who have suffered from mushroom intoxication. Cases of mushroom poisoning have been seen in Borjomi, Khashuri, Sachkhere, Chiatura, Zestaphoni and Kvarel. Three children died, and more than 50 people are also in critical condition in hospitals in Tbilisi in connection with mushroom poisoning. They were delivered to Tbilisi from the Khashaursky district. Physicians say that the poisonings were caused by one specific type of mushroom that has not yet been identified. Physicians warn the public not to consume unknown mushrooms.
Source: ProMED Nov 2, 2008.

Other Diseases/Hazards: Anthrax (sporadic human cases occur, related to exposure to livestock in rural areas, especially southern areas)
• Brucellosis (this disease has spread among cattle in the Lagodechi region which borders on Azerbaijan and has also infected 26 people. Source: ProMED-mail 20 September 2007)
• North Asian tick typhus (also called Siberian tick typhus; occurs in the steppe areas bordering Kazakhstan, Georgia, and Azerbaijan; risk elevated May–June)
• Opisthorchiasis (acquired from consumption of raw freshwater fish; reported from western European Russia)
• Plague (flea-borne; usually occurs as isolated cases or small outbreaks in semi-arid areas of the southern republics of Azerbaijan, Armenia, and Georgia)
• Tick-borne relapsing fever,
• Trichinosis

Rabies: Seven cases of human rabies were reported in 2007. 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. Note: If adequate rabies treatment is not available locally, medical evacuation is mandated to a facility that can provide treatment.

Tick-Borne Encephalitis (TBE): Tick-borne encephalitis is transmitted from the Baltics to the Crimea by ixodid ticks. Peak transmission period is April through October. Risk is present primarily in rural brushy and forested areas below 1,500 meters elevation. Highly enzootic foci occur throughout the Urals and much of the northern, forested mountainous areas, including
suburban “forests” bordering large cities. Highest number of indigenous cases are reported from the south-central areas, including Altay, Kemerovo, Novosibirsk Oblasts, and Krasnoyarsk Kray. Co-infection with Lyme disease is increasing. Travelers to endemic areas should take measures to prevent tick bites.

Travelers' Diarrhea: High risk outside of first-class hotels. All water supplies in Georgia are suspect, including municipal tap water, which may be untreated and grossly contaminated. 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 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.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working ineastern 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.