Guam (U.S. Territory)
Time Zone: +10 hours.
Tel. Country Code: 671
USADirect Tel.: 1
Electrical Standards: Electrical current is 110/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug A.
Guam is a territory of the United States. It is located in the Mariana Islands, approximately 1,300 miles east of the Philippines.
Canadian and U.K. diplomatic contacts are handled by their embassies in Washington, DC
• Canadian Embassy
501 Pennsylvania Avenue, N.W.
Washington, D.C. 20001
Tel:  202-682-1740
Fax:  202-682-7689
• U.K. Embassy
3100 Massachusetts Avenue, NW
Washington, DC 20008
Tel:  202-588-6500
Fax:  202-588-7870/50
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Passports are required by all travelers except U.S. citizens entering Guam from the U.S. mainland or a U.S. territory, provided they hold proof of citizenship and valid photo ID card. Visa requirements for Guam are the same as for mainland USA; travelers from Canada and the UK may travel visa free under the US Visa Waiver Program.
The Northern Mariana Islands, together with Guam to the south, compose the Mariana Islands. Guam, officially the Territory of Guam, is an island in the Western Pacific Ocean and is an organized unincorporated territory of the United States. It is one of five U.S. territories with established civilian government. The island's capital is Hagatna (formerly Agana). Guam is the largest and southernmost of the Mariana Islands.
As the largest island in Micronesia and the only American-held island in the region before World War II, Guam was occupied by the Japanese between December 1941 and July 1944. Today, Guam’s economy is mainly supported by tourism (primarily from Japan) and U.S. military bases.
After the war, the Guam Organic Act of 1950, which established Guam as an unincorporated organized territory of the United States, provided for the structure of the island's civilian government, and granted the people United States citizenship.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: 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.
Japanese Encephalitis: The vaccine is recommended for persons living in endemic and epidemic areas and for at-risk travelers planning extended trips (arbitrarily defined as 30 days) to rural areas. Persons visiting areas with active epidemic Japanese encephalitis should be considered for vaccination even if their projected stay is less than 30 days. Vaccination for persons staying fewer than 30 days may be considered if they expect unprotected nighttime outdoor exposure in endemic areas.
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
Adequate medical care is available in Agana but is not up to the standards of industrialized countries. Medical care is substandard in the rest of the country.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics (a quinolone is preferred) 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 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, including air ambulance medevac. In the event of a serious illness or injury that can’t be treated locally, every effort should be made to arrange medical evacuation to Hawaii or Japan.
• Guam Memorial Hospital
850 Gov. Carlos G. Camacho Road
Tel:  647 2555
Medical care at the Guam Memorial Hospital (208 beds) includes adult and pediatric medical services; inpatient and outpatient surgery; intensive care (neonatal, pediatric and adult); blood bank; radiology, nuclear medicine and CT scan, pharmacy, respiratory care; renal dialysis; and 24-hour emergency services. Other modalities available on site includes MRI and a cath lab. Cardiac diagnostic studies can also be performed at GMH then reviewed by a cardiac intervention list or surgeon for possible treatment.
• Pacificare Health Center
548 S. Marine Corps Dr. 9
Tel:  646-5825
There are many other private clinics on Guam offering a variety of services.
Destination Health Info for Travelers
AIDS/HIV: A small number of AIDS cases and HIV infections have been reported, but little data are available from Guam. The over-all prevalence of adults living with HIV in Oceania is 0.4%.
• 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.
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.
Avian Influenza A (Bird Flu): There are no reports of avian influenza in this country.
Cholera: A case of cholera has recently been confirmed in a 6-year-old child. The child and his family had traveled to Saipan, Northern Marianas for a family event the weekend before becoming ill. Neither Guam nor the Northern Mariana Islands has observed an increase in diarrheal illnesses or detected additional possible cholera cases. 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: Sporadic cases occur but no recent outbreaks have been reported. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Oceania. 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 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. 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population is elevated at 5.5%–15%. 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 but levels are unclear. The prevalence in neighboring Micronesia is 1.6% 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.
Japanese Encephalitis (JE): Rare outbreaks occur in Guam and Saipan. The Centers for Disease Control and Prevention (CDC) recommends JE vaccination for travelers spending more than 30 days in an endemic environment, or less than 30 days in areas with epidemic transmission. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodation and purpose, as well as local geography, is warranted to give adequate advice. Is travel occurring during the peak transmission season (September to January). In general, travelers to rural areas (especially where there is pig rearing and rice farming) should be vaccinated if the duration of their trip exceeds 3 to 4 weeks. They may consider vaccination for trips of shorter duration if more intense exposure is anticipated, especially during unprotected outdoor activities in the evening. Vaccination is advised for expatriates living in this country.
• Japanese encephalitis is transmitted by night-biting Culex mosquitoes. All travelers should take measures to prevent mosquito bites, especially in the evening and overnight. 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.
Malaria: There is no risk of malaria in this country.
Marine Hazards: Swimming related hazards include jellyfish, spiny sea urchins, corals, sharks, and sea snakes.
• Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking.
Rabies: Guam is currently deemed rabies-free, but there is little surveillance. Prompt medical evaluation and first-aid treatment of any animal bite is essential, regardless of vaccination status. If treatment with rabies vaccine/immune globulin is deemed advisable, medical evacuation may be required.
Travelers' Diarrhea: Food and water are safe in the major hotels. A quinolone antibiotic (Floxin or Cipro), or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of acute diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease, such as giardiasis or cryptosporidiosis.
Tuberculosis (TB): Tuberculosis is moderately endemic in Guam with an annual occurrence was greater than or equal to 25 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 Oceania, 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.