Time Zone: +1 hour.
Tel. Country Code: 39
USADirect Tel.: 800
Electrical Standards: Electrical current is 230/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, I.
Travel Advisory - Italy
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 Italy
• U.S. Embassy
Via V. Veneto 119/A
Tel:  (6) 46741
Fax:  (6) 4674-2217
Tel:  239-8276 or 217-605
• Canadian Embassy
Via Zara 30
Tel:  (6) 445-981
Fax:  (6) 445-982912
Via XX Settembre 80a
Tel:  (6) 4220-0001
Fax:  (6) 487-2334
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Italy is a developed democracy with a modern economy. The Holy See is a sovereign entity that serves as the ecclesiastical, governmental and administrative capital of the Roman Catholic Church, physically located within the State of the Vatican City inside Rome, with a unique, non-traditional economy. San Marino is a developed, constitutional democratic republic, also independent of Italy, with a modern economy. Tourist facilities are widely available.
ENTRY REQUIREMENTS: A valid passport is required. Italian authorities may deny entry to travelers who attempt to enter without a valid passport. A visa is not required for tourist stays up to three months. However, for all other purposes, such as work, study, etc., a visa is required and must be obtained from the Italian Embassy or Consulates before entering Italy. For further information concerning visas and entry requirements for Italy, travelers may contact the Embassy of Italy at 3000 Whitehaven St NW, Washington, DC 20008, or via telephone at (202) 612-4400.
Internet: http://www.ambwashingtondc.esteri.it/ambasciata_washington, or Italian Consulates General in Boston, Chicago, Detroit, Houston, Los Angeles, Miami, Newark, New Orleans, New York, Philadelphia, or San Francisco, accessible through the above Internet site.
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; 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. MMR protection is especially important for any female of childbearing age who may become pregnant.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.
Hospitals / Doctors
Medical facilities are available, but may be limited outside urban areas. Public hospitals, though generally free of charge for emergency services, sometimes do not maintain the same standards as hospitals in the United States, so travelers are encouraged to obtain insurance that would cover a stay in a private Italian hospital or clinic.
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 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 travel insurance that provides for medical evacuation to a more advanced medical facility in the event of serious illness or injury.
The U.S. Embassy maintains a listing of doctors and hospitals in the major cities in Italy at:
Decompression chambers are located near all diving resorts and in major hospitals throughout Italy.
Medical facilities used by travelers include:
• International Medical Center
via Giovanni Amendola 7
Tel:  (6) 488 2371
During night or weekends: Tel: 4884051.
They have a 24-hour doctor on duty (English spoken). They can send a qualified and dedicated GP to visit you in your apartment or hotel anywhere in Rome. They charge a fee (for a GP 140 Euros, with 50 Euros night and holiday supplement, specialist 160 Euros, same night and holiday supplement). They can possibly contact other specialists, and make them visit you at your apartment or hotel.
Via Salaria 300
Palazzina C, interno 5
Tel:  (6) 8840113
They can arrange for qualified doctors to make a call to your actual place of residence. The GP will possibly refer you to a specialist if needed. Fees begin from 100 US$ per visit, and can increase if a specialist or specialized treatment is required.
• Rome American Hospital
Via Emilio Longoni 69
Tel:  (6) 22551
Physicians on duty 24 hours.
• Salvator Mundi International Hospital
Viale delle Mura Gianicolense 67
Tel:  (6) 588961
This is a privately run clinic, with English-speaking doctors. Convenient to Janiculum or Trastevere.
Via Mercalli 11
Tel:  (2) 58319808
Fax:  (2) 58316605
Cell: 335 5701055
• Milan Medical Center
Via Angelo Mauri 3
Tel:  (2) 43990401
Fax:  (2) 43989800
• Dr Stephen Kerr MB, MS (Lond)
Via Porta Rossa 1
Tel:  055-288055
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 intercourse accounts for a growing proportion of cases. In several countries in Western Europe, including the United Kingdom, heterosexual contact is the most frequent cause of newly diagnosed infections. It is responsible for the largest proportion of diagnosed HIV infections in every country except Germany, Greece and the Netherlands, in which men who have sex with men (MSM) form the largest transmission group. Heterosexual transmission predominates even in Portugal, which has a particularly severe HIV epidemic among injecting drug users. Heterosexual transmission often occurs in immigrants from countries with a high prevelence of HIV. According to UNAIDS estimates, the largest numbers of people living with HIV in Western Europe in 2007 were in Italy, Spain and France. In Italy, the prevalence of HIV in the adult population is estimated to be 0.5%. (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.
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.
• 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.
Health insurance is essential.
Avian Influenza A (Bird Flu): Avian influenza A (H5N1) has been confirmed in this country in migratory birds, but not in poultry. The last case in birds was reported in March 2006.
• 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.
Chikungunya Fever: Italian Health authorities in Sept 2007 reported cases of chikungunya fever in the province of Ravenna, Emilia-Romagna, in northeast Italy. This represents the first time that local transmission of chikungunya virus through mosquitoes has been detected in Europe. The first case of chikungunya fever was apparently imported to Italy from a local resident who had traveled to India during a chikungunya fever epidemic.
• Chikungunya fever is a viral disease spread to people by the bite of infected mosquitoes, including the Aedes aegypti and Ae. albopictus species. Symptoms can include sudden onset of fever, chills, headache, nausea, vomiting, joint pain with or without swelling, low back pain, and rash. The symptoms are very similar to those of dengue, but, unlike dengue, there is not usually any hemorrhagic (bleeding) or shock syndrome form. This disease almost always resolves on its own and is rarely fatal.
• All travelers should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying an insect repellent (DEET most effective) to exposed skin and applying permethrin spray or solution to clothing and gear.
Dirofilariasis: Italy is the European country with the highest prevalence of human dirofilariasis, with cases reported from Monferrato, Torino, Allessandria, Vercelli, and Pavia. Human subcutaneous dirofilariasis is a rare infection caused by filarial worms. The parasites are transmitted by mosquitoes. Dogs are the usual reservoir of the parasite. The infection is usually manifested as subcutaneous nodules, but occasional lungs nodules are discovered, necessitating excisional biopsy.
Hepatitis: An increased risk of hepatitis A occurs in the south and on the islands of Sicily and Sardinia. 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 at low levels; the reported prevalence of anti-HEV IgG positivity ranges from 0.74% to 1.94%. 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 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.
• Hepatitis B is endemic at low levels. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at <2%. 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 low level, with a prevalence of 0.4% 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.
Leishmaniasis: Cutaneous and visceral leishmaniasis occur in southern rural areas, including the islands of Sardinia and Sicily and along the Mediterranean coast; risk from visceral leishmaniasis is elevated in Sicily and the Campania Region. Transmission occurs May through November, peaking in July–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.
Lyme Disease: Risk areas for Lyme disease are limited primarily to northern Italy—along the Ligurian coast, and the Adriatic coast. 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: Anthrax (animal cases reported in 2004 from mountainous areas in the south), brucellosis (cattle, sheep, and goats are the most common sources of infection; incidence declining in most areas, but hundreds of cases still reported annually from the southern regions, including Sicily, Calabria, Puglia, and Campania)
• Echinococcosis (elevated risk in the south and on Sardinia)
• Hemorrhagic fever with renal syndrome
• Q fever
• Sandfly fever
• Trichinosis (caused by eating imported horse meat or imported sausagestularemia (exposure to wild boar meat and uncooked pork)
• Toscana virus (common cause of aseptic meningitis between May and October), tulremia, and West Nile Virus.
• Legionnaire’s disease reported in tourists who have visited the Island of Ischia (near Naples). The source of the infection is thought to be contaminated water supplied by hotels; municipal thermal baths were another possible source of infection)
• Meningitis (Two clusters of serogroup C meningococci occurred in a group of seven adolescents/young adults and in three adults in two different but bordering Italian regions, Veneto and Lombardy, in December 2007 and in July 2008, respectively)
Rabies: Outbreak of fox rabies reported: Eurosurveillance reports that in October 2008, two foxes were diagnosed with rabies in the Province of Udine, north-east Italy, near the Austrian border. One case of human exposure caused by a bite from one of the foxes occurred and was properly treated. Until now, Italy had been classified as rabies-free since 1997.
• All unprovoked animal bites should be thoroughly cleansed with soap and water and medically evaluated for possible post-exposure treatment.
Read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19033
Strongyloidiasis: There is a reported reemergence of strongyloidiasis in Northern Italy in 2008. Sources of infection are filariform strongyloid larvae present in soil contaminated by infected feces; the larvae penetrate through the skin of a human host. After the first life cycle, a process of autoinfection begins, which persists indefinitely in the host if the infection is not effectively treated. The infection can remain totally asymptomatic for many years or forever or cause cutaneous (itching and rash), abdominal (epigastric pain, pseudoappendicitis, diarrhea), respiratory (cough, recurrent asthma), and systemic (weight loss, cachexia) symptoms that can be enervating. More importantly, when host immunity is impaired because of a concurrent disease or immunosuppressive therapy (including corticosteroids, sometimes used to treat symptoms of the unrecognized infection or the concurrent eosinophilia), disseminated strongyloidiasis may occur, causing a massive and almost invariably fatal invasion of virtually all organs and tissues by filariform larvae and even adult worms, often combined with bacterial superinfection. This complication is believed to be rare but is probably underestimated because of the extreme variability of the clinical presentation.
• In 1988, 118 cases of S. stercoralis infection were detected by stool examination among 4203 patients seen over a period of three years at the Division of Infectious Diseases (IRCCS, San Matteo, University of Pavia) of a University Hospital in Northern Italy.
Read more: http://www.cdc.gov/eid/content/15/9/1531.htm
• Strongyloidiasis (cattle, sheep, and goats are the most common sources of infection. Cases are still reported annually from the southern regions, including Sicily, Calabria, Puglia, and Campania).
Tapeworm Infection: Six cases of tapeworm (Diphyllobothrium latum) infection have been reported from Lake Como. All those infected had eaten raw or smoked perch filets. Re-emergence of the parasite may be attributed to improvement in pollution levels, resulting in increased population of perch-the major intermediate host of the parasite. During the past 30 years, there have been only sporadic reports of human D. latum infection, all of which came from the Northern lakes area of Italy, southern Switzerland, and France.
Tick-Borne Diseases: Lyme disease, boutonneuse fever (Mediterranean spotted fever), and ehrlichiosis are reported. Risk areas for Lyme disease are limited primarily to northern Italy—along the Ligurian coast, and the Adriatic coast.
• Boutonneuse fever occurs countrywide in rural areas but is more common along the Ligurian coast and the islands of Sicily and Sardinia. (http://www.emedicine.com/derm/topic759.htm)
• Ehrlichiosis (now called human granulocytic anaplasmosis) has been reported from Sardinia and from the northeastern Alpine area. (http://www.cdc.gov/ncidod/eid/vol4no4/nuti.htm)
• Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, 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.
Tick-Borne Encephalitis (TBE): There is a risk of TBE in some areas of the country below 1,400 meters elevation. TBE is reported around Florence, in rural or forested areas near the Swiss border, and from the Trento and Belluno area, with increased risk in the spring or summer. Vaccination against TBE should be considered by those camping near forests, for extended hiking and camping in rural endemic areas, and for forest workers. The European vaccine (FSME-IMMUN-Baxter) is available in health clinics in Europe, as well as Canada, but the administration of vaccine is generally impractical for the average traveler. Tick-bite protection is therefore essential.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, which is generally March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
More information on TBE at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/TBE.htm
Travelers' Diarrhea: Low risk in major cities, such as Rome, Milan, and Verona, where the water supplies are adequately treated. Higher risk exists in the south and on the islands of Sicily and Sardinia. A quinolone antibiotic, 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. Amebiasis is uncommon in Italy. Cryptosporidiosis is reported.
West Nile Virus: For the first time in Italy, two patients with meningoencephalitis were diagnosed with West Nile virus (WNV) infection in September 2008. The patients live in the Bologna and Ferrara provinces of Emilia Romagna where WNV infections had previously been noted in horses, crows and magpies. To prevent this disease, travelers should take precautions against daytime biting mosquitoes.
Case report: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19002