Time Zone: is local time. No daylight savings time in 2008.
Tel. Country Code: 225
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Ivory Coast
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 Ivory Coast
• U.S. Embassy
Riviera Golf neighborhood
Tel;  22-49-40-00
• Canadian Embassy
Immeuble Trade Centre
23 Avenue Nogues, Le Plateau
Tel:  20-30-07-00
Fax:  20-30-07-20
The British Embassy in Abidjan no longer handles visas or routine consular matters. All enquiries should be addressed to the British High Commission in Accra, Ghana.
• British High Commission
Gamel Abdul Nasser Avenue
Tel:  (21) 221665
Fax:  (21) 7010655
HIV Test: Not required.
Required Vaccinations: Travelers >1 year of age entering the country from an endemic area are required to present a certificate of immunization against yellow fever.
Passport/Visa: Cote d'Ivoire (Ivory Coast) is a developing country on the western coast of Africa. The official capital is Yamoussoukro, but Abidjan is the largest city, the main commercial center, and where the Ivorian government and the U.S. Embassy are located. Cote d'Ivoire is a republic whose constitution provides for separate branches of government under a strong president.
The country has experienced continued, periodic episodes of political unrest and violence, sometimes directed against foreigners, since 2002 when a failed coup attempt evolved into an armed rebellion that split the country in two. Ivorian President Laurent Gbagbo and New Forces leader Guillaume Soro signed the Ouagadougou Political Agreement (OPA) in March 2007 and a new government was formed with Soro as Prime Minister. Implementation of the accord has been slow and although the political situation has improved, it still has not returned to normal. UN and French peacekeepers remain in the country.
Tourist facilities in and near Abidjan, the commercial capital, are good; accommodations in many other locations are limited in quality and availability.
ENTRY/EXIT REQUIREMENTS: A passport is required, but U.S. citizens traveling to Cote d'Ivoire for business or tourism do not require visas for stays of 90 days or less. To stay longer than 90 days, the visitor may still enter without a visa, but then must apply for a "visa de sejour" at the National Police Headquaters within 90 days of arrival. An international health certificate showing current yellow fever immunization is required for entry into Cote d'Ivoire. Without it, the traveler may be required to submit to vaccination at the airport health office before clearing immigration, at a cost of 5,000 CFA (a little over $10). Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Cote d'Ivoire, 2424 Massachusetts Avenue NW, Washington, DC 20007, telephone (202) 797-0300. There are honorary consulates for Cote d'Ivoire in San Francisco, Stamford, Orlando, Houston and Detroit. Overseas, travelers should inquire at the nearest Ivorian embassy or consulate.
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.
Meningococcal (Meningitis): 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.
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.
• 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 is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major hotels.
Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES. Vaccination should be administered at least 10 days prior to arrival in order for the certificate of vaccination to be valid. Vaccination is recommended for all travelers >9 months of age.
Hospitals / Doctors
Abidjan has privately-run medical and dental facilities that are adequate but do not fully meet U.S. standards. Good physician specialists can be found, though few speak English. Medical care in the Ivory Coast outside of Abidjan is extremely limited.
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 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 a hospital in South Africa or Europe.
A U.S. Embassy list of medical providers is here: http://abidjan.usembassy.gov/recommended_local_medical_providers.html
• Hopital de Port Bouet
Tel:  2127 85 00
• Polyclinique Internationale Sainte Anne-Marie
Avenue Joseph Blohorn
Tel:  22 44 51 32
General medical/surgical facility; emergency room; dialysis; heliport.
• Institut de Cardiologie
Tel:  2125 81 29
Destination Health Info for Travelers
AIDS/HIV: Heterosexual contact is the predominate mode of transmission of HIV in sub-Saharan Africa. People in sub-Saharan Africa do not have many more lifetime partners than people in other parts of the world. However, researchers have found that in some areas it is not uncommon for people to have two or more regular sex partners at the same time. Someone is most likely to transmit HIV during the period shortly after they are infected, when they have very high levels of virus in their body. Therefore someone who has two or more concurrent partners is more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. This too may help to explain why HIV is more widespread in Africa.
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. In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).
West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Cote dIvoire (7.1%) and Gabon (7.9%). Until recently the national HIV prevalence rate has remained relatively low in Nigeria, the most populous country in sub-Saharan Africa. The rate has grown slowly from below 2% in 1993 to 3.9% in 2006. (Source: www.Avert.org) More statistics are available at: http://www.avert.org/subaadults.htm
• The HIV prevalence in Ivory Coast is relatively high compared to other countries in West Africa. The adult (15-49) prevalence rate is 7.1%.
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 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.
African Sleeping Sickness (Trypanosomiasis): Endemic, but levels are unclear. Risk is reported in central and east-central regions, including Dalao, Vavoua, Bouafle, and Abengourou.
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.
Avian Influenza A (Bird Flu): The World Health Organisation (WHO) has confirmed several cases of avian influenza (Bird Flu) in two separate locations in the capital Abidjan, affecting domestic birds and a wild sparrow hawk. 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.
Cholera: A series of cholera outbreaks was reported in 2006 including an outbreak in Abidjan. Although this disease is sporadically 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.
• 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: Low risk, but two cases were reported in foreigners in 2008. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring throughout the Caribbean. 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.
• You 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 your clothing and gear. There is no vaccination or medication to prevent or treat dengue.
• A world dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
Another map of endemic areas is here: http://www.phac-aspc.gc.ca/tmp-pmv/2008/gfx/dengue080428-eng.gif
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 is endemic in sub-Saharan Africa but the prevalence in this country is unclear. 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 10% 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 in the general population but levels are unclear. 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 year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.
Malaria: Risk is present year-round throughout this country, including urban areas. Increased risk occurs during and immediately after the rainy seasons (April through July and September through December in the south; April through October in the north). P. falciparum accounts for >90% of cases, followed by P. malariae and P. ovale. Chloroquine-resistant falciparum malaria is reported.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended when traveling to malarious areas.
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 Ivory Coast page on the Destinations menu or A-Z Index.
The species of malaria occurring in this country, are, approximately: Plasmodium falciparum, P. malariae and P. ovale with a proportion of 84%, 14% and 2% respectively. The occurrence of P. ovale indicates that a delayed attack of malaria is possible after discontinuation of prophylaxis.
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: Picaridin repellents (20% formulation, such as Sawyer Premium Picaridin 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 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.
Meningitis: An outbreak of meningococcal meningitis was reported in February 2007 from the city of Bouake in the northern part of the country. Outbreaks of meningitis have also been reported from Boundiali as well the department of Tengrela.
• 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.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651
Onchocerciasis: Also called river blindness, this disease is focally distributed along fast-flowing rivers. Studies carried out from July to September 2007 found that 14% of under-5 children in forest areas in southwestern Cote dIvoire suffered from onchocerciasis, a disease previously thought to be eradicated there. Travelers to endemic areas should take measures to prevent blackfly bites.
Other Diseases/Hazards: African tick typhus (This rickettsial disease, caused by R. conorii subsp. conorii, transmitted by ticks, is also known as boutonneuse fever and Mediterranean tick fever in Southern Europe and Africa)
• African tick-bite fever (transmitted by dog ticks and cattle ticks)
• Brucellosis (from consumption of raw dairy products)
• Cutaneous larval migrans
• Dengue (low risk; human incidence not known)
• Filariasis (presumably endemic; incidence not known)
• Lassa fever (virus is present but risk of disease indeterminate)
• Worms (intestinal worms are common)
Poliomyelitis (Polio): This disease is active. Most cases of polio are reported from the rebel-held northern part of the country. Immunization is recommended, due to the persistence of polio in this and other countries in sub-Saharan Africa.
• 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: Sporadic cases of human rabies are reported countrywide, with increased risk in the southeastern department of Abengourou. All animal bites or scratches, especially from a dog, should be taken seriously and immediate medical attention sought. Rabies vaccination may be required. Although rabies is rare among tourists•there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. 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 advised to a facility that can provide treatment.
Schistosomiasis: Urinary schistosomiasis is widely distributed. Major activity occurs in the southeastern (Abidjan, Adzope), central (shores of Lake Kossou), western (Man, Danane), and the northern (Korhogo) areas. Intestinal schistosomiasis is less common and is distributed in the same areas.
• 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: Piped water supplies as well as surface water sources may be contaminated or contain excess total dissolved solids (salts). Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. Outbreaks of diarrheal diseases are common during the rainy season. 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 the Ivory Coast 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 (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working in sub-Saharan Africa, 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: As of January 10, 2010, 10 suspected and 3 confirmed cases of yellow fever and 6 deaths have been reported in Côte d’Ivoire. The cases were reported in the Minignan and Madinani health districts, in the Denguélé region, which is located near the border with Guinea.
Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL countries. Vaccination should be administered at least 10 days prior to arrival in order for the certificate of vaccination to be valid.
• Vaccination is recommended for all travelers >9 months of age.