Travel Tips for Kenya, Updated Intl. Guide – Travel Medicine, Inc.
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Capital: Nairobi

Time Zone: 3 hours. No daylight saving time in 2008.
Tel. Country Code: 254
USADirect Tel.: 0
Electrical Standards: Electrical current 220/50 (volts/hz). United Kingdom Style (3-Pin) Adaptor Plug. Eurpoean-Style 2-Pin Plug.

Travel Advisory - Kenya

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 Kenya

Resource Links

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


U.S Embassy
United Nations Avenue

U.S. Citizen Services

American Citizen Services unit provides information and assistance to U.S. citizens visiting or living in Kenya.

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from travellers over 1 year of age coming from countries with risk of yellow fever transmission. Vaccination should be given at least 10 days before travel for the vaccination certificate to be valid.

Passport Information

Passport/Visa: ENTRY REQUIREMENTS: A passport and visa are required. Visas should be obtained in advance, although airport visas are available. Travelers who opt to obtain an airport visa should expect delays upon arrival. There is a fee for the visa, whether obtained in advance or at the airport. Evidence of yellow fever immunization may be requested. Travelers to Kenya and neighboring African countries should ensure that the validity of their passports is at least six months, and that their passport contains sufficient blank pages for visas and immigration stamps.

Travelers may obtain the latest information on visas as well as any additional details regarding entry requirements from the Embassy of Kenya, 2249 R Street, N.W., Washington, DC 20008, telephone (202) 387-6101.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age.

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; when receiving medical or dental injections, or transfusions; by direct contact between open skin lesions. Recommended for 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): Vaccination with a quadrivalent vaccine (Menactra or Menomune in the US) is recommended for those travelers anticipating close, extended contact with the indigenous population.
We recommend that travellers to sub-Saharan Africa during the highest risk times of December to June should be vaccinated against the disease. The vaccine is a single injection that gives a minimum of 3 years of protection.

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: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites, especially bites from dogs. 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 in the event of exposure, but does not eliminate the need for treatment with two extra booster doses of vaccine.

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.

Measles outbreaks are reported from North Eastern, Nyanza, Rift Valley and Nairobi provinces.
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.

Typhoid: Recommended for all travelers.

Yellow Fever: Yellow fever vaccine is recommended for all travelers >9 months of age. The cities of Nairobi and Mombasa have lower risk of transmission than rural areas. Kenya requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. The certificate of vaccination should be dated at least 10 days before arrival in this country.

Hospitals / Doctors

Adequate medical care is available in Nairobi, though facilities elsewhere are limited. You should be up-to-date on your immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; you should bring drugs for malaria prophylaxis, if needed according to your itinerary. If you are taking regular medications, carry them properly labelled and in sufficient quantity to last for the duration of the trip; do 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. Note: A random survey by the National Quality Control Laboratories and the Pharmacy and Poisons Board found the almost 30% of drugs sold in Kenya are counterfeit. (Source: ISTM NewsShare, May/June 2008)
• Travelers are advised to obtain comprehensive travel insurance with specific overseas and medical evacuation 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 a more advanced medical facility in Nairobi, South Africa or Western Europe.

Guide to hospitals, physicians, dentists, hospitals, pharmacies and ambulance services in Kenya

Flying Doctors Service

AMREF Flying Doctors Service operates 24hours/day, 365 days of the year through its control centre located at Wilson Airport in Nairobi. Highly qualified medical staff and aircrew are on standby to respond to emergencies . The Flying Doctors Service provides air evacuation service in medical emergencies as well as air ambulance transfers between medical facilities. In addition, patients can be repatriated to Europe, Asia and North America or medical escort is provided on commercial carriers.

Aga Khan University Hospital
3rd Parklands Ave.

Private hospital providing general medical services, specialist clinics and high-tech diagnostic services. In 2003, it was awarded ISO 9001 accreditation in all its clinical, diagnostic, support and administration services.

Upper Hill Medical Center
Ralph Bunche Road

General medical/surgical facility; Ob/Gyn/kidney dialysis

Aga Khan Hospital
Vanga Road

101 bed general medical/surgical facility with most specialties.

Aga Khan Hospital
Otieno Oyoo Street

The Aga Khan Hospital provides medical, surgical, paediatrics, obstetrics and gynaecology and acute care services.

Diani Beach Hospital

Diani Beach


All medical, surgical, gynecological, trauma and orthopedic emergencies including heart attacks, drowning, road traffic accident, fractures and dislocations. The casualty is well equipped with the latest equipments;
24- hour emergency department.

Destination Health Info for Travelers

A Country Profile: Kenya is the wealthiest nation on the east coast of Africa, serving as a commercial and economic center for the region, and an important hub for trade and transport. Tourism is a major income generator for Kenya.
Kenya’s health infrastructure is relatively well developed. The Kenya Medical Research Institute (KEMRI) is one of the leading medical research centers in Africa. Despite this, 23 percent of Kenya’s 32 million people do not have access to basic health care facilities.
In 2003 UNAIDS and the WHO revised their estimates of HIV prevalence in Kenya downwards to 9.4 percent, much lower than the 15 percent UNAIDS had estimated in 2001. In early 2004 a Kenyan Ministry of Planning and National Development study showed a prevalence rate of 6.7 percent, sparking a debate with UNAIDS over estimates of HIV prevalence in Kenya (sources:, The East African (Nairobi), 1-19-2004; UNAIDS (Kenya page)). As is the case elsewhere in Africa, the HIV/AIDS burden tends to concentrate in urban areas. The HIV/AIDS infection rate in Kenya’s capital city of Nairobi is double the rate in the countryside.
Tuberculosis has made an opportunistic comeback in conjunction with the AIDS epidemic. From a low of 11,000 cases in 1988, tuberculosis cases reached 40,000 in 1997, and 73,000 cases in 2001. The government of Kenya is offering free drugs to combat TB at hospitals throughout the country. Malaria is also a serious public health concern, with over 4.3 million cases reported in 1995.
Kenya is a remarkably young nation, with 70 percent of the population under age 20. It is the youngest adults who are hardest hit by the current AIDS crisis, with 70 percent of HIV positive persons between the ages of 18 and 25. HIV has hit young women much harder than young men, with HIV infection rates among 15 to 19 year old women exceeding 20 percent in some areas of the country, as opposed to 4 percent for men in the same age category. The Medicins Sans Frontieres program in the Lake Victoria region estimates that 35 percent of young women in the area have contracted HIV, and 60 percent of those women have latent, if not active, TB.

Doctors Without Borders/ Médecins Sans Frontières (MSF) has worked in Kenya since 1985:

AIDS/HIV: It is estimated that 6.1% of the adult population, age 15–49, is living with HIV or AIDS. Most experts agree that the vast majority of HIV infections in Africa are the result of unsafe sex, not unsafe injections. (Source:
• 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.
• 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.

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.
• East African Flying Doctor Services have introduced special Tourist Membership which guarantees that any member injured or ill while on safari can call on a flying doctor for free air transport. There are good medical facilities in Nairobi and Mombasa.

Acute Mountain Sickness/HACE/HAPE: Climbers ascending Mt. Kilimanjaro (5,790 m) and Mt. Kenya (5,180 m) are at risk. The typical tourist climbing itinerary for Kilimanjaro, with daily ascents of 1,000 m, leaves no opportunity to acclimatize properly. Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (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 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:
International Society of Mountain Medicine
The Institute for Altitude Medicine
• Everest BC Clinic
• High-Altitude Illness (NEJM)

African Sleeping Sickness (Trypanosomiasis): Sporadic cases are reported, with occasional outbreaks. Disease transmission primarily is restricted to Nyanza Province (with a recognized focus in the Lambwe Valley near Lake Victoria) and Western Province, extending along the Tanzania border into extreme southwestern Rift Valley Province. In 1996 a tourist acquired sleeping sickness in Masai Mara game preserve.

• 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 you 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.
Read more: 

Animal & Marine Hazards: Many species of venomous snakes, including mambas, puff adders, vipers, and cobras are present in this country, especially in the large arid regions of northern Kenya. Consider any snake encountered as dangerous, and do not handle. Seek immediate medical attention if bitten; untreated snakebites may cause serious illness or death within 1 hour.
• Several species of centipedes, scorpions, and black widow spiders, some with potentially fatal venom, are present throughout the region. If possible, avoid sleeping on the ground. Shake out boots, bedding, and clothing prior to use, and never walk barefoot. If bitten or stung, seek medical attention immediately.
• Sea cones, sea urchins, and anemones inhabit the shallow coastal waters of Kenya and may pose a threat to swimmers.

Chikungunya Fever: This is a mosquito-transmitted viral illness that occurs in much of sub-Saharan Africa and is the cause of numerous epidemics. Most cases in Kenya are in the coastal areas. Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. Acute Chikungunya fever typically lasts a few days to several weeks, but as with dengue, West Nile fever, and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. The fatality ate is low.
Note: Chikungunya fever must be considered in travelers who develop fever and arthritis after traveling to areas affected by an ongoing epidemic. Related arthritis mainly affects smaller joints and often persists for extended periods.

• To prevent this disease, take measures to prevent 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.

Cholera: In December 2008 an outbreak caused more than 1400 cases and 13 deaths, mostly from Nyanza Province. Outbreaks of cholera occur on a regular basis in Kenya. Although this disease is active, the threat to tourists is low. Cholera is an 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. 

Crime/Security/Civil Unrest: There are incidents of car-jacking and armed robbery involving foreign nationals in and around Nairobi. You should remain vigilant at all times, particularly at night and on the roads that link Nairobi city centre to residential areas. You should avoid stopping at the side of the road and should drive defensively, with vehicle doors locked and windows closed at all times.
The following Travel Advice has changed or been added since our last update of 22 Dec 2008.

Dengue Fever: The risk of dengue is considered to be low but outbreaks of disease have been reported in coastal areas. Dengue has been documented in neighboring Somalia. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in the Indian sub-Continent. 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.

Dengue fever maps 

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 is is prevalent in sub-Saharan Africa and epidemics have been identified in many countries, including Kenya. 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 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 of 0.9% of the general population carriers of the hepatitis C antibody. 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 who have not had a flu shot in the previous 12 months.

Leishmaniasis: Cutaneous leishmaniasis is reported from the highland areas, including the eastern slopes of Mt. Elgon, the Aberdare Range, the Baringo District and Rift Valley Province. Risk areas for visceral leishmaniasis (kala-azar) include Rift Valley Province (Baringo, West Potok, and Turkana districts), Eastern Province (Machakos, Kitue, and Meru districts) and North Eastern Province. An outbreak was reported from Wajir District in March 2008, resulting in more than 180 cases.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• 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.

Malaria: Malaria occurs year-round with the highest transmission rates during and just after the semiannual rainy seasons, March through May and October through January. Risk is countrywide below 2,500 meters elevation, including urban areas (except Nairobi). In 2006, there was an outbreak of highland malaria in the West Pokot District (north western Kenya) that was associated with several fatalities.
Primary risk areas include Western Province, Nyanza Province (Lake Victoria Basin), Coast Province (including the Tana River Valley and the coastal areas south of Mombasa and Malindi to the Tanzanian border), and southern Eastern Province. Seasonal malaria occurs in the game parks along the border with Tanzania. Transmission is limited in arid areas of the Rift Valley, northern Eastern, North Eastern, and Coast Provinces. Malaria may occur in the highland areas (above 1,600 meters elevation) during and just after periods of exceptionally heavy rainfall. P. falciparum causes 85% of cases, followed by P. malariae and less frequently by P. ovale. Chloroquine-resistant falciparum malaria is prevalent.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6PD test rquired) is recommended.

Malaria map of Kenya

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.

Note: Until recently, DEET-based repellents have been the gold standard against mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% bite protection by using a properly-applied DEET or picaridin skin repellent and wearing permethrin-treated clothing.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.

Meningitis: Risk is seasonally elevated, December through June, in western areas within the sub-Saharan meningitis belt (Western, Nyanza, and western and northern Rift Valley Provinces). In 2006, Kenya‘s health ministry reported fatal cases of meningitis in West Pokot district near the border with Uganda.

• Vaccination with a quadrivalelnt meningitis vaccine is recommended for travel to this area for anyone expecting close contact with the indigenous population or if traveling into an area with a reported outbreak.

Countries in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found here

Other Diseases/Hazards:

• Anthrax (farm workers at highest risk; an outbreaks was reported from Eastern Province in January 2009 and from Meru Central District in January 2006)
• Brucellosis (acquired by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material)
• Echinococcosis (highest known prevalence in the world occurs in the Turkana population in northwest Kenya)
• Filariasis (mosquito-borne; endemic in the coastal zone and along the Sabaki River)
• Kenya tick typhus (caused by Rickettsia conorii, which is also associated with Mediterranean spotted fever, South African tick bite fever, Indian tick typhus, and Israeli tick typhus. Transmitted by dog ticks. Read more:
• Leptospirosis (associated with rodent-infected areas; reportedly widespread around Kisumu and along the coast; leptospirosis outbreak was reported in 2004 in Bungoma district)
• Onchocerciasis (last remaining focus was located on southwestern slopes of Mt. Elgon)
• Plague (outbreak occurred in 1990 in Nairobi‘s Embakasi area)
• Toxoplasmosis
• Tuberculosis (a major health problem)
• Typhoid fever
• Intestinal worms (very common)

O’nyong-nyong Fever: This is a mosquito-transmitted arboviral illness similar to Chikungunya fever. The name comes from the Nilotic language of Uganda and Sudan and means “weakening of the joints.”
Occasional epidemics occur, but fatalities are not reported. Travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.

Poliomyelitis: This disease has been reported in 2006 from northeastern Kenya in Somalian refugees and has re-appeared in other sub-Saharan countries. All travelers to Kenya should be fully immunized against polio. A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult.

Rabies: Risk is increasing in urban areas, including Nairobi. Rabies vaccine is recommended for: all stays of over 3 months; shorter stays at locations more than 24 hours travel from a reliable source of post-exposure rabies vaccine. Consider for shorter stays in travelers desiring maximum protection.
• All animal bites or scratches, especially from a dog, should be immediately cleaned with soap and water and medically evaluated for possible post-exposure treatment.
• Travelers who are at risk after an animal bite and who are unable to receive prompt treatment locally with rabies immune globulin and/or vaccine may need to be evacuated to a facility that can provide treatment.

Rift Valley Fever: In mid-December 2006, fatalities associated with fever and generalized bleeding were reported from Garissa District in North Eastern Province (NEP) and subsequently shown to caused by Rift Valley fever (RVF). Other cases were reported in 2006-2007 from Rift Valley Province, Coast Province, Central Province, and the Eastern Province.
• RVF is an acute, febrile zoonotic disease caused by Rift Valley fever virus. Humans acquire RVF through bites from infected mosquitoes or, more frequently, through exposure to the blood, body fluids, or tissues of livestock that have been bitten by infected mosquitoes. Direct exposure to infected animals can occur during slaughter or through veterinary and obstetric procedures.

• Symptoms include fever (100%), headache (90%), bleeding (76%), muscle pain (60%), back pain (60%), vomiting (60%), and joint pain (50%).
• The most frequently reported RVF risk factors include drinking unboiled (raw); living within 100 meters of a swamp; having an ill animal; drinking milk from an ill animal; working as a herdsman; and slaughtering an animal. About 10% of patients report contact with another ill human.

You should take measures to decrease contact with mosquitoes through use of repellents and bednets and avoid exposure to blood or tissues of animals that might be infected. There is no vaccine to prevent this disease in humans.

Schistosomiasis: Urinary schistosomiasis is widely distributed, including the areas along the coastal plain and the lower Tana River Valley (Coast Province), in the Taveta region (extreme southwestern Coast Province), in Kitui District (Eastern Province), and bordering Lake Victoria (Nyanza Province). Intestinal schistosomiasis occurs primarily east of Nairobi, in the Taveta region bordering Tanzania, in the Nyanza Province bordering Lake Victoria, and on the islands of Rusinga and Mfangano.
• Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. 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, or streams. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: Moderate to high risk outside of first-class hotels and resorts. The public water supply in Nairobi is considered potable.
Although several cities have water treatment facilities, piped water supplies are frequently untreated and may be contaminated. Water- and food-borne diseases are a risk in this country. Water- and food-borne outbreaks of diarrheal disease may occur, especially during the rainy season.
• 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.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
• 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 advice if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis: Tuberculosis is highly endemic in Kenya with an annual occurrence was greater than or equal to 40 cases per 100,000 population. it is a major public health problem, exacerbated by the high incidence of HIV and AIDS in this country. 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.

West Nile Fever: This mosquito-transmitted viral illness is reported mainly from the coastal areas of Lake Victoria and the Indian Ocean. The risk to tourists is low.
• 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.

Yellow Fever: Yellow fever vaccination is required if the traveler is arriving from an endemic zone and >1 year of age. Vaccination is recommended by the CDC for all travelers >9 months of age. Yellow fever is transmitted via the bite of an infected Aedes mosquito (mainly Aedes aegypti). Aedes mosquitoes feed predominantly during daylight hours. The cities of Nairobi and Mombasa have lower risk of transmission than rural areas.

Comment: Vaccination against yellow fever for international travel is regulated under International Health Regulations (IHRs). The IHRs were developed as a legally binding public health measure to protect countries against the introduction of disease. The regulationws were not designed primarily to protect the individual traveler, although this may be desirable. Before 1992 and since 1997, there have been no reported cases of yellow fever in Kenya. The first outbreak of yellow fever near Baringo between 1992 and 1993 led to a total of 72 cases being subsequently identified. Enhanced serosurveillance during 2004, undertaken well after the outbreak in coastal Kenya, did not detect presence of the virus in circulation. Because the incidence of adverse side effects leading to seriuous injury or death from yellow fever vaccination is 1:50,000 in travelers >age 60, some travel medicine experts now question the wisdom of routinely vaccinating travelers to this country. Source: Behrens, R., Journal of Travel Medicine, Sept. 2008.