Time Zone: +6 hours. No daylight savings time in 2008.
Tel. Country Code: 996
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Kyrgyzstan
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 Kyrgyzstan
• U.S. Embassy
99/97A Furmanova Street
Tel:  3272-63-39-21; 3272-50-76-27
• Canadian Embassy
34 Karasai Batir Street (Vinogradov St.)
Tel:  3272-50-11-51
• British Embassy
62, Kosmonavtov Street
Renco Building, 6th Floor
Tel:  3172-55-62-00
HIV Test: Foreign visitors (except nationals of CIS countries) staying in Kazakhstan for longer than 3 months may be required to take an HIV test.
Required Vaccinations: A yellow fever vaccination certificate is required from travellers coming from infected areas.
Passport/Visa: Kazakhstan is a constitutional republic with a strong presidency and a market economy. Kazakhstan's tourist facilities are not highly developed; the availability of goods and services is better than in most neighboring countries, but not up to the standards found in North America and Western Europe. Internal travel and travel to neighboring countries, by air and land, can be subject to delays due to infrastructure shortcomings and winter weather.
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. The Embassy of Kazakhstan in Washington, D.C. and the Consulate of Kazakhstan in New York issue visas. The Embassy of Kazakhstan is located at 1401 16th Street N.W., Washington, D.C. 20036, telephone (202) 232-5488 or 550-9617, fax (202) 232-5845 and the Consulate at 866 United Nations Plaza, Suite 586 A, New York, N.Y. 10017, telephone (212) 230-1900 or 230-1192, fax (212) 230-1172. As of February 2004, an invitation is no longer required for single-entry business and tourist visas, but multiple-entry visas require an invitation from an individual or organizational sponsor in Kazakhstan. The U.S. Embassy in Astana and the U.S. Embassy Branch Office in Almaty do not issue letters of invitation to citizens interested in private travel to Kazakhstan. All travelers, even those simply transiting Kazakhstan for less than 72 hours, must obtain a Kazakhstani visa before entering the country. Travelers should be aware that overstaying the validity period of a visa will result in fines and delays upon exit. Travelers may be asked to provide proof at the border of their subsequent travel arrangements. Travelers transiting through Kazakhstan are reminded to check that their visas allow for a sufficient number of entries to cover each transit trip and to check the length of validity of the visa. Crossing the land border to and from the neighboring Kyrgyz Republic can result in delays or demands from border officials to pay fines.
Registration of American passports is conducted at the same time as the issuance of the visa in one of Kazakhstan’s embassies and consulates abroad or at the time of a border crossing. Americans are not required to register in Kazakhstan upon arrival at a local office of the Department of Migration Police. All registrations are valid for three months, regardless of where they are issued. To extend your registration beyond three months, please contact your local office of the Department of Migration Police. However, if you are not sure if you have been properly registered at the time of visa issuance or border crossing, please contact your local office of the Department of Migration Police.
In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points. These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian if not present. Having such documentation on hand, even if not required, may facilitate entry/departure. All children adopted in Kazakhstan after May 2003 must obtain exit stamps from both the Ministry of the Interior and Ministry of Foreign Affairs before departing the country.
Visit the Embassy of Kazakhstan’s website at http://www.kazakhembus.com for the most current visa information.
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 who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes; from unscreened blood transfusions; from contact with open skin sores of another person. Recommended for any traveler requesting protection against hepatitis B.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Rabies: Recommended for travelers spending time in remote locations, or outdoors in rural areas where there is an increased the risk of animal bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for additional treatment with rabies 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.
Typhoid: Typhoid vaccine is recommended for all unvaccinated people traveling to or working in Central Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.
Hospitals / Doctors
Medical care in Kazakhstan is limited and well below North American and Western European standards. Basic medical supplies, including disposable needles, anesthetics, and antibiotics can be in short supply.
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; may be of dubious origin; 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, you should be flown by air ambulance to a medical facility in Western Europe
• International SOS Clinic
11 Luganskovo Street
Tel:  272 581 911
Fax:  272 581 585
Comprehensive family-centered care and emergency medical assistance on a 24-hour basis. Each clinic has its own laboratory, x-ray facilities, pharmacy, emergency rooms and ambulances and is staffed with expatriate and English-speaking doctors.
• International SOS Clinic (Atyrau)
River Palace Hotel
55, Aiteke bi Street
Tel:  122 586 911
Fax:  122 586 211
24-hour emergency services. English-speaking personnel. Same services as the Almaty SOS clinic.
• Most expatriates go to the VIP Hospital in Almaty (Tel: 616-789, 613-888).
Other facilities: There is a large network of hospitals, emergency centres and pharmacies. The largest include the Central Hospital, the Maternity and Childhood Institute Clinic and the Medical Teaching Institute Clinic in Almaty, and the Spinal Centre and Hospital of Rehabilitation Treatment in Karaganda. However, standards within the public healthcare system have declined significantly since the Soviet era. It is hard to ascertain the level of expertise of the doctors, and visitors cannot rely on the availability of western medicines.
Destination Health Info for Travelers
AIDS/HIV: Kazakhstan has more cases of HIV/AIDS than in its four neighboring countries. Registered cases have almost doubled each year since 2000. Sentinel surveillance conducted in 2003 has shown prevalence levels of 3.8% in injecting drug users and 4.6% in sex workers but there are no data concerning men who have sex with men.
All provinces now have confirmed HIV+ cases. The worst affected regions are Karaganda, Pavlodar and Kostanay, and Almaty city. Young people, especially young men, have been disproportionately affected. Over half the infected people are between 20-29 years, almost 90% are between 15-39 years, and almost 80% are men. The most common mode of transmission is contaminated syringes and needles. There are 43 thousand registered drug users although the true number is probably five times greater. The virus is concentrated among unemployed youth and prisoners.
The countries of Central Asia (Kazakhstan, Uzbekistan, Turkmenistan, Kyrgyzstan and Kazakhstan) lie along the corridor through which much of the hard drug trade from Afghanistan, Pakistan, and Central Asia itself, is conducted. This region is a critical drug trafficking route, with cities on the route having some of the highest registered rates of HIV in Central Asia. The cities of Timertau (Kazakhstan), Yangi Yul (Uzbekistan), and Osh (Kyrgzstan) have some of the highest documented rates of HIV in Central Asia.
Poverty is fueling the drug trade and the narcotics industry has become deeply embedded in the economy of the region. As incomes from agriculture all but disappeared, the local population became increasingly involved in the drug trade as couriers, local distributors, and users. One report on Tajikistan found that 30% of the population is dependent on the illicit drug business. There are reports of women serving as drug couriers in exchange for food to feed their families and of payment for services in drugs rather than cash.
Poverty is fostering not only an increase in drug use but also more risky behavior. Now, access to more potent drugs is becoming both easier and cheaper, and people are switching from the more expensive vodka to cheaper heroin, and heroin users are starting to switch from smoking or snorting to injection.
Also, a culture of fear is driving drug users underground where they can spread the HIV virus undetected. Drug users often face arrest/persecution from police when they try to access services, even when they are drug-free. Control of a potential HIV epidemic that is concentrated amongst injecting drug users requires that drug users have access to service providers --clinics to treat STIs, harm reduction or needle exchange programs, and treatment centers to treat the drug addiction.
Sources: www.avert.org/ecstatee.htm and the World Bank
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.
Acute Mountain Sickness (AMS)/Altitude Illness: Kazakhstan is characterized by vast steppes in the center and west, a large desert and dead sea in the south, and the Caspian Sea to the west. The Pamir, Tien-shan and Altai Mountain ranges rise in the east (they are actually a spur of the Himalaya and include Peak Pobeda (7439 m), Khan Tengri (7010 m), Peak Lenin (7134 m) and Talgar Peak (5017 m). The mountains of the Northern Tien Shan are as spectacular as the Himalayan’s to the south.
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you do not have a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 - 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75% effective. It may also reduce the risk of HAPE.
• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE)—recognized by confusion, difficulty with balance and coordination, staggering gait. Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also will prevent HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent.
Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
• High-Altitude Illness (NEJM) http://content.nejm.org/cgi/content/extract/345/2/107
Arboviral Diseases: Tahjna virus fever (mosquito-borne; virus circulates through much of the former USSR), sand fly fever (sand fly-borne; limited to regions of southern central Asia, April–October), West Nile fever mosquito-borne; cases have occurred in the Tadzikstan), North Asian tick fever (caused by Rickettsia sibirica; occurs wherever tick vectors are found; similar to Rocky Mt. Spotted Fever found in the U.S.).
• All travelers should exercise insect-bite prevention measures. These 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.
Avian Influenza (Bird Flu): There were reports of outbreaks of bird flu around Northern Kazakhstan in July and August 2005 and in the Caspian Sea region in January 2006. The Kazakh authorities believe that the situation is now under control and preventive measures are in place. No human infections or deaths have been reported.
• H5N1 avian influenza 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 H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.
The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. 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 H5N1 cases.
• More information is here: http://content.nejm.org/cgi/content/full/358/3/261
• The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm
Brucellosis: On 9 June, 2009 ProMED reported brucellosis in 30 people and 2000 cattle in the Atyrausky area of Kazakhstan. Among the reasons for this situation are low veterinary supervision over agricultural animals and the sanitary-and-hygienic control of the dairy production, insufficient volume of preventive actions, in particular, vaccination among the persons entering into group of risk, and agricultural animals. Improvement of quality of brucellosis diagnostics in the republic has led to sharp growth of detectability of this disease among animals and, as a consequence, to diagnosing it in the people who had direct contact to them.
• You should avoid unpasteurized dairy products when visiting this country.
Cholera: Cases of cholera have been reported in this country, but most travelers are at low risk for infection. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Crimean-Congo Hemorrhagic Fever: There were 5 cases of Crimean Congo hemorrhagic fever reported in 2007. A single fatal case occurred in the village of Bidaykol. Crimean Congo hemorrhagic fever (CCHF) is caused by a virus and is transmitted by tick bite or by exposure to blood or secretions from infected animals or humans. Symptoms include fever, headache, chills, muscle aches, vomiting, red rash (which does not fade when pressed under glass), and sometimes bleeding on the roof of the mouth.
Risk is seasonal, associated with periods of high tick activity (usually March through September). Risk areas are rural steppe, savannah, semi-desert, and foothill/low mountain habitats below 2,000 meters elevation.
• Travelers are advised to take measures to prevent tick bites during the peak transmission season, March through September. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Food & Water Safety: All water should be regarded as being a potential health risk. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is pasteurised and dairy products are safe for consumption. Only eat well cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.
Hepatitis: An outbreak of Hepatitis A was reported in 2007 in Semipalatinsk. 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 but the levels are unclear. Hepatitis E is widespread in Central Asia. Sporadic cases may occur but go unrecognized. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 8% 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 but the prevalence is not clearly determined. 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 from November through March. The flu vaccine is recommended for all travelers over age6 months.
Leishmaniasis: Risk for cutaneous leishmaniasis primarily limited to the Uzbekstan, Kazakhstan, and Turkmenistan. In Kazakhstan cases of visceral leishmaniasis (kala-azar) are encountered in the thickets of the Syr-Darya floodlands in Kzyl-Orda Province. 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 the rain forest floors, 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.
Lyme Disease: Lyme disease may occur in rural forested areas below 1,500 meters elevation. The peak transmission season is March through September. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79.
Malaria: No malaria is reported in this country at this time.
Other Diseases/Hazards: Anthrax (endemic in the southern Khazakstan)
• Brucellosis (from unpasteurized dairy products. Current outbreak in the Atyrausky area of Kazakhstan)
• Echinococcosis (cysts in dog feces are infective)
• Plague (sporadic cases are reported. Three cases, from infected camel meat, were reported from Kazakh province of Mangistau in 2003)
• Tick-borne relapsing fever (reported from Kirghizstan, Turkmenistan, and Uzbekistan)
• Worms (helminthic infections, such as ascariasis, trichuriasis, hookworm disease, and strongyloidiasis are endemic)
Rabies: This disease is endemic. PROMED reports a 12 year old boy died from rabies in 2007 in South Kazakhstan (Ongtüstik Qazaqstan). Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.
Tick-Borne Encephalitis (TBE): The tick vector of tick-borne encephalitis (TBE) is distributed widely in brushy, wooded areas, especially south and east of Lake Balkhash. The TBE vaccine (available in Canada and Europe), is recommended only for people at significant risk of exposure to tick-bites, for example, campers and hikers on extended trips, or forestry workers.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, 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: All water supplies are suspect, including municipal tap water, which may be untreated and grossly contaminated. Surface water is often polluted with organic, industrial, and agricultural waste/runoff. All drinking water should preferably be bottled or from a reliable source. 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: The former Soviet republics have experienced sharp increases in the number of TB cases reported. The increase in drug resistance to anti-TB medication has contributed to this striking increase. Multidrug-resistant TB (MDR-TB), or the more serious extensively drug resistant TB (XDR-TB), may develop in people when TB infections, in response to non-compliance with required drug and treatment schedules, stop responding to the most common (or all) anti-TB drugs.
• Tuberculosis is a major public health problem in this country. Cases of tuberculosis have been reported in the Aral Sea and Semipalatinsk regions, as well as in prisons. 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 with an infected individual. 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 is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all people traveling to or working in Central Asia, 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.