Time Zone: +2 hours. GMT +1 hour daylight savings time.
Tel. Country Code: 371
USADirect Tel.: 800
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Latvia
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 Latvia
• U.S. Embassy
Raina Boulevard 7
• Canadian Embassy
Doma laukums 4, 4th Floor
• British Embassy
5, J. Alunana Street
Tel:  777 4700 Switchboard
HIV Test: Test required for persons seeking residency permits; U.S. tests results accepted.
Required Vaccinations: None required.
Passport/Visa: Latvia is a stable democracy experiencing rapid economic growth. Most tourist facilities found in a western European city are available in the capital city of Riga. However, some of the goods and services taken for granted in other countries are not yet available in other parts of the country.
ENTRY REQUIREMENTS: Latvian law requires that visitors present a passport that is valid for at least three months after their planned stay (for example, if a visitor plans to stay for one month, then a passport valid for four months is required). Individuals who arrive at Latvia's borders who do not meet this requirement are generally denied entry to the country. American citizens do not need a visa to travel to Latvia for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the "Schengen group" countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden. Multiple visits to Schengen countries may not exceed 90 days in any 6 month period. Travelers remaining in Latvia for more than 90 days, including 180 day periods that cross over two half-calendar years, must apply for temporary residence. All travelers must have a valid insurance policy, covering medical expenses while in Latvia. Repatriation costs, including funeral and disposition of remains costs also have to be covered by the policy. In addition, upon entering or exiting the country, travelers must declare cash in excess of 10,000 euros to Latvian customs. For more information, travelers may contact the Latvian Embassy, at 2306 Massachusetts Ave., NW, Washington, DC 20008, tel. (202) 328-2840, fax (202) 328-2860. See also http://www.latvia-usa.org. Within Latvia, contact the Ministry of Interiors Office of Citizenship and Migration Affairs at Raina bulv. 5, Riga, LV 1508. tel. (371)721-9664 or (371) 721-9645, fax: (371)782-0306, http://www.ocma.gov.lv/ or Foreign Service Center at Alunana iela 1, Riga LV 1050, tel: (371)721-9655. Any traveler to Russia, even in transit, is advised to obtain a visa prior to entry into Latvia. The process of obtaining a visa at the Russian Embassy in Riga can be lengthy, and involve surrender of the passport for an undetermined period of time. Visit the Embassy of Latvia website at http://www.latvia-usa.org 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 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 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.
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. Children are considered at higher risk because they tend to play with animals and may not report bites.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.
Hospitals / Doctors
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; or of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that can't be treated locally, every effort should be made to arrange medical evacuation to a country in Western Europe that has more advanced medical facilities.
State ambulance service for emergencies is available by dialing 03 anywhere in Latvia.
Facilities in Riga include:
• Diplomatic Service Medical Centre
Elizabetes Street 57, 4th floor
Tel:  720 1007
Family care, preventive care, ob/gyn, vaccinations, outpatient consultations, internal medicine, dental clinic, homes visits.
• ARS Clinic
5 Skolas iela
Tel:  720 1007
• Hospital of Traumotology and Orthopaedics
22 Duntes Street
Tel:  739 9300
Destination Health Info for Travelers
AIDS/HIV: Increased cases of AIDS and HIV are reported in Eastern Europe. The Baltic States consist of those countries in the north of Eastern Europe: Estonia, Latvia and Lithuania. Although overall numbers of infections remain low, HIV is spreading at a rapid rate in these countries. Between 2000 and 2001 there was a large increase in the number of new reported HIV cases, from 921 to 2,353, the majority of which were reported in Estonia. Between 2001 and 2003 however the number of cases reported dropped considerably with Estonia and Latvia virtually halving their cases over the two-year period. This could be due to fewer infections, or to changes in reporting methods.
UNAIDS estimates that HIV prevalence among adults exceeds 1% in Estonia, Ukraine, Moldova and Russia. The prevalence rate in Latvia is 0.8%. (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids or blood of another person. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance:
Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Diphtheria: All travelers, especially adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tadp vaccine) should be given to those who have not received a dose within the previous 10 years. During a decade-long diphtheria epidemic (1993-2003), 1359 cases and 101 diphtheria deaths were registered, the majority in unvaccinated adults.
Hepatitis: Eurosurveillance (http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18995) reports a community-wide outbreak of hepattis A in 2008. Up to 35% of cases were in injecting drug users and a large outbreak (47 cases) was associated with a restaurant.
All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation. Hepatitis E may be endemic, but levels are unclear. Transmission of HEV occurs primarily through contaminated drinking water. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 2% to 7%. 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.* 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.
* The incidence of acute hepatitis C has decreased recently, but the incidence of chronic hepatitis C has increased. There were 889 new acute and chronic cases of hepatitis C in 2003 (38.1 cases per 100 000 population). Intravenous drug use and medical treatment during the incubation period are the main risk factors. Vaccination of newborns against hepatitis B has reduced the incidence of hepatitis B over the past 2 years.
Influenza: Influenza is transmitted from November to March. The flu vaccine is recommended for all travelers over age 6 months.
Lyme Disease: There is a relatively high risk of Lyme disease in the Baltics (http://www.gideononline.com/blog/page/3/). Lyme borreliosis presents a risk to travelers throughout the country through the warmer months. Travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79)
Other Diseases/Hazards: Raw cod (“lutefish”) and other fish may contain the fish tapeworm. Travelers should avoid undercooked or raw fish.
Rabies: Occurs primarily in wild animals, especially foxes, in many rural areas of Europe. Human cases are infrequent. Any animal bite should be immediately evaluated. Pre-travel 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.
Road Safety: Highways are slowly being upgraded after years of little or no maintenance, but are treacherous to unwary. Speed limit in towns 50 km./hr., & 90 km./hr. on open road, unless otherwise marked. Legal alcohol limit for drivers is zero, & speed traps common. US drivers' licenses not valid in Latvia. so travelers should obtain valid international driver's license issued through AAA. After 90 days, Americans in country must apply for Latvian license. Contact Latvian Traffic Safety Administration (CSDD), Bauskas Iela 68, Riga LV-1004, (371) 627-437.
Tick-Borne Encephalitis (TBE): The tick vector for TBE is widely distributed in brushy and forested areas at elevations up to 1,500 meters, especially in the central part of the country around Jelgava (both town and region), Ventspils, Limbazi and Riga regions. Infections can occur in parks within Riga. Risk exists primarily between April and October. The TBE vaccine (available in Canada and Europe), is recommended for people at significant risk of exposure to tick-bites, for example, campers and hikers on extended trips, or forestry workers. This infection may also be acquired by ingesting contaminated, unpasteurized dairy products.
• Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Travelers' Diarrhea: There is a low risk of gastrointestinal disease in most western European countries. Higher risk occurs in the Balkans and eastern Europe. In Lavia, 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 dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. 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.Travelers to Latvia should drink only bottled, boiled, or treated water and avoid undercooked food. A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotics may be due to a parasitic disease, such as giardasis or cryptosporidiosis.
Tuberculosis: Tuberculosis is a major public health problem in this country. Tuberculosis is highly endemic in Latvia 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 vaccine is recommended for all unvaccinated people traveling to or working in Eastern Europe, 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. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.