Time Zone: 0 hours GMT. No daylight savings time in 2008.
Tel. Country Code: 231
USADirect Tel.: 0
Electrical Standards: Electrical current is 120/60 (volts/hz). North American Style Adaptor Plug and United Kingdom Adaptor Plug. Grounding Adaptor Plug C.
Travel Advisory - Liberia
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 Liberia
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from ALL COUNTRIES.
Passport/Visa: For the latest information on entry requirements, contact the Consular Services of the Embassy of the Republic of Liberia in Washington, DC.
ENTRY/EXIT REQUIREMENTS: A passport and a visa are required for entry, as is evidence of a yellow fever vaccination within the psst 10 years (The International Certificate of Vaccination can be obtained from a travel clinic in your area). Visa applicants may also be asked to provide evidence of health insurance. Immigration officials no longer issue visas at the airport.
Because of the current Ebola Virus outbreak, The CDC is now advising against non-essential travel to Liberia.
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): Vaccination with a quadrivalent conjugate vaccine is advised for those travelers anticipating close contact with the indigenous population.
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 and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to 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
Hospitals and medical facilities in Liberia are very poorly equipped and are incapable of providing many services. Emergency services comparable to those in the U.S. or Europe are non-existent, and the blood supply is unreliable and unsafe for transfusion.
• 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 be 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 cannot be treated locally, every effort should be made to arrange medical evacuation to Western Europe.
Travelers can contact the U.S. Embassy for emergency services.
ELWA Mission Hospital
24-hour emergency services.
JFK Medical Center
General medical/surgical facility.
“JFK” is known throughout Liberia as the nation’s largest referral hospital, located in the capital city, Monrovia. Founded in 1972, the Medical Center is the only tertiary care institution in the country and is a major teaching hospital. Although severely damaged during the Liberian Civil War, it has been largely rehabilitated and continues to improve is capabilities and grow its capacity.The Medical Center is comprised of (from left to right above) the JFK Memorial Hospital, the Liberian-Japanese Friendship Maternity Hospital, the Tubman National Institute of Medical Arts (a nursing and paramedical school), and the Catherine Mills Psychiatric Center, which was completely destroyed during the war.
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%). (Source: Avert.org)
• The HIV prevalence rate in Liberia in the population age 15 to 49 is not well established because of insufficient data. The prevalence in neighboring Ivory Coast is 7.1% in the population aged 15 to 49.
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): Sporadic cases have been reported from the north-central county of Bong. Travelers should take protection measures against tsetse fly bites.
Cholera: Cholera outbreaks occur regularly in Liberia. Several hundred cases were reported by February 2008 from Grand Kru, Maryland and River Gee Provinces. Although this disease is active in this country, but the threat to tourists is very low. Cholera is an extremely rare disease in travelers from developed countries. Cholera vaccine is usually recommended only for people, such as 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 some countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
Treatment: Rehydration therapy is the cornerstone of treatment. IV fluids are often required. A singlr 1-g dose of azithromycin is the recommended antibiotic treatment and is more effective than ciprofloxacin. (Ref: NEJM).
Ebola Virus Disease (EVD): The worst Ebola outbreak in recorded history currently wreaking havoc in West Africa is sounding alarm bells throughout the world that it may only be a matter of time before it breaks out of the African continent and makes its way to the rest of the world. The outbreak, which was first detected in March of this year, has already killed 672 and has infected 1,201 individuals. EVD is a hemorrhagic fever spread perso-to-person by contact with body fluids. There is no vaccine. Strict quarantine measures can contriol the epidemic. Travelers are advised to avoid contact with sick persons.
U.S. CDC has moved its Emergency Operations Center (EOC) to the maximum activation level. This does not indicate an increased risk to the U.S but reflects significant CDC overseas involvement in a progressive situation in Africa. According to press sources, Liberia has declared a state of emergency for 90 days, and the military is blocking entry to Monrovia from affected western regions. Sierra Leone's military has isolated Kenema and Kailahun districts. U.S. CDC has published interim guidance for health care workers in the U.S. on appropriate collection, transport, and testing of specimens from suspected EVD patients.
Filariasis (Bancroftian variety): Infection rates of up to 37% have been reported from coastal villages, with the highest rates in the eastern county of Maryland. Cases also reported in areas bordering the savanna belt in the north. All travelers should avoid mosquito bites.
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 endemic with outbreaks occurring but seroprevalence data is not available. Transmission of the hepatitis E virus (HEV) occurs primarily through contaminated drinking water. 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%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at a high level but little data are available. 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.
Lassa Fever: Most recent cases have been reported from the northwestern areas of Bong, Lofa and Nimba. Lassa fever is a life-threatening viral infection that is generally acquired by contact with the excreta of infected rodents, but may also be transmitted person-to-person. The risk for most travelers is extremely low. Travelers can lessen their exposure by avoiding bush areas and the interiors of thatch huts.
Leishmaniasis: Low risk. Sporadic cases of cutaneous and visceral leishmaniasis have been reported from neighboring countries. Travelers are advised to take general precautions against insect bites, especially during the night.
Malaria: There is a high risk of malaria in Liberia. Transmission occurs countrywide year-round, but is increased during and immediately after the rainy season, April through October. Falciparum malaria accounts for approximately 90% of cases.
Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6PD test required) is currently recommended.
A malaria map is located here.
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 (such as Ultrathon) to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents remain the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
Meningitis: Liberia lies just west of the sub-Saharan meningitis belt. Limited outbreaks reported in Sarwan town, Sinoe County. 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.
Onchocerciasis: Highly endemic in rain forest areas of Grand Bassa County. Foci reported in the west along the St. Paul and Lofa Rivers. Travelers should take personal protection measures against blackfly bites.
Other Diseases/Hazards: African tick typhus (contracted from dog ticks, often in urban areas, and bush ticks), African tick-bite fever, anthrax, brucellosis, leprosy (up to 2 cases/1,000 population), cutaneous larva migrans, louse-borne relapsing fever, tuberculosis (a major health problem), typhoid fever, typhus, and intestinal worms.
• Animal hazards include snakes (vipers, mambas, cobras), centipedes, scorpions, and black widow spiders.
• Potentially harmful marine animals found in the coastal waters of Liberia include Portuguese man-of-war, sea nettle, marine catfish, moonjelly, mauve stinger, marine catfish, eagle ray, scorpionfish, and weeverfish. Swimmers should take sensible precautions to avoid these hazards.
Paragonimiasis (lung fluke disease): Up to 7% infection rates reported from Bong County. Travelers should avoid ingesting raw or undercooked crabs and crayfish.
Poliomyelitis (Polio): Polio remains persistent in sub-Saharan Africa. All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio 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.
Rabies: Human cases reported from Monrovia and countrywide, where there are large stray dog populations. Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals (especially dog, cat, or monkey); 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: Risk is present, primarily in the northwestern and northcentral counties of Lofa, Bong, and Nimba. Infection rates have been highest in Bong County. No transmission occurs in the coastal 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: High risk. All water sources should be considered contaminated. The 3-year civil war has destroyed water treatment and sewage systems. Travelers should strictly observe food and drink precautions. A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of acute diarrhea. Diarrhea not responding to treatment with an antibiotic may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
Tuberculosis (TB): Tuberculosis is highly endemic in Liberia 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 unvaccinated people 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: This disease is reported active in this country. Yellow fever vaccination is required for entry to Liberia.