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Micronesia



Capital: Palikir

Time Zone: +11 hours. No daylight savings time in 2008.
Tel. Country Code: 691
USADirect Tel.: 288
Electrical Standards: Electrical current is 120/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug A.

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Resource Links

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

Embassies


• U.S. Embassy is located on Kaselehlie Street (the main downtown street) across from the Pohnpei Botanical Gardens. The telephone number is [691] 320-2187. The Duty Officer phone number is [691] 920-2369. The fax number is [691] 320-2186.
Website: http://kolonia.usembassy.gov/

• There is no British consular representation in the Federated States of Micronesia. Consular matters are covered by the British Embassy in Manila, the Philippines.

• There is no Canadian consular representation in the Federated States of Micronesia. Consular matters are covered by the Australian Embassy in Pohnpei.
Australian Embassy
H & E Enterprises Building, Kolonia
Pohnpei, Micronesia
Tel: [691] 320-5448
Fax: [691] 320-5449

Entry Requirements

HIV Test: Anyone applying for a permit needs to obtain a medical clearance, which may include an HIV test.

Required Vaccinations: None required.

Passport Information

Passport/Visa: The Federated States of Micronesia (FSM) consists of 607 islands extending 1,800 miles across the archipelago of the Caroline Islands east of the Philippines. The Federated States of Micronesia (FSM) is composed of four states spanning dozens of atolls scattered over a million square miles of the north central Pacific. The four states are: Pohnpei (formerly Ponape), Kosrae (formerly Kusaie), Chuuk (formerly Truk) and Yap. The federal capital is located at Palikir, on the island of Pohnpei, close to Pohnpei’s largest town, Kolonia. The FSM is a constitutional democracy and is party to a Compact of Free Association with the United States

ENTRY/EXIT REQUIREMENTS: U.S. citizens require a U.S. passport, a completed FSM Immigration Arrival and Departure Record (FSM Form 5004) and a completed FSM Customs Form to enter the FSM. The passport must be valid for at least 120 days beyond the date of entry into the FSM. The air carrier distributes the FSM Immigration Arrival and Departure Record and Customs Form prior to passengers’ arrival at the point of entry. There is no limit to the length of time U.S. citizens and nationals may remain in the FSM. All states except Yap levy a departure fee. A health certificate may be required if the traveler is arriving from an area experiencing an epidemic. Visit the Embassy of the Federated States of Micronesia web site at www.fsmembassydc.org for the most current visa information.

For more information about FSM entry requirements, travelers may consult the Embassy of the Federated States of Micronesia at 1725 N Street NW, Washington, DC 20038, Tel: (202) 223-4383 or the Embassy’s web site at http://www.visit-fsm.org/visitors/entry.html. The FSM also has Consulates in Honolulu and Guam.

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 medical or dental injections, or unscreened 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.

Rabies: This country is presumed to be free of rabies, but here is little surveillance information. Source: National Travel Health Network and Centre (NaTHNaC).

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.
• Travelers are advised to obtain comprehensive travel insurance that provides for medical evacuation to more advanced medical facility in the event of serious illness or injury that requires specialty care not available in this country.
Medical facilities are adequate for uncomplicated treatment. For more serious or complicated problems, medical evacuation (to Guam or Australia) may be required.

Health care facilities in the FSM consist of hospitals on each of the four major islands and a few scattered clinics. These facilities sometimes lack basic supplies and medicines, and the quality of health care varies. Scuba divers are advised that there are only three decompression chambers in Micronesia (in Yap, Pohnpei, and Chuuk); their availability and staff experience in treating dive injuries varies. The next closest decompression chamber outside FSM is in Guam. The flight time from Truk (Chuuk) to Guam is 1hr 50 mins.

More information on SCUBA diving is at:
http://www.truk-lagoon.com/index.html

Destination Health Info for Travelers

AIDS/HIV: A small number of AIDS cases and HIV infections have been reported from various areas. At the present, AIDS is not considered a major public health problem in Oceania. About 0.4% of the adult population of Oceania is living with HIV/AIDS. Statistics specific for the FSM are not available. (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 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.

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.

Cholera: This disease is not reported active in this country at this time. In 2000, a cholera outbreak was reported from Pohnpei island resulting in more than 3000 cases. Cholera is an unusually 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. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Dengue Fever: In September 2007, 6 suspected cases of dengue fever were reported, but there is some question whether these illnesses were instead caused by the Zika virus (see below), which is similar to dengue. A dengue fever/dengue hemorrhagic fever outbreak previously occurred in Yap State in 1995.
Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Oceania. 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.

A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
For more information on the disease, please consult the World Health Organization’s dengue fact sheet (under “health topics”) at the following website: http://www.who.int/topics/dengue/en/
• Zika virus: The total number of cases through October 2007 were 99 confirmed and 54 probable. This mosquito-borne virus have also been identified in the neighbouring islands Ulithi, Fais, Earpik, Woleai, and Ifalik.
Symptoms of Zika virus infection include fever (variable occurrence), headache, rash, joint and muscle pains, swollen glands, edema of the legs and diarrhea. Only supportive care is necessary; there is no vaccine. Travelers should take mosquito-bte precautions.
More information from the CDC about Zika virus is at: http://www.cdc.gov/news/2007/06/zika_yapislands.html
On January 27, 2008 the Outbreak Alert from the CDC was cancelled.

Filariasis: Sporadic cases are reported. Travelers should take measures to prevent mosquito bites.

Hepatitis: All travelers not previously immunized against hepatitis A should receive the vaccine. 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 the levels are unclear. Sporadic cases may occur but go underdiagnosed or underreported. 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 (HBsAg) carrier rate in the general population is estimated at as high as 15%. 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 1.5% in the general population. Most hepatitis C virus 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 world’s population. 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.

Insects: All travelers should take measures to prevent both daytime and nighttime insect 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.

Japanese Encephalitis (JE): There is no apparent risk of JE in Micronesia.

Malaria: There is no malaria in Micronesia.

Marine Hazards: Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking. Swimming related hazards include jellyfish, spiny sea urchins, and coral.

For more information about treating jellyfish stings, visit any of these Web sites:
www.bugbog.com/travel_safety/dangerous_animals/ jellyfish_stings.html;
www.mja.com.au/public/issues/dec2/fenner/fenner.html;
For more information about treating envenomation from scorpionfishes, visit:
www.emedicine.com/emerg/topic300.htm.
For more information about stingray wounds, visit:
http://www.emedicine.com/emerg/TOPIC556.HTM

Rabies: Micronesia is presumed to be rabies-free but there is little surveillance information. 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.

Travelers' Diarrhea: Low to moderate risk. In urban and resort areas, the hotels and restaurants generally serve reliable food and potable water. 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 and fish. 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 (TB): Tuberculosis is highly endemic in Micronesia 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 people traveling to or working in Oceania (outside of Australia and New Zealand), 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.

Zika Virus: Go to the section (above) on dengue fever for a Zika virus update. Like the dengue fever virus, Zika virus is transmitted by infected mosquitoes causing similar but milder symptoms. It is not spread directly from person-to-person. The symptoms include fever, skin rash, conjunctivitis and pain in small joints of the hands and feet.