Time Zone: +8 hours. No daylight savings time in 2008.
Tel. Country Code: 976
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
TRAVEL ADVISORY - MONGOLIA
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.
• U.S. Embassy
Micro Region 11
Big Ring Road
Tel:  11-329-095
The Consular Section can be emailed directly at email@example.com. The Consular Section is open for American Citizens Services Monday and Thursday from 1-3 p.m., except on U.S. and Mongolian holidays.
• Canadian Embassy (China)
Diplomatic Services Building
Tel:  11-328-285
• British Embassy
30 Enkh Taivny Gudamzh
Tel:  (11) 458-133
Fax:  (11) 458-036
HIV Test: Required for students and anyone staying longer than 3 months; U.S. test accepted.
Required Vaccinations: None required
Passport/Visa: Mongolia is the size of Alaska and is a vast country of mountains, lakes, deserts and grasslands. It peacefully abandoned its communist system in 1990 and is successfully making the transition to a parliamentary democracy. Economic reforms continue. The country•s development will depend on considerable infrastructure investment, particularly in the mining, energy, transportation, and communication sectors. Travelers to Mongolia should be aware that shortcomings in these areas might have an impact on travel plans. Read the Department of State Background Notes on Mongolia for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport is required for American visitors. No visa is required for Americans visiting for fewer than 90 days; however, visitors planning to stay in Mongolia for more than 30 days are required to register with the Immigration, Naturalization and Foreign Citizens Agency in Ulaanbaatar within the first seven days of arrival. American visitors who fail to register and who stay longer than 30 days, even for reasons beyond their control, will be stopped at departure, denied exit, and fined. It is recommended that if there is any possibility that a visitor will be in Mongolia beyond 30 days that they register with the Immigration, Naturalization and Foreign Citizens Agency within the first seven days of their arrival.
Americans planning to work or study in Mongolia should apply for a visa at a Mongolian Embassy or Consulate overseas. Failure to do so may result in authorities denying registration, levying a fine, and requiring that the visitor leave the country. Travelers arriving or departing Mongolia through China or Russia should be aware of Chinese and Russian visa regulations (transiting twice will require a double- or multiple-entry visa) and note that some land entry points have varying days and hours. American citizens are not permitted to transit through China or Russia without a visa. For more information on these requirements see the Consular Information Sheets for these countries at http://travel.state.gov/. Travelers planning travel to Russia should get visas prior to arriving in Mongolia, as they are difficult to get at the Russian Embassy in Mongolia.
Individuals without Mongolian visas are subject to an exit tax payable either in USD or Mongolian Tugrugs upon departure. This amount may or may not be included with the price of the airline ticket; travelers are advised to confirm when they purchase their airline ticket.
Visit the Embassy of Mongolia web site at http://www.mongolianembassy.us for the most current visa information. Travelers can also contact the Embassy of Mongolia at 2833 M Street NW, Washington, DC 20007, telephone (202) 333-7117 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 outdoors in rural areas where there is an increased the risk of animal bites. 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 a high-risk animal bite, but does not eliminate the need for treatment with the 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 people traveling to or working in East 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 is substandard throughout the country. Adequate evacuation coverage for all travelers is a high priority. Hospital accommodations are usually inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered.
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.
• 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. Serious illness or injury may require medical evacuation to another country.
• SOS Medica Mongolia
UB International Clinic
Monday to Friday 09:00 - 18:00
Tel:  (11) 464325 / 26 / 27
This is the most modern medical facility in Mongolia, equivalent to a U.S. general practice with all English-speaking staff. Medical services include general practice, family medicine, emergency medicine, x-ray, laboratory, pharmacy stocked with medications imported from the West, ante-natal care, travel medicine and vaccination advice.
• Hospital Number 2
Tel:  (11) 450-490
Located at the west side of the British Embassy or opposite the Naran Shop in the 13th micro-district.
This Mongolian-run facility is the designated hospital for high-ranking officials of the Mongolia government. 24-hour ambulance service is available. The Mongolian-run Hospital Number 2 is also the designated hospital for foreigners in Mongolia. It is generally considered to have the best care available in a Mongolian facility.
• Yonsei Friendship Hospital: This is a Korean-Mongolian outpatient clinic and has dentistry services as well. These facilities are designed to provide quality medical care at affordable prices to the local population and to foreigners. There are several English speaking doctors.
The U.S. Embassy maintains a listing of medical facilities at:
NOTE: There may be no English-speaking physicians or staff at any of the local hospitals. Many of the local doctors in UB were trained in the former Soviet Union, and therefore speak Russian. If you don't speak Russian or Mongolian, then an interpreter will need to accompany you to the hospital.
• Most Mongolian hospitals have not established fixed fees for foreign patients. To avoid being charged exorbitant fees for even routine care, travelers need to be advised to inquire about fees before services are rendered.
• Always telephone the hospital or clinic before visiting to be sure that it is open, that the proper staff is on duty, and that the hospital has the supplies and equipment to perform the desired service. Once again, there may be no English-speaking staff to answer your call.
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: Although the numbers at present are small, Mongolia has a number of factors that can make it vulnerable to the disease. These include rapidly increasing rates of sexually-transmitted diseases (STD), increasing numbers of sex workers, stimulant use, rising numbers of street children and increased international and internal mobility, combined with poor STD care and low levels of condom use. The HIV epidemic is accelerating rapidly in neighboring countries, Russia, Kazakhstan and China, fuelled primarily by injecting drug use. This has led to predications that injecting drug use, followed by an HIV epidemic is likely to hold in Mongolia as drug traffickers start exploiting trade routes through the country. That 50 per cent of the population is below 23 years of age is also a risk factor.
• 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.
Note: There is a risk of exposure to unsafe blood and blood products in Mongolia. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics.
• 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.
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.
Avian Influenza (Bird Flu): Outbreaks of H5N1 avian influenza (bird flu) were reported in August 2005 from poultry farms Mongolia. No human cases have been reported to date.
• 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.
Cholera: Sporadic cases may occur. Cholera is a very 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)
Hand, Foot and Mouth Disease: Disease: There has been an outbreak of Hand, Foot and Mouth Disease (HFMD) in several areas. HFMD is caused by intestinal Enterovirus 71 (EV 71) and mainly affects small children. HFMD is transmitted via respiratory droplets and is characterized by fever, blisters and rashes on the hands, feet and buttocks. The World Health Organization (WHO) provides information on preventative measures. (http://www.who.int/csr/don/2008_05_01/en/index.html)
• According to the WHO recommendations, in certain situations, it may be advisable to close child-care facilities and schools to reduce the intensity of transmission. It is NOT necessary to restrict travel or trade.
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 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.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 10% to 25%. 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 high level with a prevalence of 10.7% in the general population. 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 age 6 months.
Malaria: There is no risk of malaria in this country.
Meningitis: Epidemics of serogroup A and C disease have been reported from Mongolia. With the emergence of the W135 strain of meningococcal disease, the quadrivalent conjugate vaccine is recommended for all travelers having close contact with the indigenous population.
Other Diseases/Hazards: Anthrax (4 cases of human anthrax were reported in 2008 in Arhangay Aymag and Hovd Aymag, which are bordering China; outbreaks also reported August 2000 and July 2004, related to contact with infected animals).
• Brucellosis (the most common animal source is infected cattle, especially in sheep-raising regions; humans acquire infection 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).
• Crimean-Congo hemorrhagic fever
• Echinococcosis (endemic in rural areas).
• Hand, Foot, and Mouth disease (An outbreak of hand, foot, and mouth disease was reported from Mongolia in May 2008)
• Leishmaniasis (low incidence).
• North Asian tick typhus (tick-borne rickettsiosis caused by Rickettsia sibirica. Clinically resembles Rocky Mountain spotted fever)
• Plague: In Hovsgol Province, a 14-year-old child died from plague and was suspected to have contracted the disease through contact with a dog or marmot. Mongolia has a high incidence of plague. Cases have been reported in almost all provinces. (Source: ProMED-mail 7 and 9 August 2007).
• Scrub typhus (transmitted by infected chiggers, the larval stage of mites).
• Murine typhus (transmitted by fleas).
• Siberian tick typhus (same as North Asian tick typhus-see above).
• Tick-borne relapsing fever.
• Hemorrhagic fever with renal syndrome (viral illness, contracted through exposure to rodent excreta).
• Lyme disease (endemic status unclear).
Plague: Mongolia has a high incidence of plague. Cases have been reported in almost all provinces. (Source: ProMED August 2007) In Hovsgol Province, a 14-year-old child died from plague in Tsetserleg County and was suspected to have contracted the disease through contact with a dog or marmot. A total of 69 contacts were isolated for observation and none of them developed fever so far.
Rabies: Rabies is widespread in Mongolia and of human rabies are reported countrywide. 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): There is a low risk of TBE in some areas of the country below 1,400m elevation. Human TBEV infections are acquired through bites of infected ticks or, rarely, by ingesting unpasteurized dairy products primarily from infected goats, sheep, or cows.
The areas affected are Selenge and Bulgan provinces on the northern border with Russia, and around the capital Ulan Bator. The transmission season varies, however, ticks are most active during early spring to late autumn (March to November).
• TBE is transmitted to humans via the bite of an infected Ixodes tick. Most TBEV infections result from tick bites acquired in forested areas through activities such as camping, hiking, fishing, bicycling; collecting mushrooms, berries, or flowers; and outdoor occupations such as forestry or military training. The risk is negligible for persons who remain in urban or unforested areas and who do not consume unpasteurized dairy products.
• Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin (spray or solution) to clothing and gear.
Travelers' Diarrhea: High risk. Travelers should follow safe food and drink guidelines. Water-borne and food-borne diseases are prevalent. 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.
Tuberculosis: Tuberculosis is a major public health problem in this country with an estimated annual incidence of 100-300 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 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 Mongolia, 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.