Time Zone: +2 hours. No daylight saving time in 2008.
Tel. Country Code: 258
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, H.
Travel Advisory - Mozambique
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 Mozambique
• U.S. Embassy
193 Avenida Kenneth Kaunda
Tel: 258] (1) 49-2797, 49-0723
Fax: 258] (1) 49-0114
• Canadian Embassy
1128 Julius Nyerere Avenue
Tel:  (1) 492-623
Fax:  (1) 492-667
• British High Commission
Av Vladimir I Lenine, 310
Tel:  (21) 356 000
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from infected areas.
Passport/Visa: Mozambique is a developing country in southern Africa which has steadily rebuilt its economy and civic institutions since ending a 16-year civil war in 1992. Despite high economic growth rates in recent years, Mozambique remains among the poorest countries of the world. Facilities for tourism in Maputo, the capital city, are steadily improving but remain limited. The official language is Portuguese, although English is spoken in many tourist areas, and in some rural areas only local languages are widely spoken.
ENTRY/EXIT REQUIREMENTS: A visa is required for entry into Mozambique. It is recommended that travelers acquire the appropriate visa prior to departing for Mozambique, although a one-entry visa can be obtained at country points of entry, including airports. Foreigners in Mozambique without a valid visa can expect to pay a substantial fine for each day they are in Mozambique illegally. The passports of all travelers who wish to enter Mozambique must be valid for six months upon arrival and must contain at least three clean (unstamped) visa pages each time entry is sought. In September 2007 the Mozambican Interior and Health
Ministries decreed that all travelers entering Mozambique, having previously visited a country where yellow fever is present, must present a valid certification of vaccination against yellow fever. We recommend all travelers be vaccinated to avoid complications at the border. Any passenger who cannot present such a certificate at his or her point of entry will be vaccinated at a cost of $50 US dollars.
For further information on entry requirements, contact the Embassy of Mozambique located at 1525 New Hampshire Ave NW, Washington, DC 20036, telephone: (202) 293-7146, E-mail: firstname.lastname@example.org, fax: (202) 835 0245, or the nearest Mozambican embassy or consulate. Visit the Embassy of Mozambique web site at http://www.embamoc-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; 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): Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported.
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, business travelers, and cruise passengers who restrict their meals to major restaurants, hotels and resorts.
Yellow Fever: Travelers >1 year of age entering the country from an endemic area are required to present a certificate of immunization against yellow fever.
Hospitals / Doctors
Medical facilities are extremely limited, especially in the north of the country. Basic medical care is available in Maputo, but may be difficult to find or non-existent elsewhere.
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. 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 locally, every effort should be made to arrange evacuation to South Africa.
• Travelers should contact the U.S. Embassy for physician referrals. The Embassy maintains lists of doctors at the websites below:
Doctors and Clinics in Mozambique: http://maputo.usembassy.gov/medical_information2.html
Doctors in Nelspruit, South Africa: http://maputo.usembassy.gov/doctors_and_clinics_in_nelspruit_myy_2006.html
• Central Hospital
Av. Eduardo Mondlane
Tel:  (1) 424 633
• Urgencias Medicas Domiciliarias
Av. 24 de Julho, 823
Tel:  21 431 736 / 738
In Maputo the two best health clinics are Clinica 222 and Clinica de Sommerschield which has a lab and a doctor on call. Advance payment will be required.
• Clinica 222
Cnr Avenida 24 de Julho and Rua Augusto Cardoso
Tel:  (1) 431 735
• Clinica de Sommerschield
52 Rua Pereira do Lago
Tel:  (1) 493 924
Destination Health Info for Travelers
AIDS/HIV: HIV and AIDS are highly prevalent, with >16% of the adult population HIV-positive. The prevalence, however, varies depending on the area: it reaches 30% in the corridor of Beira. Heterosexual contact is the predominate mode of transmission in this country.
• 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.
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.
African Sleeping Sickness (Trypanosomiasis): Approximately 75 cases are reported annually, mostly from Tete Province. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so travelers should wear protective clothing and sleep under a bed net.
Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats.
Read more: hthttp://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php
Animal Hazards: Animal hazards include snakes (vipers, cobras, mambas), centipedes, scorpions, and black widow spiders.
Cholera: Outbreaks of cholera occur frequently in Mozambique. Since the recent outbreak in November 2007, over 1000 cases have been diagnosed, and over 80% of these are in Maputo and Matola cities, in Maputo Province. Cholera has also been reported in Xai-Xai, Chokwe and Guija in Gaza Province with between 10 and 20 new cases are being reported every day.
Although this disease is reported active, the threat to tourists is low. 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: Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in many countries in Africa. 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
Hepatitis: 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 is endemic but levels are unclear. Sporadic cases may be 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%. 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 moderately high level, with a prevalence of 2.1% 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.
Malaria: High risk is present throughout this country, including urban areas. There is increased
malaria risk along the coast and in the lower Zambezi Valley. Outbreaks are reported in Xai-Xai and Maputo. Falciparum malaria accounts for >95% of cases.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is recommended.
A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Mozambique page on the Destinations menu.
Malaria is transmitted via the bite of an infected female 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 to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Marine Hazards: Stingrays, jellyfish, moon jelly, sea wasps, blue cones, octopi, bat rays and eagle rays, and several species of poisonous fish are common in the country’s coastal waters and are potential hazards to unprotected swimmers.
Meningitis: Group C meningococcal meningitis outbreak have been reported. Vaccination is recommended for those travelers who will have close, prolonged contact with the indigenous population.
Other Diseases/Hazards: African tick typhus (contracted from dog ticks—often in urban areas—and from bush ticks)
• Brucellosis (from unpasteurized dairy products and infected meat)
• Dengue fever (transmitted by day-biting Aedes mosquitoes)
• Filariasis (mosquito-borne; occurs in northern coastal areas and along the Zambezi River)
• Leishmaniasis (endemic levels unclear; may occur)
• Plague (over 400 cases were reported in 1998; in 1997, outbreaks of human plague were reported from Mutarara district, Tete province and Murrumbala district, Zambezia province)
• Rift Valley fever
• Tick-borne relapsing fever
Poliomyelitis (Polio): Due to the persistence of polio in sub-Saharan, all travelers need to be fully immunized. All children should be up-to-date in their polio immunizations. 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.
Rabies: Sporadic cases of human rabies are reported countrywide, including Maputo. All animal bites or scratches, especially from a dog, should be taken seriously and immediate medical attention sought. Rabies vaccination may be required. This may require medical evacuation to another country if rabies vaccine and rabies immune globulin are not available locally. Although rabies is rare among tourists, there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals.
Pre-exposure 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. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.
Rift Valley Fever: An outbreak of Rift Valley fever was reported in April 2008 from Alaotra Mangoro, Analamanga, Itasy, Vakinakaratra and Anosy Regions.
• Rift Valley fever is a viral infection that affects both cattle and people. It is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or by consumption of unpasteurized milk. Most cases occur in livestock workers. Symptoms include chills, fever, headache, muscle aches, nausea and vomiting. Most people recover uneventfully in about a week. Approximately 1% of patients die of the disease.
Further information: http://en.wikipedia.org/wiki/Rift_Valley_fever
• All travelers should take measures to avoid mosquito 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 at night.
Schistosomiasis: Risk of urinary schistosomiasis is reported from all provinces with infection rates up to 60% in some areas. Intestinal schistosomiasis appears almost as widely distributed with major risk areas along the southern coastal plain, the Zambezi Valley, and the vicinity of Lake Malawi.
• 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. Potable water is often in critically short supply. Piped water supplies in urban areas may be grossly contaminated. 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: Tuberculosis is highly endemic in Mozambique 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 by the CDC for all 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: Travelers >1 year of age entering the country from a infected area are required to present a certificate of immunization against yellow fever.