Time Zone: +1 hour. No daylight savings time in 2008.
Tel. Country Code: 227
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Niger
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 Niger
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from ALL COUNTRIES.
ENTRY/EXIT REQUIREMENTS: A passport, visa, and proof of yellow fever inoculation are required. Travelers from countries without a Nigerien Embassy may be able to obtain a visa at the airport. Travelers from the United States should obtain a visa before arriving in Niger. Failure to do so could result in being denied entry to Niger. Travelers should obtain the latest information on entry/exit requirements from the Embassy of the Republic of Niger, 2204 R Street NW, Washington D.C. 20008, telephone: (202) 483-4224. Visit the Embassy of Niger web site for the most current visa information.
Niger is a developing, landlocked African nation whose northern area includes the Sahara Desert. Tourism facilities are minimal, particularly outside the capital city, Niamey, and the ancient caravan city of Agadez. Ecotourism and adventure tourism opportunities are plentiful.
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. The risk is greatest in the dry season, but these may vary within a country and from year to year. The dry season in West Africa is usually between November-May/June.
Polio: 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: 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 or 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. Yellow fever vaccine is recommended for all travelers >9 months of age.
Hospitals / Doctors
Medical facilities are poor, even in Niamey. Personal medicines should be brought in as these can be difficult or impossible to obtain in Niger. Serious medical treatment would require evacuation to Europe.
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 can't be treated locally, every effort should be made to arrange medical evacuation to Europe.
Doctors and hospital listing: http://niamey.usembassy.gov/niger/doctors_in_niger_niamey.html
The two main hospitals are in Niamey and Zinder. Only the main centers have reasonable medical facilities.
• Niamey Central Hospital (790 beds); general medical/surgical facility; some specialties.
• Gamkalley Hospital, Niamey (20 beds); basic emergency services only.
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 many areas it is not uncommon for people to have two or more regular sex partners at the same time, and such people more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. This is one factor that helps to explain why HIV is more widespread in Africa. Other factors include widespread venereal disease, low rate of circumcision, resistance to the use of condoms, and under-funding of public health programs.
Niger has been less affected by the AIDS epidemic than many other countries. In the 2008 Report on the Global AIDS Epidemic the UNAIDS/WHO Working Group estimated that around 56,000 adults aged 15 or over in Niger were living with HIV; the prevalence rate was estimated at around 0.8% of the adult population.
The HIV prevalence rates 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. The national adult HIV prevalence rate now exceeds 20% in Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%). Adult HIV prevalence in East Africa exceeds 6% in Uganda, Kenya and Tanzania. 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%), Ivory Coast(7.1%) and Gabon (7.9%). (Source: www.Avert.org)
• The development of 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.
• 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.
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): Historically, cases have occurred on the border with Burkina Fasso, but no cases have been reported since 1980.
Animal Hazards: Animal hazards include snakes (vipers, cobras, puff adders), scorpions, and black widow spiders; hippopotamuses and crocodiles are found along the banks of the Niger River.
Avian Influenza A (Bird Flu): The World Organisation for Animal Health (OIE) has confirmed several cases of Avian Influenza (Bird Flu) in domestic ducks near the border with Nigeria. No human infections or deaths have been reported.
• Avian influenza A (H5N1) 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 influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against bird flu. Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). 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 cases.
Cholera: According to WHO, approximately 1,000 cases of cholera have been reported in Niger since July 2010, primarily in the southern border regions of Diffa, Maradi, Tahoua, and Zinder. (Ongoing outbreaks have been reported in Chad and Nigeria since May.) Cholera, however, is an uncommon 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)
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 levels are unclear. 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 10% or higher. 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 modrate level, with a prevalence of 2.5% 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 year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.
Leishmaniasis: Foci of cutaneous leishmaniasis have been reported in southern, central, and western (including the Niamey vicinity) areas, but probably occur throughout Niger. Visceral leishmaniasis has been reported from the Air Mountains, northwestern Agadez Department; isolated cases have been reported from Zinder Department. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• All travelers should take measures to prevent sandfly 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.
Malaria: Risk (predominantly falciparum malaria) exists year-round throughout the country, including major cities.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), or doxycycline is recommended.
A malaria map is located on the Fit for Travel website, 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 Niger page on the Destinations menu or A-Z Menu.
• 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 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 mosquito 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.
Meningitis: According to Niger's Ministry of Health, more than 690 cases of meningococcal meningitis, a significant increase over average incidence, have been reported throughout the country (except for Diffa Region in the southeast) since January 1, 2015, with nearly two-thirds of the total cases reported from Niamey Capital District and Dosso Region. Quadrivalent conjugate meningitis vaccine Menactra) 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.
Other Diseases/Hazards: African tick typhus (boutonneuse fever), African tick-bite fever, anthrax, brucellosis (from consumption of raw dairy products), dracunculiasis, filariasis (mosquito-borne; risk occurs in the rural southwest), leprosy, leptospirosis, onchocerciasis (black-fly borne; endemic foci along rivers in the southwest), tuberculosis (a major health problem), and intestinal worms (very common) are reported. Lassa fever has not been confirmed, but the virus is widely distributed throughout West Africa. No cases of Ebola-Marburg virus disease have been reported.
Poliomyelitis (Polio): Eleven cases of polio were reported in 2007 and another in February 2008, mostly from Zinder Province. 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: Rabies is highly prevalent in West Africa. 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.
Schistosomiasis: Urinary schistosomiasis is widely distributed in the Niger River Valley in the southwest, with foci in southcentral Niger along the Nigerian border.
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. Treated, piped water is available in some major areas, but water supplies are generally not potable. Niger River water is bacterially contaminated. The water in Lake Chad is highly saline.Water- and food-borne diseases are prevalent with sporadic outbreaks of diarrheal diseases occurring, especially during the rainy season.
• Travelers should observe all food and drink safety precautions. 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 and undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• 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 medical advice if you have severe or bloody diarrhea, diarrhea associated with fever and abdominal pain, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in Niger 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 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: 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.