Travel Tips for Nigeria, Updated Intl. Guide – Travel Medicine, Inc.
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Capital: Abuja

Time Zone: +1 hour. No daylight savings time in 2008.
Tel. Country Code: 234
USADirect Tel.: 0
Electrical Standards: Electrical current is 230/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, F.

Travel Advisory - Nigeria

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 Nigeria

Resource Links

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


• U.S. Embassy
9 Mambilla
Maitama District
Tel: [234] (9) 523-0916

• Canadian Embassy
4 Anifowoshe Street
Victoria Island
Tel: [262] 2512, 262-2513 or 262-2515

• British High Commission (Trade/Investment, Consular and Visa Sections)
Dangote House
Aguyi Ironsi Street
Tel: [234] (9) 413 2010/2011/3885-7
Email: (Consular issues)

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from travelers over 1 year of age coming from areas with risk of yellow fever transmission.

Passport Information

Passport/Visa: Nigeria is a developing country in western Africa that has experienced periods of political instability. Its internal infrastructure is neither fully functional nor well maintained. In 1999, Nigeria returned to civilian rule after 16 years of military rule. Read the Department of State's Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance. Visas cannot be obtained aboard planes or at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court, NW, Washington, D.C., 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Vaccinations: Recommended and Routine

Cholera: Cholera vaccine (not available in the U.S.) is recommended primarily for people at high risk (e.g., relief workers in refugee camps, certain healthcare personnel) who work and live in highly endemic areas under less than adequate sanitary conditions. Not recommended otherwise.

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.

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: Recommended for travelers spending time in remote locations, or outdoors in rural areas where there is an increased the risk of animal 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 additional treatment with rabies 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: Recommended for all travelers.

Yellow Fever: Vaccination is recommended for all travelers >9 months of age. Yellow fever vaccination is required for travelers arriving from a yellow-fever-infected area in Africa or the Americas.

Hospitals / Doctors

Medical facilities in Nigeria are below Western standards. The quality of health care providers ranges from poor to fair. Most physicians and nurses do not meet US standards of training. Recent graduates lack experience with modern equipment and sophisticated procedures. Hospital facilities are generally of poor quality with inadequately trained nursing staff. The best health care in Nigeria is available in private and nonprofit medical facilities, some of which meet U.S. standards.
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 of dubious origin; may be counterfeit, or 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. Serious illness or injury may require medical evacuation to South Africa or Europe.

The U.S. Embassy maintains a listing of medical facilities at:

Facilities preferred by expatriates include:

Port Harcourt
Riverside Clinic
21 Harbour Road
Port Harcourt
Tel: [234] 84 489 023
or [234] 803 71 00 489
Satellite Tel: 871 762 959 428 & 429
Information: [234] 803 303 96 60

Emergency Medical Care has also opened facilities in Abuja, the political and administrative capital of Nigeria. The area covered by the Abuja clinic extends beyond the city limits of the capital; it covers the medical needs of companies based in Kaduna and Kano in northern Nigeria. The doctors make regular visits to the industrial sites in these areas.

Emergency Medical Care - CRI Clinic
Plot 141 of Aedtokumbo Ademola Crescent
Wuse 2
Capital Terratory Abuja
Tel: [234] 803 669 36 85 or [234] 802 377 65 24
Fax: [234] 0952 10 589
Tel: [234] 803 303 96 60
The Emergency Medical Care ambulance has authorised direct access to the runway at Abuja international airport. The clinic has the following facilities:
- an intensive care unit with one observation bed
- a consulting room
- an emergency laboratory
- a large capacity resuscitation ambulance

• Saint Nicholas Hospital
57 Campbell Street
Lagos Island
Tel: [234] 635 576, 631 739
Private facility; bed capacity: 75
General medical/surgical facility; 24-hour emergency room; orthopedics; ob/gyn. Ultrasound with CT scanner available 8 kilometers away. No blood bank. Recommended by US Embassy personnel. English-speaking staff.

• Heritage Hospital/The Cardiac Centre Lagos, Nigeria:
Located on Victoria Island, Lagos this facility does diagnostic cardiac non-invasive testing, for general x-rays This new facility with 10 beds with ICU capability, two ICU ward beds, and an emergency room and out patient non-invasive cardiac evaluation tools. The facility has a high standard of cleanliness, staffing, and equipment.

• IMC (International Medical Clinic)
No 10, Plot 296 Ozumba Mbadiwe Avenue
(Next to Tribes, nr. the Goethe Institute)
Victoria Island
Tel: [234] 146 17711/3608
Emergency: [234] 177 56080

This International SOS website has information on additional clinics in Nigeria.

• ECWA Evangel Hospital
Tel: [234] (73) 453-950
ECWA Evangel Hospital is a 150-bed general hospital located in Jos, Nigeria. Founded by the Sudan Interior Mission (now SIM) in 1959, Evangel is now under the auspices of the Evangelical Churches of West Africa (ECWA). Services include surgery, internal medicine, pediatrics, and obstetrics and gynecology. Over the past decade several new specialized areas have been added:
Ear, nose, and throat surgery
Vesicovaginal fistula (VVF) surgery
HIV care including a counseling center with support services.

Destination Health Info for Travelers

A Summary of Risk: With more than 130 million inhabitants, Nigeria is by far Africa’s most populous nation.
Nigerian society is divided by language, ethnicity, and religion. While English is the official language, over 500 languages are currently spoken; most Nigerians speak Hausa (in the north), Yoruba (in the southwest), or Igbo (in the southeast). Currently the most significant division in Nigerian society lies between the the predominantly Muslim and Hausa speaking north, and the Christian south of the country. Shariah law has been proclaimed in many of Nigeria’s northern states, and in the last couple of years tensions between Muslims and Christians have resulted in some isolated yet bloody clashes. Sporadic ethnic conflicts in the oil-rich delta region have also become a problem.
• Not quite 6 percent of Nigeria’s adult population is living with HIV or AIDS. This is low by Sub-Saharan standards, but even if the rate of infection does not increase Nigeria is predicted to suffer 4.3 million AIDS deaths by 2015; only South Africa is predicted to have higher AIDS mortality. As is the case in most countries, HIV prevalence rates are much higher in Nigeria’s cities, and the HIV prevalence rate exceeds 10 percent in the Federal Capital Territory.
• Nigeria is also a high-burden country for other communicable diseases. Malaria is endemic throughout Nigeria, and the WHO estimates the malaria mortality rate for children under five in Nigeria at 729 per 100,000. In April 2004 Nigeria’s Minister of Health reported that his country spent over $1 billion annually in treating malaria, and that malaria was the cause behind one out of three deaths in children, and one out of ten deaths of pregnant women. He cited chloroquine resistance as a growing problem, owing in part to counterfeit drugs.
• The annual incidence of tuberculosis is estimated at almost 300,000, and over 70,000 Nigerians die of that disease each year.

Doctors Without Borders/ Médecins Sans Frontières (MSF) has worked in Nigeria since 1996.
More information at:

AIDS/HIV: HIV prevalence estimated at over10% of the sexually active urban population. Some 80% of HIV infections in Nigeria are transmitted by heterosexual sex. Factors contributing to this include a lack of information about sexual health and HIV, low levels of condom use and high levels of sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which make it easier for the virus to be transmitted.
• Blood transfusions are responsible for about 10% of all HIV infections. There is a high demand for blood because of road traffic accidents, blood loss from surgery and childbirth, and anemia from malaria. As there is no coordinated national blood supply system, blood isn’t routinely tested for HIV, and a recent study found that 4% of blood donors in Lagos were HIV positive.
• The remaining 10% of HIV infections are acquired through other routes such as mother-to-child transmission, homosexual sex and injecting drug use. Source:
• 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.
• 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. 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.

African Sleeping Sickness (Trypanosomiasis): Sleeping sickness occurs in scattered areas country-wide. More risk occurs in Gboko vicinity of Benue State (southeastern areas confluent with endemic areas of Cameroon) and the southwestern states of Edo and Delta. Extreme northern areas are tsetse-fly free. Travelers should take measures to prevent insect (tsetse fly) bites.

Animal Hazards: Animal hazards include snakes (vipers, cobras, puff adders, mambas), scorpions, brown recluse spider, and black widow spiders; potentially harmful marine animals which occur in the coastal waters of Nigeria include sea wasps, Portuguese man-of-war, rosy anemone, sea urchin, weeverfish, eagle ray, and sea nettle.

Arboviral Fevers: Low risk of dengue (few cases reported, but there is serologic evidence of endemicity). West Nile and Sindbis fevers are moderately to highly endemic. Chikungunya fever may occur in cyclic outbreaks in rural or urban areas. Crimean-Congo hemorrhagic fever occurs in arid savanna grasslands where ticks abound. Travelers should take insect-bite precautions.

Avian Influenza (Bird Flu): Since February 2006, outbreaks of avian influenza have been reported from poultry farms throughout Nigeria, with at least one human fatality. Outbreaks of Avian Influenza among poultry were reported in Katsina, Kano, Kebbi and Gombe in October 2008.
• 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: Recent outbreaks in Kaduna State and Sokoto State, which killed a total of 30 people, were reported by ProMed in October 2008. Although this disease is active in this country the threat to tourists is low. Cholera 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:

Filariasis: Major area of Bancroftian filariasis in the south, including the Igwun Basin of Imo State, and the Niger Delta; infection rates up to 26% have been reported. Travelers should take measures to prevent mosquito bites.

Hepatitis: All travelers should receive hepatitis A 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 is endemic with over 80% of the population >50 years of age sero-positive for the hepatitis E virus (HEV). Transmission of the hepatitis E virus 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 hepatitis B carrier rate is 10%–11% in the general population and 15% or more in sexually active, high-risk groups. 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 highly endemic with a prevalence of 15.4% in individuals in the 41-50 age group. 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: A sharp increase in cases of cutaneous leishmaniasis occurred in the north in the 1980s. Visceral leishmaniasis may occur in the northeast. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• 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.

Loiasis: Loiasis is prevalent in the forested areas of the southeast. Measures to prevent insect (fly) bites are recommended.

Malaria: Malaria occurs year-round, countrywide, including urban areas. A malaria outbreak was reported in October 2008 from Katsina State in northern Nigeria, causing more than 50,000 cases and more than 400 deaths. Risk is elevated during and just after the rainy seasons (March through July through November in the south; May through October north of the Niger-Benin River Valley). P. falciparum causes 80% of cases, followed by P. malariae and P. ovale (5%). Chloroquine-resistant P. falciparum malaria is widespread.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine 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 and select Malaria Map from the Nigeria 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.

Meningitis: As of March 15, 2009, the Nigeria Ministry of Health has reported 17,462 suspected cases and 960 deaths this year. The states of Bauchi, Gombe, Katsina, Jigawa, and Yobe are among the most affected areas. Suspected cases have been reported from 22 of 37 states. Outbreaks of meningococcal meningitis occur periodically in this country. Quadrivalent meningitis conjugate 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 from November to June.

Onchocerciasis: Widespread along fast-flowing rivers in both savanna and forest zones in parts of all states. Travelers should take measures to prevent insect (blackfly) bites.

Other Diseases/Hazards: African tick typhus
• Brucellosis (often from consumption of unpasteurized dairy products)
• Dracunculiasis (focally endemic)
• Lassa fever (An outbreak of Lassa fever was reported in February 2009 from the Federal Capital Territory and neighboring Nassarrawa state, resulting in more than 390 suspected cases and at least 55 deaths)
• Leptospirosis
• Loiasis (deerfly-borne; occurs in southern rain forests and swamp forests)
• Paragonimiasis (19% infection rate in the Igwun Basin)
• Relapsing fever (louse-borne )
• Typhus (flea-borne and louse-borne), and intestinal worms (very common}

Poliomyelitis (Polio): This disease is active and over 1000 cases are reported annually. In 2009, the northern states of Nigeria have experienced a large polio outbreak due to wild poliovirus type 3 (WPV3) with 258 cases, compared to 32 cases for the same period in 2008. WPV3 from northern Nigeria has this year spread internationally to Niger. Since February 2009, there has also been an increasing number of polio cases due to a type 2 circulating vaccine-derived poliovirus (cVDPV2) in northern Nigeria (103 cases to date in 2009 compared to 31 cases for the same period in 2008).

In 2008, a nine-fold increase in new cases in Nigeria caused by this serotype has been reported compared with the same period in 2007. This new outbreak has occurred because upwards of 20% of children remain unimmunized in key high-risk areas for polio in the north of the country. (Source: World Health Organization 18 June 2008)
• You should be fully immunized against polio if you are traveling to Nigeria.
• 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).

From the New England Journal of Medicine Oct. 2008:
By 2003, the Global Polio Eradication Initiative had interrupted the transmission of indigenous wild polioviruses in all but six countries worldwide, including Nigeria. In that year, however, the temporary suspension of all poliovirus immunization in one Nigerian state contributed to a national epidemic of poliomyelitis and the reinfection of at least 20 previously wild-type poliovirus–free countries. Although poliovirus immunization was reinstituted within 12 months, vaccine coverage remained low across northern Nigeria, and case numbers continued to increase.
In early 2006, Nigerian health authorities adopted new tools and tactics to accelerate poliovirus eradication. Trivalent oral poliovirus vaccine was replaced with monovalent oral poliovirus vaccine on a number of immunization-plus days from February 2006 to the present. In 2007, type 1 poliomyelitis cases in Nigeria fell by 86% as compared with 2006, contributing to an overall decline in poliomyelitis cases of 75%.

Rabies: Rabies is a public health problem in many rural and urban areas, including Lagos; sporadic cases of human rabies are reported countrywide. 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.

Schistosomiasis: High risk areas include the Niger River Basin and Ogun-Oshun River Basin, the southwest (including vicinities of Lagos and Ibadan), the central and northern highlands, and around Lake Chad.
Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. 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, or streams. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: High risk. Most of Nigeria’s water sources are man-made lakes, rivers, streams, and wells, most of which are contaminated. The water supply in Lagos is pure at the source, but cross contamination with sewage may occur during distribution. 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 a major health problem in this country. 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 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.

Yellow Fever: This disease is active and the risk of yellow fever is country-wide. Yellow fever is transmitted via the bite of an infected Aedes mosquito (mainly Aedes aegypti). Aedes mosquitoes feed predominantly during daylight hours. Vaccination is recommended for all travelers >9 months of age, especially thise going outside of urban areas. A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones.