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North Korea



Capital: Pyongyang

Time Zone: + 9 hours.
Tel. Country Code: 850
USADirect Tel.: 0
Electrical Standards: Electrial current is 110/60 (voltz/hz). North American Style Adaptor Plug and European Style Adaptor Plug. Grounding Adaptor Plugs A, D.


Travel Advisory - North Korea

Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.

Dr. Rose Recommends for Travel to North Korea


Resource Links

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

Embassies

North Korean Mission to the U.N.: 212-972-3106.
No diplomatic relations are maintained with the U.S.
The Embassy of Sweden is the U.S. contact in Pyongyang: (850)(2)381-7523.

Entry Requirements

HIV Test:  (no data)

Required Vaccinations: In accordance with International Health Regulations, a yellow fever vaccination certificate is required from travellers aged 1 year and over coming from countries with a risk of yellow fever transmission.

Passport Information

Passport/Visa: Since the end of the Korean War in 1953, the Korean peninsula has been divided in two by a de-militarised zone separating North and South Korea. Peace has been maintained under an Armistice Agreement. Tensions rise and fall from time to time. As of August 2007, tensions have eased due to progress in the Six Party Talks and the North – South Summit. However, North – South cross-fire was exchanged at the DMZ for the first time in a year at the beginning of the month. You should check this Travel Advice regularly and follow developments closely.

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.

Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.

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.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

NOTE: A measles epidemic was reported from North Korea in February 2007, resulting in approximately 3600 cases and at least four deaths. You should be sure you are fully immune against measles before visiting this country.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.

Yellow Fever: Travelers >1 year of age entering the country from an infected area are required to present a certificate of immunization against yellow fever.

Hospitals / Doctors

The standard of medical facilities in the DPRK is poor. Doctors and hospitals may expect immediate cash payment for services. A hospital for foreigners, with English speaking doctors, operates in the Munsudong District of Pyongyang, but even hospitals in Pyongyang may lack adequate heating and medical supplies and often experience power outages and other difficulties.

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 or may 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. Serious illness or injury may require medical evacuation to Japan or the U.S.

Destination Health Info for Travelers

AIDS/HIV: Most people living with HIV in Asia became infected through unprotected sex or injecting drug use. In some countries, transmission through sex between men also accounts for many infections. The HIV prevalence in adults in North Korea is not well documented but estimated at 0.1% or less. (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with 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.

Avian Influenza A (Bird Flu): In Chosun of North Korea, an Avian Influenza outbreak that began in February 2005 has been brought under control by the culling of chickens and vaccination of poultry in affected areas.
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.

• More information here: http://content.nejm.org/cgi/content/full/358/3/261

Cholera: This disease may be sporadically active but most travelers are at low risk for infection. 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: There has been an outbreak of Hand, Foot and Mouth Disease (HFMD) in the region, most notably in China. 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.

Helminthic Infections: Anisakiasis, fascioliasis, fasciolopsiasis, paragonimiasis, and clonorchiasis are endemic. Travelers should avoid eating uncooked water plants and raw or undercooked seafood and shellfish, including Ke Jang (raw crab in soy sauce).

Hemorrhagic Fever with Renal Syndrome (HFRS): Year-round risk, countrywide. Elevated risk is associated with dusty, dry conditions and peak rodent populations. The virus (hantavirus) that causes HFRS is transmitted by infected rodent secretions (e.g., excreta) and virus-carrying dust particles. Most cases occur from October through December, associated with peak human activity in rodent-infected areas during harvest.

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 incidence is not clear. Eighteen percent of blood donors in Korea have been found to be positive for anti-HEV antibodies. 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 >8%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic with a prevalence of 1.7% in the general population (data from S. Korea). 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.

Japanese Encephalitis (JE): Japanese encephalitis is common, especially during the summer. This mosquito-borne disease is found throughout many regions of Asia. The Centers for Disease Control and Prevention (CDC) recommends JE vaccination for travelers spending more than 30 days in an endemic environment, or less than 30 days in areas with epidemic transmission. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodation and purpose, as well as local geography, is warranted to give adequate advice. Is travel occurring during the peak transmission season? In general, travelers to rural areas (especially where there is pig rearing and rice farming) should be vaccinated if the duration of their trip exceeds 3 to 4 weeks. They may consider vaccination for trips of shorter duration if more intense exposure is anticipated, especially during unprotected outdoor activities in the evening. Vaccination is advised for expatriates living in this country.
• Japanese encephalitis is transmitted by night-biting Culex mosquitoes. All travelers should take measures to prevent mosquito bites, especially in the evening and overnight. 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.

Malaria: Malaria is a risk in the south of the country, especially from May to September. There is no malaria risk in the capital Pyongyang. Malaria prophylaxis is not currently recommended for travelers. You should take measures to prevent mosquito bites.

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 North Korea page on the Destinations menu or A-Z Index.

• 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 remain 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.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.

Other Diseases/Hazards: Clonorchiasis (Oriental liver fluke), lung fluke disease (paragonimiasis), leptospirosis (elevated risk associated with areas of stagnant water and muddy soils), rabies (extremely rare), murine typhus (flea-borne), scrub typhus (mite-borne; risk
elevated in grassy rural areas; 90% occur October–December), tuberculosis (highly endemic), typhoid fever, and acute hemorrhagic conjunctivitis.
Animal hazards include centipedes and black widow spiders. Lynxes, bears, and wild boars may be encountered in remote areas.

Rabies: Rabies is reported in wild and domestic animals (including bats). 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.
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.

Travelers' Diarrhea: Risk is higher outside of first-class hotels. Water-borne and food-borne diseases occur from time to time. Outbreaks of diarrheal diseases may occur during the rainy season. We recommend that you boil all drinking water or drink bottled water, and avoid ice cubes and raw and undercooked food. Seek medical advice if you have a fever or are suffering from diarrhea. A quinolone antibiotic, azithromycin, or rifaximin, 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.

Tuberculosis (TB): Tuberculosis is highly endemic in North Korea 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 (with the exception of short-term visitors who restrict their meals to hotels) traveling to or working in North Korea, 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.