Northern Mariana Islands (U.S.)
Time Zone: +10 hours.
Tel. Country Code: 670
USADirect Tel.: 0
Electrical Standards: N/A
These islands have been a self-governing U.S. territory since 1986.
Canadian and U.K. diplomatic contacts are handled by their embassies in Washington, DC
• Canadian Embassy
501 Pennsylvania Avenue, N.W.
Washington, D.C. 20001
Tel:  202-682-1740
Fax:  202-682-7689
• U.K. Embassy
3100 Massachusetts Avenue, NW
Washington, DC 20008
Tel:  202-588-6500
Fax:  202-588-7870/50
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: ENTRY REQUIREMENTS
U.S. citizens require proof of citizenship such as passport, birth certificate or naturalization papers. Non-U.S. citizens need a passport valid for at least 180 days from the date of entry and an onward ticket and visa to their next destination, if not returning home. Nationals of Australia, Canada, Ireland and the UK are exempt from Visitor Entry Permits into the Northern Mariana Islands, although this may be counteracted by individual circumstances.
The Commonwealth of the Northern Mariana Islands is a self-governing commonwealth in political union with the United States, in the western Pacific Ocean. Composed of 22 islands north of Guam, the Northern Marianas extend for 450 miles (720 km). The capital, Chalan Kanoa, is on Saipan. Saipan, Tinian, and Rota are the principal inhabited islands. All the Marianas are mountainous, with the highest peak (3,166 ft/965 m) on Agrihan. There are active volcanoes, and the islands are subject to typhoons. The indigenous people are Micronesian; other inhabitants are Chamorro and Filipino.
U.S. forces occupied the Marianas (1944) during World War II, and in 1947 the group (exclusive of Guam) was included in the U.S. Trust Territory of the Pacific Islands. Residents approved separate status for the Northern Marianas as a U.S. commonwealth in 1975. They became internally self-governing under U.S. military protection in 1978, and trust territory status was officially ended in 1986. (Residents are U.S. citizens but do not vote in U.S. presidential elections.)
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: This vaccine should be considered by persons living in this country for 30 days or more. Vaccination for persons staying fewer than 30 days may be considered if they expect unprotected nighttime outdoor exposure in endemic areas.
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 with the exception of short-term visitors who restrict their meals to major restaurants and hotels.
Hospitals / Doctors
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics (a quinolone is preferred) to treat travelers• diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; may be of dubious origin; 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 Hawaii or Japan.
Adequate medical care is available in Saipan but is not up to the standards of other industrialized countries. Medical care is substandard in the rest of the country. The public health care facilities are often short of supplies and specialists.
• Commonwealth Health Center (CHC)
CHC is an 86-bed, Medicare-certified hospital, which opened in 1986 and expanded in 2007. The hospital•s scope of services includes emergency medicine, obstetrics, adult and neonatal intensive care, surgery, general medicine, pediatrics, dialysis, mental health and various outpatient services.
Private medical facilities include:
• Pacific Medical Center
Tel:  233 8100
Fax:  233 8102
• Island Medical Center
• PacifiCare Medical Center
• Marianas Medical Center
• Saipan Health Clinic
Destination Health Info for Travelers
AIDS/HIV: A small number of AIDS cases and HIV infections have been reported, but little data are available from the Northern Mariana Islands. The over-all prevalence of adults living with HIV in Oceania is 0.4%.
• 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 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.
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.
Avian Influenza A (Bird Flu): There are no reports of avian influenza in this country.
Cholera: ProMED reports that a case of cholera was confirmed in a 6-year-old child who had traveled to Saipan, Northern Marianas for a family event the weekend before becoming ill. Neither Guam nor the Northern Mariana Islands has observed an increase in diarrheal illnesses nor detected additional possible cholera cases.
Cholera is an extremely rare disease in travelers from developed countries. Cholera vaccine is usually recommended only for people, such as 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 don’t 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.
Dengue Fever: Sporadic cases occur but no recent outbreaks have been reported. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Oceania. 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 may be endemic, but levels are unclear. Transmission of HEV occurs primarily through contaminated drinking water. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is elevated 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 but levels are unclear. The prevalence in neighboring Micronesia is 1.6% 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 world’s population. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Japanese Encephalitis (JE): Rare outbreaks occur in Saipan and Guam. 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: There is no risk of malaria in this country.
Marine Hazards: Swimming related hazards include jellyfish, spiny sea urchins, corals, sharks, and sea snakes.
• Ciguatera poisoning is prevalent and can result from eating coral reef fish such as grouper, snapper, sea bass, jack, and barracuda. The ciguatoxin is not destroyed by cooking.
Rabies: The Northern Mariana Islands is currently deemed rabies-free, but there is little surveillance. Prompt medical evaluation and first-aid treatment of any animal bite is essential, regardless of vaccination status. If treatment with rabies vaccine/immune globulin is deemed advisable, medical evacuation may be required.
Travelers' Diarrhea: Medium risk outside of first-class hotels and resorts. A quinolone antibiotic ( e.g., ciprofloxacin), or azithromycin, combined with loperamide (Imodium). is recommended for the treatment of acute diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis or cryptosporidiosis.
Tuberculosis (TB): Tuberculosis is moderately endemic in Northern Mariana Islands with an annual occurrence was greater than or equal to 25 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 unvaccinated people traveling to or working in Oceania, 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.