Time Zone: -4 hours.
Tel. Country Code: 595
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Paraguay
Travelers to Central and South America and the Caribbean need to protect themselves against mosquito-transmitted viruses, such as dengue and Zika, as well as nighttime biting mosquitoes in countries where there is the threat of malaria. 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 Paraguay
• U.S. Embassy
1776 Mariscal Lopez Avenue
Tel:  (21) 213-715
• Canadian Embassy
Prof. Ramirez No. 3 at Juan de Salazar
Tel:  (21) 227-207
• There is no British Embassy in Paraguay. Any enquiries should be directed to the British Embassy in Buenos Aires, Argentina.
HIV Test: Not required.
Required Vaccinations: Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever. The CDC recommends vaccination for all travelers >9 months of age traveling to Paraguay.
Passport/Visa: Paraguay is a constitutional democracy with a developing economy. Tourist facilities are adequate in the capital city of Asuncion, but they vary greatly in quality and prices. Travelers outside Asuncion should consider seeking travel agency assistance, as satisfactory or adequate tourist facilities are very limited in other major cities and almost nonexistent in remote areas.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. U.S. citizens traveling to Paraguay must submit completed visa applications in person or by secure messenger to the Paraguayan Embassy or one of the consulates and pay a fee. Paraguay issues visas for one-entry or multiple entries up to the validity of the U.S. passport. Applicants under 18 years of age traveling alone must appear with both of their parents or a legal guardian. In case of a guardian, an original and one copy of proof of legal guardianship are required. A document of authorization from parents/guardian will be accepted only if it is notarized and certified by the county clerk. Travelers entering or departing Paraguay with regular U.S. passports will be fingerprinted. There is an airport international departure tax, payable in either U.S. or local currency (no credit cards or checks accepted). Visit the Embassy of Paraguay website at http://www.embaparusa.gov.py 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 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 (increased risk in lesser-developed countries); from contact with open skin sores of an another person. 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.
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.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels.
Yellow Fever: This disease is active. Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever.
The CDC recommends that yellow fever vaccine be given to all travellers over 9 months of age visiting Paraguay.
Hospitals / Doctors
Facilities for good private medical care exist but are limited to the major cities. Hospitals and and physicians will expect immediate payment for medical services. The availability of certain types of medicines cannot be guaranteed.
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 that provides for medical evacuation to more advanced medical facility in another country in the event of serious illness or injury that requires specialty care not available in this country.
The U.S. Embassy maintains a list of hospitals and English-speaking doctors at: http://paraguay.usembassy.gov/emergency_medical_assistance.html
Most travelers go to one of the following facilities:
• Sanatorio Migone Battilana (Migone Hospital)
Eligio Ayala 1293
Tel:  (21) 498-200
Emergency Tel: (021) 214 305
Mobile: (0981) 645-040
General medical facility; five adult ICU units; coronary/cardiovascular ICU; pediatric-neonatal Intensive care; physicians on 24-hr call.
• Centro Medico Bautista (Baptist Medical Center)
Located in the Barrio Marshal Jose Felix Estigarribia, on the street corner Avenida Rep•blica Argentina Andres Campos Cervera
Central Phone:  (21) 600-171-4
Emergency:  (21) 607 944
The Emergency room entrance is from Campos Cervera Street.
Destination Health Info for Travelers
AIDS/HIV: In the majority of South American countries, injecting drug use and sex between men are the most important routes of HIV transmission. The virus is then passed on to other sexual partners. In Central America, drug use plays a smaller role and most infections appear to be occurring through sexual transmission (both heterosexual and between men).
The HIV prevalence rate in the adult population of Paraguay is estimated at 0.5% (Source: 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 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.
• Heart attacks cause most fatalities in older travelers.
• Infections cause of only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• 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.
Animal Hazards: Animal hazards include snakes (vipers, coral snakes), centipedes, scorpions, black widow spiders, brown recluse spiders, banana spiders, and wolf spiders. Species of carnivorous fish occur in the freshwaters of Paraguay.
Chagas’ Disease: Chagas• disease is becoming a public health problem in Latin America due to the wide distribution, the high prevalence, the magnitude of the damage caused and the difficulties to control it. In Paraguay, the disease is mainly distributed in the departments of Paraguar•, Cordillera and Central.
The risk of transmission occurs primarily in those rural-agricultural areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take precautions against nighttime bites, which typically occur on the face of the sleeping victim.
• Other methods of transmission are possible, from; consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; from blood transfusions; from in-utero transmission.
Dengue Fever: There are fears of complications after the 2007 outbreak. A health alert has been declared in Paraguay in a bid to stop a new outbreak of dengue fever. Health workers have detected some 150 suspected cases of the mosquito-borne disease so far this year . This disease is widely endemic. Risk occurs primarily during the warmer months (November•April), especially in urban areas. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in South America. 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. 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 may be endemic, but levels are unclear. Sporadic cases may occur. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also by raw or uncooked shellfish. 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 overall hepatitis B (HBsAg) carrier rate in the general population is estimated at <2%. 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 low level. 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 from April through September in the Southern Hemisphere. The flu vaccine is recommended for all travelers over age 6 months.
Leishmaniasis: Cutaneous and mucocutaneous leishmaniasis are highly endemic in rural areas in the departments of Alto Paraná, Amambay, Caaguazu, Caazapa, Canendiyu, Guaira, and San Pedro. The highest incidence occurs in Caaguazu 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: Malaria risks is moderate in certain municipalities of the departments of Alto Paran• (90% of cases), Caaguaz•, Caazapa, Canendiy• and Guaira. In the other departments there is no or negligible transmission risk.
Urban areas and Iguassu Falls vicinity are risk free. Vivax malaria accounts for >95% of cases. Chloroquine prophylaxis is recommended for travel to malarious areas.
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 Paraguay page on the Destinations menu.
Another malaria map is located at: http://www.paho.org/Images/Hcp/HCT/malaria_03.gif
• 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: Anthrax, brucellosis (usually from unpasteurized dairy products), coccidiomycosis, leptospirosis, hantavirus pulmonary syndrome (very low risk; sporadic cases in eastern and western Paraguay; transmission of hantavirus is from aerosolized rodent droppings. Travelers should avoid, if possible, rodent-infested dwellings), measles, rabies (a relatively minor public health problem), tick-borne relapsing fever, tuberculosis (relatively high incidence, especially among Amerindian children), Venezuelan equine encephalitis, and strongyloidiasis and other helminthic infections are reported.
Rabies: In Paraguay, rabies is usually caused by dog bites, and most cases are reported from the departments of Central, Paraguari, and Caaguazu. 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: This disease is not reported in Paraguay but exists in adjacent areas of Brazil along the Parana River.
Travelers' Diarrhea: Low- to moderate-risk. In ten large urban areas, including the capital city of Asuncion, piped water is supplied and is considered safe for consumption. A quinolone antibiotic, azithromycin, or rifaximin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to treatment with an antibiotic may be due to a parasitic disease such as giardiasis or cryptosporidiosis.
Tuberculosis (TB): Tuberculosis is highly endemic in Paraguay 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 South America, 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: The Paraguay Ministry of Health (MOH) has reported to the World Health Organization (WHO) the first cases of yellow fever disease identified in Paraguay in more than 30 years. As of May 12, 2008, a total of 25 confirmed cases (including 8 deaths) of yellow fever in humans have been reported
New cases of yellow fever have been reported in the triangle where Argentina, Paraguay and Brazil meet and in the forested areas round the Iguassu Falls. A yellow fever outbreak was reported in February 2008 from San Pedro department in the east central region of Paraguay, northeast of Asuncion, an area where yellow fever has not occurred for many years.
• Yellow fever vaccine is recommended for by the CDC for all travelers >9 months of age traveling to Paraguay).
• Paraguay currently requires yellow fever vaccination for persons entering Paraguay from countries listed as endemic for yellow fever.
Read more: http://wwwn.cdc.gov/travel/contentYellowFeverParaguay.aspx
Yellow fever map here: http://wwwn.cdc.gov/travel/image.ashx?i=268