Time Zone: +8 hours. No daylight savings time in 2008.
Tel. Country Code: 63
USADirect Tel.: 105
Electrical Standards: Electrical current is 220/60 (volts/hz). North American Style Adaptor Plug and European Style Adaptor Plug. Grounding Adaptor Plug A.
Travel Advisory - Philippines
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 Philippines
Provides emergeny and other services to Americans traveling abrod.
HIV Test: Applicants for permanent residence must be tested. Travelers should contact the Philippine Embassy for current requirements.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from infected areas or from any country in the Yellow Fever Endemic Zones.
Passport/Visa: The Philippines is a developing nation with a democratic system of government, located in Southeast Asia. The archipelago consists of more than 7,000 islands, of which over 800 are inhabited. The major island groupings are Luzon in the north, the Visayas in the center, and Mindanao in the south. Tourist facilities are available within population centers and the main tourist areas. English is widely spoken in the Philippines, and most signs are in English. Read the Department of State Background Notes on Philippines for additional information.
ENTRY/EXIT REQUIREMENTS: U.S. citizens may enter the Philippines without a visa upon presentation of their U.S. passport, valid for at least six months after the date of entry into the Philippines, and a return ticket to the United States or an onward ticket to another country. Upon arrival immigration authorities will annotate your passport with an entry visa valid for 21 days. If you plan to stay longer than 21 days you must apply for an extension at the Philippine Bureau of Immigration and Deportation's main office.
Persons who overstay their visas are subject to fines and detention by Philippine immigration authorities. American citizens are urged to remain aware of their visa status while in the Philippines and to strictly follow immigration laws and regulations.
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; 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.
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.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: A yellow fever vaccination certificate is required from travelers over 1 year of age coming from areas with risk of yellow fever transmission.
Hospitals / Doctors
Adequate medical care is available in major cities in the Philippines, but even the best hospitals may not meet the standards of medical care, sanitation, and facilities provided by hospitals in the United States, Canada or Europe. Medical care is limited in rural and more remote areas.
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 Manila.
Decompression chambers are located in Manila, Cebu, Batangas, Subic and Palawan.
The U.S. Embassy also maintains a list of doctors and hospitals.
Top=rated hospitals include the following:
St. Luke's Medical Center
This 650-bed hospital is home to nine Institutes, 13 Departments, and 19 specialty centers. Over 1,700 hospital-affiliated medical consultants see out-patients in more than 450 private clinics. SLMC is considered one of the leading health care facilities in Asia and the Western Pacific.
Makati Medical Center
Makati City, Manila
700-bed multi-specialty hospital; 24-hour ambulance and emergency services; ICU.
Manila Doctors Hospital
Full-service hospital; all specialties.
Destination Health Info for Travelers
AIDS/HIV: The Philippines has a very low HIV prevalence, with under 0.1% of the adult population infected. Even in groups such as sex workers and men having sex with men (MSM) that are typically associated with higher levels of HIV, prevalence rates above 1% have not yet been detected – in the case of commercial sex workers, this is possibly due to efforts to screen and treat those selling sex since the early 1990s. There are reasons to believe that this situation may not last, however. Condom use is not the norm in paid sex, drug users commonly share injecting equipment in some areas, and among Filipino youth, there is evidence of complacency about AIDS. Source: www.Avert.org
• 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.
• 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.
• 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 (cobras), centipedes, scorpions, and black widow spiders.
• Monkey bites are not uncommon, and can transmit rabies and herpes B virus.
• Stingrays, jellyfish, nettles, sea cucumbers, sea wasps (potentially fatal), urchins, anemones, and the Indo-Pacific man-of-war are common in the country’s coastal waters and are potentially hazardous to unprotected or careless swimmers.
Capillariasis: Intestinal capillariasis, caused by C. philippinensis is a relatively recent infection discovered in humans, first described in 1963. Though the disease is uncommon, reports of C. philippinensis infection are growing and spreading geographically. Cases have been reported in Southeast Asia, the Middle East, and southern Europe. Humans acquire C. philippinensis mainly through the ingestion of raw freshwater fish. After an asymptomatic phase, abdominal pain, borborygmus, and intermittent diarrhea typically develop as the worm burden increases through autoinfection. Over time, the diarrhea may progress to frequent voluminous stools, resulting in significant dehydration, electrolyte imbalances, and weight loss. Unlike infections with many other intestinal nematodes, C. philippinensis infection will frequently lead to death if left untreated for weeks to months, typically owing to cardiomyopathy from irreversible electrolyte losses or sepsis from secondary bacterial infection. The treatment of choice is a 10-day course of albendazole, which is effective against both larval and adult worms. Supportive treatment, with judicious fluid and electrolyte replacement and a high-protein diet, should accompany antihelminthic therapy. Symptomatic improvement typically occurs within days to weeks. Click on link above for more information ftom the New England Journal of Medicine about this disease
Cholera: This disease is reported active in this country but the threat to tourists is very low. Cholera is a rare 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.
Crime/Security/Civil Unrest: We advise you to exercise a high degree of caution in the Philippines because of the threat of terrorist attack. There have been a number of terrorist attacks in Manila and elsewhere.
• There is a danger of kidnapping in the Philippines.
• Mindanao, including mainland Mindanao, the Zamboanga Peninsula and the Sulu Archipelago: We strongly advise you not to travel to mainland Mindanao, the Zamboanga Peninsula and the Sulu Archipelago regions of Mindanao, including Basilan, Jolo and Tawi-Tawi due to the very high threat of terrorist attack, including kidnapping and related counter-terrorism operations. Kidnap for ransom gangs are active in Mindanao.
• Crime: Criminal gangs that drug and rob or assault unsuspecting tourists are active in Manila, including the Makati central business district. As in many other big cities, street crime is of concern particularly in crowded shopping malls and other public places. Pickpocketing, bag snatching and a range of scams, including those involving credit cards and automated teller machines, are common. Gun ownership is widespread and poorly regulated, contributing to a higher incidence of violent crime.
• Taxis sourced from hotels are more reliable than those hailed on the street. Avoid travel on public buses, light rail and jeepneys where possible as opportunistic crime may occur. Armed hold-ups have occurred and in some cases have led to fatalities.
• Local Travel: Sea travel in the Philippines is hazardous. You should not travel on ferries unless no other means of travel is available. Ferries are often overloaded, lack necessary life-saving equipment and are not adequately maintained. Storms can develop quickly. In June 2008, a ferry travelling between Manila and Cebu capsized during a typhoon. Around 800 passengers and crew died.
See the bulletin on Overseas Road Safety from Smartraveller:
Standards maintained by search and rescue services, transport services and tour operators, including adventure activities such as scuba diving, may not be comparable to those elsewhere. Check operators credentials and safety equipment beforehand and ensure your travel insurance policy covers your planned activities.
Dengue Fever: Dengue fever occurs countrywide, including urban and periurban areas, year-round. In June 2008, 630 cases, including 5 deaths, were reported in Caloocan City. This is a 100% increase in dengue fever cases in the first 5 months of 2008, compared to the same period last year. More than 24,000 cases were reported during the first nine months of 2007, including 283 deaths. Peak infection rates occur during the rainy season, May through November. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Asia. 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.
Filariasis: Bancroftian and Malayan forms of filariasis are transmitted by mosquitoes in rural areas. Filariasis is endemic on Luzon, Leyte, Marinduque, Mindanao, Mindoro, Palawan, Samar, and Sulu.
• 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.
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 and accounts for 5% to 7% of cases of acute viral hepatitis in this country. 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 13%. 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 high level with a prevalence of 3.6% in the general population. Up to 70% of injecting drug users are sero-positive for hepatitis C antibodies. 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.
Japanese Encephalitis (JE): There is year-round risk of JE in rural agricultural areas, with peak transmission during the monsoon season, usually May through November. Highest risk of JE occurs on Luzon and Mindanao, with a high incidence in extreme southern Luzon, Negros, Cebu, and the Catanduanes Island.
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.
Leptospirosis: According to the Philippine Department of Health, approximately 1,000 cases of leptospirosis, a significant increase over the average incidence, have been reported in metro Manila hospitals since October. Most cases are from flooded areas of metro Manila and Rizal Province caused by tropical storm Ketsana. Travellers to flooded regions who anticipate extensive outdoors exposure, including disaster relief workers and adventure travellers, should consider prophylaxis with 200 mg of doxycycline once a week. Source: Travel Medicine Alliance
Malaria: There is year-round risk, countrywide, excluding the islands of Bohol, Catanduanes, Cebu, and Leyte, the plains of the islands of Negros and Panay, and the city of Manila and other urban centers. Risk occurs primarily in the forested foothills and rolling terrain below 1,000 meters elevation in those rural areas rarely visited by tourists. Most malaria transmission occurs during and just after the monsoon season, May through November. Chloroquine-resistant falciparum malaria is common.
Atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine prophylaxis is advised for travelers going to malaria risk areas.
A malaria tisk map is located here.
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 (such as Ultrathon) 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 endemic areas within this country.
• Long-term travelers to endemic areas 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 (Meningococcal): From October 2004 to January 2005, a total of 98 cases of meningococcal disease were reported Baguio City, Mt. Province and Ifugao (the Cordillera Region in the island of Luzon) Vaccination with a quadrivalent vaccine (Menactra or Menomune) should be considered by travelers anticipating close contact with the indigenous population of these regions.
Other Diseases/Outbreaks: Angiostrongyliasis (may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF; human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria (non-parasitic flatworms) and from raw prawns, fish, land crabs, or shellfish. There is no effective specific treatment.
• Anisikiasis is reported (occurs from consuming raw, infected tuna and mackeral)
• Capillariasis (since late October 2007, a total of 31 adults and 9 children have died of capillariasis; humans acquire the infection by eating small freshwater fish raw)
• Chikungunya fever (year-round; reported from urban and village areas of central and southern islands)
• Clonorchiasis and and fascioliasis (liver fluke diseases)
• Gnathostomiasis (prevalent in rural areas)
• Leptospirosis (risk elevated end of monsoon season, peaking early dry season). Increase in cases reported in the Manila area in October 2009. Most cases are from flooded areas of metro Manila and Rizal Province caused by recent tropical storms. Travelers to flooded regions who anticipate extensive outdoors exposure should consider prophylaxis with 200 mg of doxycycline once a week. Source: Travax.com
• Murine typhus (flea-borne)
• Paragnonimiasis (lung fluke disease)
• Scrub typhus (mite-borne; risk elevated in grassy rural areas below 3,000 meters elevation on Leyte, Samar, Mindoro, Luzon, Negros, Panay, Palawan, Cebu, and Mindanao)
Soil-transmitted helminthic infections (hookworm, roundworm, strongyloides) are prevalent in most rural areas.
• Travelers should wear shoes (to prevent the hookworm and Strongyloides larvae from penetrating the skin) and food should be thoroughly washed/cooked (to destroy roundworm eggs).
Rabies: Sporadic cases (about 200 cases/year) of human rabies are reported countrywide. Increased rabies deaths were reported in 2007. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals.
Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• 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, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.
Schistosomiasis: Schistosoma japonicum (intestinal) is present in this country. Risk exists year-round, primarily in southern Luzon, Leyte, Samar, Mindanao, and the east coast of Mindoro and Bohol Islands. 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: There is high risk of travelers diarrhea outside of first-class hotels and resorts. Over 400 cases and 4 deaths due to Shigella flexneri were reported in late 2007 in the province of Bohol.
• 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.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
• 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 is a major public 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: As of March 2008, nearly 2,000 cases of typhoid fever occurred in Calamba City, Laguna Province. Another outbreak with 217 suspected cases and one confirmed death due to the disease was reported in Iloilo City of Iloilo Province. (ProMED March 2008)
A typhoid fever outbreak, from contaminated well water, affected at least 200 people in Davao del Sur region in 2007. Several other outbeaks of typhoid also reported in the same year.
Typhoid is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all unvaccinated people traveling to or working in Asia, 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.
Volcanic Activity: Travelers should know that there is in December 2009 the imminent risk of volcano eruption on the island of Luzon. Risk areas include Tabaco City, Malilipot, Daraga, Camalig, Guinobatan, and Ligao.