Time Zone: +2 hours. GMT +3 hour during daylight savings time.
Tel. Country Code: 40
USADirect Tel.: 21
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Romania
Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.
Dr. Rose Recommends for Travel to Romania
• U.S. Embassy
Strada Tudor Arghezi 7-9
Tel:  (21) 210-4042
• Canadian Embassy
1-3 Tuberozelor Street
Tel:  (21) 307-5000
Fax:  (21) 307-5010
• U.K. Embassy
24 Jules Michelet
Tel:  (21) 201-7300/7200
• Visa: A visa is required for stays greater than 30 days. Travelers should call the Romanian Embassy for further information.
• HIV Test: Not required.
• Vaccinations: None required.
Passport/Visa: All passports must be valid for period of intended stay. Visitors must hold all documents required for further travel, onward or return tickets, sufficient funds for period of stay, and proof of reserved accommodation.
Entry requirements for Americans: United States nationals require a valid passport, but no visa for stays of up to 90 days.
Entry requirements for UK nationals: UK nationals require a valid passport but no visa for stays of up to 90 days.
Entry requirements for Canadians: Canadian nationals require a valid passport, but no visa for stays of up to 90 days.
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.
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.
• An outbreak in Indiana in 2005 was caused by unvaccinated 17-year-old American girl who acquired the infection while performing missionary work in Romania.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
Typhoid: Recommended for all travelers with the exception of short-stay visitors who restrict their meals to hotels or resorts.
Hospitals / Doctors
Medical facilities are generally below western standards and the availability of medical supplies is limited, particularly outside major cities. Treatment can be expensive and up-front payment is often required.
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. 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 Vienna or London for state-of-the-art treatment.
Romania has three decompression chambers, all located in the port city of Constanta on the Black Sea coast.
For a public ambulance in Romania, call 112 or 961. For a private ambulance, call Bio-Medica Ambulance at  21 230 4570 or mobile phone 092-338-383, or SOS Medical Emergencies at 9761 or mobile phone 092-333-000; 094-323-000.
US & Australian Embassy hospital and doctor lists: http://www.usembassy.ro/US_Citizen_Services/Visiting_Living/Health.html
• Floreasca Emergency Hospital
8, Calea Floreasca
Tel:  (21) 230 0106
• Hospital Euro Clinic
14A, Calea Floreasca Street
Tel:  21 200-6800
For routine medical care, most travelers go to one of the following private clinics:
14 A Floreasca Street
Tel:  21 231-3575
• Village Medical Clinic
119 Soseaua Nordului
Tel:  21 232-3580, 3581
Emergency Tel:  722 303 409
• Unirea Medical Center
57, Unirii Blvd.
Tel:  21 327-1188
• Unirea Medical Center
9, Batistei Street
Tel:  21 211-5942
• SIMONA Medical Services
Dr. Paul Ignat – US Board Certified Internist
8, Marasti Blvd
Tel:  (21) 224-2749
CENTRUL MEDICAL SIMONA
Str. Ing. Pascal Cristian, nr. 33, sector. 6
Tel:  (21) 317-2462
• USA Deschisa Medical Center
27, Prelungirea Ghencea
Tel:  21 444-1994
Board-certified US physicians on staff. Services include primary care, including evaluation and treatment of simple and complex outpatient problems, general and emergency medical services, ENT, EKG, laboratory testing, dentistry.
Destination Health Info for Travelers
AIDS/HIV: Central Europe has been relatively spared by the HIV epidemic, with the incidence of both AIDS cases and newly diagnosed HIV infections remaining low. There is an adult prevalence of 0.1% in people living with HIV/AIDS. This region, however, accounts for the largest proportion of pediatric AIDS cases following an outbreak of infection among young children in hospitals in Romania around 1990. (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. Note: There is a risk of exposure to unsafe blood and blood products in Romania. Travelers may need to specifically request the use of sterilized equipment.
• 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.
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.
• 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): An outbreak of H5N1 avian influenza was reported in 2005 from a poultry farm in Tulcea County, followed by cases in other parts of the country. The most recent outbreak, reported in December 2007, was also in a farm in Tulcea. No human cases have been reported to date.
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
• The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm
Hepatitis: Outbreaks of hepatitis A are reported in this country. 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 levels are unclear. Sporadic cases may be 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 hepatitis B carrier rate in the general population is estimated at up to 9%—the highest in Europe. 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 4.5% 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 population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Lyme Disease: Lyme disease, transmitted by Ixodes ticks, is a risk in wooded and brushy areas. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of this country should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Other Diseases/Hazards: • Anthrax (sporadic human cases occur, usually cutaneous, related to the slaughter of livestock in rural areas, especially southern areas)
• Brucellosis (enzootic at low levels, particularly in sheep, goats, and cattle; human cases usually due to consumption of unpasteurized milk or milk products)
• Echinococcosis (stray dogs in urban and rural areas commonly infected; human cases reported sporadically)
• Hemorrhagic fever with renal syndrome (similar to hantavirus syndrome; virus transmitted by rodent excreta)
• Lleptospirosis, rabies (enzootic in foxes, wolves, and wild canids; rare in humans)
• Trichinosis (caused by consumption of raw, cured or insufficiently cooked meat (e.g., sausages) from wild boars and domestic pigs)
• Tuberculosis (highest reported incidence in Europe)
• Typhoid fever
• Typhus (murine and louse-borne)
• West Nile Fever (See below)
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. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Rabies is endemic in Romania and sporadic cases of human rabies are reported countrywide. Feral dogs roam city streets, often in packs, and can be vicious. Dog attacks are not uncommon. You should seek medical help immediately if bitten to evaluate the need for post-exposure treatment.
• 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.
Tick-Borne Diseases: Lyme disease, Central European tick-borne encephalitis (TBE), and Mediterranean spotted fever are reported. The ticks that transmit these diseases are found in brushy, wooded areas throughout the country. There is higher risk of tick-borne encephalitis in the Tulcea District and in Transylvania at the base of the Carpathian Mountains and Transylvanian Alps. Mediterranean spotted fever is endemic along the Black Sea coast.
• A vaccine against TBE is available in Canada and Europe, but is recommended only for those who will have intense outdoor exposure in risk areas from April through October. Travelers to endemic areas should take measures to prevent tick bites.
Tick-Borne Encephalitis (TBE): Risk of tick-borne encephalitis is reported for the Tulcea district and in Transylvania at the base of the Carpathian Mountains and the Transylvanian Alps. However, details about the annual numbers of TBE cases have not been published. (Source: Eurosurveilance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916)
Vaccination against TBE should be considered by those camping near forests, for extended hiking and camping in rural endemic areas, and for forest workers. The standard vaccination schedule consists of 3 doses given at 0, 1-3 months, and at 9-12 months. An 2-dose accelerated schedule is possible (0, 21 days), with 85% protection resulting. The European vaccine (FSME-IMMUN-Baxter) is available in health clinics in Germany, Austria, Slovakia, Czech Republic and Poland, as well as Canada, but the traveler would have to initiate the vaccine after arriving in the area and hiking/camping delayed for 3 weeks before adequate protection to kick in. This makes administration of vaccine generally impractical for the average traveler. Tick-bite protection is therefore essential.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
More information on TBE at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/TBE.htm
Travelers' Diarrhea: High risk outside of first-class hotels and resorts. 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: Eastern Europe - particularly the former Soviet republics - have experienced sharp increases in the number of TB cases reported. The increase in drug resistance to anti-TB medication has contributed to this striking increase. Multidrug-resistant TB (MDR-TB), or the more serious extensively drug resistant TB (XDR-TB), may develop in people when TB infections, in response to non-compliance with required drug and treatment schedules, stop responding to the most common (or all) anti-TB drugs.
• Tuberculosis a major health problem in Romania. Tuberculosis is highly endemic in Romania 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 or resorts) traveling to or working in Eastern Europe, 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.
Viral Encephalitis: An outbreak of mosquito-transmitted West Nile encephalitis occurred in 1996 in the lower Danube valley and Bucharest. West Nile virus is transmitted by daytime-biting Aedes mosquitoes.
All travelers should exercise insect-bite prevention measures against daytime insect bites. These measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. 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.
West Nile Fever: A total of 57 cases of West Nile virus (WNV) infection were identified in Romania between July and October 2010. Cases were distributed in 19 districts in the southern, western, central and eastern parts of the country. Most cases were recorded in the southern part of the country, an area known to be endemic for WNV from previous years. However, WNV infections were reported in humans in previously unaffected areas, such as districts in central Transylvania, and in the Moldavian Plateau.
• In August 2008, a case of mosquito-transmitted West Nile Fever was reported from Braila county (south eastern Romania). The patient was a 42-year-old man who presented with severe headache, retro-orbital pain, vomiting, rash, and fever. Spinal tap showed aseptic meningitis. He recovered fully.
Analysis: Climatic conditions, temperature, humidity (rain, soil humidity, natural water reservoirs such as Danube delta) and the presence of migratory and indigenous wild birds and horses were favoring the existence and multiplication of the Culex mosquitoes responsible for transmitting the WNF virus.
• Prevention: You should exercise insect-bite prevention measures in this country. For maximum protection, apply a DEET-containing repellent to exposed skin (30%–50% concentration is recommended) and apply permethrin spray or solution to your clothing and gear.
• DEET-based repellents have long been the gold standard to prevent mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin repellents as an effective DEET alternative.