Time Zone: +3 hours GMT. The local time in Moscow and St Petersburg is GMT +3 (GMT +4 in summer). Russia has 11 time zones.
Tel. Country Code: 7
USADirect Tel.: 155
Electrical Standards: Electrical current 220/50 (volts/hz). European Style Adaptor Plugs. Grounding Adaptor Plug D.
Travel Advisory - Russia
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 Russia
• U.S. Embassy in Moscow
Bolshoy Deviatinsky Pereulok No. 8
Tel:  (095) 728-5000
Fax:  (095) 728-5090
Web Site: http://moscow.usembassy.gov/
Office Hours: Monday - Friday, 09:00 - 12:30 : 15:00 - 16:00.
The American Citizen Services Unit (telephone  095-728-5577) is open Monday through Friday from 9:00 a.m. to 12:30 p.m. and 3:00 p.m. to 4:00 p.m., except on Russian and American legal holidays. In the event of an emergency, American citizens may telephone  (095) 728-5577 anytime from 9:00 a.m. to 6:00 p.m., Monday through Friday. After 6:00 p.m., please call the Embassy duty officer at  (095) 728-5990. Please note that passport, notarial, and other fees are payable in dollars, rubles, or U.S. dollar travelers checks.
15 Ulitsa Furshtadtskaya, St. Petersburg 191028
Tel:  (812) 331-2600
Fax:  (812) 331-2646
32 Ulitsa Pushkinskaya, Vladivostok 690001
Tel:  (4232) 30-00-70
Fax:  (4232) 30-00-91
After-hours emergencies: (7) (4232) 71 00 67
Ulitsa Gogolya 15a, 4th floor
Tel:  (343)379-3001
Fax:] (343) 379-4515
After-hours emergencies: (7) 8 902 84 16653
• Embassy of Canada
23 Starokonyushenny Pereulok
Tel:  (495) 105-6000
Emergency toll-free to Ottawa: 810-800-201-41012
Fax:  (495) 105-6004
• British Embassy
Smolenskaya Naberezhnaya 10
 (495) 956 7200 (Switchboard)
HIV Test: Required for all foreign visitors staying longer than 3 months.
Required Vaccinations: None required.
Passport/Visa: The Russian government maintains a restrictive and complicated visa regime for foreign travelers who visit, transit, or reside in the Russian Federation. The Russian system includes requirements of sponsorship, visas for entry and exit, migration cards, and registration. American citizens who also carry Russian passports face additional complicated regulations. Dual citizen minors who travel on their Russian passports also face special problems.
For information concerning entry and exit requirements, travelers should contact the Embassy of the Russian Federation, Consular Section, 2641 Tunlaw Rd., NW, Washington, DC 20007, tel. 202-939-8907. In addition, there are Russian Consulates in:
Houston: 1333 West Loop South, Ste.1300, Houston, TX 77027, tel. 713-337-3300
New York: 9 East 91 St., New York, NY, 10128, tel. 212-348-0926
San Francisco: 2790 Green St., San Francisco, CA 94123, tel. 415-928-6878 or 415-202-9800
Seattle: 2323 Westin Building, 2001 6th Ave., Seattle, WA 98121, tel. 206-728-1910
Visit the Embassy of the Russian Federationweb site at:
www.russianembassy.org 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 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; 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: Vaccination is recommended for those travelers who visit or work in rural agricultural endemic areas for >3-4 weeks.
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.
Hospitals / Doctors
Russian nationalized medical care is officially free-of-charge, but the quality of service ranges from unacceptable to merely uncomfortable. Russian doctors often demand payment for disposable needles, medications, and some services. Privately-run facilities are being established in the major cities to serve business travelers, tourists, expatriates and affluent Russians.
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, may be of dubious origin, or be of unreliable quality.
Note: The Federal Service for Health Sphere Supervision reported that 10% of all drugs sold on the Russian market were counterfeit. However, other sources estimate that the real figure could be much higher. (Source: ISTM NewsShare, May/June 2008)
• 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. 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 Vienna or London.
• Ambulance services: dial 03 countrywide.
The U.S. Embassy has a listing of doctors and hospitals in Moscow at: A listing of doctors and health care facilities in Moscow is available at:
Top 7 medical centers in Moscow:
Go to: http://elementmoscow.ru/top-7.php?i=216000
Medical facilities used by travelers include:
• AMERICAN MEDICAL CENTER/AMERICAN HOSPITAL in MOSCOW
(Metro Sukharevskaya or Prospekt Mira)
1 Grokholskiy Per. / 26/6 Prospekt Mira
Tel:  (495) 933-7700
AMC is a membership organization. It will treat its members on a 24-hour per day basis. It will treat non-members in emergencies with prepayment. Some of the services available include: outpatient treatment, surgery, including: gynecological, proctologic, urological, ENT; laparoscopic and cavernous. The AMC In-patient Department has an Intensive Care Unit, as well as single and family rooms; minor surgery, pharmacy, coordination of medical evacuations, dental clinic. Direct insurance billing BUPA, PPP Alliance, Etna, ambulance, membership program available. Mon-Fri.
08:30-20:00, Sat 09:00-17:00.
• EUROPEAN MEDICAL CENTER (Metro Pushkinskaya)
5 Spiridonievskiy Per., bldg. 1
Tel:  (495) 933-6655
American and European general practitioners, gynecology, ophthalmology, pediatrics, ENT, cardiology, psychiatry, dermatology, physical therapy. Vaccination programs. Emergency assistance 24 hours a day.
In-patient and out-patient services, surgery, comprehensive laboratory, diagnostics. Direct billing with major insurance companies.
• ZAO International Medical Clinic Moscow
7 (3rd floor)
Tel:  (495) 937 5760
This is an International SOS clinic.
• International SOS Clinic
Sakhincentr, Ground Floor
32 Komunisticheskyi Prospect
Tel:  (4242) 727550
• AMERICAN MEDICAL CLINIC
Moika emb. 78
Tel: 740-2090 (24 hours)
The AMC offers 24-hour doctor availability, house calls, and emergency care. Dentistry, pharmacy and laboratory services are available on site. The majority of Russian doctors have received Western training. They have multilingual speaking staff.
• EUROMED CLINIC
Suvorovskiy Pr. 60
Tel: 327-0301 (24 hours)
Euromed offers 24-hour doctor availability, house calls, and emergency care. Dentistry, pharmacy and laboratory services are available on site. The majority of Russian doctors have received Western training. They have multilingual speaking staff and are located near Smolnyy cathedral.
Medical services in St. Petersburg listed by the U.S. Consulate:
Destination Health Info for Travelers
AIDS/HIV: The Russian Federation is experiencing one of the fastest-growing epidemics of HIV/AIDS in the world. Injecting drug use and unsafe sex drive the epidemic. The country accounts for some 70% of all HIV infections officially registered in the Europe and Central Asia region. Young people between 15 and 29 years make up some 80% of infected persons and women account for more than 30% of infected persons. The adult HIV prevalence of people living with HIV/AIDS is estimated at 1.3% of the general population.
The upheavals of transition have helped set the stage for the rapid spread of the disease. Factors include:
• Economic and social dislocation
• Increased poverty
• New freedoms, including greater mobility
• A rise in premarital and extramarital sex, commercial sex and injecting drug use
• Limited availability of sterile needles and syringes
• Inadequate public health education and prevention programs (e.g., public-service ads on TV); the government spends minimally on prevention, treatment, education, or care. There are needle exchange programs in only a few cities.
• Methadone treatment is forbidden despite the fact that many international experts say methadone treatment is critical to controlling the epidemic.
From the NY Times, July 2008: “Estimates on the number of drug addicts in Russia range from three million to six million. Most use intravenous drugs like heroin and other opium-based narcotics that largely originate in Afghanistan and easily flow across the country’s porous southern borders. Intravenous drug use is also the leading cause of H.I.V. and AIDS in Russia. It accounted for about 66% of new cases in 2006, and the epidemic continues to grow, though not as quickly as in the past, according to the United Nations’ AIDS agency.”
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.
Sources: www.Avert.org/ecstatee.htm, the World Bank, the New York Times.
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.
Alcoholism: Russia has an exceptionally low life expectancy for an industrialized nation. In 2007, the life expectancy was 59 years for males and 72 years for females. Almost half of all deaths in working age men in a typical Russian city may be accounted for by hazardous drinking. One study found that 43% of all premature deaths among Russian men in one town in the Ural Mountains were caused by excessive alcohol use, including consumption of cologne, medical tinctures and cleaning agents as well as liquor. (The Lancet June 16, 2007)
• ProMED reports 5000 cases and 350 deaths in 2007 due to methanol and alcohol poisoning in the Ural and Privoljye regions.
Anthrax: The incidence of anthrax [among humans] in comparison with the 1st 11 months of 2007 has increased: 23 cases of anthrax for the 1st 11 months of 2008, versus only 3 cases for the same period of 2007. Outbreaks reported in Astrakhan, Bashkortostan, Buryatia, and Volgograd.
• Karelian fever (mosquito-borne; most cases occur July–September in the Karelian region).
• Tahjna virus fever (mosquito-borne; occurs sporadically from the Baltic region north to the Kolsky Peninsula).
• Sandfly fever (sandfly-borne; limited to Moldova and the Crimea).
• Dengue fever (mosquito-borne; cases previously reported from extreme southern regions).
• West Nile fever (mosquito-borne; Between Jan and Sep 2007, 54 human cases have been reported including 2 deaths. Eighty percent of cases were from the Volgograd region; peak transmission occurs from July through September primarily in southern Russia, especially the Volgograd and Astrakhan Regions; cases also reported from the Rostov, Krasnodar and Stavrapol Regions).
• Sindbis virus fever (sporadically detected in the Volga Delta, July–August).
Avian Influenza A (Bird Flu): Numerous reports of avaian influenza in poultry have been reported from the Moscow and other regions throughout Russia. In April 2008, an outbreak in poultry was reported in Primorye. 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.
Brucellosis: Brucellosis is endemic in the local animals (mainly sheep and goats) in certain regions (chiefly the Caucasian districts; cases recently reported from the federal province of Altai in Siberia). Outbreaks of human brucellosis in Russia likely occur as a result of consumption of raw milk or milk products from infected animals, and occupational exposure to infected animal tissues or secretions among farmers, veterinarians, and meat industry workers.
Cholera: This disease is active in parts of this country (recent outbreak reported in the Volga river city of Kazan in the Russian republic of Tatarstan), but the threat to tourists is low. 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)
Crime/Security/Civil Unrest: In the last two years, there have been a number of terrorist attacks targeting public transport.
North Caucasus: We strongly advise you not to travel to the North Caucasus, in particular the regions of Chechnya, Dagestan, Ingushetia, North Ossetia, the south-east part of Stavropol bordering Chechnya, Karbardino-Balkaria, Karachay-Cherkessia and Abkhazia. Military clashes and terrorist attacks are common in these areas.
Crime: Petty crime and pickpocketing (sometimes committed by groups of children) is common, especially around tourist attractions such as Red Square, the Ismailovsky tourist market and the Metro underground in Moscow and St. Petersburg. Scams involving money and valuables apparently dropped by a passer-by are common. The unsuspecting traveler picks up the money to return it to the person and is told that it is not the correct amount. Travelers are advised not to pick up money, not to get involved in disputes with strangers over such incidents and to walk away immediately. Only exchange currency at bank counters. Travelers have become scam victims when trying to exchange money with strangers in the street or at the bank queue.
Racially-motivated assaults continue to occur in Russia, particularly in Moscow and St. Petersburg. Attacks are often perpetrated by skinhead groups or ultra-nationalists. There have been several large rallies by nationalists and neo-Nazis to protest against the presence of foreigners (particularly people from Central Asia and the Caucasus region) in Russia. If you are of Asian or African descent, you should take extra care.
Travelers have been drugged and robbed while drinking in nightclubs and bars in Moscow or after accepting offers of food, drink or transportation from strangers.
There have been reports of harassment, mistreatment and extortion by police or other local officials. If stopped in the street and requested to pay a fine, you should ask the name of the officer, ID and ask to contact the your embassy. Your embassy can provide assistance, including by raising such incidents with the appropriate authorities.
The Cherkizovsky/Ismailovsky markets in eastern Moscow which attract large numbers of Russian and foreign shoppers have a history of business conflicts including arson. In August 2006, an explosion at this market which killed up to ten people was linked to feuding between rival businesses or gangs.
Local travel: Routine police checks in public and tourist spots are common. You should carry with you your passport, originals of the registered visa and migration card. Photocopies are not acceptable. Failure to provide travel documentation can result in detention and/or substantial fines.
Extensive areas of Russia, especially in Siberia and the Russian Far East, are designated closed areas to which foreigners may not travel without government permission. Land borders with Georgia are closed.
Crimean-Congo Hemorrhagic Fever: Multiple cases of CCHF were reported throughout 2007 from South Russia•s Stavropol Territory, but outbreaks have also occurred in some areas of Rostov Oblast (near the sea of Azov). Ten cases of Crimean-Congo hemorrhagic fever have been reported in Stavropol so far in 2008. This represented more than 3-fold increase as compared with the same period last year.
• Crimean-Congo hemorrhagic fever is a viral infection, usually transmitted by ticks. Symptoms include fever, muscle aches, backache, joint pains, headaches, dizziness, and light sensitivity. The risk to travelers is low.
• Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, 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.
Geographic Distribution of Crimean-Congo Hemorrhagic Fever:
Diphtheria: An epidemic of diphtheria, beginning in 1990 in the Russian Federation, extensively involved all countries of the former Soviet Union. Seventy percent of these cases occurred in persons older than 15 years. All travelers to Russia, therefore, especially adults, should be fully immunized against this disease. (The CDC estimates that 20% to 60% of Americans older than 20 years lack sufficient immunity to diphtheria.) Diphtheria vaccine in the United States and Canada is widely available and is administered in combination with the tetanus toxoid vaccine (Td vaccine).
• All travelers, especially adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children.
Hemorrhagic Fever with Renal Syndrome (HFRS): An outbreak of Hemorrhagic Fever with Renal Syndrome affecting 16 workers at a fur farm occurred in the Republic of Udmurtia in 2008. (Source: ProMED - January 2009)
HFRS is an acute viral disease caused by the Hantaan virus and is transmitted by wild rodents, mainly in the autumn harvest season. The main route of transmission is inhaling aerosols of rodent excreta. (Note: Over 2700 cases of HFRS and 11 deaths were reported from Bashkortostan Republic during 2006, which is 40% more than the previous year.)
To prevent infection, travelers should:
• Avoid visiting or living in places with poor environmental hygiene.
• Do not contact rodents or their excreta.
• Apply insect repellent exposed skin and permethrin spray or solution to clothing, shoes, and gear.
• Do not sit or rest on grassland and hay stacks
• When camping, choose sites which are open and dry to lessen the chance of rodent invasion.
Hepatitis: Outbreaks of hepatitis are recorded frequently in Russia. The most recent is an outbreak of hepatitis A reported by ProMED that occurred in Ryazansk Oblast in 2009. About 20 children in the village of Kostin in the Ribnovskii region contracted hepatitis A. Most of the infected children are pupils of a local residential school. Among the possible causes of the outbreak is the poor quality of the drinking water available in the village of Kostin.
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 with a seroprevalence of 18% in children in Moscow. Nationwide, anti-HEV IgG seropositivity varies from 17% to 85%. Sporadic cases of acute hepatitis may not be recognized as hepatitis E. 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 3.8%. 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 at a moderate level with a prevalence of 2% 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.
Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over the age of 6 months.
Japanese Encephalitis (JE): Japanese encephalitis occurs in the far eastern maritime region of Khabarovsk. The peak period of transmission is July to September. The JE virus is transmitted to humans from animals (mainly pigs) and birds via the bite of an infected Culex mosquito. Culex mosquitoes feed predominantly during the hours from dusk to dawn.
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.
Leishmaniasis: The risk for cutaneous leishmaniasis is primarily limited to southern regions, including portions of Georgia Republic and the southern Ukraine, below 1,300 meters elevation. Visceral leishmaniasis is confined to areas along the southeastern coast of the Black Sea, the southeastern and southwestern coasts of the Caspian Sea and the border areas of Georgia and Azerbaijan.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• 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.
Lyme Disease: Over 200 cases of Lyme disease were reported from the South Urals regions in 2006 and about 40 cases reported in St Petersburg in 2007. Lyme disease occurs focally in rural forested areas, with the highest incidence in the Ural Mountains region. Risk also occurs in the northwest and central areas.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas 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).
Mediterranean Spotted (Boutonneuse) Fever: Mediterranean spotted fever (also called boutonneuse fever, Israeli spotted fever, Astrakhan fever, Indian tick typhus) is a rickettsial disease of the spotted fever group, and is transmitted by ticks. It is widely distributed, being found in Europe, Asia, Africa, India, Israel, Sicily, and in Russia, most commonly in the Black Sea coastal areas of the Caucasus, Transcaucasus, and the Crimea, and along the Caspian Sea coastline.
• Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, are advised to take measures to prevent tick bites during the peak transmission season. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Note: A similar disease, Siberian tick typhus (also called North Asian tick typhus) is found in Siberia, China, Mongolia, and Europe. It is caused by Rickettsia sibirica, an organism closely related to R. conorii, the cause of Mediterranean spotted fever.
Update May 2009: According to press-centre of the Territorial Management of Rospotrebnadzor, 52 cases of suspected Siberian tick typhus, including 19 cases in children, have been recorded in the Altai region. Siberian tick typhus is a rickettsiosis, due to Rickettsia sibirica.
Omsk Hemorrhagic Fever: This is an acute viral illness prevalent in some regions of western Siberia. Symptoms include fever, headache, nausea and vomiting, severe muscle pain, cough and moderately severe hemorrhagic manifestations, with bleeding from the nose, mouth, gums, and uterus and a hemorrhagic rash. A third of the patients develop pneumonia, nephrosis, meningitis or a combination of these complications.
Omsk Hemorrhagic Fever is transmitted by ticks, but people are mainly infected by contact with infected muskrats, the main host of the virus.
Treatment is supportive. Complete recovery is typical, but some cases are prolonged. There is no vaccine.
Other Diseases/Hazards: Anthrax (an outbreak in 2008 in the Republic of Buryatia in Siberia has been attributed to the consumption of contaminated meat; humans can be affected when exposed to blood and other tissues from infected animals).
• Brucellosis (Humans acquire infection by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material).
• Echinococcosis (increased incidence in southern and northeastern areas; cases reported from Bashkiria in December 2008; echinococcus is associated with reindeer culture in north, but those in close contact with cattle, sheep, and other farm animals are at risk).
• Giardiasis (high-risk)
• Helminthic infections (roundworm, hookworm, and whipworm infections and strongyloidiasis) reported, especially from the Trans-Caucasus, especially Azerbaijan.
• Legionellosis (175 people hospitalized in Sverdlovskaya province in 2007).
• Leptospirosis (a particular problem in fish-breeding areas of Rostov Province; extensive outbreaks have occurred in east central areas).
• North Asian tick typhus (infection caused by the bacterium Rickettsia sibirica; also called Siberian tick typhus; symptoms include fever, rash, and headache; occurs in the steppe areas bordering Kazakhstan, Georgia, and Azerbaijan, as well as Mongolia, China, and other north Asian republics; risk elevated May–June).
• Opisthorchiasis (acquired from consumption of raw freshwater fish; reported from western European Russia).
• Plague (flea-borne; usually occurs as isolated cases or small outbreaks in semi-arid areas of the southern republics of Azerbaijan, Armenia, and Georgia).
• Rickettsialpox, tick-borne relapsing fever (may occur south of 55 degrees north latitude).
• Trichinosis (greatest risk in western Belarus and the Ukraine).
• Tularemia (“rabbit fever”; Khanty-Mansiyskiy autonomous district [Yugra] reports 19 cases of tularaemia were registered between 16 and 30 Aug 2007). Physicians from an infectious clinical hospital have reported the 1st case of tularemia in Moscow in 2008. A 53-year-old Muscovite had acquired tularemia in Naro-Fominsk, a Moscow suburban area, where he was on vacation in the country. For several days he fished and collected mushrooms. Symptoms of the infection began in Jun 2008 with fever and groin swelling. Self-treatment had no success. In the hospital his illness was suspected as tularemia and the diagnosis was confirmed)
• Tuberculosis (40% rise in cases since the 1990’s; incidence in Moscow has doubled since the 1990s). According to the Russian Ministry of Health, 206 human cases of West Nile virus, a significant increase over the average incidence, have been reported in southern Russia, primarily in Volgograd Province, since July 16, 2010. West Nile virus, which is transmitted by mosquitoes, presents minimal risk to travelers, except those with significant outdoor exposure in the affected areas. Travelers are advised to practice daytime and evening insect precautions.
• According to the Russian Ministry of Health, 206 human cases of West Nile virus, a significant increase over the average incidence, have been reported in southern Russia, primarily in Volgograd Province, since July 16, 2010. West Nile virus, which is transmitted by mosquitoes, presents minimal risk to travelers, except those with significant outdoor exposure in the affected areas. Travelers are advised to practice daytime and evening insect precautions.
Poliomyelitis (Polio): According to WHO, 4 cases of wild poliovirus type 1 have been reported in Russia so far in 2010. Cases have been identified in Irkutsk, Chelyabinsk, the Sverdlovsk region, and Moscow. At least 1 case is a confirmed importation from the current outbreak in Tajikistan and the others are under investigation. There is no evidence of local transmission at this time. The last reported case of indigenous polio in Russia was in 1995. Polio booster vaccinations are not recommended at this time.
Rabies: Sporadic cases of human rabies, usually from dog bites, are reported countrywide and numerous cases of animal rabies, mostly in foxes, are reported as well. ProMED reports that the number of rabies cases [among humans] increased from 5 cases for the 1st 11 months of 2007 to 15 in 2008. Most recently, 2 fatal human cases of rabies were reported in Voronezhska Oblast. (Source: ProMED-mail 17 September 2008)
You should thoroughly wash with soap and water all animal bites or scratches, or licks of broken skin, especially from a dog or fox, and seek immediate medical attention for possible post-exposure treatment. Access to rabies vaccine or rabies immune globulin may require emergency travel to Moscow or Europe.
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.
Tick-Borne Diseases: Summary of tick-borne diseases in the Russian Federation:
• Astrakhan fever (Astrakhan fever is a summer spotted fever resembling Mediterranean spotted fever, endemic in Astrakhan, a region of Russia located by the Caspian sea. Its agent is a spotted fever group rickettsia, member of the Rickettsia conorii complex, transmitted to humans by Rh. sanguineus and Rhi. pumilio ticks.)
• Crimean-Congo hemorrhagic fever
• Human monocytic ehrlichiosis*
• Human granulocytic anaplasmosis (may occur)*
• Lyme disease
• Mediterranean spotted fever (also called boutonneuse fever, Israeli spotted fever, Indian tick typhus)
• North Asian tick typhus (infection caused by the bacterium Rickettsia sibirica; also called Siberian tick typhus)
• Omsk hemorrhagic fever (viral illness, occurring in western Siberia, including Omsk, Novosibirsk, Kurgan, and Tyumen. Persons engaged in camping, farming, forestry, and hunting are at risk. People are mainly infected by contact with the infected host—the muskrat)
• Powassan virus encephalitis (reported from the U.S., Canada, and Russia)
• Tick-borne encephalitis (TBE)
To prevent these illness,travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, should take measures to prevent tick bites. These prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
* Ehrlichiosis is more properly considered as 2 distinct, but related, diseases caused by different tick-borne bacteria. The Rickettsiae family was reorganized in 2001 to rename some of the Ehrlichia as Anaplasma to reflect this fact. Ehrlichiosis and anaplasmosis differ in the pathophysiology of the disease, laboratory findings, and the geographic distribution of the vector species.
Tick-Borne Encephalitis (TBE): Russia is the country with by far the highest number of registered TBE cases. There are almost 60 million people who are potentially at risk of acquiring TBE who live in a broad corridor ranging from St. Petersburg over Chelyabinsk, Kazan, Tyumen, Novosibirsk, Irkutsk to the Far East, as far as Khabarovsk and Vladivostok. A total of 54,526 cases of TBE have been officially reported over the past 10 years (1998 to 2007), but the real incidence is thought to be much higher. Western Siberia is the region with the highest known incidence of TBE in the world, with 40 to >80 cases/100,000 population.
• This year  already 37 people, including 4 children, contracted TBE in the Chelyabinsk region, with 2 cases associated with the consumption of raw goat milk.
Hundreds of cases of TBE were reported in 2007 from Sverdlovskaya province, Chelyabinskaya province, the Sverdlovsk region (Urals Federal District) and elsewhere. Risk is present primarily in rural brushy and forested areas below 1,500 meters elevation, including suburban “forests” bordering large cities.
Source: Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18916
Tickborne encephalitis (TBE), also known as spring-summer encephalitis, is a viral infection of the central nervous system. Humans acquire disease by the bite of an infected tick or rarely, by ingesting unpasturized dairy products primarily from infected goats, but also from sheep or cows.
• 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, 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 in Russia and Europe is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif
Travelers' Diarrhea: Tap water is not drinkable anywhere in Russia. Municipal tap water may be untreated and grossly contaminated. Bottled water, and other bottled beverages, are widely available.
• We recommend that you boil, filter or purify all drinking water or drink only reliably 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.
Food poisoning is common in Russia. Outbreaks of salmonellosis and shigellosis (bacillary dysentery) are reported. There are also outbreaks of giardiasis and cryptosporidiosis reported from many urban areas throughout Russia. Amebiasis occurs focally countrywide but is more common in the south. Transmission of these parasies in contaminated water is best prevented by filtration. Chemical treatment of water with iodine or chlorine is less reliable than filtration for eliminating parasites. Note: chlorine dioxide (an oxidizer) is effective against parasites, but a 4-hour contact time must be allowed.
Trichinellosis: A large outbreak of trichinellosis (also called trichinosis) from eating contaminated bear meat has been reported from Tomsk. The number of people affected with trichinellosis in Tomsk has now increased to 40. The total number of people that ate bear meat is 114. In 2007, there were 171 cases of trichinellosis registered in 34 places, and in 2006, 201 cases were registered. The majority of the cases are registered in the Siberian federal district of Russia. (ProMed July 2008)
In 2008, morbidity due to trichinosis doubled: 312 cases in 2008 against 155 in 2007 for the 1st 11 months.
Note: According to ProMED, there are two situations concerning trichinella: the most common concerns consumption of undercooked wildlife, where trichinella is widespread in carnivores like bears. This is primarily a health education problem and probably stable. The other problem concerns infections in domestic pigs and wildlife meat sold as pork. This has been reported from Poland and Latvia but not from Russia, at least not through ProMED.ProMED believes that the trichinella situation is quite stable and the increase in reports is due to increased interest rather than a real increase.
Tuberculosis (TB): Tuberculosis a major health problem in this country and there is a rising incidence of multi-drug-resistant TB. Note: The highest prevalence of multi-drug resistance is found in the former Soviet Union and China.
Tuberculosis is highly endemic in Russia 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. Domestic help hired by long-stay visitors should be screened for TB.
Typhoid Fever: Typhoid vaccine is recommended for all people traveling to or working in Eastern Europe and Russia, 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. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.
• Short-term visitors who restrict their meals to major restaurants and hotels, are at low risk, and vaccine is optional.