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Rwanda



Capital: Kigali

Time Zone: +2 hours. No daylight savings time in 2008.
Tel. Country Code: 250
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Rwanda

Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.

Dr. Rose Recommends for Travel to Rwanda


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies


• U.S. Embassy
377 Boulevard de la Revolution
Kigali
Tel: [250] 505-601/2/3, then dial zero
Fax: [250] 572-128
E-mail: amembkigali@hotmail.com
E-mail (Consulaar section): consularkigali@state.gov
Website: http://kigali.usembassy.gov

• Embassy of Canada
1534 Akagera Street
Kigali
Tel: [250] (5) 73210
Fax: [250] (5) 72719
E-Mail: kgali@international.gc.ca

• British Embassy
Parcelle No 1131
Boulevard de l'Umuganda
Kacyiru-Sud
Kigali
Tel: [250] 584098/ 586072
[250] 585771
[250] 585773
FaX: [250] 582044
Email: embassy.kigali@fco.gov.uk General
Website: www.britishembassykigali.org.rw

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year of age arriving from ALL COUNTRIES.

Passport Information

Passport/Visa: Rwanda is a landlocked developing country in central Africa. It continues to recover from the 1994 civil war and genocide in which at least 800,000 people were killed. Economic activity and tourism are on the rise in Rwanda. Hotels and guesthouses are adequate in Kigali, the capital, and in major towns, but they are limited in remote areas. Read the Department of State Background Notes on Rwanda for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and evidence of yellow fever immunization are required. Visas are not required for American citizens entering Rwanda for less than 90 days. U.S. citizens planning on working in Rwanda should apply for a work permit at the Department of Immigration as soon as possible after arrival in Rwanda. Permits are valid for one- or two-year periods depending on the requestor's occupation. Detailed entry information may be obtained from the Embassy of the Republic of Rwanda, 1714 New Hampshire Avenue, NW, Washington DC 20009, telephone 202-232-2882, fax 202-232-4544. Overseas, inquiries may be made at the nearest Rwandan Embassy or Consulate. Visit the Embassy of Rwanda web site at http://www.rwandaembassy.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; 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.

Meningococcal (Meningitis): Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported.

Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).

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.
• In addition to tetanus, all travelers, including 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 and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers.

Yellow Fever: Yellow fever vaccine is required for all travelers greater than one year of age.

Hospitals / Doctors

Only limited medical facilities are available. In the event of serious accident or illness an evacuation by air ambulance to Kenya or South Africa may be required.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit (including sterile needles/syringes) 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; or 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. In the event of a serious illness or injury that can't be treated locally, you should be evacuated to Nairobi, Europe, or South Africa.

Limited medical facilities include:

• King Faycal Hospital
Kigali
Tel: [250] 82 421
[250] 82 239

Destination Health Info for Travelers

AIDS/HIV: At the end of 2007, UNAIDS/WHO estimates that 3.1% of the population of Rwanda aged 15-49 years old were living with HIV or AIDS. Heterosexual contact is the predominate mode of transmission. HIV prevalence is estimated at up to 86% of the high-risk urban population.
• 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 the body fluid 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.

African Sleeping Sickness (Trypanosomiasis): Sporadic cases occur; risk areas include Akagera Game Park, in the northeast, and Nasho Lake vicinity (east of Kigali). Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so travelers should wear protective clothing and sleep under a bed net.
Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats.
Read more: hthttp://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php

Animal Hazards: Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders. Crocodiles are known to attack boats and people on shore. Stray and sometimes viscous dogs should be avoided.

Cholera: Cholera outbreaks occur on a regular basis in Rwanda. Outbreaks were reported from Nyagatare District, Eastern Province and Rubavu District, Western Province in 2007. Although this disease is active the threat to tourists is low. Cholera is an rare disease in travelers from developed countries. Cholera vaccine is usually 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.
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)


Ebola Virus Hemorrhagic Fever: Due to the current Ebola outbreak in Uganda, medical personnel have been dispatched to four land-border crossings in Rwanda: Cyanika, Gatuna, Gisenyi and Kagitumba. If you enter Rwanda at these points of entry you may be subject to medical screening, especially if you come from the affected provinces of Kasese or Bundibugyo.

Hepatitis: High risk. 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 in sub-Saharan Africa with major outbreaks occurring recently in Chad and Sudan. Sporadic cases and outbreaks occur in Rwanda, but the incidence is unclear. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals (pigs) and deer may serve as a viral reservoir. 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 >10%. 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 with a prevalence estimated at 1.7% 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.

Malaria: Risk is present throughout this country, including urban areas. Risk may be less in the northwest prefecture of Ruhengeri. P. falciparum accounts for approximately 90% of cases. Remainder of cases are due to the P. ovale and P. malariae species, rarely P. vivax. Chloroquine-resistant falciparum malaria is reported. Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is recommended.

A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Rwanda page on the Destinations menu or A-Z Index.

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 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: Picaridin repellents (20% formulation, such as Sawyer Picaridin 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 this country.
• Long-term travelers 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: Outbreaks of meningococcal disease have been reported from the provinces of Butare, Kibungo, Kibuye and Umutara. A prior outbreak was reported from Kabgayi district (Gitarama prefecture). Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651

Other Diseases/Hazards: African tick typhus
• Brucellosis
• Echinococcosis
• Filariasis
• Leishmaniasis (transmission occurs year-round)
• Meningitis
• Plague
• Relapsing fever
• Rift Valley fever


Poliomyelitis: This disease has remained persistent in sub-Saharan Africa. All travelers to Rwanda should be fully immunized against polio. Any traveler who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine.

Rabies: Stray and sometimes viscous dogs may be encountered throughout this country. All animal bites should be treated aggressively with soap and water and medical attention sought immediately. 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. Note: If adequate rabies treatment is not available locally, immediate medical evacuation is advised to a facility that can provide treatment.

Schistosomiasis: Intestinal schistosomiasis occurs along Lake Kivu and in the northwest around Lakes Bulera and Ruhondu, with risk also in Byumba, Kigali, and Butare prefectures. 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, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: High risk. Water supplies, even in Kigali, may be contaminated. 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 dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. 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 (TB): Tuberculosis is highly endemic in Rwanda 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 unvaccinated people traveling to or working in sub-Saharan Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.

Yellow Fever: Vaccination against yellow fever is required for all travelers over 1 year of age for entry to this country. This disease is not currently active.