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Sierra Leone



Capital: Freetown

Time Zone: 0 hours. No daylight savings time.
Tel. Country Code: 232
USADirect Tel.: 1100
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plug C.


Travel Advisory - Sierra Leone

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 Sierra Leone


Resource Links

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

Embassies

• U.S. Embassy
Leicester Square
Regent
Freetown
Tel: [232] 22-226-481
Fax: [232] 22-225-471
Website: http://freetown.usembassy.gov/

The Canadian Embassy in Cote d'Ivoire is responsible for diplomatic and consular affairs in Sierra Leone.

• Canadian Embassy
23 Nogues Avenue
Plateau
Trade Centre Building
6th and 7th floors
Abidjan
Cote d'Ivoire
Tel: (225) 20.30.07.00
Fax: [225] 20.30.07.20
E-mail: abdjn@dfait-maeci.gc.ca
Website: http://www.dfait-maeci.gc.ca/abidjan/about-en.asp

• British High Commission
6 Spur Road
Freetown
Tel: [232] (22) 232 961
[232] (22) 232 362
[232] (22) 232 563-5
Fax: [232] (22) 228 169
E-mail: freetown.consular.enquiries@fco.gov.uk
Website: www.britishhighcommission.gov.uk/sierraleone

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from all travelers arriving from all countries.

Passport Information

Passport/Visa: Sierra Leone is a developing country in western Africa still recovering from a ten-year civil war that ended in 2002. English is the official language, but Krio, an English-based language, is widely used. Tourist facilities in the capital, Freetown, are limited; elsewhere, they are rudimentary or nonexistent. 

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visitors are strongly encouraged to obtain visas in advance of travel to Sierra Leone. Visitors to Sierra Leone are required to show International Certificates of Vaccination (yellow card) upon arrival at the airport with a record of vaccination against yellow fever. The Embassy of Sierra Leone is located at 1701 19th Street NW, Washington, DC 20009; telephone (202) 939-9261. 
The Embassy also maintains a website at www.embassyofsierraleone.org. Information may also be obtained from the Sierra Leonean Mission to the United Nations, 245 East 49th St., New York, NY 10017; telephone (212) 688-1656 and from the website of the Sierra Leonean High Commission in London at http://www.slhc-uk.org.uk/. Overseas, inquiries should be made at the nearest Sierra Leonean embassy or consulate.

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 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.

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: A yellow fever vaccination certificate is required for entry to this country.

Hospitals / Doctors

Medical facilities are poor. The emergency service response in Freetown is very slow and unreliable. Outside the capital you should assume that there would be no emergency service response if you get into medical difficulty. You should carry basic medical supplies.
• 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 travel insurance that provides for air ambulance transport to a more advanced medical facility in Europe in the event of serious illness or injury requiring specialty care not available in this country.

Destination Health Info for Travelers

AIDS/HIV: Heterosexual contact is the predominate mode of transmission of HIV in sub-Saharan Africa. HIV prevalence rates vary greatly between African countries. In four southern African countries, the national adult HIV prevalence rate now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%). West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Cote dIvoire (7.1%) and Gabon (7.9%). The HIV prevalence rate in Sierra Leone is 1.6% in the population aged 15 to 49. (Source: Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with 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.

African Sleeping Sickness (Trypanosomiasis): Current incidence and risk data are not currently available. Sporadic cases were reported during the early 1980s. Travelers should take precautions to prevent insect (tsetse fly) bites.

Cholera: This disease is reported active in this country with current outbreaks in Kambia district and the town of Kenema and in Newton on the outskirts of the capital Freetown. The threat to tourists, however, is low. Although this disease is reported active in this country, most travelers are at low risk for infection. 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)

Dengue Fever: Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in many parts of Africa. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.

A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf

Hepatitis: All nonimmune travelers should receive hepatitis A vaccine. 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 and outbreaks may occur. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• 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 of 2.0% 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.

Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.


Ebola Virus Disease (EVD)
 New information for August 7, 2014: U.S. CDC has moved its Emergency Operations Center (EOC) to the maximum activation level. This does not indicate an increased risk to the U.S but reflects significant CDC overseas involvement in a progressive situation in Africa. According to press sources, Liberia has declared a state of emergency for 90 days, and the military is blocking entry to Monrovia from affected western regions. Sierra Leone's military has isolated Kenema and Kailahun districts. U.S. CDC has published interim guidance for health care workers in the U.S. on appropriate collection, transport, and testing of specimens from suspected EVD patients.

Lassa Fever: Health officials in Sierra Leone (October 2010) said 45 people had died from Lassa Fever in the first 9 months of this year, including a woman who ran a rat meat restaurant. There have been up to 152 cases so far. Risk is countrywide, particularly in Eastern Province (Kailahun and Kenema Districts). There is increased risk during the dry season, February through April.
Lassa Fever is a viral hemorrhagic fever endemic in West Africa that is contracted from contact with the urine or feces of rodents, usually rats. Inhalation of tiny particles of infective material (aerosols) is believed to be the most significant means of exposure. It is possible to acquire the infection through broken skin or mucous membranes that are directly exposed to infective material. Transmission from person to person has also been established, presenting a disease risk for healthcare workers.
Lassa Fever starts as a flu-like illness with fever and fatigue, but may progress to shock and coma. Symptoms initially may be similar to typhoid, malaria and other tropical fevers. About 80 percent of human infections are asymptomatic. Symptomatic patients are usually critically ill and the mortality rate is 15-20%. There is no vaccine but the antiviral drug Ribavirin is an effective treatment if given early in the course of clinical illness.
• The risk of Lassa fever in tourists is extremely low. Most cases have been in high risk individuals such as those working in the medical or aid sectors and who had direct contact with Lassa fever patients. Isolated cases of Lassa fever have occurred among foreign nationals.
• Travelers to endemic countries should avoid contact with rodents and use personal protection measures when caring for persons suspected to have Lassa fever.

Leishmaniasis: Risk is undetermined, but probably is low. Outbreaks of cutaneous leishmaniasis have occurred in nearby Senegal.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.

Malaria: Risk is present year-round throughout this country, including urban areas. Increased risk occurs during and immediately after the rainy season (May through November). Falciparum malaria accounts for 80% of cases, the rest due to P. malariae or P. ovale.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine (G6PD 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 Sierra Leone page on the Destinations menu or A-Z Index.

• Malaria is transmitted via the bite of an infected Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents remain the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.

Onchocerciasis: Widely distributed, except for the coastal plain and the Freetown peninsula. Travelers should take precautions to prevent insect (blackfly) bites, especially near fast-flowing rivers, where blackflies breed.

Other Diseases/Hazards: African tick typhus (transmitted by dog ticks, often in urban areas, and bush ticks), African tick-bite fever, anthrax (mostly cutaneous; usually from exposure to freshly slaughtered, infected animals), dengue (low risk), Bancroftian filariasis (mosquito-borne), leprosy, leptospirosis, and intestinal helminths (very common) are reported.

Poliomyelitis (Polio): Polio remains persistent in sub-Saharan Africa and polio is reported active in Sierra Leone with a case reported in 2009. All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio 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.

Rabies: Risk of exposure, especially from stray dogs, occurs in urban and rural areas. 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, medical evacuation is advised to a facility that can provide treatment.

Schistosomiasis: Risk is year-round. Foci of urinary schistosomiasis are distributed primarily in the eastern and central areas. Intestinal schistosomiasis is less prevalent but has the same distribution pattern.
• 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, especially 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 and fish. 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: Tuberculosis is highly endemic in Sierra Leone 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 vaccine is recommended by the CDC for all unvaccinated people traveling to or working in Africa and 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, 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: A yellow fever vaccination certificate is required for entry to this country. There is a risk of yellow fever transmission in all areas of this country.
A map of yellow fever endemic countries in Africa is here: http://www.nathnac.org/includes/contents/documents/yf_africa.gif