Time Zone: +8 hours. No daylight savings time in 2008.
Tel. Country Code: 65
USADirect Tel.: 800
Electrical Standards: Electrical current is 230/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plug C.
Travel Advisory - Singapore
Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.
Dr. Rose Recommends for Travel to Singapore
• U.S. Embassy
27 Napier Road
Tel:  476-9100 or  476-9100
Fax:  476-9340
• High Commission of Canada
One George Street, #11
Tel:  6854-5900
Emergency toll-free to Ottawa: 001-800-2326-6831
Fax:  6854-5913
Website: : http://www.singapore.gc.ca
• British High Commission
100 Tanglin Road
Tel:  6424 4200
HIV Test: Workers who earn less than $1,250 per month and applicants for permanent resident status (except spouses and children of Singapore citizens).
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from any country any part of which is infected. A certificate is also required of any traveler arriving from, or transiting through, any country in the Yellow Fever Endemic Zones.
Passport/Visa: Singapore is a small, stable, highly developed country with an elected parliamentary system of government. Tourist facilities are modern and widely available. Singapore’s resident population of over 4.2 million inhabitants is comprised of 77% Chinese, 14% Malay, 8% Indian and 1% others. English is widely spoken. Criminal penalties are strict and law enforcement rigorous; see sections on “Entry/Exit Requirements,” “Special Circumstances,” and “Criminal Penalties,” below, for further details.
ENTRY/EXIT REQUIREMENTS: A valid passport is required. U.S. citizens do not need a visa if their visit is for business or a social visit and their stay is for 90 days or less. Travelers to the region should note that Singapore and some neighboring countries, do not allow Americans to enter under any circumstances with fewer than six months of validity remaining on their passport. Female U.S. citizens who are pregnant when they apply to enter Singapore for a social visit are no longer required to make prior application through the nearest Singapore overseas mission or to provide documentation from a U.S. embassy concerning the nationality the child will acquire at birth.
Specific information about entry requirements for Singapore may be obtained from the Embassy of the Republic of Singapore at 3501 International Place, NW, Washington, DC 20008, Tel. (202) 537-3100. Visit the Embassy of Singapore’s web site at http://www.mfa.gov.sg/washington/ 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 travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.
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).
Routine Immunizations: mmunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones. Not required or recommended otherwise.
Hospitals / Doctors
Health care in Singapore is both high quality and high cost. For emergency services, travelers can access the 24-hour accident and emergency departments located in government hospitals. The Singapore Civil Defence Force runs an emergency ambulance service to transport accident and trauma cases and medical emergencies to the acute general hospitals.
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 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.
Decompression chambers are located at the Singapore Naval Base in Sembawang, the Tan Tock Seng Hospital and the Camden Medical Centre.
Traveller’s Health and Vaccination Centre
Tan Tock Seng Hospital
11 Jalan Tan Tock Seng
Tel:  6357 2222
• International Medical Clinic
The International Medical Clinic (IMC) specializes in family, pediatric and travel medicine, with emphasis on the medical needs of the international community of Singapore and South East Asia.
There are two locations:
1. Camden Clinic
Camden Medical Centre
1 Orchard Boulevard
Tel:  6733 4440
2. Jelita clinic
293 Holland Road
Jelita Cold Storage Shopping Centre
Tel:  6465 4440
• Mount Elizabeth Hospital
3 Mount Elizabeth
Tel:  6737 2666
All specialties; emergency, burn, trauma units. 24-hour medical walk-in clinic. Mount Elizabeth Hospital performs the largest number of cardiac surgeries & neurosurgeries in the private sector in the region. Considered one of the best hospitals in SE Asia.
• Gleneagles Hospital
6A Napier Road
Tel:  6473 7222
380-bed private tertiary acute care hospital providing a wide range of medical and surgical services; used by U.S. Embassy personnel. 24-hour medical walk-in clinic.
• KK Women’s and Children’s Hospital
100 Bukit Timah Road
Tel:  6293 4044
Staffed by neonatologists and pediatricians with critical care training; neonatal and children’s ICUs; emergency child transport services. The Women’s Hospital provides a full range of Ob/Gyn services.
• East Shore Hospital
321 Joo Chiat Place
Tel:  6344 7588
123-bed private general acute care hospital; 24-hour medical walk-in clinic.
Destination Health Info for Travelers
AIDS/HIV: Although the number of people living with HIV in Singapore is relatively small, the country’s status as an international travel and business hub, along with the high number of infections found in surrounding countries, make it possible that the country will experience a more serious epidemic in the future. In 2006 a record 357 people in Singapore were newly diagnosed with HIV. To combat these rising figures, the government has chosen to focus on preventing mother-to-child transmission, but controversially, has rejected widespread condom promotion. Another controversial policy in Singapore is the strict law banning sex between men, which campaigners argue undermines efforts to promote safe sex among MSM. Source: www.Avert.org
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
Avian Influenza (Bird Flu): There have been no reported cases of avian influenza (bird flu) in Singapore during the current series of outbreaks. But the World Health Organisation (WHO) has confirmed cases elsewhere in the region.
Chikungunya Fever: As of August 25, 2008, Singapore’s Ministry of Health had reported 35 cases of chikungunya fever from Kranji Way, 5 cases of chikungunya at Lim Chu Kang, and 5 cases of chikungunya fever from Pasir Panjang Wholesale Centre (PPWC). Kranji Way is a northern district of Singapore and a popular recreation area. Lim Chu Kang is located directly east of Kranji Way and PPWC is located in a southwestern district of the country.
• Chikungunya fever, like dengue fever, is a mosquito-borne disease, characterised by sudden onset of fever, chills, headache, nausea, vomiting, joint pain, back pain, and sometimes a rash. Most symptoms last for 3-10 days, but joint pains may last for weeks to months. An epidemic of chikungunya fever began in Kenya in 2004 and has spread to several Indian Ocean islands including the Comoros, Mauritius, the Seychelles, Madagascar, Mayotte, and Reunion. Cases are now being reported from Europe, imported by travelers from India.
• Chikungunya fever is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed mostly 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 chikungunya fever.
Cholera: This disease is not officially reported as active in this country, but sporadic cases may occur. 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: More than 4,600 cases of dengue fever have been reported in the country as of October 2008, according to ProMED. Dengue fever cases in Singapore have been increasing in the past decade. 2005 saw the highest number of recorded cases (over 14,000) in a single year, while there were over 8,000 cases in 2007. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Asia. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.
Information on dengue fever in Singapore, including dengue “hot spots”, is here: http://app.nea.gov.sg/cms/htdocs/category_sub.asp?cid=239
Filariasis: Low risk; both the Bancroftian and Malayan forms occur and are transmitted by a variety of mosquitoes. Travelers should take protective measures against insect bites.
Hand, Foot and Mouth Disease: As of June 2008, over 14,000 cases of HFMD had been reported. Thirty-two percent of samples tested during sentinel surveillance were positive for EV-71. The number of new cases reported has decreased weekly since 13 May 2008. A number of preschools and childcare centres have been closed in an effort to control the outbreak.
• HFMD is transmitted via respiratory droplets and is characterized by fever, blisters and rashes on the hands, feet and buttocks. The World Health Organization (WHO) provides information on preventative measures. (http://www.who.int/csr/don/2008_05_01/en/index.html)
• According to the WHO recommendations, in certain situations, it may be advisable to close child-care facilities and schools to reduce the intensity of transmission. It is NOT necessary to restrict travel or trade.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic in neighboring Malaysia where 2% of blood donors are sero-positive for the hepatitis E virus (HEV). Sporadic cases of hepatitis may occur in Singapore but not be recognized as due to HEV. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >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 low level with 0.5% of the general population seropositive for anti-C antibody.
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.
Japanese Encephalitis (JE): JE rarely occurs in this country. The transmission season is year-round, with a peak in April. Short-term travelers and those who restrict their visits to urban areas are at very low risk. Those at higher risk are travelers who visit or work in rural agricultural areas such as rice fields and marshland.
• 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.
• 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.
Malaria: There is a very low risk of malaria in Singapore. Malaria is not normally present in Singapore unless the illness was contracted abroad. However some visitors to Singapore go on short trips to the neighboring Indonesian islands of Bintan and Batam where malaria is a risk. Chemoprophylaxis is not recommended for travel to this country; travelers, however, should be aware of the small risk of malaria and know the symptoms of the disease.
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 have been 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.
NOTE: Picardin repellents (20% formulation) are now recommended by the CDC as acceptable alternatives to DEET 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.
Marine Hazards: Stingrays, poisonous fish, sea anemones, sea snakes, the Indo-China man-o’-war, and the very dangerous sea wasp are found along the coral reefs that fringe Singapore. Swimmers should take sensible precautions to avoid these hazards.
Other Diseases/Hazards: Leptospirosis (low risk), cholera (low risk), helminthic infections (ascariasis, ancylostomiasis, hookworm, clonorchiasis, opisthorchiasis, and taeniasis; low endemicity), hemorrhagic fever with renal syndrome (a few cases reported), melioidosis (rare, but an increased number of cases of melioidosis, which may cause pneumonia or sepsis, was reported in 2004.), scrub typhus, and tuberculosis (highly endemic).
Rabies: Singapore is reported to be rabies-free. No cases of indigenous rabies have been confirmed in humans or any animal species, including bats, from 2001 to mid-2006. All unprovoked dog or wild animal bites, however, should be medically evaluated for possible post-exposure treatment.
Travelers' Diarrhea: Low risk. Tap water in Singapore is potable. A quinolone antibiotic, or azithromycin, is recommended for the treatment of acute diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Over 140 cases of salmonellosis, linked to a bakery, were reported in 2007.
Tuberculosis (TB): Tuberculosis is highly endemic in Singapore with an annual occurrence 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 for all people (except short-stay visitors and cruise ship passengers) traveling to or working in Singapore and Southeast 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.