Time Zone: +1 hour. GMT +2 hour daylight savings time.
Tel. Country Code: 34
USADirect Tel.: 900
Electrical Standards: Electrical current is 220/50 and 110/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
TRAVEL ADVISORY - SPAIN
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.
• U.S. Embassy
Tel:  (91) 587-2200
• Canadian Embassy
35 Nuñez de Balboa
Tel:  (91) 423-3250;
• British Consulate-General
Paseo de Recoletos, 7-9, 4th Floor
Tel:  (91) 524 9700 Consular Services
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Spain and Andorra are both highly developed and stable democracies with modern economies. Spain is a member of NATO and the European Union.
ENTRY/EXIT REQUIREMENTS: A passport is required for both countries. U.S. citizens can stay without a visa for a tourist/business stay of up to 90 days. That period begins when you enter any of the Schengen countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden.
For further information concerning entry requirements for Spain, travelers should contact the Embassy of Spain at 2375 Pennsylvania Avenue NW, Washington, DC 20037, telephone (202) 452-0100 or the nearest Spanish Consulate in Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Francisco, or San Juan.
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.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is given.
Measles, mumps, rubella (MMR) immunity is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
NOTE: A measles outbreak was reported in February 2008 from the town of Algeciras in the south of Spain; another outbreak was reported from Barcelona in the last quarter of 2006. An outbreak of mumps was reported in August 2006 from Navarra, in northern Spain, following a local festival. As of February 2007, more than 1300 cases had been identified and new cases were still being reported.
HOSPITALS / DOCTORS
Good medical care is available in both Spain and Andorra.
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.
• 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.
The U.S. Embassy maintains a list of hospitals, clinics and doctors at:
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: Primary risk groups include men having sex with men (MSM) and intravenous drug users. Adult HIV prevalence in Spain is estimated at 0.6%. According to UNAIDS estimates, the largest numbers of people living with HIV in Western Europe in 2006 were in Italy, Spain and France.
• 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.
Update 2018: The drug Truvada© is now available for pre-exposure prophylaxis. TRUVADA for PrEP®(pre-exposure prophylaxis) is a prescription medicine that can help reduce the risk of getting HIV-1 through sex, when taken every day and used together with safer sex practices.
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.
• 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.
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; five to 7% of adults are sero-positive. Sporadic cases occur but may go unrecognized. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals 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.
• The overall hepatitis B (HBsAg) carrier rate in the general population aries from approximately 1% in the northwest to more than 3% in the southeast Mediterranean areas. 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 0.7% 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.
Leishmaniasis: Risk of cutaneous and visceral leishmaniasis (VL) occurs in rural areas of central Spain, the south (Andalucia), the east (Catalonia and Valencia), and the Balearic Islands. Human leishmaniasis is a disease caused by a parasite which is transmitted from domestic and wild reservoir hosts (often dogs and foxes) to humans by sandflies. Cases of VL and HIV co-infection are well-documented in southern European countries including Spain, Italy, and France. Travelers should take measures to prevent sandfly bites which occur during the evening and at night. Contrary to what their name suggests, sandflies are not found on beaches. They are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• 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: Lyme disease occurs in northern Spain, but the risk is low. Travelers to rural areas should take precautions against ticks. In southern Spain, an atypical form of Lyme disease occurs, caused by a related Borrelia organism.
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 known as boutonneuse fever, is transmitted by the dog tick (Rhipicephalus sanguineus) and has a characteristic rash and a distinct mark, ie, a tache noire (black spot) at the site of the tick bite. Risk areas include the southern Mediterranean coast, the west-central and northern provinces (except areas bordering the Bay of Biscay), and the Balearic Islands (Majorca, Menorca, and Ibiza). The Canary Islands are risk free. Most cases result from contact with tick-carrying dogs.
Mediterranean spotted fever is prevalent in southern Europe, Africa, and Central Asia, including India. The etiologic agent for this infection is Rickettsia conorii, which also causes Marseilles fever, Kenya tick typhus, Indian tick typhus, and Israeli tick typhus.
Prevention: Take precautions to avoid contact with ticks. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Treatment: doxycycline 100 mg twice daily for 3 to 5 days
Other effective treatments include the following: ciprofloxacin, levofloxacin, and chloramphenicol. Macrolides such as azithromycin (500 mg daily) and clarithromycin (500 mg twice daily) have been shown to be efficacious in children and can be used as alternatives to doxycycline in children less than 8 years of age.
Other Diseases/Hazards: Brucellosis (risk associated with consumption of unpasteurized dairy and goat cheese products)
• Echinococcosis (hydatid cyst disease); chiefly occurs in Guadalajara, Soria, Segovia, and Cacere.
• Fascioliasis (liver fluke diseases); greatest incidence in the Basque Country, Navarra and La-Rioja; infection is contracted by ingestion of the encysted forms of the fluke attached to edible aquatic plants such as watercress.
• Legionellosis (Legionaire Disease); outbreaks associated with resort hotel spas and hot tubs; reported in Granada and Majorca. The Spanish health authorities reported an outbreak of Legionnaires’ disease in Barcelona that was traced back to the air conditioning system of a private clinic.)
• Listeriosis: a total of 40 cases of listeriosis were documented in Navarre between 1995 and 2005 with a fatality rate of 50%; highest incidence was in pregnant women. Contaminated smoked salmon and sliced meat products are thought to be be the cause)
• Trichinosis (outbreak reported in January 2007, caused by consumption of home-made sausage (chorizo) made from the meat of two wild boars)
• Tick-borne relapsing fever
• Tularemia (an outbreak of tularemia was reported in August 2007 from a rural area in the province Castilla y Leon, located in the northern part of Spain. Tularemia may be acquired by direct contact with infected animals, or by mosquito or tick bites)
Rabies: Spain is considered rabies-free, but stray and sometimes viscous dogs may be encountered. All unprovoked animal bites should be medically evaluated for possible post-exposure treatment.
Note: Bat rabies may rarely occur in this country.
Travelers’ Diarrhea: Moderate risk throughout this country. Outside of hotels and resorts, we recommend that you 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 (e.g. ciprofloxacin), 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.
Tularemia: Contact with rodents or domestic animals such as dogs or cats (20%), handling crayfish (13%) or frequent walks through the countryside (12%) are reported in a significant number of cases. Other possible infection routes reported were recent arthropod bites (10.9%), contact with livestock (9.5%) or with manure, straw or alfalfa hay (4.9%), or having handled and/or skinned hares (6.5%).
• Tularemia may also be acquired by mosquito or tick bites, or by inhalation. Symptoms may include fever, swollen glands, and skin lesions. Severe cases may be complicated by pneumonia or sepsis.
Treatment: Ciprofloxacin (750 mg every 12 hours) or doxycicline (100 mg every 12 hours) for 10 to 14 days are effective.
Typhoid Fever: There is a higher risk of typhoid fever than in other major European countries. Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of tourists and other short-term visitors who restrict their meals to hotels) traveling to or working in Spain, 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.