Time Zone: +5.30 hours. No daylight savings time.
Tel. Country Code: 94
USADirect Tel.: 0
Electrical Standards: Electrical current is 230/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, F.
Travel Advisory - Sri Lanka
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 Sri Lanka
• U.S. Embassy
210 Galle Road
Tel:  (1) 448-007 or
 (1) 447-355
Fax:  (1) 437-345
• Canadian Embassy
6 Gregory's Road
Tel:  (1) 69-58-41
Fax:  (1) 68-70-49
• BRITISH HIGH COMMISSION
190 Galle Road
Telephone:  (11) 243 7336-43
Fax:  (11) 243 0308
 (11) 233 5803 (Consular/Visa)
Passport/Visa: Sri Lanka is a presidential parliamentary democracy with a developing economy. Civil war and terrorism have seriously disrupted the country since 1983. Incidents of violence against military personnel and civilians have increased sharply in recent months. On January 16, 2008, the Government formally withdrew from the Ceasefire Agreement they signed with the Liberation Tigers of Tamil Eelam (LTTE) in 2002. Despite the armed insurgency, Sri Lanka's beaches, hill country, and archeological sites continue to attract thousands of visitors each year from around the world. The Asian Tsunami on December 26, 2004 caused severe damage and loss of life to several coastal areas of eastern, southern, and southwestern Sri Lanka. Most affected resorts have completely recovered. The capital city of Colombo, the Cultural Triangle (Kandy, Anuradhapura, and Polonnaruwa), and many southern beach towns have good tourist facilities. Read the Department of State Background Notes on Sri Lanka for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and onward/return ticket and proof of sufficient funds are required. A no-cost visitor visa, valid for 30 days, will be granted to tourists at the time of entry into Sri Lanka. Business travelers are required to have a visa prior to arrival. Individuals traveling to Sri Lanka for purposes other than tourism (i.e. volunteering or working) must obtain an entry visa from the nearest Sri Lankan Embassy or Consulate before their arrival in Sri Lanka. Visitors staying more than 30 days for any purpose must pay residency visa fees. Travelers need yellow fever and cholera immunizations if they are arriving from an infected area. Sri Lankan law requires all foreign guests in private households to register in person at the nearest local police station. Individuals who stay in private households without registering may be temporarily detained for questioning. This requirement does not apply to individuals staying in hotels or guesthouses.
Specific inquiries should be addressed to the Embassy of the Democratic Socialist Republic of Sri Lanka, 2148 Wyoming Avenue NW, Washington, DC 20008, telephone (202) 483-4025 through 26, fax numbers (202) 232-7181, e-mail address:firstname.lastname@example.org, the Sri Lankan Consulate General in Los Angeles at 3250 Wilshire Blvd., Suite 1405, Los Angeles, CA 90010, telephone (213) 387-0210, or the U.N. Mission in New York City, telephone (212) 986-7040. There are several honorary Sri Lankan consuls general and consuls in the United States. They can be located at the Sri Lankan Embassy web site. Visit the Embassy of Sri Lanka web site at http://www.slembassyusa.org for the most current visa information.
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from infected areas.
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.
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.
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 except short-stay visitors and cruise ship passengers.
Yellow Fever: Travelers >1 year of age entering the country from an infected area are required to present a certificate of immunization against yellow fever.
Vaccinations: Recommended and Routine
A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from infected areas.
Hospitals / Doctors
Medical facilities are limited. Doctors & hospitals usually require immediate cash payment.
• 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; 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 adequately in this country, you should be evacuated by air ambulance to a hospital in Singapore or Bangkok.
Hospitals and Clinics include:
• Apollo Hospital Colombo
Tel:  (74) 530 000
• Durdans Hospital
Ceylon Hospital Limited
3 Alfred place
Tel:  (1) 575 205
• Nawaloka Hospitals (Private) Limited
23 Sri Saugathodaya Mawatha
Tel:  (1) 544 444
• Waypoint Clinic
30/51 Longden Place
Tel:  (1) 145 15770
• Asiri Hospitals Limited
181 Kirula Road
Tel:  (1) 500 608
Destination Health Info for Travelers
AIDS/HIV: The prevalence of HIV/AIDS in Sri Lanka is low. The first case of HIV infection was reported in 1986 and the cumulative total reported at the end of 2004 was 614. The estimated HIV prevalence between ages 15 - 49 in 20005 was less than 0.1%. In >86% of HIV cases, transmission is through heterosexual contact, including commercial sex. Other modes of transmission include homosexual/bisexual contact, through infected blood and blood products and transmission from an infected mother to child. The percentage of injected drug users in Sri Lanka is estimated to be less than 1% of all drug users. The only case of HIV transmission attributed to injecting drugs was reported in 2004. Sri Lanka began screening of donor blood for HIV in 1987. (Source: www.youandaids.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.
Animal Hazards: Animal hazards include snakes (kraits, cobras, coral snakes, vipers), spiders (black widow and red-backed), leopards, bears, and wild pigs. Stingrays, sea wasps, starfish, and marine invertebrates (cones, jellyfish, nettles, urchins, anemones) are common in the country’s coastal waters and are potential hazards to unprotected swimmers.
Snake bite update 2009: Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russells vipers (Daboia russelii) and hump-nosed pit vipers (Hypnale hypnale) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients.
• Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by hump-nosed pit vipers (Hypnale hypnale). Victims of pit vipers will not benefit from the existing antivenoms.
Read more: http://www.ncbi.nlm.nih.gov/pubmed/19815895
Chikungunya Fever: Outbreaks of chikungunya fever were reported from the Kuruwita-Erathna area in March 2008 and the Ratnapura District in April 2008. Since October 2006, over 40,000 cases have occurred in Sri Lanka and since 2005, outbreaks of this mosquito-transmitted viral illness have been reported throughout the Indian Ocean. Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. Acute Chikungunya fever typically lasts a few days to several weeks, but as with dengue, West Nile fever, and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. No deaths related to chikungunya infection have been conclusively documented in the scientific literature.
• To prevent this disease, and other arboviral illnesses, you should take measures to prevent 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 at night.
Cholera: Sporadic cases of cholera occur in this country, 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.
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: An outbreak of dengue fever was reported in February 2009, chiefly affecting Colombo. In 2010, over 8,600 cases of dengue fever have been reported, primarily from the districts of Jaffna, Gampaha, and Colombo. This is a significant increase over 2009. The risk of dengue fever is year-round below 1,000 meters elevation, especially in urban areas. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in throughout much of Asia and the Indian Ocean. 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
Filariasis: Bancroftian filariasis is endemic in both urban and rural areas of the southwestern coast. All travelers should take measures to prevent mosquito bites.
Food & Water Safety: All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Bottled water and a variety of mineral waters are available at most hotels. Unpasteurised milk should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Pasteurised and sterilised milk is available in some hotels and shops. Avoid dairy products made with unboiled milk. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. (A lage outbreak of hepatitis A was reported in 2007 from the Gampola area in Central Province.) 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 and sporadic cases occur, 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 (primarily pigs) 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 is estimated at <7%. 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 1.4% 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.
Japanese Encephalitis (JE): Sporadic cases occur year-round, but there have also been recent explosive epidemics in the region around Anuradhapura, due to increased mosquito breeding sites. From January 2007 to September 2007, over 146 new cases were reported.
• 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: Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka, with an increasing number of cases diagnosed since 1992. (http://www.cdc.gov/eid/content/13/7/1068.htm) The prevalence of this infection, however, is unclear. 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: Malaria occurs countrywide, including urban areas, below 800 meters elevation. The Districts of Colombo, Kalutara, and Nuwara Eliya, however, are free of malaria. The northern one-half and southeastern quadrant of Sri Lanka are highly malarious, especially around Anuradhapura. Malaria is less common in the Jaffna Peninsula or the southwestern areas because mosquito breeding sites are scarce. Falciparum malaria accounts for up to 30% of cases, vivax the rest. Chloroquine- and Fansidar-resistant falciparum malaria reported.
• Atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine (G6-PD test required) prophylaxis are recommended in malarious areas.
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 Sri Lanka 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: Picardin 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.
Other Diseases/Outbreaks: Brucellosis (Acquired by ingestion of unpasteurized dairy 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)
• Filariasis (concentrated in the southwest coastal area)
• Hand, Foot, Mouth disease (An outbreak of hand, foot, and mouth disease was reported from Colombo in March 2007, mostly affecting children)
• Leptospirosis (an increased number of cases of leptospirosis was reported from Sri Lanka in 2008. Most of the cases were recorded in rice paddy farming areas; an outbreak was reported from the Southern Province in Sri Lanka in September 2007)
• Paragonimiasis (lung fluke infection; acquired cquired by eating raw or partially cooked crabs, crayfish or shrimp)
• Scrub typhus (rural areas; transmitted by chigger bites)
• Spotted fever (a case of spotted fever rickettsiosis due to R. Conorii was reported in 2009). This particular rickettsial disease is also known as Mediterranean spotted fever or boutonneuse fever and is common in southern Europe, Africa, Russia, and India.
Rabies: Risk is present, but declining. Sporadic cases of human rabies are reported countrywide. Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.
Travelers' Diarrhea: All water supplies in Sri Lanka, including piped city water supplies, are potentially 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: Tuberculosis is highly endemic in Sri Lanka 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 people traveling to or working in India 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.