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Sudan



Capital: Khartoum

Time Zone: +3 hours. No daylight savings time in 2008.
Tel. Country Code: 249
USADirect Tel.: 800
Electrical Standards: Electrical current is 240/50 (volts/hz). United Kingdom Style Adaptor Plug and European Style Adaptor Plug. Grounding Adaptor Plugs C, D.


Travel Advisory - Sudan

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 Sudan


Resource Links

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

Embassies

• U.S. Embassy
Sharia Ali Abdul Latif
Khartoum
Tel: [249] (183) 774-701/2/3 (outside Sudan)
Tel: [249] (183) 774-701/2/3 (inside Sudan)
For after-hours emergencies, call 249-183-774-705 and leave a message for the Consular Duty Officer.

• Embassy of Canada
29 Africa Road
Block 56
Khartoum
Tel: [249] 183 56 36 70 / 249 183 56 36 73
Fax: [249] 183 56 36 71
E-Mail: khrtm@international.gc.ca

• British Embassy
Sharia Al Baladia
Khartoum East
Tel: [249] (183) 777105
Fax: [249] (183) (183) 775562 Consular/Visa
Email: Consular.Khartoum@fco.gov.uk
Website: www.britishembassy.gov.uk/sudan

Entry Requirements

HIV Test: Not Required

Required Vaccinations: Yellow fever: Required if traveling from an endemic zone and >1 year of age. May also be required for travelers leaving Sudan.

Passport Information

Passport/Visa: The Government of Sudan requires all travelers to present a passport and an entry visa. Most travelers must obtain the entry visa before arrival; only American citizens who also possess a Sudanese national identification document (such as a Sudanese passport or national identification card) may apply for an entry visa at Khartoum International Airport. The Government of Sudan routinely denies visas to travelers whose passports contain visas issued by the Government of Israel or other evidence of travel to Israel such as exit or entry stamps. Travelers must obtain an exit visa before departure from Sudan as well as pay any airport departure tax not included in the travelers airline ticket. Visitors may obtain the latest information and further details from the Embassy of Sudan, 2210 Massachusetts Avenue NW, Washington, DC 20008, tel: 202-338-8565. 

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 who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for any traveler requesting protection against hepatitis B.

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 close contact with the indigenous population.

Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received 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: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. 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 in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.

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.
• 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. 

Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas. Recommended for all travelers >9 months of age.

Hospitals / Doctors

Medical care in Sudan is extremely limited and well below Western standards. There are approximately 160 hospitals in Sudan, but they are poorly supplied and have low standards of hygiene, especially those hospitals outside Khartoum. 
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit and a sterile needle and syringe 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 counterfeit; 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 medical facility in Nairobi, Israel or Europe.

Most physicians in Sudan work in government hospitals in the mornings and hold private clinics in the evenings, usually from 6:00 pm to 9:00 pm. Many clinics are closed on Friday or Sunday. Patients are expected to pay for services when the service is provided.

The U.S. Embassy maintains a physicians list at :
http://sudan.usembassy.gov/list_of_physicians.html

A listing of medical schools in Sudan is at: 
http://www.iime.org/database/africa/sudan.htm

• Ibn Khaldoon Hospital 
Khartoum 
Tel: [249] 18 345-1747 
Fax: [249] 18 345-1750 

• Modern Medical Centre 
Khartoum 
Tel: [249] 18 347-1749 
Fax: [249] 18 377-5804 

• Sahiroon Specialized Hospital 
Khartoum 
Tel: [249] 18 326-5316 
Fax: [249] 18 326-5317

 

Destination Health Info for Travelers

A Country Profile: The malaria mortality rate in Sudan for children ages 0-4 is 408 per 100,000. Chloroquine-resistant P. falciparum and insecticide-resistance in mosquitoes are growing problems in Sudan.
The tuberculosis death rate in Sudan is 49 per 100,000 of all ages. The HIV surveillance system in Sudan is poor and estimates of HIV prevalence in the country range from 1-5 percent. In an effort to prevent the spread of the AIDS epidemic to Sudan, in 2001 the government announced a policy of deporting HIV-positive foreigners.
The WHO has identified Sudan as one of 16 countries in which over half of the TB cases in the world occur. The DOTS treatment program for TB is being implemented in the country, and WHO estimates that 81 percent of all TB cases are detected and treated under DOTS protocols.
• Doctors Without Borders/Medecins Sans Frontieres (MSF) runs one of its largest humanitarian relief operation in the western Darfur region: http://www.doctorswithoutborders.org/news/sudan.cfm

AIDS/HIV: The prevalence level of HIV/AIDS in Sudan is slightly lower than many other countries in the region. The overall prevalence rate is about 1.6% but is probably higher in the southern part of Sudan and then in some pockets of northern Sudan. Transmission of HIV in this country is primarily through heterosexual contact. Unscreened blood transfusions and contaminated medical injections are other causes.
• 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 telephone 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.
Health insurance is essential.

African Sleeping Sickness (Trypanosomiasis): The Gambian form of this illness occurs in southern Sudan, primarily in Western and Equatoria Provinces. Rhodesian sleeping sickness may occur in areas adjacent to Ethiopia and in areas adjacent to Uganda. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at much lower 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 you 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: http://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.

Avian Influenza A (Bird Flu): Sudan has supposedly regained its status as free of H5N1 avian influenza following outbreaks in 2006.
• Avian influenza A (H5N1) is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.

Cholera: A cholera outbreak was reported in June 2008 from southern Sudan. This disease is active in this country with sporadic outbreaks reported. An outbreak in Gedaref (Al Qadarif) and Kassala was also reported in 2007 but cases of watery diarrhea, most likely due to cholera, were reported in many areas countrywide in 2008. Although this disease is reported to be active the threat to tourists is relatively 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.
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)

Cutaneous Leishmaniasis: Risk is widespread. Endemic areas for cutaneous leishmaniasis include Darfur, Kordofan, and other provinces of central Sudan, and north of Khartoum, along the Nile River. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• 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.

Dengue Fever: Mosquito-borne. Reported primarily from the coastal regions and from the northeastern part of the country. Other arboviral infections include sandfly fever (widespread), Rift Valley fever, Crimean-Congo hemorrhagic fever (tick-borne), and West Nile fever.

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 with sporadic cases as well as large-scale outbreaks. An outbreak of hepatitis E occurred in the Mornay refugee camp (78,800 inhabitants) in western Darfur in 2006. 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.
• 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 at high level with a prevalence of 3.2% 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: Epidemics of visceral leishmaniasis (kala-azar) occur on a regular basis in southern Sudan. Kala-azar is also reported from the Upper Blue Nile, Blue Nile, and Kassala Provinces, and Eastern Equatoria, Darfur, and Kordofan Districts. Outbreaks have also occurred north of Khartoum along the Nile River. 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 all urban areas. Increased
risk occurs during and after the rainy season, June through October, especially in southern Sudan. There is less malaria risk in the desert areas of the extreme north and northwest. Falciparum malaria accounts for 80% to 85% of cases. Other cases of malaria are due to the P. vivax and P. malariae species, rarely P. ovale. Chloroquine-resistant falciparum malaria is prevalent. Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is recommended when traveling to 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 Sudan 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 20% 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: Sudan lies within the sub-Saharan meningitis belt. Increased risk occurs primarily in the central and southern regions. Currently the most affected counties are Aweil West, Juba, Mundri East, Rumbek, Tonj South, Wulu and Yirol. Vaccination with a quadrivalent vaccine (Menactra or Menomune) is advised for those travelers anticipating close contact with the indigenous population.
• 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 (high prevalence in the south)
• Filariasis (mosquito-borne; reported from the Nuba Mountains around Kadogli in Kurdufan Province)
• Loiasis (deer-fly-borne; confined to rain forests and nearby savanna of Western Equatoria Province in the southwest)
• Leptospirosis
• Onchocerciasis (high prevalence along rivers in southwestern Sudan)
• Relapsing fever (louse-borne and tick-borne)
• Rift valley fever (close contact with livestock is a risk factor)
• Toxoplasmosis
• Typhus (lea-borne and louse-borne)
• Worms (helminthic infections very common)

Poliomyelitis (Polio): In March 2009 the World Health Organization reports an expansion of a prolonged outbreak of wild poliovirus type 1 (WPV1) in Sudan. Previously restricted to southern Sudan and western Ethiopia, the outbreak has now spread to Kenya, Uganda and northern Sudan (in Khartoum and Port Sudan).
• 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 dog-transmitted rabies occurs in Khartoum and elsewhere, including rural areas. Rabies vaccine is recommended for: all travelers, especially at locations more than 24 hours travel from a reliable source of post-exposure rabies vaccine and rabies immune globulin. Consider for shorter stays in travelers desiring maximum protection. All dog bites or scratches while in this country should be medically evaluated on an emergency basis.
• If rabies vaccine is not readily available, medial evacuation to another country may be required.

Rift Valley Fever: In October 2007 the World Health Organisation (WHO) confirmed an outbreak of Rift Valley Fever in Gezira, White Nile and Sennar states, south of Khartoum. As of January 2008, a total of 698 cases, including 222 deaths, has been reported from six states. No new cases have been reported since January 2008. The most rapid increase in human cases has been seen in Gazeera State, which now accounts for more than half of the human cases.
• Rift Valley fever is a viral infection that affects both cattle and people. It is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or by consumption of unpasteurized milk. Most cases occur in livestock workers. Symptoms include chills, fever, headache, muscle aches, nausea and vomiting. Most people recover uneventfully in about a week. Approximately 1% of patients die of the disease.
Further information: http://en.wikipedia.org/wiki/Rift_Valley_fever
• All travelers should take measures to avoid mosquito 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 at night.

Schistosomiasis: Risk is widespread, especially in the major irrigation systems in the Gezira area between the Blue and White Nile Rivers. 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. All water supplies in this country are potentially. 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 milk and dairy products. Do not eat raw or undercooked meat or 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 (TB): Tuberculosis is highly endemic in Sudan 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 Sudan, 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: This disease is sporadically active in this country. Cases were reported in 2005 from different localities in South Kordofan State, and most recently from Dilling, Kadugli, Rashad and Talodi. The number of cases is apparently declining. Vaccination is recommended for all travelers to this country. Sudan is in the Yellow Fever Endemic Zone. Sudan requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination.