Time Zone: +2 hours. No daylight savings time in 2008.
Tel. Country Code: 268
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plugs D, H.
Travel Advisory - Swaziland
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 Swaziland
U.S. Embassy, Mbabane. Central Bank Building, Warner Street; Tel. 464-41.
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from travellers coming from countries with risk of yellow fever transmission.
ENTRY/EXIT REQUIREMENTS: A passport is required. Visas are not required for tourists and business travelers arriving in Swaziland for short visits (less than 60 days) on standard U.S. passports. Most travelers visiting Swaziland enter through South Africa. PLEASE NOTE: All travelers traveling to South Africa are strongly encouraged to have several unstamped visa pages left in their passports. South Africa requires two unstamped visa pages, excluding amendment pages, to enter the country. Visitors who do not have enough free visa pages in their passport risk being denied entry and returned to the U.S. at their own expense.
For further information on Swaziland’s visa requirements, contact the Embassy of the Kingdom of Swaziland, 1712 New Hampshire Avenue NW, Washington, DC 20009; phone (202) 234-5002.
Swaziland is a small developing nation in southern Africa. Several well-developed facilities for tourism are available. The capital is Mbabane.
Vaccinations: Recommended and Routine
A yellow fever vaccination certificate is required from travellers coming from countries with risk of yellow fever transmission.
Hospitals / Doctors
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. Serious illness or injury may require medical evacuation to a hospital in South Africa.
• Medical facilities are limited. For minor problems, most expatriates go to the Mbabane Clinic which is small but well-equipped, well-staffed, and open 24 hours a day.
Destination Health Info for Travelers
AIDS/HIV: The Kingdom of Swaziland, with a total population estimated at 980,000 people, has one of the highest rates of HIV infection in the world. It is estimated that at over 25% of adults are living with HIV/AIDS in Swaziland.
• 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.
Note: There is a risk of exposure to unsafe blood and blood products in Swziland. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics.
• 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.
African Tick Typhus: This rickettsial disease (R. conorii subsp. conorii), transmitted by ticks, is also known as boutonneuse fever and Mediterranean tick fever in Southern Europe and Africa. It represents some risk to tourists visiting game parks, who 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. Treatment with doxycycline or tetracycline is rapidly effective.
Read more: http://wwwn.cdc.gov/travel/yellowBookCh4-Rickettsial.aspx
Cholera: This disease is reported active in this country (a small outbreak was reported from the Shiselweni region in November 2005), but the threat to tourists is very 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.
• 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)
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 but the levels are unclear. Sporadic cases may occur but go underdiagnosed or underreported. There is a 4% seroprevalence rate in refugees from Mozambique. 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 >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 with a prevalence of 1.5% 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.
Malaria: Risk is present in the northern and eastern grassland and plain areas of Bordergate, Lomahasha, Mhlume, and Tshaneni. Falciparum malaria accounts for 99% of cases. Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine (G6-PD test required), is recommended.
A MALARIA MAP is located on the Fit for Travel website (www.fitfortravel.nhs.uk), 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 Swaziland page on the Destinations menu or A-Z Index.
Animated world malaria map: http://www.map.ox.ac.uk/MAP-movie-limits.mov
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 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/Hazards: African tick typhus (a rickettsial disease caused by R. conoroii; contracted from dog ticks—often in urban areas—and from bush ticks; similar to Rocky Mountain spotted fever, but less severe, with fever, a small ulcer (tache noire) at the site of the tick bite, swollen glands nearby (satellite lymphadenopathy), and a red raised (maculopapular) rash. Also called Boutonneuse fever)
African tick-bite fever (caused by Rickettsia africae, a recently identified spotted fever group rickettsia, which is transmitted by ungulate ticks of the Amblyomma genus in rural sub-Saharan Africa and the French West Indies)
Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders.
Rabies: A rabies outbreak was reported among dogs in Nhlangano and surrounding areas in September 2006. 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.
Schistosomiasis: Risk areas for urinary schistosomiasis are primarily in middleveld and lowveld areas. Intestinal schistosomiasis is found only in lowveld areas. Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. 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, or streams. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: High risk. Piped water supplies are frequently untreated and may be grossly contaminated. Travelers should observe food and drink safety precautions. 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 (TB): Tuberculosis is highly endemic in Swaziland with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis is also highly endemic in South Africa with a prevalence of >400 cases per 100,000 population. Co-infection with HIV is a significant factor in acquisition of TB and occurs in >50% of people who have this disease. 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.
• The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several factors, the most important being the HIV epidemic. Although HIV is the leading cause of death in Africa, tuberculosis is the most common coexisting condition in people who die from AIDS. Post-mortem studies show that 30 to 40% of HIV-infected adults die from tuberculosis. Among HIV-infected children, tuberculosis accounts for up to one in five of all deaths.
• In 2006, extremely drug-resistant (XDR) tuberculosis appeared. In KwaZulu-Natal Province, half the XDR cases in patients with HIV infection were acquired in hospitals or clinics, and several occurred in health care workers. Mortality exceeded 95%. XDR-TB is defined as resistance to three or more second line antibiotics for TB. The condition remains treatable with other types of medications, but those are less effective, costlier and toxic. If the afflicted persons cannot be soon diagnosed and given proper treatment, they can die within a month.