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Capital: Dar es Salaam

Time Zone: +3 hours. There is no daylight saving time in 2008.
Tel. Country Code: 255
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, F.

Travel Advisory - Tanzania

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 Tanzania

Resource Links

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


U.S. Embassy

Dar es Salaam. 

American Citizen Services (ACS) is part of Consular Services, based at the U.S. Embassy in Dar es Salaam.

We provide assistance to American citizens residing in or visiting Tanzania, including but not limited to Passport services,

Consular Reports of Births Abroad (CRBA), and Notarials. The consulates also assist in emergencies, including deaths, arrests and crisis situations.

Entry Requirements

ENTRY/EXIT REQUIREMENTS: A passport and visa are required for travel to Tanzania. U.S. citizens with valid passports may obtain a visa either before arriving in Tanzania or at any port of entry staffed by immigration officials. U.S. passports should be valid for a minimum of six months beyond the date the visa is obtained, whether it is acquired beforehand or at the port of entry. Also, foreigners are required to show their passports when entering or exiting Zanzibar. Visitors are required to have a valid yellow fever inoculation stamp on their international health cards.

Further inquiries can be made at the Embassy of Tanzania, 2139 R Street, NW, Washington, DC, 

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required for travelers over 1 year of age coming from countries with risk of YF transmission. Note: This applies to airport layovers > 12 hours in such countries.

Passport Information

Tanzania is a developing East African nation noted for both its history of stability and its astounding natural beauty. A robust tourist industry provides all levels of tourist amenities, although higher-end facilities are concentrated mainly in the cities and selected game parks. The United Republic of Tanzania was formed in 1964 with the union of the mainland country of Tanganyika and the Zanzibar archipelago, which comprises the islands of Unguja and Pemba. The U.S. Embassy is in Dar es Salaam, the location of most government offices, and the commercial center of the country.

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 infection.

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.

Adult polio boosters are not recommended for travel to this country.

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. It is a one-time shot life-time

Typhoid: Recommended for all unvaccinated travelers.

Yellow Fever:
  Not recommended, but may be required. A vaccination certificate is required for travelers over 1 year of age coming from countries with risk of YF transmission. Note: This applies to airport layovers > 12 hour in such countries. Vaccination is only recommended for highly risk-averse travelers.

Hospitals / Doctors

Medical care in Tanzania is limited but adequate for most problems. 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.
• Travelers are advised to obtain comprehensive medevac 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. Consider air ambulance transport to South Africa or Western Europe for more advanced or on-going treatment.

The US Embassy maintains a listing of doctors and hospitals:

Hospitals used by most expatriates and travelers for medical emergencies include:

Aga Khan Hospital
Ocean Road
Dar es Salaam

IST Clinic

Ruvu Street on the Msasani Peninsula
Junction Haile Selassie Road and Chole Road
Dar es Salaam

The IST Clinic is a primary care facility in Dar es Salaam. Services include general practice consultations, minor surgery and first aid care, antenatal and child clinics, ultrasound imaging and short term admission facilities. There is a pharmacy on premises.

Regency Medical Cent

Alykhan Road
Dar es Salaam

The public hospitals in Tanzania are so far below U.S. standards that most Americans will not feel comfortable using them. However, in serious emergencies, the closest hospital might be the best hospital until the patient can be stabilized.


Selian Lutheran Hospital Clinic

Aga Khan Hospital
Seth Benjamin rd.


Kilimanjaro Christian Medical Clinic

The hospital located in the foothills of the snow capped, Mount Kilimanjaro, Tanzania. It was opened in March 1971 by the Good Samaritan Foundation, who planned and raised large funds to build andequip it.

KCMC is a referral hospital for over 11 million people in Northern Tanzania. The hospital is a huge complex with over 450 beds, with hundreds of outpatients and visitors coming to the centre everyday. Over 1000 staff are employed at the centre.



Bugando Medical Center

Bugando Medical Centre is a consultant and teaching Hospital for the Lake and Western zones of the United Republic of Tanzania. It is situated along the shores of Lake Victoria in Mwanza City. It has 900 beds and over 900 employees. It is a referral centre for tertiary specialist care for six regions namely:- Mwanza, Mara, Kagera, Shinyanga, Tabora and Kigoma. It serves a catchment's population of approximately 13 million people.

Hindu Union Hospital

Destination Health Info for Travelers

A Country Profile: Tanzania is a country of 37 million located on the east coast of Africa. With a per capita Gross National Income (GNI) of $290 a year, it is one of the poorest nations in the world. About 60 percent of the population lacks access to health services, and over 40 percent of children under five are malnourished.
• The incidence of both HIV/AIDS and TB in Tanzania greatly exceed rates in most of the world. It is estimated that HIV infects about 8 percent of Tanzanian adults; about 1.3 million Tanzanians are living with HIV/AIDS, and many have already died. Over 80 percent of AIDS patients are in the 20-49 age group. Thus, AIDS strikes down many Tanzanian workers and parents, simultaneously disrupting the economic and social life of the country. 800,000 Tanzanian children have lost one or both parents to the disease.
There are also 363 TB cases per 100,000 population in Tanzania, a rate higher than in many neighboring countries. Tanzania has instituted 100 percent DOTS coverage, and the TB treatment success rate is close to 81 percent.

• Malaria is endemic throughout Tanzania, with the exception of the northern highlands region in the vicinity of Mt. Kilimanjaro. Malaria currently accounts for approximately 17 percent of deaths in Tanzania; as is the case elsewhere, malaria is most likely to kill children under the age of five. One 1995 study by the Swiss Tropical Institute estimated that malaria accounts for 29 percent of childhood deaths in Tanzania.

Doctors Without Borders/ Medecins Sans Frontieres (MSF) has been working in Tanzania since 1993:

AIDS/HIV: Heterosexual contact is the predominate mode of transmission of HIV in sub-Saharan Africa. People in sub-Saharan Africa do not have many more lifetime partners than people in other parts of the world. However, researchers have found that in many areas it is not uncommon for people to have two or more regular sex partners at the same time, and someone who has two or more concurrent partners is more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. This is one factor that helps to explain why HIV is more widespread in Africa. Other factors include widespread venereal disease, low rate of circumcision, resistance to the use of condoms, and under-funding of public health programs. Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. The national adult HIV prevalence rate now exceeds 20% in Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%). Adult HIV prevalence in East Africa exceeds 6% in Uganda, Kenya and Tanzania.

• The prevalence of people living with HIV/AIDS in Tanzania is estimated at 7% of the population age 15 to 49.
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.

African Sleeping Sickness (Trypanosomiasis)
Trypanosomiasis occurs countrywide and the incidence is increasing. Disease risk is most prevalent in a region from Kigoma at Lake Tanganyika to Arusha in the northern part of the country. 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 travelers 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:

Imported by European travelers:

Note: Human African trypanosomiasis (due to T. b. rhodesiense) is more likely to be seen in travelers to East African game parks where the ungulate wildlife serves as a reservoir for the pathogen. In recent years almost all reported cases have been infected in northern Tanzania (Serengeti, Tarangire) or in Uganda (Queen Elizabeth National Park). Some emerging tourist destinations (Malawi: Kasungu National Park, Waza Game Reserve; Rwanda: Akagera National Park; Zambia: South Luangwa National Reserve; Tanzania: Moyowosi Game Reserve) are known foci of the parasite, and may pose a risk for travelers.

Altitude Illness: Climbers ascending Mt. Kilimanjaro (5,790 m) are at risk. The typical tourist climbing itinerary for Kilimanjaro, with daily ascents of 1,000 m, gives you no opportunity to acclimatize properly. Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you have not had a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 - 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75% effective. It may also reduce the risk of HAPE.

• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE)—recognized by confusion, difficulty with balance and coordination, staggering gait. Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also will prevent HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent.

Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
Further advice:

ISMM International Society of Mountain Medicine
The Institute for Altitude Medicne
Base CampMD: Guide to High-Altitude Medicine
High-Altitude Illness (New England Journal of Medicine)

Highest Mountains in the World

Animal Hazards: Many species of venomous snakes, including mambas, adders, vipers, and cobras, live in the region. Consider any snake encountered as dangerous, and do not handle. Seek immediate medical attention if bitten; untreated snakebites may cause serious illness or death within 1 hour.
• Several species of centipedes, scorpions, and spiders, some with potentially fatal venom, are present throughout the region. If possible, avoid sleeping on the ground. Shake out boots, bedding, and clothing prior to use, and never walk barefoot. If bitten or stung, seek medical attention immediately.
• Sea cones, sea urchins, and anemones inhabit the shallow coastal waters of Tanzania and may pose a threat to swimmers.

Cholera: Recurring outbreaks of cholera and other diarrheal diseases have been reported almost continuously since March 2006, involving mainland Tanzania as well as the island of Zanzibar. In August 2007 an outbreak of cholera with 19 hospitalized cases and 10 deaths occurred in the northern Mara region. Although this disease is endemic, the threat to tourists is low. Cholera is an rare disease in travelers from developed countries. 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. 

Dengue Fever: Dengue is present in this country and provokes regular epidemic outbreaks. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in throughout much of sub-Saharan Africa. 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.

Dengue fever map

Bancroftian filariasis (mosquito-borne) is reported along the coast, including Pemba and Zanzibar, and also reported south of Lake Victoria, north of Lake Nyasa, and in the vicinity of Lake Tanganyika.

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 sub-Saharan Africa causing both sporadic cases and large outbreaks. The prevalence in Tanzania is unclear. Sporadic cases may be underdiagnosed or underreported. 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 >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 a prevalence of <1.0% 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.

Insects: All travelers should take measures to prevent both daytime and nighttime insect bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.

Leishmaniasis: Risk is estimated to be low. A few cases of cutaneous leishmaniasis have been reported from northern areas. 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.

Malaria: High risk is present throughout this country, including urban areas, the highland areas below 2,000 meters elevation, and the islands of Zanzibar and Pemba. Risk of malaria is increased during and just after the rainy seasons, November through December and March through May. Risk has also been increasing in high plateau areas, previously considered areas of limited risk. P. falciparum accounts for over 90% of cases.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is recommended.

Malaria map

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 GoReady 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 (Meningococcal): Outbreaks of Groups A and C meningococcal meningitis are intermittently reported, particularly in refugee camps. Higher risk areas include the northern part of the Arusha Region (bordering Kenya) and the northern and central regions (including Mwanza, Mara, Arusha, Kilimanjaro, Tanga, Dar es Salaam, Morogoro, Dodoma, and Tabora). Quadrivalent meningitis vaccine is recommended for travelers who expect close contact with the indigenous population.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at:

Onchocerciasis: Also known as river blindness. Black-fly borne; risk area extends from the Usambara mountains in the northeast to Lake Nyasa in the south. Travelers to these areas should take measures to prevent insect (blackfly) bites.

Other Diseases/Hazards: Anthrax (cutaneous; usually from contact with freshly slaughtered infected animals)
• African tick typhus
• Brucellosis (humans acquire infection by ingestion of unpasteurized milk 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)
• Chikungunya fever (mosquito-transmitted; explosive urban outbreaks have occurred)
• Dengue (no recent reports)
• Echinococcosis (high incidence in the Masai of northern areas)
• Leptospirosis
• Lyme disease (risk unclear; one case reported in a Peace Corps volunteer)
• Plague (outbreaks of human plague have been reported almost continuously since 1983, chiefly from the Tanga region. The most recent outbreak was reported in March 2007 from Endoji Village, Mbulu District, in Manyara Region)
• Relapsing fever (louse- and tick-borne)
• Toxoplasmosis
• Typhoid fever (endemic at moderate to high levels)
• intestinal worms (very common).

Poliomyelitis (Polio): Polio remains persistent in sub-Saharan Africa. 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: Sporadic cases of human rabies are reported countrywide. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. Access to rabies vaccine or rabies immune globulin may require emergency evacuation to another country. 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. 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, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.

Rift Valley Fever: An outbreak of Rift Valley fever was reported in February 2007 from the Dodoma region in the central part of Tanzania, followed by the Morogoro, Singida, and Arusha regions. Cases wee also reported from the Dar es Salaam, Iringa, Manyara, Mwanza, Pwani, and Tanga regions.
• 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:
• 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.

Road Safety: Travelers should not drive at night. The roads in Tanzania are often poorly maintained. During the rainy season many roads are passable only with 4-wheel-drive vehicles. Excessive speed, unpredictable driving habits & lack of basic safety equipment on many vehicles are additional hazards. Emergency service & first aid unavailable outside major cities & tourist areas.

Schistosomiasis: This disease is focally distributed country-wide. Major risk areas include the shores of Lake Victoria, Tanga and Kigoma Districts, and the Lake Rukwa area. Urban transmission occurs in Dar es Salaam. Schistosomiasis is transmitted on Zanzibar and Pemba Islands. An outbreak of schistosomiasis was reported in September 2007 among Israeli and German travelers who had been swimming in a small, man-made pond at the Kisima Ngeda tented lodge near Lake Eyasi in Ngorongoro district, Arusha Region.
• 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.

Tick-Borne Diseases: Tickborne relapsing fever (due to Borrelia spirochetes) may be endemic or sporadic. In central Tanzania, this disease is a substantial cause of child mortality. It may be associated with camping out in rural locations in close proximity to animal reservoirs of the spirochete and their associated tick vectors. The vector is the soft tick, genus Ornithodoros; it is prevalent in sub-Saharan Africa. These ticks live in traditional housing and mainly feed nocturnally.
• African tick bite fever (ATBF) and Mediterranean spotted fever are caused by two related rickettsial organisms of the spotted fever group. Both are transmitted by hard ticks. These diseases may be initially misdiagnosed as malaria.
• ATBF and Mediterranean spotted fever manifest as an acute, febrile, and influenza-like illness, frequently accompanied by severe headache, prominent neck muscle myalgia, inoculation eschars (which appear as black crusts surrounded by a red halo at the site of the tick bite), and regional lymphadenitis (lymph node swelling). As many as 50% of patients have multiple skin eschars.

Travelers' Diarrhea: Potential high risk in all areas. Several cities have water treatment facilities, but piped water supplies are frequently untreated and may be contaminated. Water- and food-borne diseases are a risk in this country. We recommend drinking only bottled water or beverages. Do not drink tap water unless it has been boiled, filtered or chemically purified. Do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw and undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits. Seek medical advice if you have a fever or are suffering from diarrhea.
• 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.

Tuberculosis: Tuberculosis is highly endemic in Tanzania 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 Tanzania, 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: Proof of yellow fever vaccination is required for all travelers arriving from any country in the yellow fever endemic zones, i.e., a valid yellow fever vaccination certificate is required for travelers coming from countries with risk of yellow fever transmission. Yellow fever vaccine is not recommended for any traveler unless it is officially required for entry to Tanzania. No human cases of yellow fever have ever been reported from this country.
Note: You may still be asked for proof of vaccination if you are going from Tanzania to a country with a YF requirement for travelers from risk countries.