Travel Tips for Tunisia, Updated Intl. Guide – Travel Medicine, Inc.
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Capital: Tunis

Time Zone: +1 hour. (GMT +2 from the last Sunday in March to the last Sunday in October).
Tel. Country Code: 216
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.

Travel Advisory - Tunisia

There is a low risk of malaria in North Africa and the Middle East, but other insect-transmitted diseases, such as leishmaniasis and viral infections, are potential threats. Safe water precautions, safe needle, and insect-bite prevention measures are important.

Dr. Rose Recommends for Travel to Tunisia

Resource Links

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


• U.S. Embassy
144 Avenue de la Liberte
Tel: [216] (71) 782-566
Fax: [216] (71) 789-719 or [216] (1) 789-923

• Canadian Embassy
3, rue du Sénégal
Place d'Afrique
Tel: [216] (71) 796-577
Fax: [216] (71) 792-37

• British Embassy
Rue du Lac Windermere
Les Berges du Lac
Tel: [216] (71) 108 700

Entry Requirements

ENTRY/EXIT REQUIREMENTS: A passport is required. For U.S. passport holders, a visa is not necessary for stays of up to four months; however, a residence permit is needed for longer stays. The residence permit can be obtained from the central police station of the district of residence. Americans born in the Middle East or with Arabic names have experienced delays in clearing immigration upon arrival. American citizens of Tunisian origin are expected to enter and exit Tunisia on their Tunisian passports. If a Tunisian-American succeeds in entering using a U.S. passport, he or she will still have to present a Tunisian passport to exit the country.

For further information concerning entry/exit requirements for Tunisia, travelers may contact the Embassy of Tunisia at 1515 Massachusetts Avenue, NW, Washington, DC 20005, tel. 202-862-1850.

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from travellers over 1 year of age coming from areas with risk of yellow fever transmission.

Passport Information

Tunisia is a presidential republic with a developing economy. Tourist facilities are widely available in large urban and major resort areas. Read the Department of State Background Notes on Tunisia for additional information.

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 travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Polio: A one-time dose of IPV 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. 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 in remote locations, or outdoors in rural areas where there is an increased the risk of animal 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 additional treatment with rabies 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 with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.

Yellow Fever: Required if arriving from an infected area. Not recommended otherwise.

Hospitals / Doctors

Medical care in Tunisia is adequate, with a number of new, private “polyclinics” available that function as simple hospitals and can provide a variety of procedures. Specialized care or treatment may not be available. Facilities that can handle complex trauma cases are virtually non-existent. While most private clinics have a few physicians who are fluent in English, the medical establishment uses French and all of the ancillary staff in every clinic communicates in Arabic and/or French. Public hospitals are overcrowded, under-equipped and understaffed.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers’ diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country—the equivalent drugs may not be available or may 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 Europe.

• Clinique Avicenne
4 Avenue Tahar Sfar
El Manar 2
Tel: [216] (71) 88 80 00

• Nouvelle Clinique du Parc
13, Bis Rue Hooker Doolittele
Tél.: [216] (71) 796 477

• Clinique El Amen
20-22 Rue Azziza Othmana
Tel: [216] (71) 79 15 33

• Clinique Les Berges du Lac
Rue Lac de Constance
1053 Les Berges du Lac
Tel: [216] (71) 96 00 00

• Clinique de Tunis/Clinique El Manar
Rue 7151 El Manar 1
Tel: [216] (71) 88 50 00

• Charles Nicolle Hospital
Boulevard 9 Avril 1938
Tel: [216] (71) 562740 
Municipal hospital; general medical/surgical facility; all specialties.

• Habib Thameur Hospital (555 beds); general medical/surgical facility.
• Hadi Chakar Hospital, Tunis (870 beds); general medical/surgical facility.

Destination Health Info for Travelers

AIDS/HIV: At present, statistical results showed that the cumulative number of AIDS cases in Tunisia is still small as compared to other countries in the region. The epidemiological data showed a very low prevalence of HIV infection among blood donors, drug users, and the group of pregnant women. The number of reported HIV infection and AIDS acquired via sexual contact are increasing steadily with high proportion of heterosexual transmission, thus suggesting that the major-mode of transmission has changed to heterosexual route. The HIV prevalence rate in adults aged 15 to 49 is 0.1% – 0.3%.
• 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 another person’s body fluids or 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.
• 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.

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.

Hepatitis: All travelers should receive hepatitis A vaccine. Hepatitis A is transmitted through 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. Large outbreaks are occasionally reported. Seroprevalence surveys show 4.3% of the population is seropositive. Four percent of acute cases of hepatitis are attributed to hepatitis E. Sporadic cases may go 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, 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.
• The overall hepatitis B carrier rate in the general population is estimated at 3% to7%. 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 seroprevalence of 0.7%. 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.

Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.

Leishmaniasis: Cutaneous leishmaniasis is reported from northern, central (primarily Qafsah, Sidi Bu Zayd, and Safaqis Governorates), and the southeastern areas. Visceral leishmaniasis (kala-azar) occurs in the northern half of Tunisia, primarily northeast, including the outskirts of Tunis. 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: There is no risk of malaria in Tunisia.

Other Diseases/Outbreaks: Boutonneuse fever (African tick typhus; distribution is widespread; contracted from dog ticks, often in suburban areas), • Brucellosis (risk from raw goat/sheep milk and cheese)
• Echinococcosis (a major health problem in central Tunisia)
• Leptospirosis

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. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. 
NOTE: Wild animal reservoir of rabies virus is primarily foxes, jackals, and hyenas.
• Rabies vaccine is recommended for travel longer than 3 months, for shorter stays for travelers who plan to venture off the usual tourist routes where they may be more exposed to the stray dog population, or when travelers desire extra protection.

Sandfly Fever: Disease risk is present in the northern, central, and southeastern areas of the country. Transmission of this viral illness, which is usually mild, occurs primarily April–October, when sandfly activity is highest.

Schistosomiasis: Schistosoma haematobium (urinary) is present in this country. Travelers are at very low risk. Primary risk areas include the oases in Qafsah and Qabis Governorates and in the village of Hadjeb El Aioun, 120 miles south of Tunis. Other areas may be involved. 
• 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: In many urban areas, and all rural areas, water supplies are not considered potable. Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. 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.

Typhoid Fever: Typhoid is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all people traveling to or working in North Africa, 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.