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Uzbekistan



Capital: Tashkent

Time Zone: +5 hours. No daylight saving time in 2008.
Tel. Country Code: 998
USADirect Tel.: 8
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Uzbekistan

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Uzbekistan


Resource Links

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

Embassies

• U.S. Embassy
Ulitsa Chilanzarskaya, 82
Tel: [998] (71) 120-5450
Fax: [998] (71) 120-6335 
Website: www.usis.uz/wwwhcon.htm

• Canadian Embassy
Center 5, No. 64, Apt. 21
Tashkent
Tel: [998] (71) 137-67-28
Fax: [998] (71) 120-72-70
E-mail: antal@online.ru

• British Embassy
U1. Gulymova 67 Street
Tashkent 
Tel: [998] (71) 120 7852 
Fax: [998] (71) 120 6430 (Consular) 
Website: http://www.britishembassy.gov.uk/uzbekistan

Entry Requirements

 A passport and visa are required. Although official invitation letters are not required for American citizens applying for tourist visas, they are required for those planning to visit an individual who resides in Uzbekistan. Tourist visas cannot be extended in Uzbekistan. Visas are issued by Uzbek embassies and consulates abroad. Visas are not available upon arrival at Uzbek airports. The Embassy has received a number of reports from American citizens who have had problems obtaining Uzbek visas or who received Uzbek visas valid for a very limited period, usually for fewer than three months. Americans seeking visas are encouraged to apply for their visas well in advance of their travel. 
Registration after entry: All travelers present in Uzbekistan for more than three business days must register with the Office of Entry, Exit, and Citizenship, commonly known as “OVIR.” Hotel guests are registered automatically, but all other travelers are responsible for registering themselves. Registration fees vary depending on length of stay. Seehttp://uzbekistan.usembassy.gov/consular for more information. Visitors without proper registration are subject to fines, imprisonment, and deportation. The fines range from $500 to $4,000. Uzbek law mandates that visitors carry a medical certificate attesting that they are not infected with HIV, but this requirement is sporadically enforced. 
Further visa information is available from the Consular Section of the Embassy of the Republic of Uzbekistan, 1746 Massachusetts Avenue NW, Washington, DC 20036; telephone: (202) 530-7291; fax: (202) 293-9633; web site: http://www.uzbekistan.org or from the Consulate General of Uzbekistan in New York City, 866 United Nations Plaza, Suite 327A, New York, NY 10017; telephone: (212) 754-7403; fax: (212) 838-9812; website: http://www.uzbekconsulny.org.

HIV Test: May be required. According to the U.S. Department of State, HIV testing is required for anyone staying more than 15 days. (Long-term visitors must renew HIV certificate after the first 3 months in Uzbekistan and annually thereafter.) Foreign test results are accepted under certain conditions.

Required Vaccinations: None required.

Passport Information

Uzbekistan gained independence from the Soviet Union in 1991. While the country has undergone significant change since then, its progress towards democratic and economic reform has been halting and uneven. Corruption is endemic at all levels of society. Much of the country, particularly areas outside of Tashkent and the major tourist destinations of Samarkand, Bukhara, and Khiva, is remote and difficult to access. Tourist facilities in these areas are typically below Western standards, and many goods and services remain difficult to find on a regular basis 

Vaccinations: Recommended and Routine

None required.

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; may be of dubious origin; 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. Serious illness or injury may require medical evacuation to another country.

• Tashkent International Medical Clinic
38 Sarikul Street
Tashkent
Tel: [998] 120 6091, 254 5595 
Facility has many of the features of a traditional family practice Western clinic. The TIMC clinic was founded in 1994 by the US, German, UK and Japanese Embassies for the sole purpose of providing quality western standard health care to the expatriate population living and working in Tashkent. Their staffing consists of a mixture of local and western trained medical providers. All doctors speak English and have a mobile phone. TIMC is located in a 2-story private building in 5 km (or 15 minutes by car) from Intourist Hotel. This clinic consists of 4 consultation rooms, one room, which can be used as an ER, X-ray room, laboratory and a small pharmacy.

Dr. J.M. Flattum-Riemers is an American doctor, specialist in Family Medicine and Obstetric medicine. Another local doctor in the clinic has a good practice in emergency medicine and has had training in USA and Europe in ACLS and ATLS.
Emergency room: Emergency room looked equipped according to international standards. All equipment is Western manufactured.
The Clinic pharmacy has a good range of Western medications and vaccines,including different cardiology medication, antibiotics.
Routine operating hours: Monday-Friday: 8.00 am - 17:00 p.m. 24 hours emergency care. They are able to organize ground ambulance transportation.

• For minor difficulties, visitors are advised to ask the management at their hotels for help. In case of emergency, travelers should get a referral from either the Tashkent International Medical Clinic or from the appropriate Embassy, since foreigners are strongly advised not to approach local health care facilities without somebody who knows local conditions and the language. For major problems, visitors are well advised to seek help outside the country. Travel insurance is essential.

Destination Health Info for Travelers

AIDS/HIV: The HIV/AIDS epidemic in Uzbekistan is still in a nascent stage, however there has been a sharp increase in the number of new cases since 2000 as a result of an outbreak among injecting drug users. Despite a relatively low reported national prevalence rate (0.2% in the 15 to 49 years of age range) the number of HIV cases in Uzbekistan is growing exponentially. The most vulnerable population groups, which often overlap, include injecting drug users, prisoners, commercial sex workers and men who have sex with men. An estimated 85% of reported infections are due to unsafe injecting drug use. The largest concentration of injecting drug users is in the city of Tashkent, where sentinel surveillance from 2001 indicates a 45% prevalence rate among this group.
• 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.

Arboviral Diseases: Tahjna virus fever (mosquito-borne; virus circulates through much of the former USSR).
• Sandfly fever (sandfly-borne; limited to regions of southern central Asia, April–October). 
• West Nile fever (mosquito-borne; cases have occurred in the Tadzikstan). 
• North Asian tick fever (occurs wherever tick vectors are found).

Cholera: Sporadic cases occur, but the threat to most travelers 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)

Crimean-Congo Hemorrhagic Fever: This viral hemorrhagic fever is also known as Central Asian hemorrhagic fever. It is usually transmitted by ticks, but is also spread by the handling of infected domestic animals, or by contact with the blood of an infected person. Risk areas are rural steppe, savannah, semi-desert, and foothill/low mountain habitats below 2,000 meters elevation.

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. The rate of hepatitis E infection in southern Uzbekistan is estimated at 51.7 per 100,000 per year. (Source: Gideon) 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, 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 13%. 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 over 10% in healthy people and over 60% among intravenous drug users (IDUs). 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.

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.
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.

Leishmaniasis: Risk for cutaneous leishmaniasis primarily limited to the Uzbekstan, Kazakhstan, and Turkmenistan. 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.

Lyme Disease: Lyme disease occurs in rural forested areas below 1,500 meters elevation. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions 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.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference:http://content.nejm.org/cgi/content/abstract/345/2/79).

Malaria: There is a very low risk of malaria in the extreme southeast of Uzbekistan, near the Tajik border. Chemoprophylaxis is not recommended for Uzbekistan, however, travelers should be aware of the small risk of malaria and also know the symptoms.

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 Uzbekistan page on the Destinations menu or A-Z Index.

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing. 
NOTE: Picardin repellents (20% formulation, such as Sawyer Picaridan 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: Brucellosis (from unpasteurized dairy products; an outbreak was reported from central Uzbekistan in January 2005)
• Echinococcosis (this disease is a major public health problem in Uzbekistan, chiefly among those who live and work with sheep, as well as those having contact with dogs, cattle, and goats; animal and dog feces are infective) 
• Tick-borne relapsing fever (reported from Kirghizstan, Turkmenistan, and Uzbekistan)
• Trichinosis
• Tularemia


Poliomyelitis (Polio): In 2010 Uzbekistan has reported several cases of acute flaccid paralysis due to polio. These cases have occurred near the country’s border with Tajikistan, where polio is also active. 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: Rabies occurs sporadically in stray dogs and is occasionally reported in humans. 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.
• In the event of exposure, 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. You may need medical evacuation for treatment is vaccine/immune globulin is not locally available.

Tick-Borne Encephalitis (TBE): Peak transmission period is April through June. Risk is present primarily in rural brushy and forested areas below 1,500 meters elevation. TBE is usually known as “Central European tick-borne encephalitis” or “Russian spring-summer encephalitis.”
• All travelers should exercise insect-bite prevention measures. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.

Travelers' Diarrhea: All water supplies are suspect, including municipal tap water, which may be untreated and grossly contaminated. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%. 
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis. 
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis: Tuberculosis is highly endemic in Uzbekistan with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis is particularly widespread among Uzbek prison inmates, and prisons are considered the epidemiological pump behind the high rate of tuberculosis in the country. Multi-drug resistance is increasing and in new patients can be as high as 14%. 
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 (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working in Central Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.