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Zambia



Capital: Lusaka

Time Zone: +2 hours. No daylight saving time in 2008.
Tel. Country Code: 260
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug and United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, D.


Travel Advisory - Zambia

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 Zambia


Resource Links

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

Embassies

• U.S. Embassy
Independence and United Nations Avenues 
Lusaka
Tel: [260] (1) 250-955
Fax: [260] (1) 252-225
Website: http://zambia.usembassy.gov

• Canadian Embassy
5199 United Nations Avenue
Lusaka 
Tel: [260] (1) 250-833
E-mail: lsaka@dfait-maeci.gc.ca

• British High Commission
5210 Independence Avenue
Ridgeway
Lusaka
Tel: [260](1) 251-133 
Email: BHC-Lusaka@fco.gov.uk 
Website: www.britishhighcommission.gov.uk/zambia 

Entry Requirements

HIV Test: Not required.

Required Vaccinations: None required.

Passport Information

A passport and visa are required. A visa may be obtained in advance at a Zambian Embassy or Consulate or at the port of entry. Visas for American passport holders cost $100. Visas are valid for 3 years for multiple entries. At the time of entry, the immigration officer will stamp your passport with the permitted length of stay. This is normally 30 days and can ordinarily be extended twice (for a total time of 90 days) by visiting the immigration home office in Lusaka. All Americans, except resident diplomats, must pay an airport departure tax which is collected in U.S. dollars. Airlines include this tax in the cost of the ticket. However, passengers will need to verify that this tax has been paid at the airport. The passenger will receive a •no-fee• receipt reflecting this payment. Travelers transiting through South Africa should ensure that they have at least two blank (unstamped) visa pages in their passports. South African immigration authorities routinely turn away visitors who do not have enough blank visa pages in their passports. Zambian Immigration officials insist visitors carry the original or a certified copy of their passport and their immigration permit at all times. Certified copies must be obtained from the immigration office that issued the permit. American citizens should closely follow immigration guidelines, including visa requirements for travel to Zambia.
Additional information on entry requirements may be obtained from the Embassy of the Republic of Zambia, 2419 Massachusetts Ave. NW, Washington, DC 20008, telephone (202) 265-9717 or 19 or online at http://www.zambiaembassy.org.

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 at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and 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.

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: 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. 

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. 
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to hotels or resorts.

Yellow Fever: Travelers >1 year of age entering the country from an endemic area are required to present a certificate of immunization against yellow fever.

Hospitals / Doctors

Medical care is substandard throughout the country. Medical facilities and communications are poor, especially in rural areas. Even basic drugs and clean needles may not be available. Emergency services are limited. Shortages of routine medications and supplies may be encountered. 
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit (a sterile medical kit including needles, dressings etc.) as well as antibiotics to treat travelers diarrhea or other infections; you should bring drugs for malaria prophylaxis, if needed according to your 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 cannot be treated locally, every effort should be made to arrange medical transport to Johannesburg, South Africa. 

The U. S. Embassy maintains a listing of hospitals and clinics at:http://zambia.usembassy.gov/zambia/local_health_care_providers.html

Health care facilities in Zambia include:

• Corpmed Medical Centre
3236 Cairo Road
Northend
Lusaka
Tel: [260] (1) 222-612
Fax: [260] (1) 236-643
Website: www.corpmedzambia.com
Emergency medical care and physician on-site 24 hours.
General Practice, Inpatient care, Paediatrics, Obstetrics and Gynaecology.

• CARE FOR BUSINESS 
Plot No. 4192 Addis Ababa Drive
Lusaka
Tel: [260] (21) 1254 396/8

• ST. JOHNS MEDICAL CENTRE
(Monica Chiumya Clinic)
Plot No. 9024 Buluwe Road
Off Leopards Hill Road near Lake Road
Tel: [260] (21) 1261 247
Services include Lab, X-ray, Ultrasound, Physiotherapy and ECG.

• Mtendere Mission Hospital
Chirundu
Kafue
Tel: [260] (1) 515-056
Fax: [260] (1) 515-007
Email: administrator@mtendere.org
Website: www.mtendere.org

• North End Emergency Centre
(formerly Milbank Clinic)
Cairo Road
Lusaka
Tel: [260] (1) 226-983

• University Teaching Hospital
Nationalist Road
Lusaka
Tel: [260] (1) 252-269
Fax: [260] (1) 252-269
Email: assistdeangeneral@yahoo.com

Destination Health Info for Travelers

AIDS/HIV: At the end of 2007, UNAIDS/WHO estimates that 20% of people aged 15-49 years old were living with HIV or AIDS. Of these million adults, 57% were women. Unlike in some countries, HIV in Zambia is not primarily a disease of the most underprivileged; infection rates are very high among wealthier people and the better educated. Heterosexual transmission is the predominate means of transmission. HIV-1 prevalence estimated at 50% of the high-risk urban population. 
• 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): Risk of African trypanosomiasis persists, particularly in the Luangwa Valley and Kafue National Park areas. One-third of rural areas countrywide are infested with tsetse flies, a grey-brown insect the size of a honey bee. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are not at risk as the tsetse fly is found only in rural locales. 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:http://www.cdc.gov/ncidod/eid/vol8no1/01-0130.htm
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.

Arboviral Fevers: Outbreaks of chikungunya fever have been reported from Zambia. This viral illness is transmitted by the Aedes aegypti mosquito (the same mosquito that transmits yellow fever and dengue), an aggressive daytime biter.

Cholera: The most recent were reported in January 2009 from Choma in Southern Province and from Solwezi in Northwestern Province. Outbreaks of cholera are frequent during the rainy season (November-April), but cholera is a 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. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Dengue Fever: Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in parts of 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. 

A dengue fever map is at:http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf

Filariasis: Risk may occur in northern areas. Travelers should take precautions against mosquito bites.

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 levels are unclear. Sporadic cases and outbreaks occur. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. 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 >12%. 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 >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.

Influenza: Influenza is transmitted year-round in the tropics. 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 or solution applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.

Leishmaniasis: Low, but undetermined, risk. Cases of visceral leishmaniasis probably occur, but rarely. 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: Risk is present year-round in the Zambezi Valley, including urban areas, but seasonal in the rest of the country, primarily from November through June (during and just after the rainy season). Incidence has been increasing in Copperbelt Province and Southern Province. Falciparum malaria accounts for >90% of cases. Chloroquine-resistant falciparum malaria is prevalent.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended. 

A malaria map is located on the Fit for Travel website (ww.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 Zambia 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 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: Zambia does not lie within the sub-Saharan meningitis belt and vaccination against meningococcal disease is not currently recommended.

Onchocerciasis: Cases of onchocerciasis are reported near Choma in the Southern Province, perhaps the southernmost limit of transmission of this disease in Africa. Travelers to this region should take precautions against insect (blackfly) bites.

Other Diseases/Hazards: African tick bite fever (http://www.ncbi.nlm.nih.gov/pubmed/12954562)
• African tick typhus (contracted from dog ticks, often in urban areas, and bush ticks. African tick typhus - also called Mediterranean spotted fever - and African tick bite fever are separate illnesses in the same geographic area. In contrast to African tick typhus, African tick bite fever causes local adenopathy and multiple eschars.contracted from dog ticks)
• Brucellosis (low incidence; from consumption of raw dairy products and/or infected meat)
Gnathostomiasis (outbreak reported in the region on the Zambezi River in western Zambia; acquired by eating raw or undercooked freshwater fish) 
• Rift Valley fever
• Tick-borne relapsing fever

Plague: Ninety cases of bubonic plague were reported in 1996 in Namwala District. No cases of the pulmonary form of the disease were reported, and there are no restrictions for travelers visiting this country.

Rabies: Dogs are the primary source of human exposure. Outbreaks in cattle have been reported, primarily in the rural areas of Southern Province. 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 travel to another country. 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. 
• 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. Pre-exposure vaccination eliminates the need for rabies immune globulin, but not for post-exposure vaccine administration.

Schistosomiasis: Urinary schistosomiasis is endemic in all provinces. Intestinal schistosomiasis is less widely distributed, with most risk in Northern Province, Luapula Province (including Lake Mweru vicinity), Lusaka vicinity, and Southern Province (including the shores of Lake Kariba). 
•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: Outbreaks of dysentery frequent, especially during the rainy season (November-April). Public water supplies are filtered and chlorinated. All water sources in the country should be considered potentially 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.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ 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. 
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis: Tuberculosis is highly endemic in Zambia 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 unvaccinated people traveling to or working in sub-Saharan 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, 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: There is currently no risk of yellow fever in Zambia and a yellow fever vaccination certificate is not required for entry to this country.