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Zimbabwe



Capital: Harare

Time Zone: +2 hours.
Tel. Country Code: 263
USADirect Tel.: 110
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug. Grounding Adaptor Plugs C, F.


Travel Advisory - Zimbabwe

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 Zimbabwe


Resource Links

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

Embassies

• U.S. Embassy
172 Herbert Chitepo Avenue
Harare
Tel: [263] (4) 250-593/4
After-hours telephone: [263] (4) 250-595 
E-mail: ConsularHarare@state.gov

• Canadian Embassy
45 Baines Avenue
Harare
Tel: [263] (4) 252-181/2/3/4/5
Fax: [263] (4) 252-186/7
E-mail: harare-consular@dfait-maeci.gc.ca 

• British Embassy
Corner House (7th Floor)
Samora Machel Avenue
Leopold Takawira Street
Harare
Tel: [263] (4) 772 990
Website: www.britishembassy.gov.uk/zimbabwe

Entry Requirements

HIV Test: Not required

Required Vaccinations: Zimbabwe requires travelers >1 year of age arriving from countries where yellow fever is present to show proof of yellow fever vaccination. Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.

Passport Information

A passport, visa, return ticket, and adequate funds are required. U.S. citizens traveling to Zimbabwe for tourism, business, or transit can obtain a visa at the airports and border ports-of-entry, or in advance by contacting the Embassy of Zimbabwe at 1608 New Hampshire Ave. NW, Washington, D.C. 20009; telephone (202) 332-7100. American citizens considering travel to Zimbabwe to visit tourist destinations, including eco-tourist sites or hunting safaris, or for business purposes, are advised that the Government of Zimbabwe has declared that American visitors with proper documentation will be allowed entry without difficulty. However, the Government of Zimbabwe has also signaled an intention to refuse entry to Americans who are believed to have a bias against the Zimbabwean government. In some instances, Zimbabwean immigration officials have used materials found in searches of travelers and their luggage as an explanation to refuse entry. 

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; 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.

Meningococcal (Meningitis): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.


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.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Typhoid: Typhoid vaccine is recommended for all travelers.

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 this country, especially outside Harare and Bulawayo. 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 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 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 you should be evacuated to Johannesburg, South Africa, which has the closest, more advanced medical facilities. 

The U.S. Embassy maintains a website (http://harare.usembassy.gov/medical_information.html) that lists physicians, dentists, clinics, and pharmacies in Zimbabwe.

Note: Public hospitals in Harare and other towns are effectively closed due to staff shortages and lack of water, power, medicines and equipment. 

Under normal curcumstances, adequate medical care is available in Harare and Bulawayo.
Medical facilities used by expatriates include: 

• Avenues Clinic 
Corner Baines/Mazowe Street
Harare
Tel: [263] (4) 251180/99

• St. Anne's Hospital 
King George Road, Avondale
Harare
Tel: [263] (4) 339933

Other facilities include:
• Parirenyatwa Hospital, Harare (900 beds); emergency services; intensive care and burn units. 

• Mpilo Central Hospital, Bulawayo (600 beds); general medical facility.

Destination Health Info for Travelers

AIDS/HIV: Zimbabwe has one of the highest HIV/AIDS infection rates in the world. At the end of 2007, UNAIDS/WHO estimates that 25% of the population aged 15-49 years old were living with HIV or AIDS. Heterosexual contact is the predominate mode of transmission. Source: http://www.avert.org/aids-zimbabwe.htm
• 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 body fluids or blood of another person. 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.
Health insurance is essential. 


African Sleeping Sickness (Trypanosomiasis): Risk areas presumably exist in the northern Zambezi River drainage area, including the Lake Kariba vicinity. Outbreaks along the border with Mozambique were reported in the 1980s. Travelers should take measures to prevent insect (tsetse fly) bites.

Animal Hazards: Animal hazards include snakes (vipers, cobras), centipedes, scorpions, and black widow spiders.

Arboviral Diseases: Explosive outbreaks of chikungunya fever have occurred in urban areas, but most cases are in rural regions. West Nile and Sinbis fevers are known to occur in this country. No outbreaks of dengue fever have been officially reported recently. All travelers should take measures to prevent insect bites.

Cholera: A major cholera outbreak was reported from Zimbabwe in August 2008, involving all provinces and as of March 2009 continues to claim lives. Cholera outbreaks occur usually during the rainy season when flooding and contamination of water sources takes place. Despite outbreaks, 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. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Ebola Virus Hemorrhagic Fever: Sporadic, rare Ebola activity occurs. Transmission is via direct contact with blood or body fluids of acutely ill patients. This disease is not considered a threat to tourists.


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 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 • Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated >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 high level with a prevalence of 7.7% 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.

Lassa Fever: Sporadic, rare Lassa fever activity occurs. Transmission is via contact with infected rodents.

Malaria: Although not present in Harare and through much of the Highveld (central districts), malaria is prevalent year-round in most other parts of the country, particularly in low lying border areas including the Zambezi Valley, Victoria Falls, Hwange National Park in the low lying parts of the Eastern Highlands and the Vumba, around Mutare. Falciparum malaria accounts for approximately 98% of cases countrywide. 
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6PD test required) is recommended. 

A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go towww.fitfortravel.nhs.uk and select Malaria Map from the Zimbabwe 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. 
• Picardin skin 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: Endemic, but most travelers are at low risk. Zimbabwe is south of the sub-Saharan meningitis belt. Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651

Other Diseases/Hazards: African tick bite fever (http://www.ncbi.nlm.nih.gov/pubmed/12954562)
• Anthrax (6 cases of anthrax in humans reported in 2007 after they consumed meat from infected cattle)
• African tick typhus (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)
• African trypanosomiasis, 
• Brucellosis (low incidence; from consumption of raw dairy products and/or infected meat)
• Leptospirosis
• Rift Valley fever
• Tick-borne relapsing fever

Plague: Sporadic cases have occurred in the northwest, and north of Harare. Low risk to tourists. Anthropologists, archaeologists, medical personnel, and missionaries may be at higher risk and might consider prophylaxis with doxycycline.

Poliomyelitis (Polio): Immunization is recommended, due to the persistence of polio in sub-Saharan Africa. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine (IPV). 

Rabies: Sporadic human cases are reported, with dogs and jackals as the primary source of exposure. Most cases occur in Matabeleland North and South Provinces, which have been declared rabies endemic areas. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. 
Pre-travel 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. 

Schistosomiasis: A schistosomiasis outbreak was reported in December 2006 from Hurungwe district, Zimbabwe. Peak transmission of urinary schistosomiasis occurs in the northeast during the hot, dry season (September to October). Transmission is year-round in the Zambezi Valley, the shores of Lake Kariba and the southeast lowveld. Intestinal schistosomiasis occurs primarily in the north and east. 
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: Up to 900 cases a day of diarrhea and dysentery were being reported from Harare in August 2007. The outbreak is blamed on poor sanitation and erratic water supplies. 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 a major public health problem in this country. Tuberculosis is highly endemic in Zimbabwe 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 vaccine is recommended for all 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. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.