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General information

The information on these pages should be used to research health risks and to
inform the pre-travel consultation. For advice regarding safety and security
please check the UK Foreign and Commonwealth Office (FCO) website.
Travellers should ideally arrange an appointment with their health professional
at least four to six weeks before travel. However, even if time is short, an
appointment is still worthwhile. This appointment provides an opportunity to
assess health risks taking into account a number of factors including
destination, medical history, and planned activities. For those with pre-
existing health problems, an earlier appointment is recommended.
While most travellers have a healthy and safe trip, there are some risks that
are relevant to travellers regardless of destination. These may for example
include road traffic and other accidents, diseases transmitted by insects or
ticks, diseases transmitted by contaminated food and water, sexually
transmitted infections, or health issues related to the heat or cold.
All travellers should ensure they have adequate_travel_health_insurance.
A list of useful resources including advice on how to reduce the risk of
certain health problems is available below.

Resources


* Food_and_water_hygiene
* Insect_and_tick_bite_avoidance
* Personal_safety
* Sexually_transmitted_infections
* Sun_protection


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Vaccine recommendations

Details of vaccination recommendations and requirements are provided below.

All Travellers

Travellers should be up to date with routine vaccination courses and boosters
as recommended_in_the_UK. These vaccinations include for example measles-mumps-
rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine.
Those who may be at increased risk of an infectious disease due to their work,
lifestyle choice, or certain underlying health problems should be up to date
with additional recommended vaccines. See the individual chapters of the ‘Green
Book’ Immunisation_against_infectious_disease for further details.

Certificate Requirements

Please read the information below carefully, as certificate requirements may
be relevant to certain travellers only. For travellers further details, if
required, should be sought from their healthcare professional.

* There is a risk of yellow fever transmission in all areas of this country
  (see ‘Most Travellers’ section below).
* Under International Health Regulations (2005), a yellow fever vaccination
  certificate is required from all travellers over 9 months of age.
* For this country, the yellow fever vaccination certificate is assumed to be
  valid for 10 years until further notice.

The yellow fever vaccine is not suitable for all travellers, there are specific
undesirable effects associated with it. This vaccine is only available at
registered_yellow_fever_vaccination_centres. Health professionals should
carefully assess the risks and benefits of the vaccine, and seek specialist
advice if necessary.

Most Travellers

The vaccines in this section are recommended for most travellers visiting this
country. Information on these vaccines can be found by clicking on the blue
arrow. Vaccines are listed alphabetically.
Hepatitis A
Hepatitis A is a viral infection transmitted through contaminated food and
water or by direct contact with an infectious person. Symptoms are often mild
or absent in young children, but the disease becomes more serious with
advancing age.  Recovery can vary from weeks to months. Following hepatitis A
illness immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives,
long-stay travellers, and those visiting areas of poor sanitation.

Prevention

All travellers should take care with personal, food and water hygiene.

Hepatitis A vaccination

As hepatitis A vaccine is well tolerated and affords long-lasting protection,
it is recommended for all previously unvaccinated travellers.
Hepatitis_A_in_brief
Tetanus
Tetanus is caused by a toxin released from Clostridium tetani and occurs
worldwide.  Tetanus bacteria are present in soil and manure and may be
introduced through open wounds such as a puncture wound, burn or scratch.

Prevention

Travellers should thoroughly clean all wounds and seek appropriate medical
attention.

Tetanus vaccination


* Travellers should have completed a primary vaccination course according to
  the UK schedule.
* If travelling to a country where medical facilities may be limited, a booster
  dose of a tetanus-containing vaccine is recommended if the last dose was more
  than ten years ago even if five doses of vaccine have been given previously.

Country specific information on medical facilities may be found in the ‘health’
section of the FCO_foreign_travel_advice website.
Tetanus_in_brief
Typhoid
Typhoid is a bacterial infection transmitted through contaminated food and
water. Previous typhoid illness may only partially protect against re-
infection.
Those at increased risk include travellers visiting friends and relatives,
those in contact with an infected person, young children, long-stay travellers,
and those visiting areas of poor sanitation.

Prevention

All travellers should take care with personal, food and water hygiene.

Typhoid vaccination


* Both oral and injectable typhoid vaccinations are available and are
  recommended for those at increased risk.
* Vaccination could be considered for other travellers.

Typhoid_in_brief
Yellow Fever
Yellow fever is a viral infection transmitted by mosquitoes which predominantly
feed between dawn and dusk, but may also bite at night, especially in the
jungle environment. Symptoms may be absent or mild, but in severe cases it can
cause internal bleeding, organ failure and death.

Yellow Fever in Central African Republic

There is a risk of yellow fever transmission throughout this country.

Prevention

Travellers should avoid mosquito bites at all times.

Yellow fever vaccination


* Vaccination is recommended for travellers aged 9 months and older.
* See vaccine recommendation map below.

The yellow fever vaccine is not suitable for all travellers, there are specific
undesirable effects associated with it. This vaccine is only available at
registered_yellow_fever_vaccination_centres. Health professionals should
carefully assess the risks and benefits of the vaccine, and seek specialist
advice if necessary.
Yellow_fever_in_brief

Yellow fever vaccine recommendations in Africa

Map_provided_by_the_Travelers’_Health_Branch,_Centers_for_Disease_Control_and
Prevention

_YF-map-Africa_
Current as of September 2014. This map, which aligns with recommendations also
published by the World Health Organization (WHO), is an updated version of the
2010 map created by the Informal WHO Working Group on the Geographic Risk of
Yellow Fever.
1. Yellow fever (YF) vaccination is generally not recommended in areas where
there is low potential for YF virus exposure. However, vaccination might be
considered for a small subset of travelers to these areas who are at increased
risk for exposure to YF virus because of prolonged travel, heavy exposure to
mosquitoes, or inability to avoid mosquito bites. Consideration for vaccination
of any traveler must take into account the traveler’s risk of being infected
with YF virus, country entry requirements, and individual risk factors for
serious vaccine-associated adverse events (e.g. age, immune status).

Some Travellers

The vaccines in this section are recommended for some travellers visiting this
country. Information on when these vaccines should be considered can be found
by clicking on the arrow. Vaccines are listed alphabetically.
Cholera
Cholera is a bacterial infection transmitted by contaminated food and water.
Cholera can cause severe watery diarrhoea although mild infections are common.
Most travellers are at low risk.

Prevention

All travellers should take care with personal, food and water hygiene.

Cholera vaccination

This oral vaccine is recommended for those whose activities or medical history
put them at increased risk.  This includes:

* aid workers
* those going to areas of cholera outbreaks who have limited access to safe
  water and medical care.
* those for whom vaccination is considered potentially beneficial.

Cholera_in_brief
Hepatitis B
Hepatitis B is a viral infection; it is transmitted by exposure to infected
blood or body fluids. This mostly occurs during sexual contact or as a result
of blood-to-blood contact (for example from contaminated equipment during
medical and dental procedures, tattooing or body piercing procedures, and
sharing of intravenous needles).   Mothers with the virus can also transmit the
infection to their baby during childbirth.

Hepatitis B in Central African Republic

2% or more of the population are known or thought to be persistently infected
with the hepatitis B virus (intermediate/high prevalence).

Prevention

Travellers should avoid contact with blood or body fluids. This includes:

* avoiding unprotected sexual intercourse.
* avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile
  equipment is used).
* not sharing needles or other injection equipment.
* following universal precautions if working in a medical/dental/high risk
  setting.

A sterile medical equipment kit may be helpful when travelling to resource poor
areas.

Hepatitis B vaccination

Vaccination could be considered for all travellers, and is recommended for
those whose activities or medical history put them at increased risk including:

* those who may have unprotected sex.
* those who may be exposed to contaminated needles through injecting drug use.
* those who may be exposed to blood or body fluids through their work (e.g.
  health workers).
* those who may be exposed to contaminated needles as a result of having
  medical or dental care e.g. those with pre-existing medical conditions and
  those travelling for medical care abroad including those intending to receive
  renal dialysis overseas.
* long-stay travellers
* those who are participating in contact sports.
* families adopting children from this country.

Hepatitis_B_in_brief
Meningococcal Disease
Meningococcal disease is a bacterial infection transmitted by inhaling
respiratory droplets or direct contact with respiratory secretions from an
infected person. This is usually following prolonged or frequent close contact.
The most common forms of meningococcal disease are meningococcal meningitis
(infection of the protective lining around the brain) and septicaemia (blood
poisoning).
Those at increased risk include healthcare workers, those visiting friends and
relatives and long-stay travellers who have close contact with the local
population.

Meningococcal disease in Central African Republic

This country lies within the meningitis belt of sub-Saharan Africa.

Prevention

Travellers should avoid, if possible, overcrowded conditions.

Meningococcal disease vaccination

Vaccination is recommended for those whose activities or medical condition put
them at increased risk including:

* healthcare workers
* those visiting friends and relatives
* those who live or travel ‘rough’ such as backpackers
* long-stay travelers who have close contact with the local population
* those with certain rare immune system problems (complement disorders) and
  those who do not have a functioning spleen

For travellers at risk, the ACWY conjugate vaccines are recommended.
Meningococcal_disease_in_brief
Rabies
Rabies is a viral infection which is usually transmitted following contact with
the saliva of an infected animal most often via a bite, scratch or lick to an
open wound or mucous membrane (such as on the eye, nose or mouth). Although
many different animals can transmit the virus, most cases follow a bite or
scratch from an infected dog. In some parts of the world, bats are an important
source of infection.
Rabies symptoms can take some time to develop, but when they do, the condition
is almost always fatal.
The risk of exposure is increased by certain activities and length of stay (see
below). Children are at increased risk as they are less likely to avoid contact
with animals and to report a bite, scratch or lick.

Rabies in Central African Republic

Rabies has been reported in domestic and wild animals in this country. Bats may
also carry rabies-like viruses.

Prevention


* Travellers should avoid contact with all animals. Rabies is preventable with
  prompt post-exposure treatment.
* Following a possible exposure, wounds should be thoroughly cleansed and an
  urgent local medical assessment sought, even if the wound appears trivial.
* Post-exposure treatment and advice should be in accordance with national
  guidelines.


Rabies vaccination

Pre-exposure vaccinations are recommended for travellers whose activities put
them at increased risk including:

* those at risk due to their work (e.g. laboratory staff working with the
  virus, those working with animals or health workers who may be caring for
  infected patients).
* those travelling to areas where access to post-exposure treatment and medical
  care is limited.
* those planning higher risk activities such as running or cycling.
* long-stay travellers (more than one month).

Rabies_in_brief
Tuberculosis (TB)
TB is a bacterial infection transmitted most commonly by inhaling respiratory
droplets from an infectious person. This is usually following prolonged or
frequent close contact.

Tuberculosis in Central African Republic

The average annual incidence of TB from 2010 to 2012 was greater than or equal
to 40 cases per 100,000 population.

Prevention

Travellers should avoid close contact with individuals known to have infectious
pulmonary (lung) TB.
Those at risk during their work (such as healthcare workers) should take
appropriate infection control precautions.

Tuberculosis (BCG) vaccination

According to current national guidance, BCG vaccine should be recommended for
those at increased risk of developing severe disease and/or of exposure to TB
infection. See Public Health England’s Immunisation against infectious disease,
the_‘Green_Book’.
For travellers, BCG vaccine is also recommended for:

* unvaccinated, children under 16 years of age, who are going to live for more
  than 3 months in this country. A tuberculin skin test is required prior to
  vaccination for all children from 6 years of age and may be recommended for
  some younger children.
* unvaccinated, tuberculin skin test negative individuals under 35 years of age
  at risk due to their work such as healthcare workers, prison staff and vets.
  Healthcare workers may be vaccinated over the age of 35 years following a
  careful risk assessment.

There are specific contraindications associated with the BCG vaccine and health
professionals must be trained to administer this vaccine intradermally (just
under the top layer of skin).
Following administration, no further vaccines should be administered in the
same limb for 3 months.
The BCG vaccine is given once only, booster doses are not recommended.
Tuberculosis_in_brief

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Malaria

Malaria is transmitted by mosquitoes which predominantly feed between dusk and
dawn.
Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more.
Other symptoms may include feeling cold and shivery, headache, nausea, vomiting
and aching muscles. Symptoms may appear between eight days and one year after
the infected mosquito bite.
Prompt diagnosis and treatment is required as people with malaria can
deteriorate quickly. Those at higher risk of malaria, or of severe
complications from malaria, include pregnant women, infants and young children,
the elderly, travellers who do not have a functioning spleen and those visiting
friends and relatives.

Prevention

Travellers should follow an ABCD guide to preventing malaria:
Awareness of the risk – Risk depends on the specific location, season of
travel, length of stay, activities and type of accommodation.
Bite prevention – Travellers should take mosquito bite avoidance measures.
Chemoprophylaxis –Take antimalarials (malaria prevention tablets) if
appropriate for the area (see below). No antimalarials are 100% effective but
taking them in combination with mosquito bite avoidance measures will give
substantial protection against malaria.
Diagnosis – Travellers who develop a fever of 38°C [100°F] or higher more than
one week after being in a malaria risk area, or who develop any symptoms
suggestive of malaria within a year of return should seek immediate medical
care. Emergency standby treatment may be considered for those going to remote
areas with limited access to medical attention.

Risk Areas


* There is a high risk of malaria in Central African Republic: atovaquone/
  proguanilOR doxycyclineOR mefloquine recommended


Recommended Antimalarials

The recommended antimalarials for Central African Republic are listed below. 
If these are not suitable please seek further specialist advice.
Please note, the advice for children is different, the dose is based on body
weight and some antimalarials are not suitable.
Atovaquone/Proguanil
Atovaquone 250mg/Proguanil 100mg combination preparation:

* start one to two days before arrival in the malaria risk area
* for adults, one tablet is taken every day, ideally at the same time of day
  for the duration of the time in a malaria risk area and daily for seven days
  after leaving the malaria risk area
* take with a fatty meal if possible
* for children paediatric tablets are available and the dose is based on body
  weight (see table below)

Doxycycline
Doxycycline 100mg:

* start one to two days before arrival in the malaria risk area
* adults and children over 12 years of age take 100mg daily, ideally at the
  same time of day for the duration of the time in a malaria risk area and
  daily for four weeks after leaving the malaria risk area
* take with food if possible; avoid taking this drug just before lying down
* not suitable for children under 12 years of age

Mefloquine
Mefloquine 250mg:

* this drug is taken weekly, adults take one 250mg tablet each week
* start two to three weeks before arrival in the malaria risk area and continue
  weekly until four weeks after leaving the malaria risk area
* for children the dose is based on the body weight (see table below)


Resources


* Malaria_in_brief
* Malaria_factsheet 
* Insect_and_tick_bite_avoidance  
* Children’s_antimalarial_dose_table
* Malaria_prevention_guidelines_for_travellers_from_the_UK


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Other risks

The risks below may be present in all or part of the country and are presented
alphabetically.

Dengue

Dengue is a viral infection transmitted by mosquitoes which predominantly feed
between dawn and dusk.  It causes a flu-like illness, which can occasionally
develop into a more serious life-threatening form of the disease. Severe dengue
is rare in travellers.
The mosquitoes that transmit dengue are most abundant in towns, cities and
surrounding areas. All travellers to dengue areas are at risk.

Dengue in Central African Republic

Dengue is known or has the potential to occur in this country.

 Prevention


* All travellers should avoid mosquito bites particularly between dawn and
  dusk.
* There is no vaccination or medication to prevent dengue.

Dengue_in_brief

Schistosomiasis

Schistosomiasis is a parasitic infection. Schistosoma larvae are released from
infected freshwater snails and can penetrate intact human skin following
contact with contaminated freshwater. Travellers may be exposed during
activities such as wading, swimming, bathing or washing clothes in freshwater
streams, rivers or lakes.
Schistosomiasis infection may cause no symptoms, but early symptoms can include
a rash and itchy skin (‘swimmer’s itch’), fever, chills, cough, or muscle
aches. If not treated, it can cause serious long term health problems such as
intestinal or bladder disease.

Schistosomiasis in Central African Republic

According to World Health Organization (WHO), cases of schistosomiasis were
reported in this country in 2012.

Prevention


* There is no vaccine or tablets to prevent schistosomiasis.
* All travellers should avoid wading, swimming, or bathing in freshwater where
  possible. Swimming in chlorinated water or sea water is not a risk for
  schistosomiasis.
* Topical application of insect repellent before exposure to water, or towel
  drying after accidental exposure to schistosomiasis are not reliable in
  preventing infection.
* All travellers who may have been exposed to schistosomiasis should have a
  medical assessment.

Schistosomiasis_in_brief


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22 Feb 2016 Mbomou. Central African Republic
As of 5 February 2016, 13 cases and 2 deaths have been reported since 4
December 2015.
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