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Armenia Travel Health Information

Read below for travel health advice on Armenia from the MDtravelhealth channel on Red Planet Travel.

Page Sections

  1. Summary
  2. Medications
  3. Immunizations
  4. Recent outbreaks of diseases
  5. Other Infections
  6. Food and Water
  7. Insect Tick Protection
  8. General Advice
  9. Ambulance
  10. Medical Facilities
  11. Pharmacies
  12. Travel with children
  13. Travel and pregnancy
  14. Maps
  15. Embassy
  16. Safety Information
  17. Page Drop Box

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  • Summary You can't Edit

    1

    Summary of recommendations

    Most travelers to Armenia will need vaccinations for hepatitis A and typhoid fever, as well as medications for travelers' diarrhea. All travelers should be up-to-date on tetanus-diphtheria vaccine. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.

    Malaria: Prophylaxis is recommended only for travel to the Ararat Valley in the Ararat and Artashat region near the Turkish border in the west. Risk is greatest in the Masis district.

    Vaccinations:

    Tetanus-diphtheria For all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.
    Hepatitis A Recommended for all travelers
    Typhoid For travelers who may eat or drink outside major restaurants and hotels
    Hepatitis B Recommended for all travelers
    Polio One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult
    Measles, mumps, rubella (MMR) Two doses recommended for all travelers born after 1956, if not previously given

  • Medications You can't Edit

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    Medications

    Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

    Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

    If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

    Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

    Malaria prophylaxis with choloroquine is recommended only for travel to the Ararat Valley in the Ararat and Artashat region near the Turkish border in the west. Risk is greatest in the Masis district. Peak transmission occurs from June to October. There is no risk of malaria in the areas frequented by tourists. Malaria had not been reported in Armenia since the 1940's, but recurred in the 1990's following the dissolution of the former Soviet Union and the war with Azerbaijan, which led to a breakdown in public health infrastructure and the cessation of mosquito-control activities (see Epidemic Malaria Transmission -- Armenia, 1997 (MMWR July 03, 1998 / 47(25); 526-528).

    Insect protection measures (see below) are strongly advised for travel to the Ararat Valley.

    For further information on malaria in Armenia, including a map showing the risk in different parts of the country, go to World Health Organization.

  • Immunizations You can't Edit

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    Immunizations

    The following are the recommended vaccinations for Armenia:

    Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years. In the 1990s, a massive diphtheria epidemic occurred in the newly independent states of the former Soviet Union (see CR Vitek and M Wharton, Emerging Infectious Diseases).

    Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

    Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

    Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

    Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

    Polio immunization is recommended for all travelers, due to recent reports of polio cases in Central Asia. Any adult who received the recommended childhood immunizations but never received a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine

    Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

    Rabies vaccine is not recommended, since rabies has not been reported from Armenia in recent years.

    Cholera vaccine is not generally recommended, even though the disease sometimes occurs in Armenia, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

  • Recent outbreaks of diseases You can't Edit

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    Recent outbreaks

    An outbreak of tularemia was reported in March 2007 from Tsovagyuk, a village in the Gegarkuniq region of Armenia (see ProMED-mail; March 15, 2007). The source of the outbreak was not determined.

    A small cholera outbreak was reported from a village 60 km from Yerevan in September 1998. Cholera vaccine is not recommended for travel to Armenia at this time.

  • Other Infections You can't Edit

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    Other infections

    • Anthrax (most cases occur in farmers and others who work with animals; outbreaks reported from the Kotayk and the Gegarkunik regions in October 2012; see ProMED-mail August 17, 2001, November 22, 2006, and November 21, 2012)
    • Brucellosis (generally acquired by consumption of unpasteurized dairy products from infected animals; may cause fever, malaise, depression, loss of appetite, headache, muscle aches, and back pain; may be complicated by arthritis, hepatitis, and meningitis)
    • HIV (human immunodeficiency virus) (travelers not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions)

  • Food and Water You can't Edit

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    Food and water precautions

    Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

    All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

    If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

  • Insect Tick Protection You can't Edit

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    Insect and Tick Protection

    Wear long sleeves, long pants, hats and shoes (rather than sandals). Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.

  • General Advice You can't Edit

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    General advice

    Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

    Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

    Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

    Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

  • Ambulance You can't Edit

    9

    Ambulance and Emergency Services

    For a city ambulance in Yerevan, call 103. Alternatively, you can call the 24-hour emergency services line 15-536-641 (city line) or 51-43 (government line), or go to the Ministry of Health Hospital Number 4 at 21 Paronian Street, which usually has English-speaking doctors on staff. Ambulance response times may be slow.

  • Medical Facilities You can't Edit

    10

    Medical facilities

    Medical care in Armenia is extremely limited, especially outside the major cities. Hospitals and polyclinics have achieved much greater independence since the end of the Soviet era, but private medical care has been slow to develop. The training of physicians is not comparable to that found in most Western countries. Hospitals suffer from outdated equipment and insufficient supplies. For private medical care, which is generally superior to that in the former state system, many expatriates go to the European Medical Center, which is open 24 hours a day (3/1 Vazgen Sargsyan str. 0010, Yerevan; Robert E. Young MD, Head of Family Medicine Department; ph. (374 10) 540 003, 540 540; email emc_ap2003@yahoo.com; by appointment or walk-in; most major credit cards accepted) or Dr. Armen Pirouzyan at the Malatia Medical Centre (28A Varoughan Street, Yerevan 375032; ph. (374 1) 773 079 or 773 458). Among the former state facilities, the 4th Yerevan City Polyclinic has been designated by the Armenian government to serve foreign travelers (13 Moskovyan Street, Yerevan; contact person: Chief Doctor Ruben Vardanyan, ph. (374-2) 580-395). For a guide to other physicians, dentists, hospitals, and emergency services in Armenia, go to the U.S. Embassy website. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

  • Pharmacies You can't Edit

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    Pharmacies

    Most medications are imported from the Russian Federation. The Ministry of Health is responsible for regulating the quality and prices of all pharmaceuticals, but quality control remains inadequate. Prescription drugs are widely sold without a doctor's prescription.

  • Travel with children You can't Edit

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    Traveling with children

    Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).

    All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

    The recommendations for malaria prophylaxis are the same for young children as for adults, except that the dosage of chloroquine is lower. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

    When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

    Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

  • Travel and pregnancy You can't Edit

    13

    Travel and pregnancy

    International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

    Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary (see the U.S. Embassy website). In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

    Pregnant women should avoid visiting the Masis District in the Ararat Valley near the Turkish border in the west, due to the risk of malaria. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, chloroquine must be taken each week and insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

    Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

  • Maps You can't Edit

    14

    Maps

    Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

  • Embassy You can't Edit

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    Embassy/Consulate Location

    (reproduced from the U.S. State Dept. Consular Information Sheet)

    Americans living in or visiting Armenia are encouraged to register at the Consular Section of the U.S. Embassy in Armenia and obtain updated information on travel and security within Armenia. The U.S. Embassy in Yerevan is located at 18 Marshall Baghramyan Street, tel. 011 (3741) 151-551 and fax: 011 (3741) 151-550. The Consular Section is open from 9:00 a.m. until 5:30 p.m., with time reserved for American citizen services from 2:00 p.m. until 5:30 p.m., Monday through Friday. For more information, see the Embassy's website at http://yerevan.usembassy.gov/.

  • Safety Information You can't Edit

    16

    Safety information

    For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.

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