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Burundi Travel Health Information

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

Page Sections

  1. Summary
  2. Medications
  3. Immunizations
  4. Bottled Drinking Water
  5. Recent outbreaks of diseases
  6. Other Infections
  7. Food and Water
  8. Insect Tick Protection
  9. Swimming and Bathing
  10. General Advice
  11. Medical Facilities
  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 Burundi will need vaccinations for hepatitis A, typhoid fever, yellow fever, meningococcus, and polio, as well as medications for malaria prophylaxis and travelers' diarrhea. Additional immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Insect repellents are recommended, in conjunction with other measures to prevent mosquito bites. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.

    Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas.

    Vaccinations:

    Hepatitis A Recommended for all travelers
    Typhoid Recommended for all travelers
    Yellow fever Required for all travelers
    Meningococcus 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
    Hepatitis B Recommended for all travelers
    Rabies For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats
    Measles, mumps, rubella (MMR) Two doses recommended for all travelers born after 1956, if not previously given
    Tetanus-diphtheria Revaccination recommended every 10 years

  • 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 in Burundi: prophylaxis is recommended for all travelers. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

    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. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

    Insect protection measures are essential.

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

  • Immunizations You can't Edit

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    Immunizations

    The following are the recommended vaccinations for Burundi:

    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. 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.

    Meningococcal vaccine is recommended for all travelers. Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.

    Yellow fever vaccine is required for all travelers. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to those who are younger than six months of age, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a malignant neoplasm and those with a history of thymus disease or thymectomy. Caution should be exercised before giving the vaccine to those who are between the ages of 6 and 8 months, age 60 years or older, pregnant, or breastfeeding. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.

    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. 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.

    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.

    Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

    Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

    Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

    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.

    Cholera vaccine is not generally recommended, despite recent cholera outbreaks (see below), 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.

  • Bottled Drinking Water You can't Edit

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    Bottled drinking water

    (from the U.S. Embassy website, August 31, 2012)

    "This Emergency Message is to alert U.S. citizens living in Burundi that Embassy personnel have been advised to avoid drinking Kinju brand bottled water until we can determine that it is safe to consume. The embassy recommends U.S. citizens consider taking similar precautions.

    "One embassy staff member has fallen ill after drinking Kinju bottled water with an unusual taste. Several other sealed Kinju water bottles have given off a strong gasoline smell once opened. Our embassy medical staff is currently testing water samples from these bottles to determine whether biological contaminants are present. U.S. citizens who fall ill after ingesting Kinju brand bottled water should seek immediate medical care. Individuals who have taken ill following a similar experience may wish to inform the embassy of the incident..."

    Update

  • Recent outbreaks of diseases You can't Edit

    5

    Recent Outbreaks

    An outbreak of Rift Valley fever was reported in May 2007 near the Tanzanian border, apparently caused by consumption of meat from animals which had come from Tanzania, which was experiencing a major outbreak of Rift Valley fever at that time (see ProMED-mail, May 19, 2007). Rift Valley fever is a viral infection that primarily affects domesticated animals. The disease is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or their tissues or by consumption of raw milk. Aerosol transmission has been documented. Most cases occur in those who work with livestock. The incubation period ranges from two to six days. Initial symptoms may include fever, chills, muscle aches, backache, headache, nausea, vomiting, and light sensitivity. Most people recover uneventfully in four to seven days, but the course may be complicated by loss of vision (retinitis), liver inflammation (hepatitis), kidney failure, excessive bleeding (hemorrhage), inflammation of the brain (encephalitis), or death. Travelers to affected areas should follow insect protection measures, as below, and avoid direct contact with livestock.

    Cholera outbreaks are periodically reported from Burundi. The most recent was reported in August 2011, particularly affecting Bujumbura city, the nation's capital. More than 600 people were affected, including 12 deaths. In July 2009, another outbreak occurred in Bujumbura. Previous outbreaks were reported in December 2008 from Rugombo commune in Cibitoke province, in the extreme northwestern part of Burundi; in December 2007 from Makamba province, in the southeastern part of the country, and from Rugombo commune; and in October 2006 from the capital Bujumbura and the surrounding Bujumbura Rural Province, in the western part of the country bordering on Lake Tanganyika.

    The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain 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. All travelers should carefully observe food and water precautions, as below.

    Several clusters of cholera cases were reported beginning in December 2003. As of February 10, 2004, a total of 234 cases, including 6 deaths, had been identified in the provinces of Bubamza, Bujumbura, Bururi, and Citiboke (see the World Health Organization). A previous cholera outbreak was reported in June 2002, causing 794 cases and 13 deaths as of August 22. The majority of cases were in Bujumbura Rurale, particularly Rushubi, Nyambuye, Gihosha, and Gikungu. Cases were also reported from the provinces of Bubanza and Cibitoke (see the World Health Organization). An outbreak also occurred in Bujumbura Province in April-May 1998.

    An outbreak of meningococcal disease was reported in the summer of 2002 from the provinces of Ngozi, Muyinga, Cankuzo, Ruiygi, and Kirundo. As of September 22, a total of 934 cases and 68 deaths had been identified, with the number of cases decreasing in the two most affected provinces, Muyinga and Ruyigi, but increasing in the provinces of Gitega and Karuzi. See the World Health Organization for further information. A prior outbreak occurred in Kirundo Province in September-October, 1996. Meningococcal vaccine is recommended for all travelers to Burundi, as above.

    A malaria epidemic affecting an estimated 276,000 people in the northern highland districts of Burundi was reported in January 2001. (See World Health Organization for further information.) A previous outbreak involving more than 600,000 people was reported in early 1999. The increase in malaria has been attributed to poor nutrition, substandard living conditions, lack of medications, and the breakdown of public health systems, all related to the ongoing civil war.

    An epidemic of louse-borne typhus, involving nearly 24,000 cases, occurred in 1997, chiefly in the rural parts of Bujumbura Province.

  • Other Infections You can't Edit

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    Other infections

    Schistosomiasis may be acquired by swimming, wading, rafting, or bathing in contaminated fresh water. Swimming and bathing precautions are advised (see below).

    HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

    Other infections include

  • 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.

    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

    8

    Insect and Tick Protection

    Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. 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. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

    Insect repellents are ineffective against tsetse flies, which transmit sleeping sickness (African trypanosomiasis). Areas infested with tsetse flies, which are usually known to local inhabitants, should be avoided. Travelers at risk should wear long sleeves and long pants of medium weight fabric in neutral colors that blend with the environment. Also, travelers should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and should take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day.

  • Swimming and Bathing You can't Edit

    9

    Swimming and bathing precautions

    Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

  • 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.

  • Medical Facilities You can't Edit

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    Medical facilities

    The main health institution is the Hospital Prince Regent Charles in Bujumbura (Ibarabara Rya 28 Munyonyo, BP 1020, Bujumbura; ph. 257 232 074). There is also a Seventh Day Adventists clinic in Bujumbura (Association des Services de Sante Adventistes au Burundi, B.P. 1710, Bujumbura, ph. 257 223 130). Medical facilities are extremely limited. There are frequent shortages of essential supplies and medications. Equipment may not be properly sterilized. 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.

  • Travel with children You can't Edit

    12

    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.

    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).

    Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Burundi.

    The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. 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

    Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Burundi. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, 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.

  • 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 Burundi are encouraged to register at the Consular Section of the U.S. Embassy in Bujumbura and to obtain updated information on travel and security within Burundi. The U.S. Embassy is located on the Avenue des Etats-Unis, mailing address B.P. 34, 1720 Bujumbura, Burundi. The Consular Section of the Embassy may be reached at tel. (257) 22-34-54; or fax (257) 22-29-26. The Embassy's Internet website is http://bujumbura.usembassy.gov/.

  • Safety Information You can't Edit

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    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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