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Congo Travel Health Information
Read below for travel health advice on Congo from the MDtravelhealth channel on Red Planet Travel.
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Summary You can't Edit
1Summary of recommendations
Most travelers to the Republic of the Congo will need vaccinations for hepatitis A, typhoid fever, yellow fever, 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.
If you need more geographical information, you may find it helpful to consult one of the on-line maps produced by the United Nations(PDF) or the CIA (found in the University of Texas Map Library) or to go to the Getty Thesaurus of Geographic Names.
For hyperlinks marked PDF, you may need to download Adobe Acrobat Reader.
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Medications You can't Edit
2Medications
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 Congo: 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 the Congo, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization.
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Immunizations You can't Edit
3Immunizations
The following are the recommended vaccinations for the Congo:
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.
Yellow fever vaccine is required for all travelers greater than one year of age. Though not required, it is also recommended for travelers between 9 and 12 months of age. 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, even though cholera is reported, 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.
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Recent outbreaks of diseases You can't Edit
4Recent Outbreaks
A single case of yellow fever was reported from Ewo District in Cuvette-Ouest region in December 2012 (see the World Health Organization). In April 2009, a case occurred in Mbama district, Cuvette West Department (see the World Health Organization). Yellow fever vaccine is required for all travelers to the Republic of the Congo who are greater than one year of age.
A measles outbreak was reported from the Republic of Congo in June 2011, causing more than 800 cases, including 32 deaths. All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to the Republic of Congo.
Cholera outbreaks were reported in the summer of 2011 from the provinces of Brazzaville, Cuvette, Likouala and Plateaux. As of February 2012, the outbreak in Likouala had caused 340 cases, nine of them fatal. Outbreaks were reported in November 2008 from Kinkakassa village, in the southern Congolese Pool District, and in July 2008 from the Loudima district in the Bouenza division, causing 127 cases and three deaths by the end of November. In January 2007, a cholera outbreak in the Republic of Congo's economic capital, Pointe-Noire, caused more then 4000 cases and at least 82 deaths (see ProMED-mail, February 2, 7, and 24, 2007; July 30, 2008). .
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.
An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, was reported in June 2011 from poor neighborhoods south of Brazzaville, Republic of Congo, causing more than 7000 case. By July, the outbreak had spread to neighboring Pool, causing more than 400 cases there. No fatalities were reported (see ProMED-mail, June 17 and 25, and July 23, 2011). Symptoms of chikungunya fever include fever, joint pains, muscle aches, headache, and rash. The disease is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites.
A polio outbreak was reported from the Congo in November 2010, causing 409 cases and 169 deaths as of November 22. Nearly all cases were reported from the port city of Pointe Noire, with cases also reported from Niari, Bouenza, Brazzaville, and Kouilou. The number of cases appeared to be falling by early 2011 (see the World Health Organization, the Centers for Disease Control, and Eurosurveillance). Any adult traveler who received the recommended childhood polio 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.
An outbreak of monkeypox, which is a febrile, pustular illness closely related to smallpox, was reported in September 2007 from the northern department of Likouala in the Republic of Congo. Most of those affected were refugees from the Democratic Republic of the Congo younger than age 15 (see ProMED-mail; September 25, 2007). Monkeypox usually results from contact with infected squirrels or primates, but can also be spread from person to person. Smallpox vaccination protects against monkeypox but is not recommended.
An outbreak of Ebola hemorrhagic fever was reported in May 2005 from Etoumbi and Mbomo, Cuvette Ouest region, resulting in 12 cases and 9 deaths. The outbreak was officially declared over on June 17. For further information, go to the World Health Organization and Medecins sans Frontieres. At least three recent Ebola outbreaks have occurred in the Cuvette Ouest region. In November 2003, an outbreak was reported from the Mbomo and Mbandza villages in Mbomo district, resulting in 31 probable cases and 29 deaths as of December 11 (see the World Health Organization). Between February and May, 2003, an outbreak occurred in the districts of Mbomo and Kell, resulting in 143 cases and 128 deaths. From December 2001 through April 2002, an Ebola outbreak caused 32 cases and 20 deaths in Mbomo district and 25 cases and 23 deaths in Kelle district.
Ebola virus is usually spread by direct contact with secretions from infected persons, typically in the home, at a funeral, or in a health care facility. Travelers to the Congo should refrain from visiting households possibly affected by Ebola and should not participate in funeral rites, which usually involve close contact with the body of the deceased. Those who care for Ebola patients should wear protective gowns, gloves, and masks, as well as eye protection or a face shield. Travelers should also avoid eating meat from wild animals, especially primates, which may be sold in markets as "bushmeat". For further information, go to the World Health Organization, the Centers for Disease Control, Health Canada, and ProMED-mail.
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Other Infections You can't Edit
5Other infections
- Schistosomiasis (acquired by swimming, wading, or bathing in contaminated fresh water; see swimming and bathing precautions below)
- African trypanosomiasis (sleeping sickness) (prevalent in rural areas)
- Rift Valley fever
- Monkeypox (reported from Likouala region)
- Lymphatic filariasis
- Onchocerciasis
- Brucellosis (low incidence)
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.
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Food and Water You can't Edit
6Food 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.
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Insect Tick Protection You can't Edit
7Insect 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.
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Swimming and Bathing You can't Edit
8Swimming 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.
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General Advice You can't Edit
9General 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.
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Medical Facilities You can't Edit
10Medical facilities
Medical facilities are extremely limited. Essential medications and supplies may not be available. 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.
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Travel with children You can't Edit
11Traveling 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 the Congo.
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.
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Travel and pregnancy You can't Edit
12Travel and pregnancy
Because of the risk of malaria and yellow fever, pregnant women should not in general travel to the Congo. 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.
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Maps You can't Edit
13Maps
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.
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Embassy You can't Edit
14Embassy/Consulate Location
(reproduced from the U.S. State Dept. Consular Information Sheet)
The Brazzaville U.S. Embassy office is co-located at the U.S. Embassy in Kinshasa. While the U.S. Embassy in Brazzaville is still not open for normal operations, one American officer and some staff members are normally available in Brazzaville to provide information and guidance to American citizens. The staff may be contacted through the workshop in the Mpila neighborhood of Brazzaville on telephone 242- 81-39-82. U.S. citizens living in or visiting Congo-Brazzaville are encouraged to register with either the U.S. Embassy in Kinshasa or the workshop in Mpila. The Embassy in Kinshasa is located at 310 Avenue des Aviateurs, Gombe. The telephone number is 243-081-225-5872 (do not dial the zero when calling from abroad into the Congo), and the mailing address from the U.S. is Brazzaville Embassy Office, American Embassy Kinshasa, Unite 31550, APO AE, 09828-1550.
Entrance to the Consular Section of the U.S. Embassy in Kinshasa is on Avenue Dumi, opposite Ste. Anne residence. The Consular Section of the Embassy may be reached at tel. 243-88-43608, 243-88-46859 or 243-88-44609; fax 243-88-00228, 243-88-43467 or 243-88-03276. Cellular phones are the norm, as other telephone service is often unreliable.
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Safety Information You can't Edit
15Safety 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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