Read below for travel health advice on Egypt from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Egypt will need vaccinations for hepatitis A, typhoid fever, and polio, as well as medications for travelers' diarrhea. Additional medications and 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.
|Hepatitis A||Recommended for all travelers|
|Typhoid||Recommended for all travelers|
|Yellow fever||Required for travelers arriving from a yellow-fever-infected area in Africa or the Americas.|
|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|
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.
The following are the recommended vaccinations for Egypt:
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.
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Prencipe, Senegal, Sierra Leone, Somalia, Sudan (south of latitude 15 N), Tanzania, Togo, Uganda, and Zambia
Americas: Belize, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, and Venezuela
Caribbean: Trinidad and Tobago
Air passengers who are in transit but who are arriving from one of these countries without a yellow fever vaccination certificate will be detained in the precincts of the airport until they resume their journey. All travelers arriving from Sudan are required to possess a vaccination or location certificate issued by a Sudanese official center stating that they have not been in Sudan south of latitude 15 N within the preceding 6 days.
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.
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.
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 recommended. Cholera is not being reported from Egypt at this time.
A malaria outbreak was reported from a village in the Aswan governorate in June 2014, causing 19 cases. The Aswan governorate lies along the southern part of the Nile River. The outbreak was casued by Plasmodium vivax; it is believed that the organism was introduced by Sudanese migrants. The US Centers for Disease Control advises travelers to the Aswan governorate to take measures to protect themselves from mosquito bites, as below, but does not recommend preventative malaria pills.
A mumps outbreak was reported from Egypt in October 2012, causing over 500 cases, chiefly from Giza Governorate. All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.
A total of 176 human cases of H5N1 avian influenza ("bird flu") have been reported from Egypt, 63 of them fatal. Most of the cases have occurred in the Delta region. All human cases had a history of close contact with dead or diseased poultry. Most of the fatalities occurred in women, presumably because, in Egypt, women are responsible for raising poultry. Poultry outbreaks are regularly reported from farms in almost all governorates. For further information on avian influenza in Egypt, go to the official Bird Flu site of the Egyptian government.
Most travelers are at extremely low risk for avian influenza. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Egypt should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
Cases of hepatitis A were reported among French, Belgian, and German travelers who had visited Egypt between September and November, 2008. The cases appeared to be related to Nile river cruises, though the source of infection was never determined (see Eurosurveillance). An outbreak of hepatitis A was reported in August 2004 among travelers from Germany and other European countries who had stayed at a particular hotel in the Egyptian resort of Hurghada by the Red Sea. A total of 351 cases were identified. The outbreak appeared to be linked to contaminated orange juice. See Eurosurveillance and Emerging Infectious Diseases for further information. As above, immunization against hepatitis A is recommended for all trips to Egypt.
An outbreak of Rift Valley fever was reported in August 2003 from Seedy Salim District, a remote rural area in Kafr Al-Sheikh Governorate, about 150 kilometers north of Cairo. As of August 28, a total of 45 cases had been identified, including 17 deaths. All those involved so far have been Egyptian farmers. See the World Health Organization and ProMED-mail (August 27, 2003) for further information. A previous outbreak occurred in the Aswan Governorate in the southern part of the country in 1993.
Rift Valley fever is a viral infection that primarily affects domesticated animals, especially sheep and goats, but may involve humans as well. The disease is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or their tissues. Aerosol transmission has been documented. Most cases occur in people who work with livestock. Complications may include liver failure, kidney failure, hemorrhagic manifestations, loss of vision (retinitis), and inflammation of the brain (encephalitis). There is no treatment except supportive care. Travelers to affected areas are advised to follow insect protection measures, as described below, and to avoid contact with livestock.
The incidence of hepatitis C is the highest in the world. More than 500,000 new cases of hepatitis C occur in Egypt each year. Hepatitis C is a viral infection of the liver that has a propensity to cause chronic liver damage and may sometimes lead to liver cancer or liver failure. The virus is usually transmitted by exposure to infected blood (i.e. by transfusions or by contaminated needles). Less frequently, the disease is acquired through sexual intercourse or passed from mother to infant at birth. The infection is not usually transmitted from person to person in the absence of sexual contact or needle sharing. The symptoms of hepatitis C may include fever, jaundice, nausea, vomiting, abdominal pain, and malaise, but most cases are asymptomatic.
Schistosomiasis occurs in the Nile delta area and the Nile valley. Swimming and bathing precautions are strongly advised in these areas (see below).
Two cases of dengue fever were reported in June 2010 in Italian travelers who had visited the Red Sea resorts in Egypt. Dengue fever is a mosquito-borne flu-like illness which is sometimes complicated by hemorrhage or shock. Cases are rarely reported from North Africa, but it is unclear if this is due to absence of the virus or underdiagnosis (see ProMED-mail, June 7, 2010).
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 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 and Tick Protection
When visiting rural areas, wear long sleeves, long pants, hats and boots with pants tucked in. 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. After a day in rural areas, perform a thorough tick check 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.
Swimming and bathing precautions
Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers, or in the Nile and its canals. Avoid walking barefoot along the Nile. 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. There is no risk of schistosomiasis from the beaches on the Mediterranean and Red Sea coasts, which are also generally unpolluted.
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 and Emergency Services
For an ambulance in Egypt, call 123, but ambulance service is not reliable.
For a guide to physicians, dentists, and hospitals in Egypt, go to the U.S. Embassy website. Many physicians in Egypt are Western-trained and speak English. Medical facilities in Cairo, Alexandria, Sharm El Sheikh, and most other tourist areas are adequate for routine problems, but emergency and intensive care services are limited. Facilities elsewhere, including Luxor and Aswan, are inadequate or non-existent. Many Nile cruise boats have a medical practitioner who is not a physician and whose qualifications are uncertain. 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.
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).
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
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.
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.
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.
(reproduced from the U.S. State Dept. Consular Information Sheet)
U.S. citizens living in or visiting Egypt are encouraged to register at the Consular Section of the U.S. Embassy in Egypt and obtain updated information on travel and security within Egypt. The American Citizens Services office of the U.S. Embassy is located at 5 Latin America Street, Garden City, Cairo, and is open to the public from 8:00 a.m. until 12:00 noon. The workweek in Egypt is Sunday through Thursday. Telephone calls are accepted from 8:00 a.m. until 4:30 p.m.
The mailing address from the United States is: Consular Section, Unit 64900, Box 15, APO AE 09839-4900. Within Egypt or from a third country, it is 8 Kamal el-Din Salah Street, Garden City, Cairo. The main Embassy telephone number is (20)(2) 797-3300. The telephone number of the Consular Section's American Citizen Services Unit is: (20)(2) 797-2301, the fax number is (20)(2) 797-2472, and the e-mail address is firstname.lastname@example.org. Consular information is available via the Internet at http://www.usembassy.egnet.net. Visa related inquiries should be directed by e-mail to email@example.com.
Once a month, American citizen services are available at the American Center, 3 Pharana Street, Azarita, Alexandria from 11:00 a.m. - 2:00 p.m. Please check the Embassy web site for a schedule of upcoming dates. Every five to ten weeks, American citizen services are available at the Cairo American College, Room 600, Maadi, from 11:30 a.m. to 1:30 p.m. Please check the Embassy web site for dates and details of services available.
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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