Read below for travel health advice on Uganda from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Uganda 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.
|Hepatitis A||Recommended for all travelers|
|Typhoid||Recommended for all travelers|
|Yellow fever||Recommended for all travelers. Required for travelers arriving from a yellow-fever-infected area in Africa or the Americas.|
|Polio||One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult|
|Meningococcus||Recommended for all travelers to northern Uganda|
|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.
Malaria in Uganda: 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 on malaria in Uganda, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization and Roll Back Malaria.
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. For children less than one year of age or children who are behind in their immunizations, see the accelerated immunization schedule. The following are the recommended vaccinations for Uganda:
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 recommended for all travelers greater than nine months of age. The vaccine is required for all travelers greater than one year of age arriving from a yellow-fever-infected country in Africa or the Americas. 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.
Meningococcal vaccine is recommended for all travelers to northern Uganda, especially if prolonged contact with the populace is likely (see "Recent outbreaks" below). Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.
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, though cholera is reported (see "Recent outbreaks" 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.
An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, was reported from Uganda in February 2014, especially around the River Semliki and in the West Nile region (see ProMED-mail, February 4, 2014). 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. There is no treatment or vaccine. 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. For further details on the outbreak, go to ProMED-mail. For background information, go to the Chikungunya Fever Fact Sheet on the CDC website.
An outbreak of meningococcal disease was reported in January 2014 from Adjumani and Arua districts in northwestern Uganda (see ProMED-mail, February 13, 2014). Meningococcal vaccine is recommended for travelers to northern Uganda.
In January 2009, an outbreak of meningococcal disease occurred in western and northwestern Uganda, resulting in 336 cases and 42 deaths. The outbreak started in from Arua and Hoima districts and spread to Masindi, Adjumani and Moyo. As of February, the outbreak appeared to be under control (see ProMED-mail, January 24 and February 20, 2009). An outbreak in Arua district between December 2007 and January 2008 caused a total of 380 cases and 17 deaths (see the World Health Organization). Between July and December 2007, a meningococcal outbreak caused 255 cases and 27 deaths, chiefly in Arivu sub-county in Vurra County and parts of Upper Madi. A major meningococcal outbreak was reported in January 2007 from Arua/Maracha-Terego, Nebbi, Nyadri, Koboko, Moyo, Adjumani, and Yumbe districts, an area bordering South Sudan and the Democratic Republic of the Congo. As of February 19, a total of 2728 suspected cases and 100 deaths had been identified. A smaller number of cases were reported from the northeastern districts of Kotido, Moroto, and Nakapiripirit in the Karamoja area (see the World Health Organization and ProMED-mail; February 7 and 13 and March 2, 2007). In January 2006, a meningococcal outbreak was reported from the northeastern part of the country, resulting in 514 suspected cases and 44 deaths (see the World Health Organization and Health Action in Crises). At about the same time, a smaller outbreak was reported from the Internally Displaced Persons (IDP) camps in Gulu district.
An outbreak of Ebola hemorrhagic fever, a highly contagious and often deadly viral infection, was reported in November 2012 from Lowero and Kampala, causing 10 cases (6 confirmed and 4 probable), including 5 deaths (see the World Health Organization). The outbreak was officially declared over in January 2013. In July 2012, an Ebola ourbreak was reported from the Kibaale district in western Uganda, causing 24 cases, 17 of them fatal. The outbreak was declared over in October (see the World Health Organization and ProMED-mail). Those at risk for Ebola include household contacts of other victims, health care providers, and those participating in funeral rites, which usually involve close contact with the body of the deceased. The virus may also be transmitted by eating wild animals and bushmeat, including primates. Most travelers are at low risk. No travel restrictions are recommended for Uganda.
A single fatal case of Ebola was reported in May 2011 from Luwero district, central Uganda, about 25 miles from Kampala (see the World Health Organization). A major outbreak of Ebola hemorrhagic fever was reported in November 2007 from Bundibugyo District, western Uganda, resulting in 149 suspected cases and 37 deaths as of January 2008. Among the reported fatalities were four health care workers. In retrospect, the outbreak might have begun in September 2007. The outbreak was declared over in February 2008, but two more suspected cases were reported in March 2008. The outbreak was caused by a new species of Ebola virus, provisionally named Bundibugyo ebolavirus, that appears to be less likely than others to cause bleeding phenomena (see the World Health Organization and ProMED-mail). A previous Ebola outbreak began in October 2000 and was declared officially over in February 2001. The outbreak began in Gulu district in the northern part of the country and spread to neighboring Masindi district. A few cases were also reported from Mbarara district in the south. The outbreak killed a total of 224 people, mostly in Gulu district (see the World Health Organization).
An outbreak of Marburg hemorrhagic fever was reported in October 2012 from four districts in Uganda (Kabale, Ibanda, Mbarara, and Kampala). A total of 20 cases, nine of them fatal, were identified by late November (see the World Health Organization). Three cases of Marburg hemorrhagic fever were reported in travelers who had visited “the python cave” in the Maramagambo Forest in western Uganda (at the southern edge of Queen Elizabeth National Park): an American traveler who had visited the cave in January 2008, a Dutch tourist in July 2009, and a U.S. citizen in January 2009. The Dutch case was fatal. Travelers should avoid these caves until further notice (see the Centers for Disease Control, MMWR, and ProMED-mail, July 11, 2008). A fatal case of Marburg fever was reported in July 2007 in a miner in Kamwenge district, western Uganda, followed by a case in a close contact. The mine was shut down and the outbreak appeared to be over but, in October 2007, a third case occurred in a man who entered the mine against instructions (see the World Health Organization and ProMED-mail, Octoer 2, 2007).
Marburg virus infections, which are closely related to Ebola virus infections, may be highly infectious and rapidly fatal. Health care workers are at particularly high risk. Initial symptoms include fever, muscle aches, headaches, fatigue and conjunctivitis, followed by sore throat, vomiting, diarrhea, and rash. Complications may include excessive bleeding, dangerously low blood pressure, low platelets, liver impairment, and kidney failure. There is no treatment for Marburg fever except aggressive supportive measures, including intravenous fluids and transfusions as needed. Suspected cases must be strictly isolated, including both respiratory and body fluid precautions. There is no vaccine for Marburg virus at present. Travelers should avoid contact with bats and other wild animals and should not enter caves or mines where bats may live. Any traveler who develops fever after contact with animals or sick people or after visting a a bat-infested cave should seek immediate medical attention.
A measles outbreak was reported from Uganda in April 2012, affecting more than 3000 children (see ProMED-mail). In July 2006, a measles outbreak occurred in northern Uganda, resulting in 190 cases, including three deaths (see IRIN). All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. 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 Uganda.
An outbreak of hepatitis B was reported from Kitgum and Gulu in September 2011 (see ProMED-mail, September 16, 2011). Hepatitis B vaccination is recommended for all travelers to Uganda.
An outbreak of hepatitis E was reported in June 2011 from the Kaabong, Moroto, and Kotido districts of the Karamoja sub-region of Uganda. In February 2010, a hepatitis E outbreak occurred in Moroto District in northeastern Uganda, affecting at least 28 people. In December 2009, a hepatitis E outbreak occurred in Kaabong district in northeastern Uganda, causing more than 200 cases and 12 deaths. In November 2007, a hepatitis E outbreak occurred in a camp for internally displaced persons in Madi Opei Sub-county in Lamwo County, Kitgum District of northern Uganda, bordering southern Sudan. The outbreak spread to all but two of the other sub-counties in Kitgum District, as well as Pader, Gulu, Adjumani, Yumbe and Amuru districts. As of May 2009, a total of 1010 cases and 160 deaths had been identified. As of September 2009, the outbreak was still ongoing (see ProMED-mail, March 4, May 29, June 20, July 16, August 4 and 13, and September 5, 2008, and March 9, May 7 and 30, and December 11, 2009, and February 26, 2010). Hepatitis E virus is transmitted by contaminated food or water. The mortality rate is particularly high in pregnant women, especially in the third trimester. Most travelers are at low risk.
A yellow fever outbreak was reported from northern Uganda in December 2010, resulting in 226 cases and 53 deaths by January 2011. Most of the cases were reported from three districts: Abim (specifically Morulem sub-county), Agago (Omiya P’Chua, Adilang and Paimoi sub-counties) and Kitgum (Orum, Namokora and Kitgum Town Council). Cases were also reported from Lamwo, Pader, Gulu, Arua, Kaabong, Nebbi, and Lira districts. See ProMED-mail for further information. Yellow fever vaccine is recommended for all travelers to Uganda.
An outbreak of acute hemorrhagic conjunctivitis caused by coxsackievirus A24v was reported from Uganda, affecting thousands of people. Symptoms include Symptoms subconjunctival hemorrhage ("pink-eye"), foreign-body sensation, light sensitivity, and discharge, and usually resolve within 1-2 weeks. Treatment is symptomatic. The key to prevention is good personal hygiene and scrupulous hand-washing. See the Centers for Disease Control for further information.
A case of African trypanosomiasis (sleeping sickness) was reported in August 2009 in a Polish tourist who had been bitten by a tsetse fly while visiting Queen Elizabeth National Park. In March 2009, an outbreak of African trypanosomiasis was reported from Dokolo district, resulting in 120 cases and 18 deaths (see ProMED-mail, March 15 and August 10, 2009). The number of cases of African trypanosomiasis has been increasing in recent years, due in part to large-scale movements of cattle, which carry the infection, and the arrival of large numbers of refugees from the Sudan. The disease is transmitted by the bite of tsetse flies and occurs mainly in rural lakeshore areas. Travelers to rural areas in the northwestern part of the country, where transmission is high, are at greatest risk for infection. There is also a focus of disease in southeast Uganda, which has been spreading north to areas previously free of the disease, probably due to livestock movements. The best means of prevention is to avoid areas infested with tsetse flies, which are usually known to local inhabitants. 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. Insect repellents are ineffective. For further information on personal protection measures, go to Health Canada. In December 2007, an outbreak occurred in Mayuge District in the southeastern part of Uganda, resulting in 12 cases.
Two cases of polio were reported from Uganda in May 2009: one from Pader district and one from Moyo district. Additional cases were reported from the Bugiri district in October 2010. All travelers to Uganda should make sure they are fully immunized against polio. 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.
An outbreak of typhoid fever was reported from Kasese district in northwestern Uganda in November 2008. Typhoid vaccine is recommended for all travelers to Uganda.
Outbreaks of human plague occur regularly in Uganda. In November 2008, an outbreak of bubonic plague was reported from the northwestern Ugandan districts of Arua and Nebbi, killing at least 68 people by the end of the year. In December 2007, outbreaks were reported from the Logiri and Vurra sub-counties of Arua and from the Nyapea area in Nebbi, all in the northwestern part of the country (see ProMED-mail, December 6, 2007, and November 4 and December 23, 2008). Between July and December 2006, an outbreak in Arua and Nebbi districts caused 127 cases and 11 deaths (see MMWR). In February 2006, an outbreak of pneumonic plague was reported from Masindi district in northwestern Uganda, killing 10 people. In October 2006, an outbreak of pneumonic plague occurred in Logiri sub-county, near the northeastern Congolese border, resulting in 24 cases and 6 deaths. In December 2004, a small outbreak involving four people was reported from Kango Subcounty in the West Nile region (see Emerging Infectious Diseases). In 2001, a plague outbreak caused 17 deaths in Nebbi district, Western region, and three deaths in nearby Arua district. A previous outbreak in Nebbi district resulted in 49 cases and 16 deaths in 1998. Outbreaks of the plague also occurred in 1982, 1986, and 1993.
The plague is usually transmitted by the bite of rodent fleas. Less commonly, the disease is acquired by inhalation of infected droplets, which may be coughed into the air by a person with plague pneumonia, or by direct exposure to infected blood or tissues. Most travelers are at low risk for the plague. Those who may have contact with rodents or their fleas should bring along a bottle of doxycycline, to be taken prophylactically if exposure occurs. Those less than eight years of age or allergic to doxycycline may take trimethoprim-sulfamethoxazole instead. To minimize risk, travelers should avoid areas containing rodent burrows or nests, never handle sick or dead animals, and follow insect protection measures, as described below.
Cases of schistosomiasis were reported in September 2007 among those who had gone whitewater rafting on the Nile River in Uganda (see the Centers for Disease Control). An increase in the number of schistosomiasis cases was reported from Jinja District in April 2011. Travelers to Uganda should avoid swimming, wading, rafting, or bathing in bodies of fresh water (see below). Chlorinated swimming pools are considered safe.
Cholera outbreaks occur regularly in Uganda. The most recent oubreaks were reported in October 2010 from Nakapiripirit, in eastern Uganda; in May 2010 from Tororo district, eastern Uganda, and from Moroto district; in February 2010 from Manafwa district; in November 2009 from Kasese district and Bugiri district; in October 2009 from Kampala; in September 2009 from Bugiri District; in September 2008 from Kampala; in June 2008 from the eastern districts of Mbale, Pallisa and Manafwa; in May 2008 from Butaleja and Kibaale districts; in January 2008 from Kampala; in late 2007 from the Arua and Nebbi districts in northwestern Uganda, ongoing as of February 2008; in December 2007 from the Yumbe district; in September 2007 from the Hoima, West Nile, and Buliisa districts; and in January 2007 from two fishing villages on Lake Albert in Ndaiga parish, Kibaale district, in western Uganda, from Ntungamo district in southwestern Uganda, and from a refugee camp at Bunagana in Kisoro district. In December 2006, a major cholera outbreak was reported from Kampala city, resulting in over 1000 cases before the outbreak ended in March 2007 (see ReliefWeb). At about the same time, a cholera outbreak was reported from eight other districts in western and northwestern Uganda (Nebbi, Arua, Yumbe, Koboko, Moyo and Adjumani in the northwestern region, Kasese and Bundibugyo in the western region). In October 2006, outbreaks were reported from the province of Rakai and the newly created Amuru district bordering South Sudan and Adjumani district. In August 2006, outbreaks were reported from Yumbe District and from Rhino Camp, a Sudanese refugee settlement. In July 2006, outbreaks were reported from Gulu district and from Kenya Ward of River Oli division. In June 2006, a cholera outbreak was reported from the districts of Hoima, Kibaale and Bundibugyo in the western part of the country, killing 23 people. In April 2006, outbreaks were reported from Maracha County and from the Agoro IDP (internally displaced persons) camp in Kitgum District. The Agoro outbreak spread to 12 other IDP camps, particularly the Potika camp. See Health Action in Crises and IRIN for further information. A cholera epidemic that began in late 1997 resulted in more than 40,000 cases and 1700 deaths.
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 O'nyong-nyong fever was reported from Rakai, Mbarara and Masaka districts in south central Uganda beginning in June 1996 (see E.B. Rwaguma, Emerging Infectious Diseases).
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.
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.
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
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.
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.
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 are extremely limited in Kampala and may be nonexistent elsewhere. Essential medications and supplies may be unavailable. 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.
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 Uganda.
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
Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Uganda. 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.
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 are encouraged to register with the U.S. Embassy in Kampala and to obtain updated information on travel and security in Uganda. The chancery is located at Gaba Road, Kansanga, Kampala; telephone 256-41-234-142;
fax 256-41-258-451; e-mail: ConsularKampala@state.gov. The U.S. Embassy website is http://kampala.usembassy.gov.
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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