Health Information for Overseas Travel
3.7  North Africa and the Middle East, including Afghanistan and Turkey

(Afghanistan, Algeria, Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, United Arab Emirates, Yemen)

3.7.1  Disease risks

Food and water-borne diseases: particularly the dysenteries and other diarrhoeal diseases, hepatitis A, intestinal helminth infections including taeniasis (tapeworm), brucellosis and giardiasis. Typhoid fever and hepatitis E in some areas. Sporadic cases of cholera. Dracunculiasis in isolated foci in Yemen.

Malaria: limited but variable risk, especially towards the east and south of the area; see country by country guide below.

Other arthropod-borne diseases (see Chapter 7) generally not a major problem:

  •   Murine (endemic) and tick-borne typhus.

  •   Cutaneous leishmaniasis.

  •   Visceral leishmaniasis - central Iraq, SW Saudi Arabia, NW Syria, Turkey (SE Anatolia only) and Yemen.

  •   Relapsing fever.

  •   Rift Valley fever.

  •   Sandfly fever.

  •   West Nile fever in some areas.

  •   Crimean-Congo haemorrhagic fever in Iraq.

  •   Onchocerciasis - limited foci in Yemen.

  •   Filariasis - locally in the Nile delta.

  •   Plague foci.

Diseases of close association:

  •   Poliomyelitis - countries reporting polio cases in 1998 and 1999 include: Afghanistan, Egypt, Iraq, Turkey, Syria and Yemen.

  •   Tuberculosis endemic - most countries have incidence rates higher than in western Europe, particularly Afghanistan, Iraq, Morocco and Yemen.

  •   Trachoma.

  •   Meningococcal infection for pilgrims to Saudi Arabia.

Sexually transmitted and blood-borne infections:

Hepatitis B of intermediate prevalence; reported rates of HIV infection low for most countries.

Other hazards could include:

  •   Schistosomiasis (bilharziasis) especially Nile delta and Nile valley, SW Iran, Iraq, Saudi Arabia, Syria and Yemen.

  •   Rabies, snakes and scorpions.

  •   Dehydration and heat exhaustion for pilgrims to Mecca and Medina if the Hajj coincides with the hot season.

    3.7.2  Recommendations for immunisations and malaria chemoprophylaxis (see later chapters for general health precautions)

    FOR ALL COUNTRIES

    Check routine immunisations including tetanus.

    Immunisation against poliomyelitis (see 1.8), hepatitis A and typhoid for most countries; however, it should be noted that typhoid and/or hepatitis A are less important for short stays in tourist or business hotels

    For longer stays, consider immunisation against diphtheria and hepatitis B and check BCG status; consider immunisation against rabies for longer rural travel.

    3.7.3  Country by country variations and malaria chemoprophylaxis:

    Afghanistan

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Malaria risk, predominantly P.vivax, May-November below 2,000m. Chloroquine resistant P.falciparum in the south of the country.

    Recommended prophylaxis: chloroquine plus proguanil.

    Algeria

    Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

    Malaria risk limited to a small focus of P.vivax in Ihrir (Illizi Dept) which is not usually visited by tourists. (Anyone going to this area should be aware of the risk).

    Recommended prophylaxis: none.

    Egypt

    Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas. (Air passengers in transit coming from these countries or areas without a certificate will be detained in the precincts of the airport until they resume their journey). The following countries and areas are regarded as infected:

    •   Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan (south of 15ºN), Tanzania, Togo, Uganda, Zambia.

    •   America: Belize, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, French Guiana, Guyana, Panama, Peru, Surinam, Trinidad and Tobago, Venezuela.

    All arrivals from Sudan are required to possess either a vaccination certificate or a location certificate issued by a Sudanese official centre stating that they have not been in Sudan south of 15ºN within the previous six days.

    Malaria risk: limited risk (P.vivax and P.falciparum) June-October and confined to the El Faiyum area which is 50 miles SW of Cairo and rarely visited by tourists.

    Recommended prophylaxis: for tourist areas including Nile cruises - none; for the risk area, June-October, chloroquine.

    Iran

    Malaria risk (P.vivax) in parts of the central, western and south-western regions during the summer months. P.falciparum from March to November more in the south east. In practice this means there is limited risk over much of the country, greater risk in the south and especially the south-east. Chloroquine resistant P.falciparum reported.

    Recommended prophylaxis: for areas outside the main cities, March-November, chloroquine plus proguanil.

    Iraq

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Malaria risk, exclusively P.vivax, from May to November in some areas in the north below 1,500m (Duhok, Erbil, Ninawa, Sulaimaniya and Ta'min provinces), and also in Basrah province.

    Recommended prophylaxis: for these rural areas in the North and for Basrah, May-November, chloroquine.

    Jordan

    Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

    Lebanon

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Libya

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Morocco

    Malaria risk: limited risk of P.vivax malaria May-October in some rural areas.

    Recommended prophylaxis: none, but remember slight risk.

    Oman

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Malaria risk: limited risk, including P.falciparum, in rural areas. No transmission in Muscat. Chloroquine resistance reported.

    Recommended prophylaxis: for rural areas, chloroquine plus proguanil.

    Saudi Arabia

    Yellow fever vaccination certificate required from all travellers coming from countries any part of which is infected.

    Vaccination requirements for pilgrims to Mecca (Hajj) for 2001:

    •   Yellow fever: all travellers arriving in Saudi Arabia from countries known to be infected with yellow fever (as shown in the WHO Weekly Epidemiological Record), must present a valid yellow fever vaccination certificate. In the absence of such a certificate an individual will be vaccinated upon arrival and placed under strict surveillance for six days from the day of vaccination or the last date of potential exposure to infection.

    •   Meningococcal infection: all visitors arriving for 'Umra' or pilgrimage or seasonal work are requested to produce a certificate of vaccination against meningococcal A infection, issued not more than three years and not less than ten days before arrival in Saudi Arabia (but see below).

    •   Those arriving from countries in the African meningitis belt will be checked at entry points to ensure they are vaccinated. Cases with suspected meningococcal infection will be isolated and contacts put under close supervision. Chemoprophylaxis will be administered to all visitors from these countries to lower the carriage rate among them.
      Source: Ministry of Health, Saudi Arabia.

    •   NB. The new conjugate meningococcal (MenC)vaccine, which protects only against C strains, and the polysaccharide A&C vaccine give insufficient protection. From 2001, the UK recommends quadrivalent ACWY meningococcal polysaccharide vaccine, which also protects against W135 strains, for protection of pilgrims travelling to Saudi Arabia (see also 8.4.4).

    •   Malaria risk, predominantly P.falciparum, throughout the year in most of the Southern Region (except the high altitude areas of Asir Province) and in certain rural areas of the Western Region. Chloroquine resistance reported.

    Recommended prophylaxis: for risk areas, chloroquine plus proguanil.

    Syria

    Yellow fever vaccination certificate required from travellers coming from infected areas.

    Malaria risk, exclusively P.vivax, from May to October along northern border areas, and especially in the north-east.

    Recommended prophylaxis: for northern border areas, May-October, chloroquine.

    Tunisia

    Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

    Turkey

    Malaria - potential risk, exclusively P.vivax, March-November in the plain around Adana, Antalya (Side) and SE Anatolia.

    Recommended prophylaxis: for most tourist areas, none; for tourist areas along the south coast east of, and including, Side, and for those going to inland SE Turkey from March to November, chloroquine prophylaxis is recommended.

    United Arab Emirates

    Malaria risk confined to foothill areas and valleys in the mountainous regions of the northern Emirates. Not considered a risk in Abu Dhabi or in the cities of Dubai, Sharjah, Ajman and Umm al Qaiwain.

    Recommended prophylaxis: for the northern rural areas of the emirates other than Abu Dhabi, chloroquine plus proguanil.

    Yemen

    Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

    Malaria risk, predominantly P.falciparum, throughout the year but mainly September-February, except in Aden and the airport perimeter. Chloroquine resistance reported.

    Recommended prophylaxis: chloroquine plus proguanil.

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    Prepared 18 October 2001