Vaccination and Travel Information for Afghanistan

AFGHANISTAN


 Information current as at:  February 2009 by The D2 Medical centre No 1 Fitzwilliam street Dublin 2 Ph 6314500. The experts in travel vaccines Dublin 2


Climate: Being landlocked, there are considerable differences in temperature between summer and winter, and day and night in lowland regions and in the valleys.

Afghanistan has clearly defined seasons; summers are hot and winters can be bitterly cold. Summer temperatures as high as 49° C have been recorded in the northern valleys. Midwinter temperatures as low as -9° C are common around the 2000 metre level in the Hindu Kush. The climate in the highlands varies with elevation. The coolest temperatures usually occur on the heights of the mountains. Temperatures often range greatly within a single day. Variations in temperature during the day may range from freezing conditions at dawn to the upper 30°s at noon.

Capital City: Kabul
Altitude: 1800 metres
Main Cities: Herat, Kandahar, Mazceri-I-Sharif
Population: 25,838,797
Land Area (sq km): 652,000 sq km
Currency: 1 afghani (AF) = 100 puls
Languages: Pashtu 35%, Afghan Persian (Dari) 50%, Turkic languages (primarily Uzbek and Turkmen) 11%, 30 minor languages (primarily Balochi and Pashai) 4%, much bilingualism.
Religions: Sunni Muslim 84%, Shi'a Muslim 15%, other 1%
Economy: Agriculture, crops, e.g. cotton, tobacco, castor beans, fruits and nuts, hand-woven carpets, wool, cotton, hides and natural gas.



 The D2 medical advises all travellers to be 'up-to-date' for:

Cholera Immunisation is neither required nor recommended.
DIPHTHERIA We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.
HEPATITIS 'A' Immunisation is strongly recommended but not compulsory. This risk of acquiring this disease is very high.
HEPATITIS 'B' Immunisation is recommended for travellers who will be in the area for 1 month or more.Transmission of Hepatitis B is through sex or contact with contaminated blood, needles and syringes.
JAP.B.ENCEPHALITIS Immunisation is recommended for travellers who will be in the rural or remote areas for 1 month or more at a time.
POLIO Adults who are travelling to areas where poliomyelitis cases are occurring, or where the contracting the disease is possible, and who have received a primary series with either IPV or OPV should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.
RABIES Immunisation is recommended for travellers who will be staying in rural areas for 1 month or more at a time.
TUBERCULOSIS (TB) TB can occur in this country. Immunisation is not compulsory, and is not recommended for adults.Children should be immunisedatany age.A skin test is available if immune status is in doubt.
TETANUS We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.
TYPHOID FEVER Immunisation is recommended.
YELLOW FEVER A yellow fever vaccination certificate is required from travellers coming from infected areas.




Transmission generally occurs during the warmer months, May through October, with peak transmission during August and September. There is most risk of malaria in the provinces in the east (Konarha, Laghan, and Nangarhar), in the north-northeast (Kunduz, Takhar, and Badakhshan), and in the south (Helmand, Qandahar). There is no malaria risk in Kabul. There may be malaria risk, however, in the urban areas in the south. Malaria risk is predominantly in the P.vivax form. Malaria is highly endemic at elevations less than 2,000 meters (6,500 feet). Transmission is generally limited to May through November when Anopheles mosquito vectors breed in standing water. P. vivax, predominates ( 95-98% ) but the deadlier P. falciparum recently has accounted for 10% of all cases. Approximately 40% of the population is infected with malaria. Chloroquine resistance is reported.

 

General Advice on Mosquito Prevention.
Malaria is transmitted by mosquito bite, so recommend all travellers to the country to:

  • cover exposed skin after dusk when they are at most risk for getting bitten
  • use insect repellent with DEET in it.
  • return before dusk from country areas where malarial mosquitoes are the most active
  • sleep in screened room or use a bed net, remembering to tuck in the edges & spray inside.
  • sleep in air conditioned rooms or rooms with fans. Vapour pads and smoke coils also help. Insect buzzers are useless.




General
Medical facilities are few and far between throughout Afghanistan. Developed country medicines are generally unavailable, and there is a shortage of basic medical supplies. Basic medicines manufactured in Iran, Pakistan and India are available. Travellers will not be able to find Western-trained medical personnel in most parts of the country. An emergency hospital in Kabul with some Italian staff can provide limited services. There are also some international aid groups temporarily providing basic medical assistance in various cities and villages. For any medical treatment, payment is required in advance. No commercial medical evacuation capability from within Afghanistan exists. All travellers abroad are advised to take out adequate comprehensive insurance. Travellers should also carry their prescription medicine in the original container along with a copy of the prescription, or a note from their doctor.

HEALTH, ACCIDENTS AND INSURANCE
Accidents and injuries are the leading cause of death among travellers under the age of 55. Most are caused by motor vehicle and motorcycle crashes; and to a lesser degree, drowning, aircraft crashes, murders, and burns.

Heart attacks cause most fatalities in older travellers, but infections cause only 1% of fatalities in overseas travellers. Generally, infections are the most common cause of travel-related illness.

Travellers are advised to obtain, before departure, travel health insurance with specific overseas coverage. The policy should include a medical evacuation benefit. Check for any exclusions that are part of the policy, and keep in mind that many insurance policies have terrorism exclusion clauses. The D2 medical recommends that the policy also provide 24-hour access to an assistance centre that can help arrange and monitor delivery of medical care, and determine if air ambulance services are required.


                                                                                                                        DR JOHN J RYAN MEDICAL DIRECTOR

 

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