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Kenya
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionSwimming and bathing precautionsGeneral advice
Medical facilitiesTraveling with childrenTravel and pregnancy
MapsEmbassy/Consulate LocationSafety information

 

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Summary of recommendations:

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

Malaria: Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas except Nairobi and the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley, and Western Provinces.
Vaccinations:

Hepatitis A

Recommended for all travelers

Typhoid

Recommended for all travelers

Yellow fever

Recommended for all travelers greater than nine months of age, except that those whose itinerary is limited to the North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coastal Province; and the cities of Mombasa and Nairobi, need the vaccine only if at risk for a large number of mosquito bites.

Polio

One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult

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

Medications

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 Kenya: prophylaxis is recommended for all areas except Nairobi and the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley, and Western Provinces. Malaria epidemics frequently occur during the rainy season, which begins in April, but transmission occurs year-round. 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 Kenya, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization, Roll Back Malaria, the Kenya Malaria Information Service.

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Immunizations

The following are the recommended vaccinations for Kenya:

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, except for those whose itinerary is limited to the following areas: the entire North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coastal Province; and the cities of Mombasa and Nairobi (see map). For travelers to the the latter areas, the vaccine should be considered only for those at increased risk due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. The vaccine is required for all travelers greater than one year of age arriving from a country in Africa or the Americas with risk of yellow fever transmission. 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

Fourteen cases of polio were reported from Kenya for the year 2013, representing the first cases confirmed in Kenya since July 2011. At least two of the cases were reported from a refugee camp in Dadaab, which houses people from across the Horn of Africa, including Somalia. Thirteen cases of polio were reported from Kenya betgween 2008 and 2011, including three cases in the Kamagambo area of Rongo District, Western Province, in September 2011 (see the World Health Organization). A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult. Children should be fully immunized against polio before traveling to Kenya.

An outbreak of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, was reported from Mombasa in May 2013. Several cases were reported in travelers. In October 2011, a dengue outbreak occurred in Mandera, northeastern Kenya, causing at least 5000 cases and four deaths. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures, as below, are advised.

Two cases of African trypanosomiasis (sleeping sickness) were reported in early 2012 in travelers who had visited the Masai Mara game park: a German tourist in January 2012 and a Belgian tourist in February 2012 (see ProMED-mail). Several other cases have recently been reported among visitors to game parks in East Africa (see Emerging Infectious Diseases). African trypanosomiasis is a potentially fatal parasitic infection transmitted by the bite of the tsetse fly. 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.

An increased number of cases of visceral leishmaniasis (kala-azar) have been reported from northeastern Kenya since 2000. An outbreak was reported from Wajir District in March 2008, resulting in more than 180 cases as of August (see ProMED-mail; August 6, 2008). In July 2006, a leishmaniasis outbreak was reported from Isiolo District, Eastern Province, leading to the admission of more than 30 children to the local hospital in neighboring Wajir District (see IRIN). Visceral leishmaniasis is transmitted by the bite of infected female sandflies. The disease is characterized by fever, weight loss, anemia, and enlargement of the liver and spleen which may develop over months to years. The infection may be especially severe in those with HIV disease. To prevent sandfly bites, follow the same precautions as for mosquito bites, except that netting must be finer-mesh (at least 18 holes to the linear inch) since sandflies are smaller.

Cholera outbreaks are regularly reported from Kenya. The most recent were reported in May 2010 from West Pokot district (Rift Valley province) and Kilifi district (Coast province); in March 2010 from Coast, Eastern and Rift Valley provinces (particularly affecting Kajiado District and Pokot Central district in Rift Valley Province); in November 2009 from the Coast province, Central province, and Eastern province; in September 2009 from Turkana in northwestern Kenya and from Laisamis, Marsabit; in December 2008 from western Nyanza province, causing 4000 cases and 89 deaths by July 2009; in March 2009 from Moyale town, in the extreme north of Eastern Province; in December 2008 from the three districts of Mandera, causing more than 1400 cases and 13 deaths; in September 2008 from the Nandi hills area in Rift Valley province; in June 2008 from the Rachuonyo, Migori and Kisumu East districts of Nyanza Province and the Busia and Samia districts in Western Province; in April 2008 from the western province of Nyanza and from the town of Naivasha in Rift Valley province; in February 2008 from Mandera district in the Northeastern province, near the Somali border; in January 2008 at a center hosting victims of post-election violence in Nandi in Rift Valley province; in July 2007 from Siaya District in Nyanza province, in southwestern Kenya; and in April-May 2007 from West Pokot and Turkana districts in Rift Valley province, in the western part of the country bordering Uganda; from the town of Mandera in Northeastern province, near the border with Somalia and Ethiopia; and from Kisumu and Siaya districts in Nyanza province (see ProMED-mail). In December 2006, a cholera outbreak was reported from Northeastern province after flooding. A small flood-related outbreak was also reported from Mombasa in November 2006. In September 2006, a cholera outbreak was reported from Vanga Village in Kwale district, apparently related to contaminated well water (see ProMED-mail (September 29, 2006). A cholera outbreak was previously reported from this area in 2004. In December 1998, a major cholera outbreak occurred in Nyanza, Eastern, Rift Valley and Nairobi provinces, resulting in over 1000 cases and 25 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 an intestinal infection was reported in January 2008 among British tourists who had been staying at the Sun'n Sand Hotel in Kikambala. Some of the cases were reportedly confirmed as salmonellosis. For further information, go to ProMED-mail (January 15, 2008).

An outbreak of Rift Valley fever was reported in December 2006, causing 684 cases and 155 deaths by May 2007. The outbreak began in flooded areas in North Eastern Province, especially the districts of Garissa, Ijara, and Wajir. Cases were also reported from Coast Province (districts of Kilifi, Tana River, Malindi, Isiolo, and Taita Taveta), Central Province (districts of Kirinyanga and Maragua), and Rift Valley Province (Kajiado district). 684 cases including 155 deaths (case-fatality ratio, 23%) of RVF was reported in Kenya. See the International Federation of Red Cross and Red Crescent Societies, World Health Organization, MMWR, IRIN News, NATHNAC, and ProMED-mail for further information. The human cases occurred at the same time that outbreaks were occurring among sheep, cattle, and goats in the area. In February 2010, seven additional cases, one fatal, were reported from the Free State and Northern Cape.

Rift Valley fever is a viral infection that primarily affects domesticated animals. The disease is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or their tissues or by consumption of raw milk. Aerosol transmission has been documented. Most cases occur in those who work with livestock. The incubation period ranges from two to six days. Initial symptoms may include fever, chills, muscle aches, backache, headache, nausea, vomiting, and light sensitivity. Most people recover uneventfully in four to seven days, but the course may be complicated by loss of vision (retinitis), liver inflammation (hepatitis), kidney failure, excessive bleeding (hemorrhage), inflammation of the brain (encephalitis), or death. Travelers to affected areas should follow insect protection measures, as below, and avoid direct contact with livestock.

Cases of Rift Valley fever reached epidemic levels in late 1997 and early 1998 after torrential rains and severe flooding, causing at least 170 deaths. Cases were confirmed in the North Eastern, Eastern, Central, and Rift Valley provinces. The chief risk factors for infection were direct contact with sheep body fluids and housing livestock indoors. See "An Outbreak of Rift Valley Fever in Northeastern Kenya, 1997-98" in Emerging Infectious Diseases, and "An outbreak of Rift Valley Fever, Eastern Africa, 1997-1998"(PDF) in Weekly Epidemiological Record, Vol. 73, 15 1998.

Outbreaks of Chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, occurred in coastal Kenya (Lamu, then Mombasa) in 2004, followed by sporadic cases, including an American traveler who spent three months in Kenya and Somalia in 2005 (see MMWR). 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.

An outbreak of dysentery was reported in May 2006 from the Kotulu area in El Wak division of Mandera District in North Eastern Province. As of May 16, a total of 13 children had died. The outbreak appeared to be related to contaminated drinking water obtained from a local pond. See IRIN and ProMED-mail (May 12, 2006) for details.

A measles outbreak was reported in April 2006 from North Eastern, Nyanza, Rift Valley and Nairobi provinces. See the International Red Cross for details. As of the end of 2006, the outbreak appeared to be waning. 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, consider giving an initial dose of measles vaccine to children between the ages of 6 and 11 months who will be traveling to Kenya. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.

A meningococcal outbreak was reported in February 2006 from four divisions (Alale, Chepareria, Kachelila and Kasei) of West Pokot, an area bordering the epidemic districts of Uganda. As of February 26, a total of 74 cases and 15 deaths had been identified. See the World Health Organization for details. Meningococcal vaccine is recommended for travelers to this area.

A leptospirosis outbreak was reported in June 2004 from a high school in Bungoma district, resulting in 141 suspected cases and 6 deaths as of June 17. Cases have also been reported from a nearby elementary school. See the World Health Organization for further information.

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Other infections

Schistosomiasis may be acquired from exposure to bodies of fresh water. In 1984, acute schistosomiasis developed in a group of 15 American students traveling in Kenya, two of whom became paraplegic from transverse myelitis (inflammation of the spinal cord due to deposition of schistosomal eggs.) (See Acute Schistosomiasis with Transverse Myelitis in American Students Returning from Kenya, MMWR August 10, 1984 / 33(31); 445-7). Swimming and bathing precautions are strongly advised (see below).

Marburg fever was reported from Kenya in 1980 and 1987.

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

  • Cutaneous and diffuse cutaneous leishmaniasis (transmitted by sandflies)
  • Crimean-Congo hemorrhagic fever
  • Kenyan tick typhus
  • Plague (outbreak involving 44 people occurred in 1990, and foci of disease are believed to persist in rodents; any traveler at risk for exposure to wild rodents or their fleas, which transmit the plague, should bring along a bottle of doxycycline, to be taken prophylactically if exposure occurs)
  • O'nyong-nyong fever (cases reported from the Coast Province in December 2004; see ProMED-mail, December 16, 2004, for details)
  • Anthrax (outbreaks reported from Embu District in Eastern Province in January 2009 and again in May 2014, and from Meru Central District in January 2006; those who work with farm animals are at highest risk; see ProMED-mail
  • Brucellosis (low incidence)

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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.

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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 accomodation 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.

To prevent sandfly bites, follow the same precautions as for mosquito bites, except that netting must be finer-mesh (at least 18 holes to the linear inch) since sandflies are smaller.

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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.

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General 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

For a guide to physicians, dentists, hospitals, pharmacies and ambulance services in Kenya, go to the U.S.Embassy website. Adequate medical care is available in Nairobi, though facilities are limited elsewhere. 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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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).

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 Kenya.

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

Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Kenya. 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

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/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living in or visiting Kenya are encouraged to register at the Consular section of the U.S. Embassy in Kenya and obtain updated information on travel and security within Kenya.

The U.S Embassy is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (254)(20)363-6000; fax (254)(20)363-6410. In the event of an after-hours emergency, the Embassy duty officer may be contacted at (254)(20)363-6170. The Embassy's international mailing address is P.O. Box 606, Village Market 00621, Nairobi, Kenya. Mail using U.S. domestic postage may be addressed to Unit 64100, APO AE 09831. The Embassy home page is http://kenya.usembassy.gov.

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Safety 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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