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Russia (major cities only)
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
General adviceEmergency servicesPhysicians and hospitals
Medical facilitiesMapsRegistration/Embassy location
Safety information

 

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Summary of recommendations:

The following recommendations are for short-term trips limited to major cities in the Russian Federation. For all other trips, please see Russia (complete). All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.


Vaccinations:

Tetanus-diphtheria

For all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Hepatitis A

Recommended for all travelers

Typhoid

For travelers who may eat or drink outside major restaurants and hotels

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

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) (PDF) 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.

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Immunizations

The following are the recommended vaccinations for major cities in Russia:

Tetanus-diphtheria vaccine is recommended for all adults who have not received a tetanus-diphtheria immunization within the last 10 years. In the 1990s, a massive diphtheria epidemic occurred in the newly independent states of the former Soviet Union (see CR Vitek and M Wharton, Emerging Infectious Diseases). Cases of diphtheria have been reported among U.S. citizens who have traveled to this area.

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, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers. 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.

Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester.

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.

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Recent outbreaks

The number of cases of meningococcal meningitis in Moscow was approximately twice as great in the year 2003 as it had been the previous year. A total of 273 cases and 24 deaths were reported as of October 2003. Most cases occurred in children. No institutional or family outbreaks were identified. The city health authorities responded by ordering a mass vaccination campaign. As of April 2004, it appeared that the number of cases had significantly fallen. Meningococcal vaccine is no longer recommended for travelers to Moscow. For further information, go to Eurosurveillance, Health Canada, and the National Travel Health Network and Centre.

Eight young children in Vladivostok became ill after playing with discarded ampules of smallpox vaccine, which is made from vaccinia virus, not smallpox virus. See Disease Outbreak News (June 20, 2000) for further information.

Cases of Crimean-Congo hemorrhagic fever, a potentially deadly viral infection which is usually transmitted by tick bites, are reported annually from the Stavropol region in southern Russia. In July 1999, an outbreak resulting in 65 cases and six deaths occurred in the village of Oblivskaia, north of Stavropol, in the region between Volgograd and Rostov-on-Don in the southern part of the country. At approximately the same time, a smaller outbreak, causing four cases and two deaths, was reported from the Stavropol region between the Black Sea and the Caspian Sea. In May 2001, the Russian Ministry of Health reported six cases: two from the Stavropol area (one patient died), three from the Republic of Dagestan, and one from the Republic of Kalmykia. For further information, see ProMED-mail (April 26 and May 11, 2001).

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Other infections

  • West Nile fever (southern Russia; transmitted by mosquitoes; see Emerging Infectious Diseases)
  • Lyme disease (widespread in Russia; for St. Petersburg area, see EpiNorth; for Arkhangelsk province, go to EpiNorth)
  • Tick-borne encephalitis (may occur in travelers to major cities if they take recreational trips to the suburbs or surrounding countryside)
  • Shigellosis (see ProMED-mail May 10, 2001)
  • Brucellosis (cattle, sheep, and goats are the most common sources of infection)
  • Hemorrhagic fever with renal syndrome (transmitted by rodents)
  • HIV (human immunodeficiency virus) (travelers not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions)

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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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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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Emergency services

In Moscow and most other areas, call 03 for emergency medical assistance. In Yekaterinburg, foreigners should dial (343) 29-82-28 to reach an English-speaking ambulance dispatcher. For other emergency services in Moscow, Vladivostok, St. Petersburg, and Yekaterinburg (Urals and Western Siberia), including medical evacuation, go to the U.S. consular websites for those cities.

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Physicians and hospitals

For an online guide to hospitals, clinics, dentists, and pharmacies in Moscow, St. Petersburg, and Yekaterinburg (Urals and Western Siberia), go to the U.S. consular websites for those cities.

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

Medical care is below western standards, with shortages of basic medical supplies and equipment and inferior standards of care and hygiene. The few quality facilities in Moscow that approach acceptable standards have limited spaces and do not accept all cases (i.e., they may reject cases of infectious illnesses or trauma. Access to these facilities usually requires cash payment at western rates upon admission.

The U.S. embassy and consulates maintain lists of such facilities and English-speaking doctors. Many resident Americans travel to the west for their medical needs. Such travel can be very expensive if undertaken under emergency conditions. Travelers should check their insurance coverage and purchase supplemental coverage for medical evacuation. A medical evacuation from Russian can cost between 50,000 to 100,000 U.S. dollars, depending on the complexity of the situation. Elderly travelers and those with existing health problems may be at particular risk. Elective surgery and non-essential blood transfusions are not recommended, due to uncertainties surrounding the local blood supply. Most hospitals and clinics in major urban areas have adopted the use of disposable syringes as standard practice; however, travelers to remote regions should bring a supply of sterile, disposable syringes for eventualities. Travelers should refrain from visiting tattoo parlors or piercing services due to the risk of infection.

Rates of HIV infection have risen markedly in recent years. While most prevalent among intravenous drug users, prostitutes, and their clients, the HIV/AIDS rate in the general population is increasing. Reported cases of syphilis are much higher than in the U.S., and some sources suggest that gonorrhea and chlamydia are also more prevalent than in Western Europe or the U.S. Travelers should be aware of the related health and legal risks and take all appropriate measures.

Information on appropriate health precautions can be obtained from local health departments or private doctors. General guidance can also be found in the U.S. Public Health Service book, "Health Information For International Travel," available from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402. Tourists in frail health are strongly advised not to visit Russia because of the harsh conditions and lack of adequate medical facilities.

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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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Registration/Embassy location (reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living or traveling in Russia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within Russia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy's consular section is located in Moscow at Novinskiy Bulvar 19/23; The Embassy's switchboard is 7 (095) 728-5000, American Citizen Service's tel: (7) (095) 728-5000, after-hours emergencies: (7) (095) 728-5000, fax: (7) (095) 728-5084, email: consulmo@state.gov, and website: http://www.usembassy.ru.

U.S. Consulates General are located in:

St. Petersburg

15 Ulitsa Furshtadtskaya, St. Petersburg 191028 Tel: (7) (812) 331-2600 Fax: (7) (812) 331-2646 Email: acsstpete@state.gov. Website: http://www.stpetersburg-usconsulate.ru/

Vladivostok

32 Ulitsa Pushkinskaya, Vladivostok 690001 Tel: (7) (4232) 30-00-70 Fax: (7) (4232) 30-00-91 After-hours emergencies: (7) (4232) 71 00 67 E-mail: conssect@gin.ru Website: http://vladivostok.usconsulate.gov

Yekaterinburg

Ulitsa Gogolya 15a, 4th floor, Yekaterinburg 620151; Tel: (7) (343)379-3001 Fax: (7) (343) 379-4515 After-hours emergencies: (7) 8 902 84 16653 Email: consulyekat@state.gov Website: http://www.usa.ural.ru

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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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