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| :::::::::::Abkhazia Travel Guide Edit This The best resource for sights, hotels, restaurants, bars, what to do and see Beach in Abkhazia Beach in Abkhazia TBN The war in the area finally ended in peace.There is a dynamic social and intellectual revolution in Abkhazia.There are many natural and historical sites to visit.If you are interested in the medieval period and epidemic? plants; it is really for you.There are cosy hotels and wide roads. Everything is neat and extraordinarily nice. _________Sights Edit This Illegal Tourism in Abkhazia can cause devastating outbreak of cholera Written by Ramaz Mitaishvili, MD Monday, 16 July 2007 First recorded evidence of cholera epidemics goes back to 16 century AD in a medical report from Asia. But disease probably has been common since ancient time. Populations all over the world have sporadically been affected by devastating outbreaks of cholera, and single bacterial type has been responsible for each of the seven recorded cholera pandemics. In the nineteenth century cholera spread from Asia to other parts of the world, producing pandemic in Europe, which was recorded in 1817. During the 1990s, over 1 million cholera cases have been reported from Latin America, 2000 from Ukraine and the Russian Republic during 1994 alone. Of the 208,755 cases of cholera (5034 fatal) officially reported to the World Health Organization in 1995,3 41.1% were from Latin America, 34.0% from Africa, 24.4% from Asia, and 0.5% from Europe and Oceania. Interest in Abkhazia (breakaway province of Georgia) stems from the popularity of tourism, that takes place illegally and the possible spread of disease in neighboring areas, such is Sochi, host of Winter Olympics 2014 (*Sochi is located 20 miles away from the Abkhazia). Poor surveillance and fear of international stigmatization and sanctions lead to underreporting of official numbers by Abkhazian self-proclaimed government. Nobody can estimated numbers of cases per year in Abkhazia. Increasing spread of cholera may reflect a lack of international quarantine enforcement by Abkhazia, which also has inadequate sanitary regulations and primitive water supplies. Many illegal tourists returns with the infection to Russia from Abkhazia, which officially claims to have no cholera. Cholera is an infection caused by the bacteria Vibrio cholerae. People become infected by drinking water or eating food contaminated by the bacteria, poor sanitation as well as personal and domestic hygiene practices. The bacteria present in faeces of an infected person are the main source of contamination and the principal site affected is the gastrointestinal tract. Symptoms include acute profuse watery diarrhea, vomiting, dehydration, fall of blood pressure, cramps in legs and abdomen, subnormal temperature, and complete collapse. Death may occur within 24 hours of onset unless prompt medical treatment is given to the patient. Healthy carriers of V. Cholerae may vary from 1.9 to 9.0%. These symptomless carriers excrete vibrios intermittently with the duration of pathogen discharge being relatively short, averaging 6 to 15 days with a maximum period between 30 to 40 days. Chronic convalescent carriers have been observed to shed vibrios intermittently for periods of 4 to 15 months. Survival of vibrios in the aquatic environment relates sharply to various chemical, biological and physical characteristics of a given stream or estuarine water. The viability of V. cholerae in surface waters has been observed to vary from 1h to 13 days. Although cholera vibrios may persist for only a short time in grossly polluted aquatic environment, faecal contamination from victims of epidemics and the carriers may continue to reinforce their population in water. Cholera occurs in epidemic form when there is adequate sanitation and access to clean drinking water, poor hygiene, and lack of safe food preparation and handling. Unstable political and environmental conditions in Abkhazia caused by breakdown of infrastructure are very important risk factors. Adequate water supply and sanitation are basic requirements for life. Access to clean water and improved sanitation facilities is a fundamental human right. Yet, in Abkhazia (breakaway province of Georgia), water source quality shows continued deterioration and in many cases depleted. These effects are a function of increasing tourism pressure, agricultural misuse and the inability to keep pace with the increasing demands on the resource. Reported numbers underestimate incidence of water supply and sanitation related diseases, particularly the low endemic diseases that are widespread in Abkhazia. A better understanding of the socio-economic, environmental and public health consequences of water supply and sanitation related diseases obtainable through better monitoring surveillance systems, may help the public and policy makers understand the value of microbiologically safe water as well as improved sanitation facilities. AISER reminds that tourism in Abkhazia takes place illegally. Medical science has long been frustrated in its search for an effective vaccine. ___________Practical Information Edit This [http://rmgh.net/wiki/index.php?title=Ramaz_Mitaishvili Mitaishvili R], MD At a Glance Hiding behind the images from Russian tourist websites of beautiful sea, and green mountains is a land, where ethnic cleansing and genocide of Georgians just 14 years ago were committed by bunch of Abkhazian separatists and Russian mentors. More than thirty thousand civilians have been killed in Abkhazia. Tens of thousands of women were raped, some of them more than a hundred times, while their sons and husbands were beaten and tortured in front of them. Three Hundred thousand lost their homes due to a process called "ethnic cleansing." Ethnic Cleansing is a process in which advancing army of one ethnic group expels civilians of other ethnic groups from towns and villages it conquers in order to create ethnically pure enclaves for members of their ethnic group. Political Tension and Regional Unrest Political riot in Abkhazia have created an uncertain security situation across the Abkhazia (breakaway province of Georgia. Travelers should exercise caution, particularly in Sukhumi, Gudauta, Ochamchira, Pitsunda, Gagra, avoid large gatherings and monitor news sources to avoid potential trouble areas. The Gudauta region is the site of ongoing civil unrest and should be avoided. When To Go The best time to visit Abkhazia is in the cold season, from November to February. Avoid Summer and Autumn when humidity and heat gang up to make conditions intolerable. Fast Facts Full Name Abkhazia, breakaway province of Georgia Capital City Sukhumi Currency Russian ruble Electricity 220V 50HzHz Electric Plug Details European plug with two circular metal pins Background Information Weights Measures System Metric Visas Overview Travelling in Abkhazia without permission and Visa from Georgian government is illegal Government Type Criminal Regime Government Leaders Sergey Bagapsh – self-proclaimed president. Not recognized by any country. Characterized by unpredictable behavior. Local Health Conditions cholera This diarrheal disease can cause rapid dehydration and death. Cholera is caused by bacteria, Vibrio cholerae. It's transmitted from person to person by direct contact (often via healthy carriers of the disease) or via contaminated food and water. It can be spread by seafood, including crustaceans and shellfish, which get infected via sewage. Cholera exists where standards of environmental and personal hygiene are low. Every so often there are massive epidemics, usually due to contaminated water in conditions where there is a breakdown of the normal infrastructure. The time between becoming infected and symptoms appearing is usually short, between one and five days. The diarrhea starts suddenly, and pours out of you. It's characteristically described as 'rice water' diarrhea because it is watery and flecked with white mucus. Vomiting and muscle cramps are usual, but fever is rare. In its most serious form, it causes a massive outpouring of fluid (up to 20L a day). This is the worst case scenario - only about one in 10 sufferers get this severe form. It's a self-limiting illness, meaning that if you don't succumb to dehydration, it will end in about a week without any treatment. You should seek medical help urgently; in the meantime, start re-hydration therapy with oral re-hydration salts. You may need antibiotic treatment with tetracycline, but fluid replacement is the single most important treatment strategy in cholera. Prevention is by taking basic food and water precautions, avoiding seafood and having scrupulous personal hygiene. The currently available vaccine is not thought worthwhile as it provides only limited protection for a short time. hepatitis Several different viruses cause hepatitis; they differ in the way that they are transmitted. The symptoms in all forms of the illness include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored (white-gray) faces, jaundice (yellow skin) and yellowing of the whites of the eyes. Hepatitis A is transmitted by contaminated food and drinking water. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious in pregnant women. Hepatitis B is spread through contact with infected blood, blood products or body fluids, for example through sexual contact, unsterilized needles (and shaving equipment) and blood transfusions, or contact with blood via small breaks in the skin. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications. There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types. Following the basic rules about food and water (hepatitis A and E) and avoiding risk situations (hepatitis B, C and D) are important preventative measures. malaria If you are travelling in endemic areas it is extremely important to avoid mosquito bites and to take tablets to prevent this disease. Symptoms range from fever, chills and sweating, headache, diarrhea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately if malaria is suspected. Without treatment malaria can rapidly become more serious and can be fatal. If medical care is not available, malaria tablets can be used for treatment. You should seek medical advice, before you travel, on the right medication and dosage for you. If you do contract malaria, be sure to be re-tested for malaria once you return home as you can harbour malaria parasites in your body even if you are symptom free. Travelers are advised to prevent mosquito bites at all times. The main messages are: wear light-colored clothing; wear long trousers and long-sleeved shirts; use mosquito repellents containing the compound DEET on exposed areas (prolonged overuse of DEET may be harmful, especially to children, but its use is considered preferable to being bitten by disease-transmitting mosquitoes); avoid perfumes and aftershave; use a mosquito net impregnated with mosquito repellent (permethrin) - it may be worth taking your own, and impregnating clothes with permethrin effectively deters mosquitoes and other insects. meningococcal meningitis Not every headache is likely to be meningitis. There is an effective vaccine available which is often recommended for travel to epidemic areas. Generally, you're at pretty low risk of getting meningococcal meningitis, unless an epidemic is ongoing, but the disease is important because it can be very serious and rapidly fatal. You get infected by breathing in droplets coughed or sneezed into the air by sufferers or, more likely, by healthy carriers of the bacteria. You're more at risk in crowded, poorly ventilated places, including public transport and eating places. The symptoms of meningitis are fever, severe headache, neck stiffness that prevents you from bending your head forward, nausea, vomiting and sensitivity to light, which makes you prefer the darkness. With meningococcal meningitis, you may get a widespread, blotchy purple rash before any other symptoms appear. Meningococcal meningitis is an extremely serious disease that can cause death within a few hours of you first feeling unwell. Seek medical help without delay if you have any of the symptoms listed earlier, especially if you are in a risk area. If you've been in close contact with a sufferer it's best to seek medical advice. Weather Overview The climate of Abkhazia is subtropical and tropical with days still averaging 0- 5°C in January, 35°C (95°F) in summer. Abkhazia has three main seasons: the autumn or 'wet' season from late October to early December; the 'cold' season from mid-November to the end of February; and the 'hot' season from mid-March to mid-September. Despite the fact that these are the only observable seasons, locals commonly refer to two: “Sleepy season” (when 100 000 of remaining population lazily awaits “tourist season”- to serve and robbe tourists. ___________Getting Around Edit This Preparing for Your Trip to Abkhazia: Manual for Russian tourists 2 Don’t forget, that tourism in Abkhazia takes place illegally! Before visiting Abkhazia, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.) To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it. Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling. CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons. If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school. Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get. Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule. Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection. Vaccine-Preventable Diseases Vaccination or Disease Recommendations or Requirements for Vaccine-Preventable Diseases Routine Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, etc. Hepatitis A or immune globulin (IG) Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors. Hepatitis B Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map) and who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment, such as for an accident, and for all adults requesting protection from HBV infection. Typhoid Recommended for all unvaccinated people traveling to or working in Eastern Europe and Northern Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Rabies Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, hiking, or work. Also, children are considered at higher risk because they tend to play with animals and may not report bites. Malaria Drugs to Prevent Malaria (Antimalarial drugs) If you will be visiting a malaria risk area in Abkhazia, chloroquine is the recommended antimalarial drug. Malaria risk area in Abkhazia: Risk in southeastern part of the country near Russian border and Bzib River and risk in the districts of Guadauta, Novi Afon, Gagra, Pitsunda, Sukhumi, Ochamchira . A Special Note about Antimalarial Drugs You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available. For detailed information about these antimalarial drugs, see Information for the Public: Prescription Drugs for Malaria. More Information About Malaria Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below). Travelers to malaria risk-areas in Abkhazia, including infants, children, and former residents of Abkhazia, should take one of the following antimalarial drugs listed above. Symptoms Malaria symptoms may include * fever * chills * sweats * headache * body aches * nausea and vomiting * fatigue Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip. Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel. Items to Bring With You Medicines you may need: * The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids. * Antimalarial drugs, if traveling to a malaria-risk area in Abkhazia and prescribed by your doctor. * Medicine for diarrhea, usually over-the-counter. Other items you may need: * Iodine tablets and portable water filters to purify water if bottled water is not available. See Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water and Safe Food and Water for more detailed information. * Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information. * Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol. * To prevent insect/mosquito bites, bring: o Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible. o Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes. o Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes. See other suggested over-the-counter medications and first aid items for a travelers' health kit. Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items. Other Diseases Found in Eastern Europe and Northern Asia Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies. The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available. Tickborne encephalitis (TBE) is widespread, occurring in warmer months in the southern part of the nontropical forested regions of Europe and Asia. Most intense transmission has been reported in Russia, the Czech Republic, Latvia, Lithuania, Estonia, Hungary, Poland, and Slovenia. The annual incidence rate of tuberculosis is high in some countries in the region. High rates of drug-resistant TB are found in Estonia, Kazakhstan, Latvia, Lithuania, parts of Russia, and Uzbekistan. Cases of diphtheria have declined (after a large outbreak in the 1990s) with improved rates of immunization. Highly pathogenic avian influenza virus H5N1 has been documented in wild birds or other avian species in several of the countries in Eastern Europe. Human cases and death were reported from Azerbaijan in 2006. Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds and avoid places such as poultry farms and bird markets where live birds are raised or kept. For a current list of countries reporting outbreaks of H5N1 among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE), and for total numbers of confirmed human cases of H5N1 virus by country, see the World Health Organization (WHO) Avian Influenze website. For more information, see the Geographic Distribution of Potential Health Hazards to Travelers and Goals and Limitations in determining actual disease risks by destination. Staying Healthy During Your Trip Prevent Insect Bites Diseases, like malaria, are spread through mosquito bites. One of the best protections is to prevent these bites by: * Using insect repellent with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs to be applied more frequently. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. * Wearing long-sleeved shirts, long pants, and a hat outdoors. * Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn). * Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room. * Spraying rooms with products effective against flying insects, such as those containing pyrethroid. For detailed information about insect repellent use, see Insect and Arthropod Protection. Be Careful about Food and Water Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking: * Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). * Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink. * Do not eat food purchased from street vendors. * Make sure food is fully cooked. * Avoid dairy products, unless you know they have been pasteurized. Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself. Avoid Injuries Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by: * Not drinking and driving. * Wearing your seat belt and using car seats or booster seats in the backseat for children. * Following local traffic laws. * Wearing helmets when you ride bikes, motorcycles, and motor bikes. * Hiring a local driver, when possible. * Avoiding night driving. Other Health Tips * To avoid animal bites and serious diseases (including rabies and plague) do not handle or pet animals, especially dogs and cats. If you are bitten or scratched, wash the wound immediately with soap and water and seek medical attention to determine if medication or anti-rabies vaccine is needed. * To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections. * To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms. After You Return Home If you are not feeling well, you should get medical attention and mention that you have recently traveled. If you have visited a malaria-risk area, continue taking your chloroquine for 4 weeks after leaving the risk area. Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history. Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. __________Things to do Edit This Preparing for Your Trip to Abkhazia: Manual for Russian tourists 2 Don’t forget, that tourism in Abkhazia takes place illegally! Before visiting Abkhazia, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.) To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it. Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling. CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons. If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school. Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get. Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule. Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection. Vaccine-Preventable Diseases Vaccination or Disease Recommendations or Requirements for Vaccine-Preventable Diseases Routine Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, etc. Hepatitis A or immune globulin (IG) Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors. Hepatitis B Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map) and who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment, such as for an accident, and for all adults requesting protection from HBV infection. Typhoid Recommended for all unvaccinated people traveling to or working in Eastern Europe and Northern Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Rabies Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, hiking, or work. Also, children are considered at higher risk because they tend to play with animals and may not report bites. Malaria Drugs to Prevent Malaria (Antimalarial drugs) If you will be visiting a malaria risk area in Abkhazia, chloroquine is the recommended antimalarial drug. Malaria risk area in Abkhazia: Risk in southeastern part of the country near Russian border and Bzib River and risk in the districts of Guadauta, Novi Afon, Gagra, Pitsunda, Sukhumi, Ochamchira . A Special Note about Antimalarial Drugs You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available. For detailed information about these antimalarial drugs, see Information for the Public: Prescription Drugs for Malaria. More Information About Malaria Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below). Travelers to malaria risk-areas in Abkhazia, including infants, children, and former residents of Abkhazia, should take one of the following antimalarial drugs listed above. Symptoms Malaria symptoms may include * fever * chills * sweats * headache * body aches * nausea and vomiting * fatigue Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip. Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel. Items to Bring With You Medicines you may need: * The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids. * Antimalarial drugs, if traveling to a malaria-risk area in Abkhazia and prescribed by your doctor. * Medicine for diarrhea, usually over-the-counter. Other items you may need: * Iodine tablets and portable water filters to purify water if bottled water is not available. See Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water and Safe Food and Water for more detailed information. * Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information. * Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol. * To prevent insect/mosquito bites, bring: o Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible. o Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes. o Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes. See other suggested over-the-counter medications and first aid items for a travelers' health kit. Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items. Other Diseases Found in Eastern Europe and Northern Asia Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies. The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available. Tickborne encephalitis (TBE) is widespread, occurring in warmer months in the southern part of the nontropical forested regions of Europe and Asia. Most intense transmission has been reported in Russia, the Czech Republic, Latvia, Lithuania, Estonia, Hungary, Poland, and Slovenia. The annual incidence rate of tuberculosis is high in some countries in the region. High rates of drug-resistant TB are found in Estonia, Kazakhstan, Latvia, Lithuania, parts of Russia, and Uzbekistan. Cases of diphtheria have declined (after a large outbreak in the 1990s) with improved rates of immunization. Highly pathogenic avian influenza virus H5N1 has been documented in wild birds or other avian species in several of the countries in Eastern Europe. Human cases and death were reported from Azerbaijan in 2006. Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds and avoid places such as poultry farms and bird markets where live birds are raised or kept. For a current list of countries reporting outbreaks of H5N1 among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE), and for total numbers of confirmed human cases of H5N1 virus by country, see the World Health Organization (WHO) Avian Influenze website. For more information, see the Geographic Distribution of Potential Health Hazards to Travelers and Goals and Limitations in determining actual disease risks by destination. Staying Healthy During Your Trip Prevent Insect Bites Diseases, like malaria, are spread through mosquito bites. One of the best protections is to prevent these bites by: * Using insect repellent with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs to be applied more frequently. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. * Wearing long-sleeved shirts, long pants, and a hat outdoors. * Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn). * Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room. * Spraying rooms with products effective against flying insects, such as those containing pyrethroid. For detailed information about insect repellent use, see Insect and Arthropod Protection. Be Careful about Food and Water Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking: * Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). * Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink. * Do not eat food purchased from street vendors. * Make sure food is fully cooked. * Avoid dairy products, unless you know they have been pasteurized. Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself. Avoid Injuries Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by: * Not drinking and driving. * Wearing your seat belt and using car seats or booster seats in the backseat for children. * Following local traffic laws. * Wearing helmets when you ride bikes, motorcycles, and motor bikes. * Hiring a local driver, when possible. * Avoiding night driving. Other Health Tips * To avoid animal bites and serious diseases (including rabies and plague) do not handle or pet animals, especially dogs and cats. If you are bitten or scratched, wash the wound immediately with soap and water and seek medical attention to determine if medication or anti-rabies vaccine is needed. * To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections. * To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms. After You Return Home If you are not feeling well, you should get medical attention and mention that you have recently traveled. If you have visited a malaria-risk area, continue taking your chloroquine for 4 weeks after leaving the risk area. Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history. Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. www.abkhazia.com |