Russia
Avoid dental treatment as the standards of care and hygiene cannot be guaranteed.
Little international brand medication is available outside of Moscow or St Petersburg. If medication is required in these cities use the larger, reputable pharmacies where you are less likely to find counterfeits
Screening is inconsistent in Russia, therefore blood supplies should be considered as unsafe
Medical care is usually far below Western standards, with severe shortages of basic medical supplies. Access to the few quality facilities that exist in major cities usually requires cash payment at Western rates upon admission.
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood or rare meat. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors. Only pasteurized dairy products should be consumed.
Press reports indicate increased incidences of diphtheria and other communicable diseases, and CDC reports a severe shortage of vaccines to combat these diseases. Health officials state the situation is particularly bad in the cities of St. Petersburg, Moscow, Krasnodar and Vladivostok, as well as in the Far East, including Primorsky, Maritime and Saratov regions. Travelers to Russia should be up-to-date on routine and recommended immunizations and are reminded to strictly follow food and beverage precautions.
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
According to CDC, breakdowns in water purification plants have led to significantly higher rates of gastroenteritis, hepatitis A and bacterial dysentery. Also, a report from the country's Environment Ministry states that half of the country's population must rely on substandard drinking water.
The intestinal parasite Giardia lamblia has been linked to St. Petersburg's water supply - which should be considered contaminated under all circumstances.
Hikers should take protective measures against ticks.
Hepatitis A: Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese Encephalitis: Consider vaccination if staying a month or more in the far eastern maritime areas south of Khabarovsk from July to September, especially if travel includes rural areas. Also consider if staying less than 30 days during that period and at high risk (in case of epidemic outbreak or extensive outdoor exposure in rural areas).
Polio: A one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Typhoid: Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited. Contraindications depend on vaccine type.
Note: All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
Health conditions and sanitation in Moscow and other large cities, formerly on par with U.S. and European standards, have deteriorated in recent years. Conditions in smaller cities and villages are below the standards of industrialized countries.
Insect-borne illness:
Encephalitis (Japanese type) - occurs in southeast (human cases reported in recent past for first time in 30 years)
Encephalitis (tick-borne) - occurs in southern Siberia and forested areas bordering southeastern Europe
Hemorrhagic fever - occurs in southern Siberia
Leishmaniasis (cutaneous) - occurs in southern areas
Lyme disease - occurs
Typhus (tick-borne) - occurs in eastern and central Siberia
Food-borne and water-borne illness:
Cholera - occurs
Diphyllobothriasis (fish tapeworm) may be a problem in the Baltic Sea area
Giardiasis - occurs in western areas
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.
According to the CDC, a decrease in immunization practices since the late 1980s has led to significantly higher rates of several diseases, including diphtheria. While proof of diphtheria immunity is not required for international travel, the CDC recommends that travelers to areas where diphtheria is occurring should be immunized.
Influenza risk extends from November to April.
Rabies - occurs (especially among foxes in rural areas)
AIDS: According to the Department of State and the Russian Consulate General in New York, a certificate showing an HIV negative status is required for any person applying for a visa for a stay of more than 3 months. The certificate must contain the applicant's passport data, proposed length of stay in Russia, blood test results for HIV infection, including date of the test, signature of the doctor conducting the test, medical examination results, diagnostic series, and seal of the hospital or medical organization. The certificate must be in both Russian and English and valid for 3 months from the date of medical examination and blood test. Foreign test results are accepted under certain conditions. Contact Russia's embassy for details.
Diphtheria: A number of travelers to Russia have recently been informed that diphtheria vaccination is necessary for entering Moscow. Per Mr. Goryachev in the Russia Consulate in New York, an up-to-date diphtheria vaccination is recommended, although not required. Mr. Goryachev also provided the following toll-free number (from the U.S.) for an automated fax service regarding current visa requirements: (800) 634-4296. Callers must use a touch-tone phone to type in their own fax machine number.
