World Country Guide

1
A yellow fever vaccination certificate is required of travellers arriving from infected areas. Travellers arriving from non-endemic zones should note that vaccination is strongly recommended for travel outside the urban areas, even if an outbreak of the disease has not been reported and they would normally not require a vaccination certificate to enter the country.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is not a condition of entry to Sierra Leone. However, cholera is a serious risk in this country and precautions are essential. Up-to-date advice should be sought before deciding whether these precautions should include vaccination, as medical opinion is divided over its effectiveness; see the Health appendix for further details.

3
Polio and typhoid both occur.

4
Malaria risk exists, predominantly in the malignant falciparum form, throughout the country all year. Resistance to chloroquine has been reported. The recommended prophylaxis is mefloquine.

Food & drink
All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is unpasteurised and should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid dairy products which are likely to have been made from unboiled milk. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks
Bilharzia (schistosomiasis) is present. Avoid swimming and paddling in fresh water; swimming pools which are well chlorinated and maintained are safe. Filariasis and dengue fever are present. Trachoma, hepatitis A and E, tungiasis and dysentery are widespread. Trypanosomiasis (sleeping sickness) may be present and there is a significant risk of infection for travellers visiting or working in rural areas. Meningococcal meningitis and TB may occur. Hepatitis B is hyperendemic. Lassa fever can be contracted in Kenema and the east; the last widely publicised outbreak was in April 2004. There is a high incidence of HIV/AIDS.
Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay. For more information, consult the Health appendix.

Health care
Medical facilities are extremely limited and continuing to decline. According to UN estimates, Sierra Leone has the highest death rate and the second-highest infant mortality rate (200 out of every 1000 infants die within one year of birth). Missions and foreign aid organisations provide some medical facilities. Health insurance is essential. It is advisable to take personal medical supplies.