This Travel Warning (June 11, 2007) updates U.S. citizens on ongoing safety and security concerns, including concerns about rebel activities in eastern and southeastern Chad, and notes that the government-declared State of Emergency is still in effect. The Department continues to advise American citizens to avoid non-essential travel to eastern Chad. This supersedes the Travel Warning of November 20, 2006.
The Department of State urges American citizens to avoid non-essential travel to eastern Chad, and to take into consideration the increase in crime and the unstable security situation throughout the country, including the capital N?Djamena, before making travel plans. The Government of Chad declared a State of Emergency on November 13, 2006, in response to inter-ethnic violence and rebel activity throughout the country, especially in the east. In December of 2006, the State of Emergency was extended for a period of six months, and has not been lifted. The State of Emergency covers the eastern regions of Ouaddai, Wadi Fira, and Salamat, as well as the regions of Hadjer-Lamis, Bourkou-Ennedi-Tibesti (BET), Moyen Chari, Mondoul, and the capital city of N?Djamena. The Government continues to censor the independent media on occasion, and American journalists traveling to Chad should ensure all required permits and authorizations are obtained before their arrival.
American citizens should exercise caution when traveling in Chad, including within N?Djamena. Since February 2007, there has been an increase in violent crimes and serious security incidents, some involving Chadian security forces (police, military, and gendarmes), and expatriates. American citizens should continue to expect increased police and military patrols around the capital. The Chadian government has introduced travel restrictions outside N?Djamena at various points during the State of Emergency, and may continue to do so, particularly in eastern Chad. American citizens not affiliated with humanitarian relief efforts should avoid travel to eastern Chad and the Chad/Central African Republic border.
American citizens should avoid crowds, political rallies, street demonstrations, and government installations, including the Presidential Palace, which is across from the Parade Grounds. Vehicles should never stop in front of the Presidential Palace. When traveling anywhere in Chad, American citizens should travel in groups, keep a cell phone(for use when service is available) or two-way radio in reach at all times, avoid travel after dusk, and leave detailed travel plans with a reliable point of contact. American citizens traveling with Thurarya satellite phones should register the phones with Chadian authorities.
Reports indicate an increase in the number of ?couper de routes?, or highway banditry incidents, across the country. Some American citizens have reported harassment at Chadian government roadway checkpoints. American citizens are urged to carry all necessary travel documents, including valid passports and visas, and any specific documents required for travel within the country. American citizens who encounter problems at these checkpoints should contact the U.S. Embassy (See below for contact details).
Since 2006, clashes between Government forces and anti-government rebel groups occurred primarily in the east of Chad but on one occasion reached as far as the capital. There is a potential for further clashes between rebel movements and government forces in eastern and southeastern Chad and possibly closer to N?Djamena. In the east, there are continued reports of cross-border banditry and United Nations (UN) and Non-Governmental Organizations (NGO) vehicles have been targeted for carjacking. At least one foreigner has been critically injured as a result of a carjacking, and another expatriate was seriously wounded during an armed robbery at an NGO compound in 2006. U.S. citizens affiliated with humanitarian relief efforts in eastern Chad are strongly urged to coordinate travel plans with UN High Commissioner for Refugees (UNHCR) security offices in Abeche and N?Djamena, and to follow UNHCR guidance regarding safety and security. The government of Chad requires all individuals traveling to or residing in refugee-affected areas in eastern Chad to obtain permits issued by the Ministry of Territorial Administration in N?Djamena, and to register in Abeche upon arrival in eastern Chad.
American citizens who intend to enter Sudan from Chad despite the Department's Travel Warnings for both countries must obtain the appropriate visas and permits in advance of entry into Sudan. In August 2006, five foreigners, including two Americans, were arrested and detained in Darfur after entering Sudan via the Chadian border town of Bahai without the appropriate documentation. Several of these individuals had solicited and obtained escorts in Chad who allegedly promised to facilitate entry into Sudan, but who were ultimately unable to follow through with their commitments. Further information is available in the Department's Travel Warning for Sudan.
In southern Sudan, along Chad's border with the Central African Republic (CAR), the situation is volatile, with over 50,000 refugees in Chad who have fled ongoing fighting in the CAR between northern Central African rebels and CAR forces. In the northern Tibesti region and the area north of Lake Chad, there have been occasional clashes between government forces and a rebel group known as the Chadian Movement for Justice and Democracy (MDJT).
American citizens traveling to or resident in Chad should register with the U.S. Embassy by completing a registration form on line at https://travelregistration.state.gov and provide contact information and specific travel data if traveling outside the capital. Americans without Internet access may register directly with the U.S. Embassy in N?Djamena. By registering, the Embassy is better able to contact American citizens in case of emergency and provide updates on the security situation as necessary. The U.S. Embassy is located in N?Djamena on Avenue Felix Ebou; mailing address B.P. 413; telephone (including after hours): (235) 51-62-11, 51-70-09, 51-77-59, 51-90-52, 51-92-18, and 51-92-33; fax (235) 51-56-54; web site http://usembassy.state.gov/ndjamena.
For additional information, consult the Department of State's latest Consular Information Sheet for Chad and the Worldwide Caution Public Announcement at http://travel.state.gov. American citizens may also obtain up-to-date information on security conditions by calling 
1-888-407-4747
toll free in the United States and Canada, or 1-202-501-4444 from overseas. 202-501-4444.
Routine Vaccinations
Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.
Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). See the schedule for adults and the schedule for infants and children. Some schedules can be accelerated for travel.
See your doctor at least 4-6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.
Recommended Vaccinations and Preventive Medications
The following vaccines may be recommended for your travel to Central Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.
* Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
* Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11-12 years who did not receive the series as infants.
* Malaria: your risk of malaria may be high in all countries in Central Africa, including cities. See your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications, see Malaria Information for Travelers to Central Africa.
* Meningococcal (meningitis), if you plan to visit countries in this region that experience epidemics of meningococcal disease during December through June, (see see Map 4-9 on the Meningoccocal Disease page).
* Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
* Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors
* Yellow fever, a viral disease that occurs primarily in sub-Saharan Africa and tropical South America, is transmitted to humans through the bite of infected mosquitoes. The virus is also present in Panama and Trinidad and Tobago. Yellow fever vaccination is recommended for travelers to endemic areas and may be required to cross certain international borders (For country specific requirements, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country.). Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.
* As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.
Required Vaccinations
* A certificate of yellow fever vaccination may be required for entry into certain countries in Central Africa. For detailed information, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country. Also, find the nearest authorized U.S. yellow fever vaccine center.
Risk can vary by country and region within a country; quality of in-country surveillance also varies.
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. Your risk of malaria may be high in all countries in Central Africa, including cities. All travelers to Central Africa, including infants, children, and former residents of Central Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below). All travelers should take one of the following drugs:
* atovaquone/proguanil,
* doxycycline,
* mefloquine, or
* primaquine (in special circumstances).
For additional information on malaria risk and prevention, see Malaria Information for Travelers to Central Africa.
Yellow Fever
A certificate of yellow fever vaccination may be required for entry into certain countries in Central Africa . For detailed information, see Comprehensive Yellow Fever Vaccination Requirements. Also, find the nearest authorized U.S. yellow fever vaccine center.
Food and Waterborne Diseases
Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.
Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Central Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage ( hepatitis).
Other Disease Risks
Dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. The risk for contracting African sleeping sickness (trypanosomiasis), which is caused by the bite of an infected tsetse fly, is high in northern Angola, Central African Republic, Cameroon, Chad, Congo, Democratic Republic of the Congo, and southern Sudan and there is significant risk of infection for travelers visiting or working in rural areas. Plague, an infectious disease of animals and humans caused by a bacterium, is present in wild rodent populations in rural areas of Africa. Ituri District in the Democratic Republic of the Congo is known to be one of the most active areas for plague worldwide. People usually get plague from being bitten by an infected rodent flea. Generally, the risk of plague infection for travelers is low, especially for persons staying in hotels in cities. A number of rickettsial infections also occur in this region. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection. Schistosomiasis, a parasitic infection, can be contracted in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. (For more information, please see Swimming and Recreational Water Precautions.) Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, HIV and hepatitis B.
Injuries
Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.
What You Need To Bring With You
* Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
* Insect repellent containing DEET.
* Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
* Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
* 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 for more detailed information.
* Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information.
* Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
* Always carry medications in their original containers, in your carry-on luggage.
* Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea. See suggested over-the-counter medications and first aid items for a travel kit.
* New security measures were implemented on August 10, 2006, regarding what passengers may carry onto the airplane. Up-to-date information may be obtained at the Transportation Security Administration's Guidance For Airline Passengers Fact Sheet and Frequently Asked Questions.
Travelers should take the following precautions
To stay healthy, do...
*When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.
Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.
* In developing countries, 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.
* Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
* To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
* Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
* Protect yourself from mosquito insect bites:
o Wear long-sleeved shirts, long pants, and hats when outdoors.
o Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.
o If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
o If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.
Do not
* Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
* Do not drink beverages with ice.
* Avoid dairy products, unless you know they have been pasteurized.
* Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis. (For more information, please see Swimming and Recreational Water Precautions.)
* Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas. For more information, please see Animal-Associated Hazards.
* Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.
* Avoid poultry farms, bird markets, and other places where live poultry is raised or kept.
If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguani or primaquine) 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 to1 year), you should seek immediate medical attention and should tell the physician your travel history.