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Health Information for Travelers to Sierra LeoneClinician View

Warning - Level 3, Avoid Nonessential Travel

CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of an unprecedented outbreak of Ebola.

Map - Sierra Leone

Vaccines and Medicines

Prepare travelers to Sierra Leone with recommendations for vaccines and medications.


  Recommendations Transmission Guidance
Routine vaccines

Recommended for all travelers


Immunization schedules

Hepatitis A

Recommended for most travelers, including those with "standard" itineraries and accommodations

Fecal-oral route (contaminated food and water)

Person-to-person contact

Hepatitis A (Yellow Book)

Dosing info

Hepatitis B

Consider for most travelers; recommended for those who might be exposed to blood or other body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).

Contact with blood and other body fluids:

  • Unprotected sex
  • Injection drug use
  • Contaminated transfusions
  • Exposure to human blood
  • Contaminated tattoo and piercing equipment

Hepatitis B (Yellow Book)

Dosing info


Antimalarials recommended unless contraindicated.

Bite of infected mosquito (female Anopheles)

Malaria (Yellow Book)

Considerations when choosing a drug for malaria prophylaxis (Yellow Book)

Malaria information for Sierra Leone.


Recommended for the following groups:

  • Travelers involved in outdoor and other activities that might bring them into direct contact with dogs, bats, and other mammals (such as campers, hikers, bikers, adventure travelers, and cavers).
  • Those with occupational risks (such as veterinarians, wildlife professionals, researchers).
  • Long-term travelers and expatriates.
  • Children, because they are considered at higher risk; consider lower threshold for vaccination.

Mammal bites (including dogs, bats, other carnivores)

Rabies (Yellow Book)


Recommended for most travelers, especially those who are staying with friends or relatives; visiting smaller cities, villages, or rural areas where exposure might occur through food or water; or prone to "adventurous eating"

Fecal-oral route (contaminated food and water)

Typhoid (Yellow Book)

Dosing info (Yellow Book)

Yellow Fever

Required for arriving travelers from all countries. (Updated Jan. 23, 2015)

Recommended for all travelers ≥9 months of age.

Bite of infected mosquitoes

Yellow Fever (Yellow Book)



Non-Vaccine-Preventable Diseases

The following diseases are possible risks your patients may face when traveling in Sierra Leone. This list is based on our best available surveillance data and risk assessment information at the time of posting. It is not a complete list of diseases that may be present in a destination. Risks may vary within different areas of a destination.


  Guidance Patient Education Notes


African Tick-Bite Fever
  • Although the disease is not confirmed in Sierra Leone, the vector is present and surrounding countries do have the disease.
  • Increased risk:
    • game hunting
    • traveling to southern Africa
    • traveling during warmer months when the vector is more active

Mosquitoes carrying chikungunya bite during the day and night, both indoors and outdoors, and often live around buildings


Bloodborne & Direct Physical Contact


For information about the current outbreak of Ebola in West Africa, see the Ebola page.

HIV Infection
  • Risk for travelers generally low but determined more by behaviors than destination
  • High-risk travelers may consider preexposure prophylaxis
  • Health care workers should follow standard precautions and assess local availability of (or bring) reliable postexposure prophylaxis

Airborne & Droplet

Tuberculosis (TB)
  • Risk generally low for most tourist travelers
  • Those anticipating possible prolonged exposure to TB environments (such as working in hospitals, prisons, or homeless shelters) or those who stay for years in an endemic country should have a 2-step tuberculin skin test (TST) or a single interferon-γ release assay (IGRA) before leaving the US. If predeparture test is negative, a single TST or IGRA should be repeated 8–10 weeks upon return.



Patient Counseling

Counsel your patients on actions they can take on their trip to stay healthy and safe.

Eat and drink safely

Counsel travelers to be diligent about food and water precautions:

  • Avoid cooked food served at room temperature.
  • Avoid raw food, including raw vegetables unless they can be washed thoroughly.
  • Drink only beverages from sealed bottles or cans.
  • Water is safe if it has been boiled or chemically treated.
  • Avoid ice unless made from bottled/disinfected water.

Consider prescribing an antibiotic for self-treatment of travelers’ diarrhea, factoring in resistance issues at the destination.

Additional Resources

Food & Water Precautions (YB)
Water Disinfection for Travelers (YB)
Food Poisoning from Marine Toxins (YB)
Travelers’ Diarrhea (YB)
Persistent Travelers’ Diarrhea (YB)


Prevent bug bites

Counsel travelers to be diligent in insect precautions:

  • Cover exposed skin.
  • Use an appropriate insect repellent. (see below)
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Travelers can buy pre-treated clothing and gear or treat them at home. Treated clothing remains protective after multiple washings. Permethrin should NOT be used directly on skin.
  • Stay and sleep under in air-conditioned or screened rooms.
  • Use a bed net if sleeping area is exposed to the outdoors.
More Information on Insect Repellents

DEET (concentration of 20% or more) is the only insect repellent shown to be effective against ticks. However, several EPA-registered active ingredients provide reasonably long-lasting protection against mosquitoes:

  • DEET (chemical name: N,N-diethyl-m-toluamide or N,N-diethyl-3-methyl-benzamide): Concentrations above 50% show no additional protective benefit.
  • Picaridin (KBR 3023 [Bayrepel] and icaridin outside the United States; chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester): Must be reapplied more often than DEET.
  • Oil of lemon eucalyptus (OLE) or PMD (chemical name: para-menthane-3,8-diol), the synthesized version of OLE. “Pure” oil of lemon eucalyptus (essential oil) is not the same product; it has not undergone similar testing for safety and efficacy, is not registered with EPA as an insect repellent, and is not covered by this recommendation.
  • IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester).

Products with <10% active ingredient may offer only limited protection (1–2 hours).

Encourage patients to use repellents and reapply only as instructed. If sunscreen is also needed, they should apply sunscreen first and repellent second. Encourage them to follow package directions for using repellent on children and avoid applying to their hands, eyes, and mouth.

For more detailed information, visit the Yellow Book: Protection against Mosquitoes, Ticks, & Other Insects & Arthropods

Additional Resources

Stay safe outdoors

Advise travelers to exercise caution during outdoor activities. Important tips include dressing appropriately for the climate (such as loose, lightweight clothing in hot climates and warm layers in cold climates), staying hydrated, avoiding overexposure to the sun, and practicing safe swimming habits. To avoid infection while swimming, travelers should not swallow water when swimming and avoid contact with water that may be contaminated from poor sanitation.

Encourage travelers to learn basic first aid and CPR before travel, especially if they will be traveling to remote areas where medical assistance may not be accessible. Help them assemble a travel health kit.

Additional Resources:

Problems with Heat & Cold

Schistosomiasis is endemic in Sierra Leone. Travelers should avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.

Additional Resources

Map 3-14. Geographic distribution of schistosomiasis



Keep away from animals

Counsel travelers to be cautious around all animals.

  • Travelers should avoid touching, petting, handling, or feeding animals, including pets.
  • Arthropods such as spiders and scorpions can pose a stinging risk, and travelers should exercise care in environments where these creatures are likely to be present.
  • Stress the urgency of treating suspected and probable rabies infection by:
    • Washing the wound immediately with soap and clean water.
    • Seeking medical attention as soon as possible.
  • Travelers at risk for rabies should consider medical evacuation insurance, since postexposure prophylaxis may not be available at the destination.
Additional Resources

Animal-Associated Hazards (YB)
Rabies (YB)
Criteria for Preexposure Immunization for Rabies (YB)
Protection against Mosquitoes, Ticks, & Other Insects & Arthropods (YB)



Reduce your exposure to germs

People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.


Avoid sharing body fluids

Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.

Travelers should:

  • Use a latex condom correctly every time they engage in sex (vaginal, anal, and oral-genital).
  • Not inject drugs.
  • Limit alcohol consumption.
  • Not have tattoos, piercings, or other procedures that use needles (acupuncture) unless the needles are packaged new or sterilized.
  • Ensure that medical and dental equipment is sterile or disinfected if seeking care.
Additional Resources:
Hepatitis B (YB)
Hepatitis C (YB)
Medical Tourism (YB)


Know how to get medical care while traveling

Travelers should plan for how to obtain health care during their trip, should the need arise.

Discuss supplemental travel health insurance and medical evacuation insurance, and consider helping the traveler obtain an extra month of prescriptions for any needed medications.

Travelers may think they can find cheaper antimalarial drugs at their destination. To ensure medication quality, urge them to have their prescriptions filled in the United States.


Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

Most recommendations for safe transportation are basic and could be considered common sense. However, travelers often do not think about the importance of being aware and careful when walking, riding, driving, or flying.

In many places cars, buses, large trucks, rickshaws, bikes, pedestrians, and even animals share the same lanes of traffic, increasing the risk for crashes.

Counsel travelers to think about transportation options before they arrive, especially if they will be driving in Sierra Leone.

Medical Evacuation Insurance

If your patient is seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Encourage patients to purchase medical evacuation insurance.

Some basic reminders to review with your patients:

  • Choose safe vehicles and avoid motorbikes when possible.
  • Wear a seatbelt or a helmet at all times.
  • Do not drive after drinking alcohol or ride with someone who has been drinking.
  • Avoid driving at night; street lighting in certain parts of Sierra Leone may be poor.
  • If they will be driving, remind them to get any driving permits and insurance they may need. It is recommended to get an International Driving Permit (IDP).
  • Avoid using local, unscheduled aircraft, and fly on larger planes (more than 30 seats) when possible.
Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, Auto Insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.


Maintain personal security

Travelers should be reminded on how to protect their personal safety during travel, regardless of their destination. 

The US Department of State has an extensive website with safety information for international travelers, travel alerts and warnings, and country-specific information. Travelers should be directed to the Department of State resources for information and tips on safe travel.

Stay abreast of current events, particularly those that could pose a safety or health problem for travelers. You can also receive updates on new travel alerts and warnings from the US Department of State by subscribing to their RSS feeds.




Healthy Travel Packing List

Remind your patients to pack health and safety items. Use the Healthy Travel Packing List for Sierra Leone for a list of health-related items they should consider packing.



Travel Health Notices

Stay aware of current health issues in Sierra Leone in order to advise your patients on additional steps they may need to take to protect themselves.

Warning Level 3, Avoid Nonessential Travel

  • Ebola in Sierra Leone Updated January 06, 2015 CDC urges all US residents to avoid nonessential travel to Sierra Leone, Guinea, and Liberia because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick, because of the possibility they may be sick with Ebola. Read More >>



Advising Returning Travelers

Although some illnesses may begin during travel, others may occur weeks, months, or even years after return. A history of travel, particularly within the previous 6 months, should be part of the routine medical history for every ill patient. A newly returned, ill international traveler should be preferentially evaluated by a physician versed in travel-related illness.

Here are two professional medical organizations that provide directories of travel clinics throughout the United States:

Malaria is always a serious disease and may be a deadly illness. Any patient presenting with a fever after traveling in a malaria-risk area during the last year should be evaluated immediately using the appropriate diagnostic tests for malaria. Malaria, especially P. falciparum, requires urgent intervention as clinical deterioration can occur rapidly and unpredictably.

For more information on advising patients after international travel, see Yellow Book Chapter 5: Post-Travel Evaluation.


Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.

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