This Travel Warning (August 9, 2007) is being reissued to alert Americans of heightened security concerns as a result of fighting between rebels and government forces in the north prefectures of the country. It supersedes the travel warning for the Central African Republic issued March 6, 2007.
American citizens are strongly advised not to travel to the Central African Republic (CAR) until further notice. Active rebel movements are still present in the northern regions of the country. In the northwestern prefectures of Ouham and Ouham-Pende, roadblocks by rebels and by government forces pose a serious and continuing threat to aid workers and travelers. Fighting between rebels and government forces has forced much of the population near the town of Ngaounday to flee into neighboring Cameroon and Chad. An expatriate aid worker was killed in an attack on a well-marked vehicle north of Bocaranga in June 2007.
U.S.-sponsored development and aid work in the northwest area has been temporarily suspended, and U.S. Government employees on temporary duty and other contract visitors to the Mission will not be allowed to visit the northwestern or northeastern CAR prefectures without specific authorization of the Chief of Mission.
Rebels and armed men are also present in the northeastern Vakaga prefecture, and pose a threat to travelers in that area. The rebels wish to overthrow the constitutionally-elected president and seek new elections, and continue to pose a threat to travelers despite recent tentative steps in the peace process.
In addition, highway bandits (?coupeurs de route? in French) pose a serious threat to travelers throughout the country. Two World Health Organization physicians were murdered by unidentified assailants outside Bossembélé in April 2006. There have been repeated attacks on Central African and expatriate travelers on the Berberati-Carnot-Baoro-Bouar-Bozoum axis. The U.S. Embassy in Bangui strongly discourages American citizens, including aid, development, and religious workers, from traveling on these roads at any time of day or night.
Poachers and armed men also pose a threat to game hunters in the north central CAR, in and around the ?Parc National de Bamingui-Bangoran.? A French hunter was murdered in a targeted attack on a hunting party that included an American outside the town of Ndélé in April 2007. The poachers in this area are heavily armed, often with automatic weapons, and outside local and national government authority.
The Central African government is unable to guarantee the safety of visitors in most parts of the country. The U.S. Embassy advises its personnel to exercise caution in traveling to all parts of the country. In addition to the above warnings, the Embassy recommends that Americans traveling outside the capital not travel with a CAR military escort, or any armed escort, as the armed escort may draw fire from rebel troops.
U.S. citizens already in the Central African Republic should contact the American Embassy in Bangui to verify their locations and contact points. They should avoid travel outside the capital unless absolutely necessary and exercise caution at all times, particularly at public gatherings. U.S. citizens are advised to avoid the area around the Presidential Palace in Bangui and to exercise caution if they encounter presidential guards. The presidential guards have various checkpoints around the Palace and have harassed official personnel driving in that area.
There are approximately 300 peacekeeping troops from neighboring member countries of the Economic and Monetary Union of Central Africa (CEMAC) that move in and out of the capital. CAR security forces, sometimes with French military assistance, staff checkpoints throughout the city. Some crimes are perpetrated by uniformed CAR security and military personnel. In particular, military elements charged with presidential security are likely to be aggressive and belligerent. Activities of the Presidential Guard throughout the CAR indicate that they operate with near-total impunity.
The U.S. Embassy in Bangui has just three American officers and can provide only limited emergency services to U.S. citizens at this time.
U.S. citizens in the CAR are strongly urged to register on the State Department's web site at https://travelregistration.state.gov. Americans without Internet access may register directly with the U.S. Embassy in Bangui. By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy in the CAR is located at Avenue David Dacko, B.P. 924, Bangui; tel. (236) 61-02-00; fax (236) 61-44-94. For additional information on safety and security in the CAR, contact the Consular Section of the U.S. Embassy in Yaounde, Cameroon, at telephone 
(237) 220-1500
, fax (237) 220-1572; web site http://yaounde.usembassy.gov/. Americans may also obtain updated information from the American Embassy in N'djamena, Chad, at telephone (235) 51-70-09, 51-92-33 or 51-90-52; fax (235) 51-56-54; web site http://ndjamena.usembassy.gov/.
U.S. citizens should also consult the Department of State's most recent Consular Information Sheet for Central African Republic and the Worldwide Caution Public Announcement, which are located on the Department's web site at http://travel.state.gov. Up-to-date information on safety and security is also available at 
1-888-407-4747 toll free in the U.S. and Canada, or for callers from other countries, on a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
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.