Inoculation regulations can change at short notice. Please take medical advice in the case of doubt.

1
A yellow fever vaccination certificate is required from travellers over one year of age coming from infected areas.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is no longer a condition of entry to Djibouti. However, cholera is a serious risk in this country and precautions are essential. Up-to-date advice should be sought before deciding if these precautions should include vaccination as medical opinion is divided over its effectiveness. For more information, consult the Health appendix.

3
Immunisation against typhoid is usually advised.

4
Malaria risk, predominantly in the malignant falciparum form, exists throughout the year in the whole country. Resistance to chloroquine has been reported. Mefloquine, doxycycline or atovaquone/proguanil are recommended.

Food & drink
Mains water is normally heavily chlorinated and, whilst relatively safe, may cause mild abdominal upsets. Bottled water is available and is advised for the first few weeks of the stay. Drinking water outside main cities and towns is likely to be contaminated and sterilisation is considered essential. 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. It is advised not to buy food from street vendors. Vegetables should be cooked and fruit peeled.

Other risks
Diarrhoeal disease, giardiasis, dysentery and typhoid fever are widespread throughout the country. Onchocerciasis (river blindness) exists and cutaneous and visceral leishmaniasis may be found in drier areas. Human trypanosomiasis (sleeping sickness) is reported in certain locations. Bilharzia (schistosomiasis) is present. Travellers are advised to avoid swimming and paddling in fresh water; swimming pools which are well chlorinated and maintained are safe. It is recommended to avoid walking bare foot, even on beaches. Hepatitis A, B and E occur and precautions should be taken. Visitors should also consider immunisation against diphtheria. Meningococcal meningitis risk exists, depending on area and time of year.
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 insurance is advisable. Doctors and hospitals may expect immediate cash payment for any form of medical treatment.