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Iran

Health & safety

Before you go

A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. See your dentist before a long trip; carry a spare pair of contact lenses and glasses (and take your optical prescription with you); and carry a first-aid kit.

It’s tempting to leave it all to the last minute – don’t! Many vaccines don’t ensure immunity for two weeks, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received. While yellow fever is not a problem in Iran, if you’re arriving from a country where it is a problem you might be asked to show proof of yellow fever vaccination before you’re allowed in.

Travellers can register with the International Association for Medical Advice to Travellers (IAMAT; www.iamat.org). Its website can help travellers to find a doctor with recognised training. Those heading off to very remote areas may like to do a first-aid course (Red Cross and St John Ambulance can help), or attend a remote medicine first-aid course such as that offered by the Royal Geographical Society (www.rgs.org).

Bring medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.

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Insurance

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures (in many countries doctors expect payment in cash); it’s also worth ensuring your travel insurance will cover repatriation home or to better medical facilities elsewhere. Your insurance company might be able to locate the nearest source of medical help, but it’s probably faster to ask your hotel or, in an emergency, call your embassy or consulate. Travel insurance usually covers emergency dental treatment. Not all insurance covers emergency aeromedical evacuation home or to a hospital in a major city, which may be the only way to get medical attention for a serious emergency.

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Recommended vaccinations

The World Health Organization recommends that all travellers regardless of the region they are travelling in should be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as hepatitis B. While making preparations to travel, take the opportunity to ensure that all of your routine vaccination cover is complete. However, in Iran outbreaks are rare.

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Medical checklist

Following is a list of other items you should consider packing in your medical kit.

Acetaminophen/paracetamol (Tylenol) or aspirin

Adhesive or paper tape

Antibacterial ointment (eg Bactroban) for cuts and abrasions

Antibiotics (if travelling off the beaten track)

Antidiarrhoeal drugs (eg loperamide)

Anti-inflammatory drugs (eg ibuprofen)

Antihistamines (for hay fever and allergic reactions)

Bandages, gauze, gauze rolls

DEET – containing insect repellent for the skin

Iodine tablets (for water purification)

Oral rehydration salts

Permethrin – containing insect spray for clothing, tents, and bed nets

Pocket knife

Scissors, safety pins, tweezers

Steroid cream or cortisone (allergic rashes)

Sun block

Syringes and sterile needles (if travelling to remote areas)

Thermometer

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Internet resources

There is a wealth of travel health advice on the internet. The World Health Organization (www.who.int/ith) publishes a superb book, International Travel and Health, which is revised annually and is available online at no cost. MD Travel Health (www.mdtravelhealth.com) provides complete travel health recommendations for every country, updated daily and free. The Centers for Disease Control and Prevention website (www.cdc.gov) is also useful.

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Further reading

Lonely Planet’s Travel With Children is packed with useful information including pretrip planning, emergency first aid, immunisation and disease information and what to do if you get sick on the road.

Other recommended references include Traveller’s Health by Dr Richard Dawood (Oxford University Press), International Travel Health Guide by Stuart R. Rose, MD (Travel Medicine Inc) and The Travellers’ Good Health Guide by Ted Lankester (Sheldon Press).

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Dangers & annoyances

Earthquakes

Earthquakes happen every day in Iran, but most travellers will never feel one. If you are unlucky enough to be in the wrong place when a big quake strikes, the following precautions might help.

The greatest danger is from falling debris, so if you’re indoors stay inside and try to take cover under a sturdy desk, table or other furniture. Hold on to it and be prepared to move with it. Hold the position until the shaking stops and you can move to a clear area outside. Stay clear of windows, appliances and heavy furniture (such as freestanding wardrobes) that might fall over. In a hotel room, use the pillow to protect your head.

In a mud-brick building it’s important to create space (under a bed, perhaps) that won’t be filled with dirt and dust, which could lead to suffocation – which was the primary cause of death in Bam.

If you’re outside, get into the open, away from buildings and power lines.

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Bogus police

The most notable of Iran’s mercifully few organised scams is the bogus police sting. The good news is that a concerted effort by police, particularly in Tehran and Esfahan, has largely ended the problem. Still, it pays to be aware… The usual procedure is for men in plain clothes and an unmarked car to pull up beside you, say ‘police’ and ask to see your passport or for you to hand over your bag/camera. The usual motive is theft of passports, cameras or money. The best advice it to ignore the ‘policemen’ and they’ll probably leave. If they are real police they will take you to the station or your hotel, otherwise they will eventually disappear. Never hand over your passport or anything else to un-uniformed officers until you are at one of these places.

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In transit

Deep Vein Thrombosis (DVT)

Deep vein thrombosis occurs when blood clots form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.

The chief symptom of DVT is swelling or pain of the foot, ankle, or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and breathing difficulty. If this happens to you seek medical attention. To prevent DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol and tobacco.

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Jet lag & motion sickness

Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger, which some people swear by.

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While you're there

Availability & cost of health care

There are few, if any, reciprocal medical arrangements between Iran and other countries so be prepared to pay for all your medical and dental treatment. The good news is that costs are negligible. The quality of hospitals varies from place to place, but in Tehran, Esfahan and Shiraz, in particular, you’ll find international-standard hospitals and well-trained doctors.

But, seriously, medical care is not always readily available outside major cities. Medicine, and even sterile dressings or intravenous fluids, may need to be bought from a local pharmacy. Nursing care may be limited or rudimentary as this is something families and friends are expected to provide. The travel assistance provided by your insurance may be able to locate the nearest source of medical help, otherwise ask at your hotel. In an emergency contact your embassy or consulate.

Standards of dental care are variable and there is an increased risk of hepatitis B transmission via poorly sterilised equipment. Travel insurance usually only covers emergency dental treatment.

For minor illnesses such as diarrhoea, pharmacists can often provide advice and sell over-the-counter medication. They can also advise when more specialised help is needed.

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Diphtheria

Diphtheria is spread through close respiratory contact. It causes a high temperature and severe sore throat. Sometimes a membrane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years.

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Hepatitis A

Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, can cause prolonged lethargy and delayed recovery. Symptoms include dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year while a booster 12 months later will provide a subsequent 10 years of protection. Hepatitis A and typhoid vaccines can also be given as a single dose vaccine, hepatyrix or viatim.

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Hepatitis B

Infected blood, contaminated needles and sexual intercourse can all transmit hepatitis B. It can cause jaundice, and affects the liver, occasionally causing liver failure. All travellers should make this a routine vaccination. (Many countries now give hepatitis B vaccination as part of routine childhood vaccination.) The vaccine is given singly, or at the same time as the hepatitis A vaccine (hepatyrix). A course will give protection for at least five years. It can be given over four weeks, or six months.

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HIV

HIV remains mercifully rare in Iran but the growing use of prostitutes and, more problematically, the large number of intravenous drug users, means the HIV rate is rising. For some visa types Iran requires a negative HIV test.

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Leishmaniasis

Spread through the bite of an infected sand fly, leishmaniasis can cause a slowly growing skin lump or ulcer. It may develop into a serious life-threatening fever usually accompanied with anaemia and weight loss. Infected dogs are also carriers of the infection. Sand-fly bites should be avoided whenever possible.

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Malaria

There is very little malaria in Iran. Still, it’s worth knowing that malaria almost always starts with shivering, fever and sweating. Muscle pains, headache and vomiting are common. Symptoms may occur anywhere from a few days to three weeks after the infected mosquito bite. The illness can start while you are taking preventative tablets if they are not fully effective, and may also occur after you have finished taking your tablets.

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Poliomyelitis

Generally poliomyelitis is spread through contaminated food and water. It is one of the vaccines given in childhood and should be boosted every 10 years, either orally (a drop on the tongue), or as an injection. Polio may be carried asymptomatically, although it can cause a transient fever and, in rare cases, potentially permanent muscle weakness or paralysis.

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Rabies

Spread through bites or licks on broken skin from an infected animal, rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. Three injections are needed over a month. If you have not been vaccinated you will need a course of five injections starting within 24 hours or as soon as possible after the injury. Vaccination does not provide you with immunity; it merely buys you more time to seek appropriate medical help.

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Tuberculosis

Tuberculosis (TB) is found in Iran, especially in the southeast. TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population. It is more important for those planning on a long stay or mixing closely with local people. TB can be asymptomatic, although symptoms can include cough, weight loss or fever months or even years after exposure. An X-ray is the best way to confirm if you have TB. BCG gives a moderate degree of protection against TB. It causes a small permanent scar at the site of injection, and is usually only given in specialised chest clinics. As it’s a live vaccine it should not be given to pregnant women or immunocompromised individuals. The BCG vaccine is not available in all countries.

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Typhoid

This is spread through food or water that has been contaminated by infected human faeces. The first symptom is usually fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur. Typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available.

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Traveller’s diarrhoea

While water is safe to drink almost everywhere in Iran, avoiding tap water unless it has been boiled, filtered or chemically disinfected can help you avoid diarrhoea. Eat only fresh fruits or vegetables if cooked and avoid dairy products that might contain unpasteurised milk. Freshly prepared meals are best; while pre-prepared dishes like khoresht should be avoided by anyone with a fragile stomach.

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking, chills or severe abdominal pain you should seek medical attention.

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Insect bites & stings

Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitoes also spread dengue fever.

Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar.

Scorpions are frequently found in arid or dry climates. They can cause a painful bite, which is rarely life threatening.

Mercifully, Iran doesn’t seem to suffer too badly from bed bugs, though occasionally they do pop up (as opposed to appearing – who’s ever seen one of the critters?) in hostels and cheap hotels. They lead to very itchy, lumpy bites. Spraying dubious-looking mattress with insecticide will help get rid of them, or use a sleep sheet.

Scabies might also be found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.

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Snake bites

Your chances of getting bitten by a snake in Iran are microscopic. To make them even smaller, don’t stick your hand into holes or cracks. Half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site, firm pressure, similar to a bandage over a sprain. Do not apply a tourniquet, or cut or suck the bite. Get to medical help as soon as possible so that antivenin can be given if necessary.

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Water

Tap water is safe to drink in most of Iran, though many travellers stick to bottled water, which is widely available. Do not drink water from rivers or lakes as this may contain bacteria or viruses that can cause diarrhoea or vomiting.

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Women’s health

Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, remember some antibiotics, and diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy – remember to take condoms with you just in case.

Emergency contraception is most effective if taken within 24 hours after unprotected sex. Apart from condoms you should bring any contraception you will need. Tampons are almost impossible to find in Iran, but sanitary towels are available in cities.

Travelling during pregnancy is usually possible but there are important things to consider. Have a medical check-up before embarking on your trip. The most risky times for travel are during the first 12 weeks of pregnancy, when miscarriage is most likely, and after 30 weeks, when complications such as high blood pressure and premature delivery can occur. Most airlines will not accept a traveller after 28 to 32 weeks of pregnancy, and long-haul flights in the later stages can be very uncomfortable. Antenatal facilities vary between cities in Iran and there are major cultural and language differences. Taking written records of the pregnancy, including details of your blood group, are likely to be helpful if you need medical attention while away. Ensure your insurance policy covers pregnancy, delivery and postnatal care.

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