The most common types of illnesses are caused by contaminated food and water. Drink only bottled, boiled, or purified water and drinks; don't drink from public fountains or use ice. You should even consider using bottled water to brush your teeth. Make sure food has been thoroughly cooked and is served to you fresh and hot; avoid vegetables and fruits that you haven't washed (in bottled or purified water) or peeled yourself.
Specific Issues in Moscow and St. Petersburg
A visit to Russia poses no special health risk, but the country's medical system is far below world standards, a fact you should consider if you have chronic medical conditions that may require treatment during your visit. There are, however, Western-style clinics in Moscow and St. Petersburg. Bear in mind that treatment at these clinics will be expensive unless you have traveler's health insurance. You should also purchase insurance that covers medical evacuation. Sometimes even minor conditions can’t be treated adequately because of the severe and chronic shortage of basic medicines and medical equipment. Tuberculosis is a serious problem in Russian prisons, but the short-term visitor to Russia needn't worry about infection.
You should drink only boiled or bottled water. The water supply in St. Petersburg contains giardia, an intestinal parasite that can cause diarrhea, stomach cramps, and nausea. The gestation period is two to three weeks, so symptoms usually develop after an infected traveler has already returned home. The condition is easily treatable, but be sure to let your doctor know that you may have been exposed to this parasite. Avoid ice cubes and use bottled water to brush your teeth, particularly in St. Petersburg. In Moscow and St. Petersburg, imported and domestic bottled water is widely available in shops. It's a good idea to buy a liter of this water whenever you can. Hotel floor attendants always have a samovar in their offices and will provide boiled water if asked. Many top-end hotels filter their water, but it's best to double-check with reception. Mild cases of traveler's diarrhea may respond to Imodium (known generically as loperamide) or Pepto-Bismol, both of which can be purchased over the counter. Drink plenty of purified water or tea—chamomile is a good folk remedy. In severe cases, rehydrate yourself with a salt-sugar solution—½ teaspoon salt and 4 tablespoons sugar per quart of water.
Fruits and vegetables served in restaurants are generally washed with purified water and are thus safe to eat. However, food poisoning is common in Russia, so be wary of dairy products and ice cream that may not be fresh. The pierogi (meat- or cabbage-filled pies) sold everywhere on the streets are cheap and tasty, but they can give you a nasty stomachache.
Shots and Medication
Foreigners traveling to Russia are often advised to get vaccinated against diphtheria—in the early 1990s, both Moscow and St. Petersburg had outbreaks of this disease, and cholera isn’t unknown either. These outbreaks are now rare, but in particular, children should be immunized against diphtheria, measles, mumps, rubella, and polio, as well as hepatitis A and typhus. A flu shot is also recommended for winter travel for people of all ages.
If you travel a lot internationally—particularly to developing nations—refer to the CDC's Health Information for International Travel (aka Traveler's Health Yellow Book). Information from it is posted on the CDC website ( wwwnc.cdc.gov/travel ), or you can buy a copy from a bookstore for $24.95.
National Centers for Disease Control and Prevention. 800/232–4636; www.cdc.gov/travel.
World Health Organization. www.who.int.
Just about everything is available in pharmacies without a prescription, and many pharmacies stock Western painkillers and cold medicines, which mostly come from Germany and France. If you can't find your favorite brand, just ask for either aspirin or Panadol, which is another brand name for acetaminophen, the active ingredient in Tylenol. However, there's a good chance of buying a counterfeit medicine as well. According to official statistics, up to 30% of the most popular drugs in Russian pharmacies are fake or made illegally with inadequate technology. Large chains—including 36.6, PetroFarm, Natur Produkt, Pharmacy Doctor, and Pervaya Pomoshch—as well as the pharmacies of international clinics are believed to be free of such fakes. The chains are also more likely to stock Western brands.