HEALTH AND VACCINATIONS
Safety and sanitary standards in Latin America are often not as high as those in Europe or North America. Health facilities are available, but these are often only rudimentary, especially those provided by the public services. In a number of countries, such as Brazil, private facilities are both modern and of an excellent standard, and many private doctors have had training in Europe or the United States. It is therefore essential that you take out comprehensive health insurance so you can make use of expensive private health care. In isolated places, there are few facilities of any kind, and if you are going to travel off the beaten track, you should take with you a well-equipped first-aid kit. Virtually all first aid posts, surgeries, health centers and hospitals now use only disposable needles which the staff will unwrap in front of you, so it is not necessary to come armed with a vast stock of these. Pharmacies in Latin America are well stocked and most products (even antibiotics) can be bought over the counter. Check the validity dates on the packaging.
Travelers should be aware of the risks of contracting Aids or Hepatitis B. High risk groups in Latin American countries include prostitutes and drug addicts, as in the rest of the world.
All the inoculations / vaccines you will need (with the common exception of Yellow Fever), are available from your local doctor or from a Travel Clinic (these centers will make a charge). Your doctor will normally require notice to acquire them.
Yellow Fever vaccinations are available at yellow fever vaccination clinics and occasionally at surgeries. There often appears to be a shortage of the Yellow Fever vaccine, so you should guard against this by having the vaccination as early as possible before travelling.
For the latest information on endemic diseases, like malaria, health outbreaks and vaccination requirements for Latin America you can check online.
Validity of recommended vaccines (correct at time of publishing).
Yellow Fever 10 years
Typhoid 3 years
Hepatitis A 10 – 20 years (depending on the vaccine)
Polio 10 years
Tetanus 10 years
Always carry with you your International Certificate of Vaccination, signed by a doctor and validated with an official stamp, as you may be required by local health authorities to prove that you have been inoculated against Yellow Fever. For Brazil, an international certificate of vaccination against Yellow Fever is essential for travelers who, within three months prior to their arrival in Brazil, have been to any of the following countries: Angola, Bolivia, Cameroon, Colombia, Ecuador, French Guyana, Gabon, Gambia, Ghana, Guinea Republic, Guyana, Liberia, Mali, Nigeria, Panama, Peru, Sudan, Suriname, Zaire.
A Yellow Fever vaccination is recommended for travelers visiting the following areas of Brazil: Carreiro in Amazonas, Macapá in Amapá, Mirador and Barra Corda in Maranhão, and Agua Azul do Norte, São Felix do Xingu and Tucumá in Pará. A valid certificate of vaccination against Yellow Fever is required for entry to Easter Island if, during the last 10 years, you have visited any country where Yellow Fever is present. An international certificate of vaccination against polio is necessary for children entering Brazil between the ages of three months and six years.
Traveler’s diarrhea can be caused by change of climate, water and food. You can reduce the risk of contracting it by drinking only bottled or sterilized water (never tap water), avoiding ice in drinks, fruit juices to which water has been added, peeling all fruit, not eating salad or seafood and avoiding ice-cream not of a recognized brand. If suffering from diarrhea, it is advisable to eat little but to drink plenty of clean water with mineral replacement supplements, or fizzy drinks (no fruit juice or milk). Rehydration products, such as Dioralyte, should be taken to replenish lost salts. If it does not clear up or is accompanied by a fever, you should seek medical advice as you may need to take a course of antibiotics. Take with you some anti-diarrhea tablets such as Lomotil or Imodium, but we don’t recommend these be used as a preventative.
Specific Regional Requirements
Malaria: If you are travelling to coastal and jungle regions within the tropics, you may enter infected zones and should take an appropriate prophylactic. Which anti-malarials to take depends on a number of variables, such as current illnesses and medication, previous illnesses, pregnancy, previous travel, duration of intended stay, so seek advice from your doctor or Health Centre before traveling. The best widely available repellent (in the UK) is the Jungle Formula range. The effectiveness of repellents depends on the percentage of diethyl toluamide (deet), the active ingredient. If you prefer something natural, Mosiguard can be very effective. Many other brands have only 10-15% deet and are therefore not very effective. Some repellents have up to a 95% concentration – this is very powerful and should not be used for long periods. It also has a deterious effect on leather, plastics and Lycra.
This is a guideline only. We strongly advise that you seek medical advice for individual recommendations on required drugs, doses and schedules.
Countries considered high risk
Bolivia. Risk is minimal in urban areas near to La Paz, Oruro and Potosi. However, rural areas below 2500m in the east of the country and for Amazon basin areas to the east of the Andes are classed as high risk.
Brazil. Risk is minimal along the South Eastern coast including the cities of Rio de Janeiro and Sao Paulo. However, the areas named “Legal Amazonia” (Acre, Amapa, Amazonas, W. Maranhão, N. Mato Grosso, Para, Rondônia, Roraima and Tocantins) are classed as high risk.
Colombia. Substantial risk throughout the year in all areas below 800m.(especially to the North around Cartagena and Santa Marta as well as Colombian Amazonia in the South East). However, the risk is minimal in the capital, Bogotá.
Guyana. Risk exists throughout inland regions including the North West and along the Pomeroon River at all times of year. Only Georgetown and New Amsterdam cities are transmission free.
Suriname. Risk from the malignant form is present throughout the year in the three Southern districts of the country. However, in Paramaribo City and other coastal regions the risk is minimal.
Venezuela. Risk throughout the year in the southern states and Southern and Western parts of Amazonas, Apure, Bolivar and delta Amacuro states. There is minimal risk in Caracas, Mérida, Margarita Island and in central coastal regions.
Countries considered medium risk
Costa Rica. Risk is mainly of the benign form and exists throughout the year in rural areas below 500m. A moderate risk exists along the Caribbean coast (excluding Tortuguero) as well as in the area of Los Chiles on the border with Nicaragua. Lower transmission risk exists in the North East province of Guanacaste, and the central provinces of Alajuela and Heredia.
Ecuador. Risk is present throughout the year in most areas below 1500m. It is mostly of the benign type. Malaria is not normally present in the Galapagos Islands or around Quito.
Panama. Main risk is in three provinces: Bocas de Toro in the West, Darien and San Blas in the East. Risk for those passing through the Panama Canal is low.
Peru. Risk is mainly from the benign forms and is present throughout the year mostly in areas below 1500m to the west of the Andes. This includes the surrounding lowland areas of Iquitos and Puerto Maldonado. Malignant malaria is present all along the Northern border of the country. Lima city is a no risk area.
Countries considered low risk
Argentina. Malaria, mainly of benign forms, is present in some far northern districts below 1200m between October and May. The risk is confined to rural areas along the borders with Bolivia and Paraguay. Buenos Aires is classified as no risk.
Belize. Risk is mainly of the benign form and is variable to low throughout the year in all rural areas. There is only minimal risk in the Belize City district.
El Salvador. Risk is mainly of the benign form and is present throughout the year in the Western Santa Ana province and in rural areas of migratory influence from Guatemala.
Guatemala. Risk is mainly of the benign form and is present in most areas below 1500m.
Honduras. Risk is mainly, but not exclusively, of the benign form and is present throughout the year including major cities.
Mexico. Risk is present throughout the year in rural areas (this includes some regions along the Western Pacific coast, most of the lowland Chiapas region as well as the Yucatan Peninsula). Mexico City is considered to be a no risk area.
Nicaragua. Risk is present from the benign forms throughout the year. The risk is less in the departments of Madriz, Carazo and Masaya.
Paraguay. Risk is mainly in the rural municipalities of Caaguazu, Alto Parana, Amambay and Canendiyu and along the borders with Bolivia.
Countries considered very low risk
Chile. Malaria is not normally present and no special precautions are needed.
Cuba. Malaria is not normally present and no special precautions are needed.
Uruguay. Malaria is not normally present and no special precautions are needed.
Please note that chloroquinE resistance has been reported in the following countries: Bolivia, Brazil, Colombia, Guyana and Ecuador.
Water-purifying tablets, e.g. Sterotabs, are a useful standby in the jungle – or when trekking off the beaten track but are ineffective against amoebae and give the water an unpleasant taste. Boiling water for 10 minutes will kill amoeba. Mineral water is available at most jungle lodges that we book from here. It is important to ensure that you have a high intake of liquids in tropical and semi-tropical regions. You should also be aware of the fact that the sun is much stronger than at temperate latitudes and sunstroke is a danger. Avoid midday sun on tropical beaches, especially in the summer. Take plenty of high factor sunscreen lotion and sun block.
Please see the country specific notes on malaria in the appendices.
Effects of altitude: At altitudes over 2500m you will probably start to feel breathless. Above 3000m, marked breathlessness, pins and needles and palpitations are a common response. A minority of people may experience dizziness, headache, slight nosebleed, nausea or vomiting. The likelihood of experiencing these symptoms can be minimized by slow ascent, resting upon arrival for at least a few hours, avoiding alcohol and eating lightly for a day or so. Local remedies are available. They include various local drugs and “maté de coca” (an infusion of coca leaves).
Please note that on no account should you attempt to bring these teabags back to the US, or across any border as they contain coca leaves which are prohibited.
Oxygen is available in good hotels and on trains, if necessary. Our advice is to take some of your usual headache pills with you and to simply take it easy. Should the symptoms be severe and prolonged, you must descend to a lower altitude. The thin, dry air at altitude also exposes travelers to the risk of sunburn, skin cracking, sore eyes and bunged-up noses. Wear a hat in direct sunlight and use high factor sun cream (minimum sun protection factor of 20). Some people prefer not to wear their contact lenses at altitude. There is also a marked difference in temperature between sun and shade at high altitudes.
Advice given in this dossier is intended solely for the purpose of providing general information. You should always seek the advice of a doctor before travelling.