Disease Risks and Precautions
in Central America and Mexico
The material
provided below is for informational purposes only.
It may not be current, and it should not be considered definitive.
All travelers
should check the Center for Disease Control (CDC) website
for the most current disease risk and disease prevention information.
DISEASES TRANSMITTED BY INSECTS
DISEASES TRANSMITTED THROUGH
FOOD AND WATER
DISEASES TRANSMITTED THROUGH
INTIMATE CONTACT
OTHER DISEASES
RECOMMENDATIONS FOR CENTRAL
AMERICA AND MEXICO
COUNTRIES IN REGION
Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico,
Nicaragua, Panama.
GENERAL PRECAUTIONS
Travelers to Mexico and Central America may be exposed to potential
diseases from a number of sources. The most frequently reported
illness is traveler's diarrhea, but there are other diseases which
are unique to Mexico and Central America or the tropics. These
diseases are transmitted by insects, contaminated food and water,
or close contact with infected people. Specific diseases are discussed
under each of these topical headings.
In order to reduce the risk of infection travelers must (1) protect
themselves from insects, (2) ensure the quality of their food
and drinking water, and (3) be knowledgeable about potential diseases
in the region to be visited. Finally, diseases are not restricted
to cleanly defined geographical areas, i.e. mosquitoes can fly
over city or country borders, therefore, all travelers should
protect themselves by taking the basic preventive precautions.
DISEASES TRANSMITTED BY INSECTS
Many diseases are transmitted through the bite of infected insects
such as mosquitoes, flies, fleas, ticks, and lice. In general
travelers must protect themselves from insect bites by wearing
proper clothing, using bednets, applying an insect repellent to
exposed skin and clothing, and if possible, avoiding high risk
situations, i.e. outdoor activities during night time hours from
dusk to dawn when mosquitoes bite, unscreened living accommodations,
etc. If a mosquito net is unlikely to be available, consideration
should be given to purchasing a portable mosquito net.
MALARIA
Risk: Malaria exists throughout the year in many parts of the
Mexico and Central American countries including some urban areas.
Belize: risk in the rural areas (including forest preserves and
offshore islands, including the resort areas), except no risk
in the central coastal District of Belize;
Costa Rica: limited risk in the rural areas, except no risk in
the central highlands (Cartago and San Jose Provinces);
El Salvador: risk in the rural areas only;
Guatemala: risk in the rural areas only, no risk in the central
highlands;
Honduras: risk in rural areas only;
Mexico: Risk exists in some rural areas of the following states:
Oaxaca, Chiapas, Guerrero, Campeche, Quintana Roo, Sinaloa, Michoacan,
Nayarit, Colima, and Tabasco. Travelers to the major resort areas
on the Mexican Gulf and Pacific Coasts need no drugs for malaria
prevention.
Nicaragua: risk in rural areas only, however, risk exists in outskirts
of Chinandega, Granada, Leon, Managua, Nandaime, and Tipitapa
towns;
Panama: risk in rural areas of the eastern provinces (Darien and
San Blas) and the northwestern provinces (Boca del Toro and Veraguas),
and around the Lake Boyana and Lake Gatun areas. There is no risk
in the Canal Zone, Panama City, or surrounding vicinity. Travelers
to Panama who will be visiting locations of malaria risk west
of the Canal Zone should take the preventive drug CHLOROQUINE.
Travelers visiting areas of risk to the east of the Canal Zone
(including San Blas Islands) should take MEFLOQUINE. P. falciparum
(the most dangerous type), resistant to the drug chloroquine,
has been reported in Panama, east of the Canal Zone.
Prevention: Most travelers to Mexico and Central America who are
at risk for malaria should take CHLOROQUINE to prevent malaria.
Travelers to Panama east of the Canal Zone and to the San Blas
Islands should take MEFLOQUINE to prevent malaria.
In addition to using drugs to prevent malaria, travelers should
use measures to reduce exposure to malaria-carrying mosquitoes,
and protect themselves from mosquito bites. These mosquitoes bite
mainly during the evening and night, from dusk to dawn.
YELLOW FEVER
Risk: Cases of yellow fever are rare for Mexico and Central American
countries. (Panama was the last to report a case). .
Prevention: In general, if you are traveling to an area of risk,
the easiest and safest thing to do is to get a yellow fever vaccination
and a signed certificate. Yellow fever vaccination, a one dose
shot, may be administered to adults and children over 9 months
of age. The vaccine is not recommended for persons who are pregnant
or whose immune systems are not functioning normally. In addition
to the vaccine, travelers should use measures to reduce exposure
to mosquitoes, and protect themselves from mosquito bites. These
mosquitoes bite mainly during the evening and morning hours.
CDC recommends a yellow fever vaccination only if you are traveling
to areas of risk (Darien Province in Panama, tropical South America,or
Africa). (However, yellow fever vaccine is the ONLY vaccine that
may be officially required for entry into certain countries.)
Costa Rica has no yellow fever vaccination requirements.
Belize, El Salvador(age 6 months), Guatemala, Honduras, Mexico
(age 6 months), and Nicaragua, require a yellow fever vaccination
for all travelers (Age > 1) arriving from all "Infected
Countries".
Countries where yellow fever infection occurs are found in tropical
South America, and East, West, and Central Africa.
Yellow Fever Certificate: After immunization an International
Certificate of Vaccination is issued and is valid 10 days after
vaccination to meet entry and exit requirements for all countries.
The Certificate is good for 10 years. You must take the certificate
with you.
DENGUE FEVER
Risk: Dengue fever occurs naturally in Mexico and Central America.
Recent epidemics occurred in Belize, El Salvador, Guatemala, Honduras,
Mexico, and Nicaragua. The risk of infection is small for most
travelers except during periods of epidemic transmission.
Prevention: There is no vaccine for dengue fever therefore the
traveler should avoid mosquito bites. These mosquitoes bite mainly
in the daytime.
OTHER INSECT DISEASES
Risks: Other diseases spread by mosquitoes, sand flies, black
flies, or other insects are prevalent, especially in rural areas.
These diseases include: Filariasis (mosquito), leishmaniasis (sandfly),
Onchocerciasis (blackflies), Trypanosomiasis, American Chagas'
Disease ("cone nose or kissing" bug), Oropouche Virus
(gnats or midges), typhus (lice), and Plague (fleas).
PREVENTING INSECT BITES
To reduce mosquito bites travelers should remain in well-screened
areas, use mosquito nets, and wear clothes that cover most of
the body. Travelers should also take insect repellent with them
to use on any exposed areas of the skin. The most effective repellent
is DEET (N,N-diethyl meta-toluamide) an ingredient in most insect
repellents. Travelers should also purchase a flying insect-killing
spray to use in living and sleeping areas during the evening and
night. For greater protection clothing and bednets can be soaked
in or sprayed with PERMETHRIN, which is an insect repellent licensed
for use on clothing. If applied according to the directions, permethrin
will repel insects
from clothing for several weeks.
DISEASES TRANSMITTED THROUGH FOOD AND
WATER
Food and waterborne diseases are the number one cause of illness
to travelers and are very common in South East Asia. Traveler's
diarrhea is the most frequent health problem for travelers. It
can be caused by viruses, bacteria, or parasites which are found
universally throughout the region.Transmission is most often through
contaminated food or water. Infections cause diarrhea and vomiting
(typhoid fever, cholera, and parasites), liver damage (hepatitis),
or muscle paralysis (polio).
CHOLERA
Risk: A recent epidemic of cholera has swept through the entire
Central American area. The majority of cases have been reported
from Peru, Ecuador, Colombia, Guatemala, and Mexico. Cholera has
been reported in coastal cities and inland areas of most of these
countries. Cholera has also been reported in Cuzco in Peru and
in the Galapagos Islands of Ecuador. Other countries to report
cases include Argentina, Belize, Bolivia, Brazil, Chile, Costa
Rica, El Salvador, French Guiana, Guyana, Honduras, Nicaragua,
Panama, Suriname, and Venezuela. Bolivia has reported cases from
the departments of Oruro and La Paz. Cholera has been reported
from five states in Brazil: Amazonas, Mato Grosso, Rondonia, Amapa,
and Para. Several municipalities near the mouth of the Amazon
River have been affected. Cholera cases were first recognized
in Peru in the last week of January 1991. Cholera has been reported
in a small number of U.S. residents traveling to Peru and Ecuador.
The risk of infection to the U. S. traveler is very low, especially
those that are following the usual tourist itineraries and staying
in standard accommodations. Travelers should consider the vaccine
if they have any problems with their stomach, such as anti-acid
therapy, ulcers, or if they will be living in less than sanitary
conditions in areas of high cholera activity.
Prevention: Travelers to cholera infected areas should follow
the standard food and water precautions of eating only thoroughly
cooked food, peeling their own fruit, and drinking either boiled
water, bottled carbonated water, or bottled carbonated soft drinks.
Persons with severe cases respond well to simple fluid and electrolyte-replacement
therapy, but medical attention must
be sought quickly when cholera is suspected. The available vaccine
is only 50% effective in reducing the illness, and is not recommended
routinely for travelers.
TYPHOID FEVER
Risk: Travelers to Mexico and Central America are at risk for
typhoid fever, especially when traveling to smaller cities, villages,
or rural areas. Typhoid fever is more common in Mexico.
Prevention: By drinking only bottled or boiled water and eating
only thoroughly cooked food, a traveler lowers the risk of infection.
Currently available vaccines have been shown to protect 70- 90%
of the recipients. Therefore, even vaccinated travelers should
be cautious in selecting their food and water. Two available vaccines
provide equivalent protection against typhoid fever- oral and
injectable.
Recommendations: CDC recommends a typhoid vaccination for those
travelers who are going off the usual tourist itineraries, traveling
to smaller cities and rural areas, or staying long term, that
is, a traveler for six weeks or more. Typhoid vaccination is not
required for international travel.
HEPATITIS A
Risk: Travelers are at high risk for Hepatitis A, especially if
travel plans include visiting rural areas and extensive travel
in the countryside, frequent close contact with local persons,
or eating in settings of poor sanitation. A study has shown that
many cases of travel-related hepatitis A occur in travelers to
developing countries with "standard" itineraries, accommodations,
and food consumption behaviors.
Prevention: The virus is inactivated by boiling or cooking to
85 degrees centigrade for one minute, therefore eating thoroughly
cooked foods and drinking only treated water serve as general
precautions. Havrix, the hepatitis A vaccine currently licensed
for use in the U.S., or immune globulin (IG) is recommended before
travel for persons 2 years of age orolder. Hepatitis A vaccine
is preferred for persons who plan to travel repeatedly or reside
for long periods of time in intermediate or high risk areas.
Recommendations: CDC recommends hepatitis A vaccine or IG for
protection against hepatitis A. Immune globulin should be used
for travelers < 2 years of age. Immune globulin is recommended
for persons of all ages who desire only short term protection.
PARASITES
Parasitic infections are acquired by eating or drinking contaminated
food or water, through direct contact with soil or water containing
parasites or their larva, or by contact with biting insects.
Symptoms and evidence of infection may include, but are not limited
to fever, swollen lymph nodes, rashes or itchy skin, digestive
problems such as abdominal pain or diarrhea, eye problems, and
anaemia.
Risk: Travelers to Mexico and Central America are at risk of parasitic
infections. There are many types of parasites and infection may
occur in several ways: by eating undercooked meats infected with
parasites or their larva; by eating food or drinking water contaminated
with parasites or their eggs; by contact with soil or water infected
with parasites; or through insect bites. Several types of parasites
can penetrate intact skin and travelers are advised to wear shoes
and avoid swimming, wading, or washing in fresh water.
Prevention: Travelers should eat only thoroughly cooked food,
drink safe water, wear shoes, refrain from swimming in fresh water,
and avoid contact with insects, particularly mosquitoes, biting
flies, gnats, and midges.
DISEASES TRANSMITTED THROUGH INTIMATE
CONTACT
HIV / AIDS
Risk: AIDS is found throughout the region. In Mexico and Central
America, heterosexual transmission is now the predominant mode
of transmission, and there are high numbers of HIV-positive injecting
drug users. The risk to a traveler depends on whether the traveler
will be involved in sexual or needle-sharing contact with a person
who is infected with HIV. Receipt of unscreened blood for transfusion
poses a risk for HIV infection.
Prevention: No effective vaccine has been developed for HIV. Travelers
should avoid sexual or needle-sharing contact with a person who
is infected with HIV. If a blood transfusion is necessary, screened
blood should be from an HIV-negative blood donor.
Recommendations: Travelers should avoid activities known to carry
risks for infection with HIV.
HEPATITIS B
Risk: The risk of Hepatitis B virus infection is modrate for Mexico
and Central America. The risk to the individual international
traveler is determined by the extent of: (1) direct contact with
blood or other body fluids, etc.; (2) intimate sexual contact
with an infected person; (3) the duration of travel.
Prevention: The primary prevention consists of either vaccination
and/or reducing intimate contact with those suspected of being
infected. For those travelers expecting to reside in countries
of high risk, as well as all health workers, vaccination is strongly
recommended. Vaccination should
ideally begin 6 months before travel.
Recommendations: CDC recommends vaccination for any of the following
people: any health care worker (medical, dental, or laboratory)
whose activities might result in blood exposure; any traveler
who may have intimate sexual contact with the local population;
any long-term (6 months or more) traveler, e.g. teachers, who
will reside in rural areas or have daily physical contact with
the local population; or any traveler who is likely to seek either
medical, dental, or other treatment in local facilities during
their stay. Hepatitis B vaccination is not required for travel
to any country.
OTHER DISEASES
RABIES
Risk: For most countries in Mexico and Central America, there
is a risk of rabies infection particularly in rural areas, or
in areas where large numbers of dogs are found.
Prevention: Do not handle any animals! Any animal bite should
receive prompt attention. When wounds are thoroughly cleaned with
large amounts of soap and water, the risk of rabies infection
is reduced. Exposed individuals should receive prompt medical
attention and advice on post-exposure preventive treatment.
Recommendations: There are no requirements for vaccination, but
pre-exposure vaccination is recommended for:
- travelers visiting, for more than 30 days, foreign areas where
rabies is known to exist;
- veterinarians and animal handlers;
- spelunkers; and
- certain laboratory workers.
Pre-exposure vaccination does not nullify the need for post exposure
vaccine, but reduces the number of injections.
Recommendations for MEXICO AND CENTRAL
AMERICA
Travelers should (1) take appropriate country specific malaria
prevention measures (mefloquine, doxycycline, or chloroquine),
(2) follow precautions to prevent insect bites, (3) pay attention
to the quality of their drinking water and food, (4) have a dose
of Immune Globulin (IG) or the Hepatitis A vaccine, and (5) consider
booster doses of tetanus (Td) and polio (eIPV) vaccines. (6) Depending
on the locations to be visited, planned activities, and health
of the traveler, the following vaccines should be considered:
Hepatitis B, Japanese Encephalitis, Typhoid, Rabies (pre-exposure),
and Cholera. (7) Finally, the normal "childhood" vaccines
should be up-to-date: Measles, Mumps, Rubella (MMR Vaccine); Diphtheria,
Tetanus, Pertussis (DTP Vaccine) [ < 7 years of age], and Polio
vaccine.
Disease risks and precautions