http://www.paho.org/English/HCP/HCT/malaria_PPTindex.htm
BELIZE: There is no risk of malaria in the centre of large towns. Malaria risk, nearly exclusively due to P. vivax, exists in all districts but varies within the different regions. Risk is high in the Toledo district and in Stan Creek, moderate in the Cayo district and low in the Belize District and the Corozal and Orange Walk districts. No resistant P. falciparum strains have been reported. During adventurous tours away from the centers of large towns and out in the countryside (especially in the southern part) there is a risk of malaria and the recommendations for the prevention of malaria discussed in NOTE 1 apply.
CARIBBEAN: There is no malaria risk at all, except in HAITI (more information below) and to a very limited extent in the DOMINICAN REPUBLIC & JAMAICA - Kingston (more information below).
COSTA RICA: There is no particular malaria risk in most areas of the country. There is no risk of malaria in areas above 500 m, nor in the towns. There is a moderate risk of malaria (almost exclusively the mild vivax-type) throughout the year in the province of Limón, with highest risk in the Matina district. Negligible to no risk of malaria transmission exists in the other cantons of the country. The recommendations discussed in NOTE 1 apply only for adventure tours in the countryside.
CUBA: There is no malaria risk.
DOMINICAN REPUBLIC: In most of the country there is no risk of malaria. There is a limited malaria risk in rural areas. No antimalaria measures are necessary for a well-organised tourist trip using first class hotels. The risk of malaria is higher in the provinces bordering Haiti (especially in the western provinces of Dajabon, Elias Pina and San Juan). Cases of Plasmodium falciparum malaria have sporadically occurred in the province of Altagracia, even with travellers staying in good hotels in Punta Cana. The measures for protection against mosquito bites in the evening and at night are recommended. Persons spending more hours outside the hotel zone after sunset or making inland excursions until late in the evenings can consider taking Nivaquine (NOTE 1). The recommendations discussed in NOTE 1 should be taken into account for adventurous tours in rural areas (for the whole country – but especially in the western border provinces). In case of fever after returning from the Dominican Republic, malaria should always be considered.
EL SALVADOR: There is practically no malaria risk in El Salvador any longer, and certainly not in the areas above 600 m, or in the large towns. Only in the remote areas of the Santa Ana Province, on the border with Guatemala, there
is a limited malaria risk (exclusively the mild vivax-malaria); the recommendations for prevention of malaria discussed in
NOTE 1 apply for adventure tours in the countryside. WHO: only the
measures against mosquitoes apply here.
GUATEMALA: There is no malaria risk in the capital, or in the areas above
1500 m. There is only a risk of malaria (especially due to the mild vivax-type
of malaria) in the low-lying rural areas (below 1500 m):
Moderate risk in the Escuintla and Izabal provinces, low risk
in Alta Verapaz, Baja Verapaz, Chiquimula, Petén, Quiché (Ixcan) and
Suchitepéquez.
The recommendations for the prevention of malaria discussed in NOTE 1 apply only for an adventure
tour in the rural areas of the northern border with Mexico and Belize (Petén).
HAITI: There is malaria risk (exclusively P. Falciparum malaria - the
dangerous form - with no resistance to Chloroquine until now) during the
whole year in the entire country, also in the coastal and border areas. The
risk is very low in the main urban quarters of Port-au-Prince. In these areas, it is necessary to take antimalaria precautions and tablets if you are staying overnight in primitive conditions - see
NOTE 1.
HONDURAS: There is no malaria risk in the large towns of Honduras. There
is a Plasmodium falciparum malaria risk (the dangerous type of malaria) in the rural areas of the Colón and
Gracias a Dios departments. The risk is lower in the Atlantida and Olancho
departments. In the rural areas of Gracias a Dios, there is high risk of P. vivax malaria (mild type of malaria); the risk is
moderate in the Atlantida, Colon, Islas de la Bahia, Olancho, Valle and Yoro departments.
The recommendations discussed in NOTE 1 apply for adventure tours to
the countryside. There is a minimal risk of malaria in the remaining areas.
The measures for protection
against mosquito bites in the evening and at night are sufficient here. In
case of fever malaria should always be considered.
JAMAICA: This is a temporary recommendation.
Since the end of 2006 there is a very limited risk of malaria in certain areas of
Kingston (St. Andrew Parish). The measures for protection against mosquito bites in the evening
and at night are recommended here. Persons spending more time outside of the
hotel zone after sunset or making inland excursions until late in the
evenings, may consider taking Nivaquine (NOTE 1). In case of fever
after returning from Jamaica, malaria should always be considered.
MEXICO: There is no malaria risk in the areas above 1000 m and none in the district of Mexico City. In
the tourist areas along the coast of Mexico, the risk of malaria is also non-existent.
For most of the tourist trips, there is no need to take antimalaria
tablets.
There is moderate risk of malaria (exclusively due to P. vivax) in
limited places in some rural areas of Chiapas & Oaxaca; there is very low
risk in Chihuahua, Durango, Nayarit, Quintana Roo and Sinaloa. For overnight stays in primitive conditions in the rural areas below
1000 m the recommendations discussed in NOTE 1 apply.
NICARAGUA: There is a risk of malaria the whole year (due to the mild type of
vivax malaria) in al number of provinces (the rural areas and also in the
suburbs of urban areas). The risk is moderate to high in the Chinandega,
Léon, Managua, Matagalpa, Region Autonoma del Atlantico Norte and Region Autonoma
del Atlantico Sur provinces. The recommendations for prevention of malaria discussed in NOTE 1 apply
for stays in primitive conditions. Sporadic cases have been reported in the other municipalities; but the risk
there is low to negligible.
PANAMA: There is no malaria risk in the capital Panama City, or in the Canal Zone.
There is a low malaria risk (99% the mild Plasmodium vivax type) in rural areas of the following provinces
the whole year and the recommendations for prevention of malaria apply only
for adventure trips.
1) West of the Panama Canal,
in the direction of Costa Rica (in the provinces of Bocas del Toro (Ngobe Bugle included),
Chiriqui, Veraguas,
the western part of Panama and Colon) the measures discussed in
NOTE 1 apply.
2) East of the Panama Canal, in the
direction of Colombia (in Darien,
San Blas (Embera and Kuna Yala included), the eastern part of Panama
and Colon) the measures discussed in
NOTE 2 apply.
Cloroquine resistant Plasmodium falciparum has been reported.
In the remaining provinces the risk is absent to very low.
WHO Yellow Fever vaccination recommendation: "Vaccination against
yellow fever is recommended for all travellers from the age of 9 months visiting the province of
Darien, the Kuna Yala region (old San Blas), East Panama (including the
districts of Chep, Chiman and Balboa). This does not include the City of
Panama, the Panama Canal area (old Canal Zone) nor the San Blas islands.
If you are travelling from another country where yellow fever can occur
(Africa, South America), vaccination is officially required.
Precautions against mosquito bites in the evenings and at night are always essential for protection against possible malaria. People visiting endemic malaria areas during the daytime and staying in reputable hotels in the evenings and overnight run no risk, and do not need to take antimalaria tablets. However, they should always have a mosquito repellent with them for application to the skin, in case they cannot get back to the hotel in time in the evening, due for example to problems such as illness, car breakdown etc. The mosquito repellent should also be generously applied when on a trip or safari in the early morning, in the evening or at night. When on adventure-type trips out in the countryside, with overnight stays in primitive conditions, it is also advisable to impregnate the mosquito net with permethrine or deltamethrine, a chemical substance that provides an extra mosquito-repellent and mosquitocidal effect. Taking antimalaria tablets is also necessary.
N.B. In many regions in Central America (http://www.dtg.org/21.0.html) one can dispense with the malaria tablets (also for adventurous travellers) after having an extensive talk with a specialized doctor who will evaluate the malaria risk depending on the type of lodging, and only when strict measures are taken against mosquito bites from dusk till dawn and malaria emergency treatment is available (Nivaquine®) with complete instructions.
| NOTE 1 |
| NIVAQUINE® 3 tablets per week, taken all in one dose, starting 1 week before departure and continuing until 4 weeks after returning home. |
| NOTE 2 |
| MALARONE® (1 tablet daily from 1 day before departure until 7 days after returning home)
OR DOXYCYCLINE (1 tablet daily from 1 day
before departure until 4 weeks after returning home;
in some cases a tolerance test during a few days is
necessary)
OR LARIAM® (1 tablet once a week, from a
few weeks before departure until 4 weeks after
returning home) are the first choice medication.
To have an effective level of LARIAM® in your blood on arrival in the malaria area, it is recommended to start taking this drug 2 to 3 weeks before departure. People who have never taken this medicine should start taking it at least 2 to 3 weeks beforehand to deal with possible side effects (dizziness, insomnia, nightmares, agitation, inexplicable anxiety, cardiac palpitations). Lariam will not be prescribed if the doctor thinks there are contraindications (pregnancy wish, epilepsy, depression, or cardiac rhythm disorders for which medications such as beta-blockers, calcium antagonists or digitalis are being taken), or if you did not tolerate this medication on an earlier occasion. You should continue to take the medication until 4 weeks after returning home. If Lariam® is well tolerated, it can if necessary be taken for many months or even years. For a short trip MALARONE® is an excellent choice. MALARONE can also be taken for several months but it is in that case an expensive choice. DOXYCYCLINE: 100 mg daily, to be taken the day before departure and continuing until 4 weeks after returning home. Doxycycline should be taken sitting down with plenty of liquid or during a meal. Doxycycline can sometimes give rise to phototoxicity and fungal infections of the mouth and genitals. Doxycycline can be taken for several months. All this should be discussed with your doctor or with the doctor at the travel advice centre. |
DIARRHOEA is a frequent travel problem. Even when travelling in good conditions, it is not always possible to avoid it. Some advice and the correct medication from the travel pharmacy are very useful. In any case consult the text on traveller’s diarrhoea where the measures for prevention and correct treatment of diarrhoea are discussed.
DENGUE
In Latin America dengue fever occurs. Prevention = apply protective measures against moquito bites during the day. Consult the text on dengue - www.travelhealth.be & consult the world card on www.who.int/ith ® "disease distribution maps".
- YELLOW FEVER vaccination is NOT required if you depart from Belgium, unless you are on a visit to the province of Darièn, the Kuna Yala region (the ancient San Blas), East Panama (Chepo, Chiman and Balboa districts included). This does not include Panama City and the Panama Canal region (the ancient Canal Zone). As many other countries regard Panama as a country where yellow fever currently occurs, our advice is that it is safer for every traveller to Panama to be vaccinated against yellow fever. You will thus avoid problems on entering other countries. However, if you are travelling from another country where yellow fever can occur (Africa, South America; see http://www.who.int/ith/en/index.html ® disease distribution maps), anyone over 1 year of age should certainly be vaccinated when going to Belize, Guatemala, Haiti, Honduras, Nicaragua and Panama; for El Salvador from the age of 6 months and for Costa Rica from the age of 9 months until 60 years (exemption for pregnant women, breast-feeding women and immunosuppressive persons).
- Going on a trip is furthermore the ideal opportunity to update the TETANUS, DIPHTHERIA and POLIO VACCINATIONS. These infectious diseases are in any case completely preventable by means of vaccination. A booster vaccination is effective for ten years. Concerning polio: one booster injection after 15 years is sufficient when the basic vaccination scheme has been administered during childhood or later in life (=3 doses on 0-2-12 months). This provides life-long immunization against the virus. The American continent has been free of polio for a number of years.
- Anyone travelling to Latin America, regardless of the duration and the circumstances of the trip, should be vaccinated against HEPATITIS A. Vaccination against TYPHOID is always recommended for people who are travelling in poor hygienic conditions, or who go abroad frequently or for long periods (e.g. for at least 2-3 weeks), even if in good hygienic conditions. Vaccination against HEPATITIS B is also recommended in a lot of cases. For further details see the general information on "VACCINATIONS".
-
People on adventure trips through the countryside lasting more than 4 weeks or people who will be staying there for a long time should consider vaccination against RABIES.
All this should be individually discussed with your doctor or with the doctor at a travel advice centre.
CHAGAS DISEASE (OR AMERICAN TRYPANOSOMIASIS)
Hikers travelling through rural areas in Latin America (except on the Caribbean) should be aware of the risk of infection caused by a single cell parasite, called Trypanosoma cruzi, and transmitted by large bugs. In these areas, travellers should certainly not stay the night in primitive huts or in the open air. If this is unavoidable, and also when staying in cheap hotels, you should always sleep under a mosquito net (and even better, put a sheet over the net to avoid contact with the falling faeces of the triatomes). It is best to use an insect spray if large insects are found in the room (mostly behind picture frames, in drawers or even under the mattress). You should also apply insect repellent to bare skin in the evening.