Travel Notices in Effect
Update: Dengue, Tropical and Subtropical Regions
2009 H1N1 Flu: Global Situation
Preparing for your Trip to Costa Rica
Before visiting Costa Rica, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)
To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.
Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.
CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.
If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.
Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.
Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.
Vaccine Preventable Diseases and Vaccines:
Routine: Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc.
Yellow Fever: CDC yellow fever vaccination recommendation for travelers to Panama: For all travelers ≥9 months of age traveling to the provinces of Darien, Kuna Yala (old San Blas), Comarca Emberá, and Panama east of the Canal Zone, EXCLUDING the Canal Zone, Panama City, and San Blas Islands Panama requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. Vaccination should be given 10 days before travel and at 10-year intervals if there is ongoing risk.
Hepatitis A: Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with “standard” tourist itineraries, accommodations, and food consumption behaviors.
Hepatitis B: Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
Typhoid: Recommended for all unvaccinated people traveling to or working in Mexico and Central America, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.
Malaria
Areas of Costa Rica with Malaria: Limon province, but not in Limon city (Puerto Limon). Rare cases in Puntarenas, Alajuela, Guanacaste, and Heredia provinces.
If you will be visiting an area of Costa Rica with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
• Taking a prescription antimalarial drug
• Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
• Sleeping in air-conditioned or well-screened rooms or using bednets
For Limon province in Costa Rica, primaquine is the preferred antimalarial drug (only after G6PD testing). Atovaquone/proguanil, chloroquine, doxycycline, and mefloquine are alternative choices. For all other provinces where there have been rare cases of malaria in Costa Rica, the risk of malaria is low and taking an antimalarial drug is not recommended.
Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites
Travelers to malaria risk-areas in Costa Rica, including infants, children, and former residents of Panama, should take one of the antimalarial drugs listed in the box above.
Malaria symptoms may include
• fever
• chills
• sweats
• headache
• body aches
• nausea and vomiting
• fatigue
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
Items to Bring with You
Medicines you may need:
• The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
• Antimalarial drugs, if traveling to a malaria-risk area in Panama and prescribed by your doctor.
• Medicine for diarrhea, usually over-the-counter.
Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.
Other items you may need:
• Iodine tablets and portable water filters to purify water if bottled water is not available.
• Sunblock and sunglasses for protection from harmful effects of UV sun rays. Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
• To prevent insect/mosquito bites, bring:
o Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
o Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas.
Staying Healthy During your Trip
Prevent Insect Bites
Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:
• Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
• Wearing long-sleeved shirts, long pants, and a hat outdoors.
• Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
• Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
• Spraying rooms with products effective against flying insects, such as those containing pyrethroid.
Prevent Animal Bites and Scratches
Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.
• Be sure you are up to date with tetanus vaccination.
• Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
• Help children stay safe by supervising them carefully around all animals.
• If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away.
• After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.
Be Careful about Food and Water
ADiseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:
• Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
• Do not eat food purchased from street vendors.
• Make sure food is fully cooked.
• Avoid dairy products, unless you know they have been pasteurized.
Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.
Avoid Injuries
Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:
• Not drinking and driving.
• Wearing your seat belt and using car seats or booster seats in the backseat for children.
• Following local traffic laws.
• Wearing helmets when you ride bikes, motorcycles, and motor bikes.
• Not getting on an overloaded bus or mini-bus.
• Hiring a local driver, when possible.
• Avoiding night driving.
After You Return Home
If you are not feeling well, you should see your doctor and mention that you have recently traveled. Also tell your doctor if you were bitten or scratched by an animal while traveling.
If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.
Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.
http://wwwnc.cdc.gov/travel/destinations/costa-rica.aspx
