Immunizations
Required Vaccinations
No vaccinations are required to enter this country.
Recommended Vaccinations
Routine Immunizations
Your trip is a good occasion for a reminder to keep your routine immunizations updated; more than 80% of adults in developed countries have not maintained their immunization status. The following vaccinations are recommended for your protection and to prevent the spread of infectious diseases.
Tetanus-Diphtheria, Poliomyelitis, Measles, Mumps, Rubella should be reviewed and updated if necessary.
Seasonal influenza vaccine is recommended for children, persons over the age of 50, and those of any age suffering from chronic heart disease, emphysema, asthma, renal disorders, immuno-suppressive disorders, and organ transplant recipients. Note: Flu seasonal patterns are opposite in the southern and northern hemispheres. If the flu vaccine is not available at the time of departure, contact your doctor or travel health clinic regarding influenza anti-viral protection.
Pneumococcal vaccine is recommended for persons over the age of 65 and persons of any age suffering from cardiovascular disease, diabetes, renal disorders, liver diseases, sickle cell disease, asplenia, or immuno-suppressive disorders.
Hepatitis A
The Hepatitis A virus is primarily transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Prevention includes good personal hygiene, ensuring safe water supply, eating well cooked foods, and peeling your own fruits.
Vaccination is recommended for all travellers over one year of age. The vaccine is often combined with Hepatitis B and affords excellent long-term protection for both viral diseases.
Vaccination is highly recommended for persons going outside the areas usually visited by tourists such as travelling extensively in the interior of the country (trekkers, hikers) and for persons on long-term working assignments in remote areas.
Typhoid Fever
This intestinal infection, caused by Salmonella typhi bacteria, is transmitted from person to person primarily through ingestion of contaminated food and water in areas with poor sanitary and hygienic conditions. Prevention includes good personal hygiene such as washing your hands frequently, ensuring safe water supply, eating well cooked foods, and peeling your own fruits. Vaccination is also recommended for travellers' protection.
Vaccination is highly recommended for persons going outside the areas usually visited by tourists such as travelling extensively in the interior of the country (trekkers, hikers) and for persons on long-term working assignments in remote areas.
Selective Vaccinations
There are no selective vaccinations for this country.
The recommendations for vaccinations outlined above are intended as guidelines only. Your immunization needs depend on your health status, previous immunizations received, and your travel itinerary. Seek further advice from your doctor or travel health clinic.
Disease Risks
CHAGAS' DISEASE
Infection is spread by the Triatoma insect in rural and suburban areas of Mexico, Central America, and South America.
The entire country has been declared free of Chagas' disease transmission since 1999. Blood supply screening is mandatory.
Prevention Guidelines:
OTHER DISEASES OF INTEREST TO TRAVELLERS
Acute Mountain Sickness
Acute mountain sickness (AMS), also known as altitude illness, is a common condition above 2400 metres (8000 ft). It is especially common if you have not had a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). Your ascent should include rest days. If possible, increasing your sleeping altitude by more than 300-450 metres (1000-1500 feet) each night, should be avoided.
Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea.
You should not continue to ascend (especially to a higher altitude) if you have any persistent symptoms of altitude illness. If symptoms worsen and there is no improvement you should descend (at least 500 metres/1600 feet) to a lower altitude.
More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate onset of high-altitude cerebral edema (HACE) - recognized by confusion, difficulty with balance and co-ordination, staggering gait. Start treatment with medication and descend immediately. Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Descent combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE, or HAPE. Consider evacuation if necessary.
The use of medications may be helpful for preventing and treating altitude sickness. It is best to consult a physician prior to your departure for a high-altitude trip (climb).
Ojos del Salado (6870 metres/22539 feet) is the highest mountain in Chile and lies on the border between Chile and Argentina. Many ski resorts are over 3000 metres (9800 feet) in elevation. Tourists arriving in Quito (2800 metres/9350 feet) are at risk for altitude sickness as are tourists going to higher altitude destinations. Travellers should spend several days acclimatizing and avoiding strenuous activity.
Intestinal Parasites
Food-transmitted parasitic infections can be prevented by washing salads and/or vegetables or thoroughly cooking food to destroy infective eggs. Travellers should avoid raw or undercooked food that may be contaminated. Soil-transmitted infections may be avoided by not walking barefoot and not touching soil with bare hands.
Amoebiasis (amoebic dysentery) is a parasitic infection causing intestinal disease. Transmission occurs by eating food that is contaminated with feces from an infected person or drinking water containing amoebic cysts. Transmission also occurs sexually by fecal/oral contact. Infection rates are highest in areas where sanitation is poor.
Ancylostomiasis (hookworm, Necator americanus) is an intestinal parasite of humans. It causes mild diarrhea and abdominal pain. Humans can become infected by direct contact with contaminated soil, generally through walking barefoot, or accidentally swallowing contaminated soil. Do not walk barefoot or touch soil with bare hands where hookworm is common or where there may be fecal contamination of soil. Common in tropical and subtropical regions.
Angiostrongyliasis (roundworm) is a parasitic infection found mainly among people who eat snails, prawns, crabs, vegetables, contaminated by the mucous of infected slugs, land snails or aquatic snails.
Ascariasis (roundworm, Ascaris lumbricoides) is an intestinal helminthic disease. The primary route of infection is ingestion of eggs from contaminated soil or vegetables.
Trichuriasis (whipworm, Trichuris trichuria, Trichuris vulpis) is an intestinal parasite of humans, primarily affecting children. They may become infected if they ingest soil contaminated with whipworm eggs. Some outbreaks have been traced to contaminated vegetables (due to presumed soil contamination). Most commonly found in countries with warm, humid climates.
Sexually Transmitted Infections
Avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home.
Some countries have entry restrictions for travellers with HIV / AIDS. See The Global Database on HIV Related Travel Restrictions for details on this country.
Traveller's Diarrhea
Diarrhea is the most common cause of illness during travel. The source of illness is the ingestion of contaminated food or water, person-to-person transmission, or recreational exposure to water bodies. The infective agents can be bacteria, viruses, protozoa or toxins found in food. Good personal hygiene practices (including frequent and thorough hand washing), proper food handling, and water purification are the most effective methods to prevent infection.
Consult your doctor for the best treatment options tailored to your needs, including taking prescription medication on your trip in case you suffer from diarrhea. Travellers with chronic conditions are more susceptible to infections and should consider taking preventive medication.
See our Guide to Healthy Travel for prevention and treatment tips.
DISEASES PRESENT - LOW RISK TO TRAVELLERS
Anthrax
Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. A bacterium is a very small organism made up of one cell. A spore is a dormant cell which becomes an infective agent under the right the right conditions.
Humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores present on infected animal products (like wool or hides). People also can become infected with gastrointestinal anthrax by eating undercooked meat from infected animals.
Echinococcosis
Echinococcosis is a potentially fatal parasitic disease that affecting wildlife, commercial livestock and humans. Humans become infected by accidentally swallowing the eggs of the E. multilocularis tapeworm. Humans can be exposed to these eggs by directly ingesting food contaminated with stool from infected foxes or coyotes. This might include grass, herbs, greens or berries collected from fields. Humans may also be contaminated by petting infected cats or dogs. These pets may shed the tapeworm eggs in their stool and their fur may be contaminated.
Basic hygiene practices such as thoroughly cooking food and vigorous hand washing before meals can prevent the infective eggs entering the human digestive tract.
Food and Water Safety
Drinking water is chlorinated and has no ill effect on the local population. However, some strains of E. coli (naturally occurring bacteria found in your gastro-intestinal system) may be present in very small concentrations in the local water supply. Some local strains are different than those that you may be used to, and may cause diarrhea in travellers since immunity is not developed as a result of short-term exposure. Using bottled water for the first few weeks will help you adjust and decrease the chance of traveller's diarrhea.
Milk should be boiled before consumption because of possible improper refrigeration during distribution. Powdered and evaporated milk are available and safe. Butter should not be used as a table food. Cream, ice cream, and whipped cream should not be consumed. Cheese, unless cured, is best avoided. Yoghurt is safe only if it is known to be made from pasteurized milk.
All meat, poultry, and fish must be well cooked and served while hot. Pork is best avoided; vegetables should be well cooked and served hot. Salads are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid raw and undercooked eggs, and dishes prepared with raw eggs (steak tartar, mayonnaise, and dressings). Avoid cold buffets, uncured cheeses, custards, and any frozen desserts.
First rate hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement.
Gastro-intestinal infections are the most common illnesses affecting travellers and can occur in any country you are visiting. Proper food handling, drinking purified water, and maintaining good personal hygiene are key to prevention. Below is a summary of the agents causing gastro-intestinal illnesses.
Bacterial Contamination
It is estimated that about 85% of traveller’s diarrhea is caused by bacteria of which the following are the most important agents:
Enterotoxigenic Escherichia coli (ETEC) and Enteroaggregative Escherichia coli (EAEC) account for most cases of traveller’s diarrhea associated with contaminated food and water world wide. They are the cause of large outbreaks in developed countries when food and water sanitation have not been properly maintained. Symptoms include watery stools, abdominal cramps, and possible vomiting lasting three to seven days.
Campylobacter jejuni is more prevalent in developing countries and is associated with contaminated water, undercooked food, and unpasteurized milk. Symptoms include diarrhea, abdominal cramps, and fever lasting from two to ten days.
Salmonella enteritidis is associated with contaminated eggs, poultry, milk, fruits, and uncooked vegetables. Symptoms include diarrhea, vomiting, abdominal cramps, and fever lasting from four to seven days. Infected persons can become asymptomatic carriers and shed the bacteria for years, becoming the source of infection for others through poor hygiene practices.
Shigellosis is a human infection caused by one of four species and transmitted by fecal-oral route due to unsanitary conditions, contaminated food and water, and overcrowded living conditions. Symptoms include diarrhea, abdominal cramps, fever, and may cause bloody diarrhea and mucous lasting four to seven days.
Vibrio cholera is associated with contaminated water, raw and undercooked seafood. Cholera infection in travellers is rare; symptoms include watery diarrhea and vomiting lasting three to seven days, but can lead to severe dehydration and death in undernourished persons. Vibrio parahaemolyticus is also related to the consumption of raw and undercooked seafood. Vibrio vulnificus is associated with contaminated shellfish and raw oysters in particular, and has caused septicemia in persons with liver disorders.
Viral Contamination
Gastro-intestinal infections caused by viruses account for about 5%. The main agents are Norovirus, associated with outbreaks at large gatherings and on cruise ships, and Rotavirus, which is more prevalent in developing countries. Symptoms include vomiting, diarrhea, fever, and myalgia lasting 12 to 60 hours.
Protozoal Contamination
Gastro-intestinal infections with protozoa account for about 10% of traveller’s diarrhea, but may cause prolonged illnesses (lasting weeks) and cause serious complications if not diagnosed in a timely manner.
Giardia lamblia (Giardiasis) and Entamoeba hystolytica (Amebiasis) are the most important agents in this category and both infections are acquired through contaminated food and water, as well as person to person transmission due to poor hygiene practices. Cryptosporidium and Cyclospora cayetanensis are implicated with contaminated food, water, and fresh produce (berries).
Toxins Causing Food Poisoning
Clostridium perfringens is the most important agent causing food poisoning in developed countries. The spores of the bacterium germinate on cooked food that is cooled and stored at room temperature over a prolonged period of time. After ingestion, the spores produce an enterotoxin in the small intestine causing abdominal pain, diarrhea, and vomiting. Foods implicated are meats and poultry.
Staphylococcus aureus enterotoxins are spread by unsanitary practices of infected persons. The foods implicated are custards, creamy desserts, meats, and salads.
Clostridium botulinum bacteria produce a very potent toxin. It is associated with improperly canned food, lightly preserved vegetables, salted fish, and meats. Symptoms include nausea, vomiting, and neurological symptoms such as blurred and double vision, paralysis of respiratory and motor muscles that may progress rapidly.
Seafood Poisoning
Fish and shellfish can be contaminated with the toxins produced by marine micro-organisms called dinoflagellates found in all oceans, especially in coral reef areas. Larger fish have usually more toxins accumulated in the skin, musculature, and organs, as these toxins are passed up through the food chain. The toxins are not destroyed through cooking, smoking, or freezing, they are odorless and tasteless, and do not alter the appearance of the fish.
Ciguatera Fish poisoning is the most common illness in this category. The most affected fish are amberjack, barracuda, grouper, kahala, parrotfish, sea bass, red snapper, surgeon fish, ulua. Symptoms usually appear within a few hours but can be delayed for a day or more and include nausea, vomiting diarrhea, muscle pain, itchiness, dizziness and temperature reversal (hot feels cold and cold feels hot). Symptoms can last for months. Persons who had a previous episode of ciguatera fish poisoning should avoid a second exposure as symptoms will be more severe. Prevention: Avoid large fish (more than 2.5 to 3 kilos [6 lbs]) or fillet of large fish, avoid head, roe, intestines and liver where the toxin is more concentrated.
Scombroid poisoning is the result of improper handling and refrigeration of fish containing high levels of natural occurring histidine (amino acid in protein). Contamination with bacteria will convert histidine to histamine-causing symptoms similar to allergic reactions, which occur very rapidly and include headache, abdominal cramps, diarrhea, itching, flushed face, and paralysis may occur. Scombroid poisoning occurs worldwide and affects fish from the Scombridae family: yellow tuna, mackerel, skipjack, and bonito. It can also affect other species such as herring, bluefish, sardine, anchovy, amberjack, and mahi-mahi. Prevention: Proper handling and immediate refrigeration of catch.
Shellfish poisoning is associated with the algal blooms (red tides) occurring in temperate and tropical areas. Shellfish – oysters, clams, cockles, mussels, crabs, lobsters – filter or ingest toxins produced by dinoflagellates micro-organisms. Each different toxin produces characteristic symptoms:
- Symptoms of diarrheic shellfish poisoning occur about 30 minutes to hours after ingestion and include nausea, vomiting, and diarrhea. Recovery occurs within two to three days.
- Symptoms of neurotoxic shellfish poisoning appear rapidly after ingestion and include tingling of mouth, arms and legs, stomach upset, and severe muscle pain. Recovery occurs within two to three days.
- Symptoms of paralytic shellfish poisoning appear rapidly after ingestion and include nausea, numbness of face arms and legs, headache, loss of coordination and dizziness, in severe cases respiratory failure and paralysis may lead to death.
- Symptoms of amnesic shellfish poisoning occur within 24 hours of ingestion and include vomiting, diarrhea, and disorientation. Permanent short-term memory loss has been observed, and in severe cases seizures, paralysis, and death may occur. Persons with kidney disease are especially vulnerable.
Puffer Fish poisoning (Fugu) is caused by a tetrodotoxin accumulating mainly in the liver, intestines and ovaries of puffer fish, ocean sunfish, globe fish, and porcupine fish. Symptoms appear between six and 20 hours and include profuse sweating, salivation, headache, hypothermia, and neurological symptoms of paralysis and respiratory failure. The mortality rate is very high.
