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Zika Virus in El Salvador

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions
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What is the current situation?

Local mosquito transmission of Zika virus infection (Zika) has been reported in El Salvador. Local mosquito transmission means that mosquitoes in the area are infected with Zika virus and are spreading it to people.

Because Zika virus is primarily spread by mosquitoes, CDC recommends that travelers to El Salvador protect themselves from mosquito bites. The mosquitoes that spread Zika usually do not live at elevations above 6,500 feet (2,000 meters) because of environmental conditions. Travelers whose itineraries are limited to areas above this elevation are at minimal risk of getting Zika from a mosquito. The following map shows areas of El Salvador above and below 6,500 feet.* For more information, see Questions and Answers: Zika risk at high elevations.

* The categories shown on this map are intended as a general guideline and should not be considered to indicate absolute risk. Elevation may vary within an area to a larger extent than this map can depict. The presence of mosquitoes may change seasonally, with increasing temperatures or rainfall, and may change over time. Travelers to destinations that cross or are near an elevation border may wish to consider the destination as an area of lower elevation. Travelers to high elevations are still at risk of getting Zika from sex.

*The categories shown on this map are intended as a general guideline and should not be considered to indicate absolute risk. Elevation may vary within an area to a larger extent than this map can depict. The presence of mosquitoes may change seasonally, with increasing temperatures or rainfall, and may change over time. Travelers to destinations that cross or are near an elevation border may wish to consider the destination as an area of lower elevation. Travelers to high elevations are still at risk of getting Zika from sex.
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Zika Virus in Pregnancy

A pregnant woman can pass Zika virus to her fetus. Infection during pregnancy can cause serious birth defects. CDC recommends special precautions for the following groups:

  • Women who are pregnant:
    • Should not travel to any area of El Salvador below 6,500 feet (see map).
    • If you must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip. If your itinerary is limited entirely to areas above 6,500 feet, there is minimal risk of getting Zika from a mosquito.
    • If you have a partner who lives in or has traveled to El Salvador, either use condoms (or other barriers to prevent infection) or do not have sex (vaginal, anal, or oral) during your pregnancy.
  • Women who are trying to become pregnant:
    • Before you or your partner travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection.
    • See CDC guidance for how long you should wait to get pregnant after travel to El Salvador.
  • People who have traveled to El Salvador and have a pregnant partner should use condoms or not have sex (vaginal, anal, or oral) during the pregnancy.

 

Sexual transmission of Zika virus is also possible, so travelers are encouraged to use condoms (or other barriers to prevent infection) or not have sex.

Many people infected with Zika virus do not get sick. Among those who do develop symptoms, sickness is usually mild, with symptoms that last for several days to a week. Guillain-Barré syndrome (GBS) is a rare disorder that can cause muscle weakness and paralysis for a few weeks to several months.  Current CDC research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS. Most people fully recover from GBS, but some have permanent damage. For more information, see Zika and GBS.

As more information becomes available, this travel notice will be updated. Please check back frequently for the most up-to-date recommendations.

What can travelers do to prevent Zika?

There is no vaccine or medicine for Zika. Travelers can protect themselves by preventing mosquito bites:

  • Cover exposed skin by wearing long-sleeved shirts and long pants.
  • Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE, also called para-menthane-diol [PMD]), or IR3535. Always use as directed.
    • Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
    • Most repellents, including DEET, can be used on children older than 2 months. (OLE should not be used on children younger than 3 years.)
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
  • Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites.

Because Zika can be sexually transmitted, if you have sex (vaginal, anal, or oral) while traveling, you should use condoms.

After travel:

Many people infected with Zika virus do not feel sick. If a mosquito bites an infected person while the virus is still in that person’s blood, it can spread the virus by biting another person. Even if they do not feel sick, travelers returning to the United States from El Salvador should take steps to prevent mosquito bites for 3 weeks so that they do not spread Zika to uninfected mosquitoes.

Travelers returning from El Salvador who have a pregnant partner should either use condoms or not have sex for the rest of the pregnancy.

People who have traveled to El Salvador should use condoms for at least 8 weeks after travel to protect their sex partners. Men who have Zika symptoms or are diagnosed with Zika should use condoms for at least 6 months after symptoms start; women with symptoms should use condoms for at least 8 weeks after symptoms start.

Travelers who are thinking about pregnancy should talk with their health care provider. Men who have traveled to El Salvador should wait at least 8 weeks after travel before trying to conceive or at least 6 months after symptoms start if they develop symptoms of Zika. Women who have traveled to El Salvador should wait at least 8 weeks after travel before trying to get pregnant, or at least 8 weeks after symptoms start if they develop symptoms.

For more information, see Zika and Sexual Transmission.

If you feel sick and think you may have Zika:

  • Talk to your doctor if you develop a fever with a rash, joint pain, or red eyes. Tell him or her about your travel.
  • Take acetaminophen (paracetamol) to relieve fever and pain. Do not take aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs, such as ibuprofen.
  • Get lots of rest and drink plenty of liquids.

If you are pregnant:

Talk to a doctor or other health care provider after your trip, even if you don't feel sick. Pregnant travelers returning from El Salvador, or who have had possible sexual exposure, should be offered testing for Zika virus infection.

  • If you develop a fever with a rash, joint pain, or red eyes, talk to your doctor immediately and tell him or her about your travel or possible sexual exposure.
  • If you do not have symptoms, testing should be offered if you see a health care provider, up to 12 weeks after you return from travel or your last possible sexual exposure.

Clinician Information

All pregnant women should be assessed for Zika virus exposure at each prenatal care visit. Possible exposures to Zika virus that warrant testing include:

  • Travel to or residence in an area with a current Zika outbreak.
  • Sex (vaginal, anal, or oral) with a partner who has traveled to or resides in an area with a current Zika outbreak.

The type of testing recommended varies according to when a woman’s last possible exposure occurred or when her symptoms began. For more information, please visit the clinical guidance for healthcare providers caring for pregnant women.

Clinical Guidance for Healthcare Providers Caring for Infants & Children is also available.

Additional Resources

For Travelers:

For Clinicians:

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