Chapter 4 Select Destinations The Americas & the Caribbean
Mexico, the second most populous country in Latin America, has a population of >110 million, with 76% living in urban areas. The United States’ third-largest trading partner overall and second-largest agricultural trading partner, Mexico is now considered a middle-income country with the world’s 14th-largest economy. Mexico has a rich history and proud culture that reflect its pre-Columbian civilizations and Hispanic heritage. With one-fifth the area of the United States (about 3 times the size of Texas), Mexico has diverse geographic features. The Sonoran desert is in the northwest, beautiful beaches are available on both coasts, and forested mountain ranges traverse the western and eastern mainland. Impressive volcanic peaks rise up to 18,000 feet above the high central plateau. The Yucatán Peninsula and southern regions are tropical. The Copper Canyon in the northwestern state of Chihuahua is larger than the US Grand Canyon.
Mexico City is one of the world’s largest cities, with a population >20 million. Despite increasing national prosperity, Mexico’s large cities contain much poverty. Extensive migration has taken place from the poor rural south to the northern border for jobs in bustling border cities, such as Ciudad Juárez and Tijuana.
Mexico has the most foreign visitors of any Latin American country and is the country most frequently visited by US tourists. Travel to beach resorts such as Acapulco, Cancún, Cozumel, Puerto Vallarta, and Cabo San Lucas, along with cruise ship tours, makes up a large portion of tourist travel to Mexico. Also common are day trips to northern border cities and longer cultural trips to historical and World Heritage sites. Popular pre-Columbian anthropologic destinations include Teotihuacan outside Mexico City, Chichen Itzá in Yucatán, Monte Alban in Oaxaca, and Palenque in Chiapas. Baja California offers whale watching on the Pacific Coast and sports fishing in the Gulf of California.
Hepatitis A is still endemic in Mexico, and all susceptible travelers should be immunized for hepatitis A. Hepatitis B vaccine is also recommended. Other vaccines, such as typhoid and rabies, may be considered, especially if visitors, such as field biologists or missionaries, will be traveling extensively to less-developed, nontourist areas.
Travelers’ Diarrhea and Foodborne Infections
Travelers’ diarrhea is common among visitors to Mexico. In addition to taking food and water precautions, travelers should bring along an antibiotic for empiric self-treatment of diarrhea (see the Food & Water Precautions and Travelers’ Diarrhea sections in Chapter 2). Travelers who eat raw dairy products and vegetables are at some risk for more serious foodborne infections, including amebiasis, cysticercosis (especially in rural areas where pigs are raised), brucellosis, Mycobacterium bovis, and Listeria.
Dengue is endemic throughout Mexico, except for the state of Baja California Norte and at higher elevations (for example, it is not present in Mexico City at 7,350 ft [2,240 m]). Large outbreaks of dengue have been reported in recent years, and dengue virus transmission should be considered a risk year-round. Travelers to Mexico should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Insects & Arthropods).
Malaria incidence has decreased dramatically in recent decades in Mexico, and only a few cases of Plasmodium vivax are reported among US travelers each year. Major resorts are free of malaria, as is the US–Mexico border region. Malaria prophylaxis is recommended only for low-lying areas of Chihuahua, Durango, Sinaloa, and Nayarit in the west and Oaxaca, Chiapas, and Tabasco in the south.
Influenza virus strains similar to those in the United States circulate in Mexico, as was demonstrated by the emergence of pandemic influenza A H1N1 in North America in the spring of 2009. Coccidioidomycosis, a fungal respiratory disease caused by inhaling spores in the soil, is endemic in northwestern Mexico. Several outbreaks of coccidioidomycosis have been reported among missionary groups from the United States doing construction projects in this region. Histoplasmosis, another fungal respiratory disease agent found in soil, is endemic in other regions of Mexico. As occasional hotel clusters of legionellosis have been reported from Mexico, Legionnaires’ disease should be considered in elderly and immunocompromised travelers who develop acute pneumonia.
Cutaneous leishmaniasis, transmitted by sandflies, is found in focal areas of coastal and southern Mexico. The risk is higher for ecotourists and long-term travelers. Vector preventive measures are indicated, including avoiding outdoor activities at night. Travelers to beach areas are at risk for cutaneous larva migrans, a creeping skin eruption most commonly associated with the dog hookworm infection, preventable by wearing shoes and avoiding direct skin contact with sand. Chagas disease is also endemic in Mexico and is sometimes diagnosed in Mexican immigrants to the United States, but no cases have been reported among travelers.
All travelers should be warned of the risk of acquiring rabies and educated in how to prevent animal bites. Preexposure rabies vaccination should be considered for those who are likely to come into contact with domestic or wild mammals or those who will be traveling to areas with limited access to medical care.
In Mexico, rickettsial diseases, febrile rash illnesses transmitted by ticks or fleas, include Rocky Mountain spotted fever, which is potentially fatal unless treated promptly with antibiotics, and fleaborne typhus, which usually causes an illness similar to dengue. Travelers should take precautions to avoid flea and tick bites both indoors and outside. Rocky Mountain spotted fever associated with Rhipicephalus sanguineus, the brown dog tick, has been identified recently in northern Mexico in urban and rural areas with large stray dog populations.
Mexico’s TB incidence is lower than rates in Asia, Africa, and Eastern Europe but is 5 times that of the United States.
Other Health and Safety Risks
Good health care is available in most sizable Mexican cities, and hotels in tourist resorts usually have well-trained physicians available. Medical tourism has increased in Mexico in recent years. Clinics offering unproven and often dangerous interventions for cancer and other serious illnesses can operate in northern border cities, such as Tijuana, for varying periods before regulatory authorities intervene.
Mexico’s highway system and roads have become increasingly modernized over the years. Toll highways are often of high quality. Nevertheless, driving in traffic in cities and at night through the countryside can be dangerous, and motor vehicle accidents are a leading cause of death for visitors. Although travel in Mexico is generally safe and enjoyable, drug-related violence has continued to increase in parts of the country. Department of State advisories should be monitored for alerts in areas where tourists are planning to visit.
Air pollution in Mexico City, while decreased in recent years, can be particularly severe during the dry winter months and can exacerbate asthma and chronic lung and heart conditions. Both healthy travelers from lower elevations and people with lung and heart conditions should cautiously acclimate to Mexico City’s altitude.
A population that requires increasing attention is the large numbers of travelers of Mexican birth or descent who return to visit friends and relatives.
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- CDC. Preventing and controlling tuberculosis along the US-Mexico border. MMWR Recomm Rep. 2001 Jan 19;50(RR-1):1–27.
- CDC. Update: novel influenza A (H1N1) virus infection—Mexico, March–May, 2009. MMWR Morb Mortal Wkly Rep. 2009 Jun 5;58(21):585–9.
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- White AC, Atmar RL. Infections in Hispanic immigrants. Clin Infect Dis. 2002 Jun 15;34(12):1627–32.
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