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Health Information for Travelers to Costa RicaClinician View

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Vaccines and Medicines

Prepare travelers to Costa Rica with recommendations for vaccines and medications.

 

  Recommendations Transmission Guidance
Routine vaccines

Recommended for all travelers

varied

Immunization schedules

Hepatitis A

Recommended for most travelers, including those with "standard" itineraries and accommodations

Traveling with Children

Age <1 year is a contraindication. Immunoglobulin (0.02/mL/kg) injection may be used for protection up to 3 months.

Fecal-oral route (contaminated food and water)

Person-to-person contact

Hepatitis A (Yellow Book)

Dosing info

Hepatitis B

Consider for most travelers; recommended for those who might be exposed to blood or other body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).

Contact with blood and other body fluids:

  • Unprotected sex
  • Injection drug use
  • Contaminated transfusions
  • Exposure to human blood
  • Contaminated tattoo and piercing equipment

Hepatitis B (Yellow Book)

Dosing info

Malaria

Advise mosquito avoidance; consider prophylaxis for high-risk patients (e.g., pregnant or immunocompromised)

Bite of infected mosquito (female Anopheles)

Malaria (Yellow Book)

Considerations when choosing a drug for malaria prophylaxis (Yellow Book)

Rabies

Recommended for the following groups:

  • Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats and other mammals (such as adventure travelers and cavers).
  • Those with occupational risks (such as wildlife professionals and researchers).

Mammal bites (bats and other carnivores). Canine rabies is not present.

Rabies (Yellow Book)

Typhoid

Recommended for most travelers, especially those who are staying with friends or relatives; visiting smaller cities, villages, or rural areas where exposure might occur through food or water; or prone to "adventurous eating"

Traveling with Children

Injectable vaccine is indicated for children aged ≥2 years. Oral vaccine is indicated for children aged ≥6 years.

Fecal-oral route (contaminated food and water)

Typhoid (Yellow  Book)

Dosing info (Yellow Book)

Yellow Fever

Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1 This requirement includes Eritrea, São Tomé and Principe, Somalia, Tanzania, and Zambia, and excludes Argentina, Guyana, Panama, Paraguay, and Suriname.

Traveling with Children

Age <6 months is a contraindication, and age 6–8 months is a precaution.

Bite of infected mosquitoes

Yellow Fever (Yellow Book)

Routine vaccines

Recommendations

Recommended for all travelers

Transmission

varied

Guidance

Hepatitis A

Recommendations

Recommended for most travelers, including those with "standard" itineraries and accommodations

Transmission

Fecal-oral route (contaminated food and water)

Person-to-person contact

Guidance

Hepatitis A (Yellow Book)

Dosing info

Traveling with Children

Age <1 year is a contraindication. Immunoglobulin (0.02/mL/kg) injection may be used for protection up to 3 months.

Hepatitis B

Recommendations

Consider for most travelers; recommended for those who might be exposed to blood or other body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).

Transmission

Contact with blood and other body fluids:

  • Unprotected sex
  • Injection drug use
  • Contaminated transfusions
  • Exposure to human blood
  • Contaminated tattoo and piercing equipment
Guidance

Hepatitis B (Yellow Book)

Dosing info

Malaria

Recommendations

Advise mosquito avoidance; consider prophylaxis for high-risk patients (e.g., pregnant or immunocompromised)

Transmission

Bite of infected mosquito (female Anopheles)

Guidance

Rabies

Recommendations

Recommended for the following groups:

  • Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats and other mammals (such as adventure travelers and cavers).
  • Those with occupational risks (such as wildlife professionals and researchers).
Transmission

Mammal bites (bats and other carnivores). Canine rabies is not present.

Guidance

Rabies (Yellow Book)

Typhoid

Recommendations

Recommended for most travelers, especially those who are staying with friends or relatives; visiting smaller cities, villages, or rural areas where exposure might occur through food or water; or prone to "adventurous eating"

Transmission

Fecal-oral route (contaminated food and water)

Guidance

Typhoid (Yellow  Book)

Dosing info (Yellow Book)

Traveling with Children

Injectable vaccine is indicated for children aged ≥2 years. Oral vaccine is indicated for children aged ≥6 years.

Yellow Fever

Recommendations

Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1 This requirement includes Eritrea, São Tomé and Principe, Somalia, Tanzania, and Zambia, and excludes Argentina, Guyana, Panama, Paraguay, and Suriname.

Transmission

Bite of infected mosquitoes

Guidance

Yellow Fever (Yellow Book)

Traveling with Children

Age <6 months is a contraindication, and age 6–8 months is a precaution.

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Note: Zika is a risk in Costa Rica. Zika infection during pregnancy can cause serious birth defects. Therefore, pregnant women should not travel to Costa Rica. Partners of pregnant women and couples planning pregnancy should know the possible risks to pregnancy and take preventive steps (more information).

 

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Non-Vaccine-Preventable Diseases

The following diseases are possible risks your patients may face when traveling in Costa Rica. This list is based on our best available surveillance data and risk assessment information at the time of posting. It is not a complete list of diseases that may be present in a destination. Risks may vary within different areas of a destination.

 

  Guidance Patient Education Notes

Vectorborne

Chagas disease (American Trypanosomiasis)
  • Risk to travelers is extremely low
  • Higher risk if staying in poor-quality housing
  • Spread by the feces of triatomine bugs (also known as reduviid bugs or “kissing” bugs), not the bug bite
Dengue
  • More risk in urban and residential areas than for other vectorborne diseases
  • Leading cause of febrile illness among travelers returning from the Caribbean, South America, and South and Southeast Asia

Vectorborne

Chagas disease (American Trypanosomiasis)

Guidance
Patient Education
Notes
  • Risk to travelers is extremely low
  • Higher risk if staying in poor-quality housing
  • Spread by the feces of triatomine bugs (also known as reduviid bugs or “kissing” bugs), not the bug bite

Dengue

Guidance
Patient Education
Notes
  • More risk in urban and residential areas than for other vectorborne diseases
  • Leading cause of febrile illness among travelers returning from the Caribbean, South America, and South and Southeast Asia

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Patient Counseling

Counsel your patients on actions they can take on their trip to stay healthy and safe.

Eat and drink safely

Counsel travelers to be diligent about food and water precautions:

  • Avoid cooked food served at room temperature.
  • Avoid raw food, including raw vegetables unless they can be washed thoroughly.
  • Drink only beverages from sealed bottles or cans.
  • Water is safe if it has been boiled or chemically treated.
  • Avoid ice unless made from bottled/disinfected water.

Consider prescribing an antibiotic for self-treatment of travelers’ diarrhea, factoring in resistance issues at the destination.

Additional Resources

Food & Water Precautions (YB)
Water Disinfection for Travelers (YB)
Food Poisoning from Marine Toxins (YB)
Travelers’ Diarrhea (YB)
Persistent Travelers’ Diarrhea (YB)

Traveling with Children

Counsel parents to pay close attention to their children’s diet. If diarrhea develops, oral rehydration is the cornerstone of therapy. Empiric antibiotic treatment options are limited for children. Some clinicians prescribe azithromycin (10 mg/kg qd for 3d). Fluoroquinolones are contraindicated in children younger than 18 years, although the American Academy of Pediatrics suggests that they can be considered to treat severe infections caused by multidrug-resistant strains of Shigella, Salmonella, Vibrio cholerae, or Campylobacter jejuni.

Additional Resources

Traveling Safely with Infants and Children (YB)

Mission/Disaster Relief

A natural disaster may compromise the food and water supply. Counsel travelers to adhere to food and water precautions. If potable water will be difficult to come by, travelers should plan to disinfect their own.

Additional Resources

Water Disinfection for Travelers (YB)

Visiting Friends or Family

In the United States, 66% of imported typhoid cases are in VFRs, primarily those returning from South America and Southeast Asia. Stress food and water precautions and handwashing. Discuss food preparation with travelers, since the source of foodborne illness is often a meal served in someone’s home.

Do not assume that immigrants are immune to hepatitis A. Many young adults and adolescents from developing countries are susceptible. Children aged <15 years are at highest risk.

Additional Resources

Immigrants Returning Home to Visit Friends and Relatives

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Prevent bug bites

Counsel travelers to be diligent in insect precautions:

  • Cover exposed skin.
  • Use an appropriate insect repellent. (see below)
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Travelers can buy pre-treated clothing and gear or treat them at home. Treated clothing remains protective after multiple washings. Permethrin should NOT be used directly on skin.
  • Stay and sleep under in air-conditioned or screened rooms.
  • Use a bed net if sleeping area is exposed to the outdoors.
More Information on Insect Repellents

DEET (concentration of 20% or more) is the only insect repellent shown to be effective against ticks. However, several EPA-registered active ingredients provide reasonably long-lasting protection against mosquitoes:

  • DEET (chemical name: N,N-diethyl-m-toluamide or N,N-diethyl-3-methyl-benzamide): Concentrations above 50% show no additional protective benefit.
  • Picaridin (KBR 3023 [Bayrepel] and icaridin outside the United States; chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester): Must be reapplied more often than DEET.
  • Oil of lemon eucalyptus (OLE) or PMD (chemical name: para-menthane-3,8-diol), the synthesized version of OLE. “Pure” oil of lemon eucalyptus (essential oil) is not the same product; it has not undergone similar testing for safety and efficacy, is not registered with EPA as an insect repellent, and is not covered by this recommendation.
  • IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester).

Products with <10% active ingredient may offer only limited protection (1–2 hours).

Encourage patients to use repellents and reapply only as instructed. If sunscreen is also needed, they should apply sunscreen first and repellent second. Encourage them to follow package directions for using repellent on children and avoid applying to their hands, eyes, and mouth.

For more detailed information, visit the Yellow Book: Protection against Mosquitoes, Ticks, & Other Insects & Arthropods

Additional Resources

Note: Zika is a risk in Costa Rica. For more information, see Zika Virus in Costa Rica.

Traveling with Children

Counsel parents to protect their children with similar precautions to those recommended for adults.

Most insect repellents are safe for use on children. The American Academy of Pediatrics recommends ≤30% DEET for use on children >2 months. Products containing OLE should not be used on children aged <3 years. EPA does not recommend any additional precautions for using registered repellents on children.

For parents of infants <2 months of age, encourage the use of a carrier draped with mosquito netting with an elastic edge for a tight fit to protect against biting insects.

Children should not handle repellents. Instead, adults should apply repellents to their own hands first, then gently spread on the child’s exposed skin. They should avoid applying directly to children’s hands.

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Stay safe outdoors

Advise travelers to exercise caution during outdoor activities. Important tips include dressing appropriately for the climate (such as loose, lightweight clothing in hot climates and warm layers in cold climates), staying hydrated, avoiding overexposure to the sun, and practicing safe swimming habits. To avoid infection while swimming, travelers should not swallow water when swimming and avoid contact with water that may be contaminated from poor sanitation.

Encourage travelers to learn basic first aid and CPR before travel, especially if they will be traveling to remote areas where medical assistance may not be accessible. Help them assemble a travel health kit.

Additional Resources:

Sunburn
Problems with Heat & Cold

Traveling with Children

Advise parents to minimize sun exposure for children. Infants under 6 months have thinner, more sensitive skin, and therefore require additional protection from the sun. Sunscreen is recommended for use on children above 6 months of age; physical precautions such as seeking shade and wearing protective clothing are recommended for infants under 6 months of age, as well as minimal use of sunscreen on exposed areas (e.g., face and hands).

Travelers with children should never leave children unattended while swimming, and should be advised of the risk of infection from swimming in and/or swallowing contaminated water.

Parents should also be advised to avoid contact with potentially contaminated soil. Children should wear protective footwear and should play on a sheet or towel instead of directly on the ground.

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Keep away from animals

Counsel travelers to be cautious around all animals.

  • Travelers should avoid touching, petting, handling, or feeding animals, including pets.
  • Arthropods such as spiders and scorpions can pose a stinging risk, and travelers should exercise care in environments where these creatures are likely to be present.
  • Stress the urgency of treating suspected and probable rabies infection by:
    • Washing the wound immediately with soap and clean water.
    • Seeking medical attention as soon as possible.
  • Travelers at risk for rabies should consider medical evacuation insurance, since postexposure prophylaxis may not be available at the destination.
Additional Resources

Animal-Associated Hazards (YB)
Rabies (YB)
Criteria for Preexposure Immunization for Rabies (YB)
Protection against Mosquitoes, Ticks, & Other Insects & Arthropods (YB)

 

Traveling with Children

  • Counsel families to avoid all stray or unfamiliar animals.
  • Children are at increased risk for animal-associated injuries. They are more likely to suffer severe injuries to the neck or head.
  • Children should be encouraged to tell adults about all contact with animals.
  • Families should consider purchasing medical evacuation insurance, since postexposure prophylaxis may not be available at the destination.
Additional Resources

Traveling Safely with Children & Infants (YB)

Mission/Disaster Relief

People traveling for relief work may be at increased risk for bites from stray animals. Consider rabies vaccine for these travelers.

Visiting Friends or Family

Domestic animals may not be vaccinated for rabies in developing countries. Urge VFR travelers to avoid even family pets.

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Reduce your exposure to germs

People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.

Traveling with Children

Scrupulous attention should be paid to washing bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others; water used to clean these items should be potable.

Parents should be particularly careful to wash hands after changing diapers.

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Avoid sharing body fluids

Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.

Travelers should:

  • Use a latex condom correctly every time they engage in sex (vaginal, anal, and oral-genital).
  • Not inject drugs.
  • Limit alcohol consumption.
  • Not have tattoos, piercings, or other procedures that use needles (acupuncture) unless the needles are packaged new or sterilized.
  • Ensure that medical and dental equipment is sterile or disinfected if seeking care.
Additional Resources:
HIV & AIDS (YB)
Hepatitis B (YB)
Hepatitis C (YB)
Medical Tourism (YB)

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Know how to get medical care while traveling

Travelers should plan for how to obtain health care during their trip, should the need arise.

Discuss supplemental travel health insurance and medical evacuation insurance, and consider helping the traveler obtain an extra month of prescriptions for any needed medications.

Traveling with Children

Adults traveling with children should be counseled about the signs and symptoms of dehydration and the proper use of oral rehydration salts (ORS), and when to seek medical care.

Extended Stay/Study Abroad

People spending prolonged periods abroad are at increased risk of illness and injury that requires local medical care. Emphasize the need for these travelers to buy travel health and medical evacuation insurance.

Mission/Disaster Relief

Humanitarian aid workers should be advised to prepare a travel health kit that is more extensive than a typical kit.

Encourage humanitarian workers to learn basic first aid to self-treat injuries and minor medical problems. This is useful in a humanitarian setting, as medical attention may be difficult to obtain.

Visiting Friends or Family

Consider whether patients are likely to use risky or unproven traditional medicines at the destination. Discuss any potential risks of traditional therapies.

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Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

Most recommendations for safe transportation are basic and could be considered common sense. However, travelers often do not think about the importance of being aware and careful when walking, riding, driving, or flying.

In many places cars, buses, large trucks, rickshaws, bikes, pedestrians, and even animals share the same lanes of traffic, increasing the risk for crashes.

Counsel travelers to think about transportation options before they arrive, especially if they will be driving in Costa Rica.

Medical Evacuation Insurance

If your patient is seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Encourage patients to purchase medical evacuation insurance.

Some basic reminders to review with your patients:

  • Choose safe vehicles and avoid motorbikes when possible.
  • Wear a seatbelt or a helmet at all times.
  • Do not drive after drinking alcohol or ride with someone who has been drinking.
  • Avoid driving at night; street lighting in certain parts of Costa Rica may be poor.
  • If they will be driving, remind them to get any driving permits and insurance they may need. It is recommended to get an International Driving Permit (IDP).
  • Avoid using local, unscheduled aircraft, and fly on larger planes (more than 30 seats) when possible.
Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, Auto Insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

Encourage your patients to look up the information provided under Travel and Transportation on US Department of State's country-specific information for Costa Rica.

 

Traveling with Children

Counsel parents of children to bring their own car or booster seats from home and use them according to the same guidelines they follow here in the United States.

Parents will need to choose vehicles that have seatbelts in order to properly secure the car or booster seat. 

Also remind parents that they should use FAA-approved car or booster seats when flying in aircraft.

Extended Stay/Study Abroad

Patients who will be living or studying abroad may be considering purchasing a bicycle, vehicle, or motorbike. Counsel them to make sure they have the appropriate permits and insurance.

Remind students that crashes involving in-country travel are a major cause of injury to people studying abroad, so they need to be diligent about finding and using safe modes of travel. (Refer to guidance on traveler pages of the website.)

Mission/Disaster Relief

Depending on the type and extent of the disaster, normal transportation services and routes may be limited or nonexistent. Encourage your patient to learn as much as possible about transportation options before arrival.

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Maintain personal security

Travelers should be reminded on how to protect their personal safety during travel, regardless of their destination. 

The US Department of State has an extensive website with safety information for international travelers, travel alerts and warnings, and country-specific information. Travelers should be directed to the Department of State resources for information and tips on safe travel.

Stay abreast of current events, particularly those that could pose a safety or health problem for travelers. You can also receive updates on new travel alerts and warnings from the US Department of State by subscribing to their RSS feeds.

Traveling with Children

Because of concerns about illegal transport of children across international borders, if only 1 parent is traveling with the child, he or she may need to carry custody papers or a notarized permission letter from the other parent. Children should also carry their own identifying information and contact numbers, in case family members become separated.

Extended Stay/Study Abroad

Students are at risk for heavy drinking. Counsel students on alcohol and drug safety abroad. Emphasize the need to understand and abide by local drug and alcohol laws.

Guide patients to the Students Abroad website from the US Department of State, which has excellent information and resources specifically for study-abroad travel.

Mission/Disaster Relief

Travel for humanitarian aid often carries specific risks, such as working long hours, often in close proximity with affected populations; damaged or absent infrastructure; reduced levels of security and protection; and ethical and moral challenges related to the event.

Accidents and violence are documented risks for humanitarian aid workers and cause more deaths than disease and natural causes. Violence occurs most often in insecure locations and areas of active conflict. Workers deployed to conflict areas should also be aware of landmines and other potential hazards.

Patients who travel for humanitarian assistance should be aware of and prepared for the risk of this type of work. Much of this preparation should come from the organization with which the traveler is working, but support and resources vary widely. Encourage travelers to research the level of support they should expect to receive from their organization during an emergency.

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Healthy Travel Packing List

Remind your patients to pack health and safety items. Use the Healthy Travel Packing List for Costa Rica for a list of health-related items they should consider packing.

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Travel Health Notices

Stay aware of current health issues in Costa Rica in order to advise your patients on additional steps they may need to take to protect themselves.

Alert Level 2, Practice Enhanced Precautions

  • Zika Virus in Costa Rica August 29, 2017 Zika virus (or Zika) has been reported. Public health officials have reported that mosquitoes are infected with Zika and spreading it to people.

Watch Level 1, Practice Usual Precautions

  • Malaria in Costa Rica September 22, 2017 The Costa Rican Ministry of Health has reported limited local transmission of malaria in Matina Canton in Limón Province, Sarapiquí Canton in Heredia Province, and Pital District in San Carlos Canton in Alajuela Province. Local transmission means that mosquitoes in the area are infected with malaria and spreading it to people. Other than a small outbreak at the end of 2016, this is the first local transmission of malaria in Costa Rica since 2011. Public health authorities are responding to this outbreak by enhancing malaria surveillance, making sure that patients are diagnosed and treated prom

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Advising Returning Travelers

Although some illnesses may begin during travel, others may occur weeks, months, or even years after return. A history of travel, particularly within the previous 6 months, should be part of the routine medical history for every ill patient. A newly returned, ill international traveler should be preferentially evaluated by a physician versed in travel-related illness.

Here are two professional medical organizations that provide directories of travel clinics throughout the United States:

Malaria is always a serious disease and may be a deadly illness. Any patient presenting with a fever after traveling in a malaria-risk area during the last year should be evaluated immediately using the appropriate diagnostic tests for malaria. Malaria, especially P. falciparum, requires urgent intervention as clinical deterioration can occur rapidly and unpredictably.

For more information on advising patients after international travel, see Yellow Book Chapter 5: Post-Travel Evaluation.

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Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.

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