Dominican RepublicClinician View
Outbreak alert: There is a dengue outbreak in the Dominican Republic. Dengue is spread by mosquitoes. Travelers going to the Dominican Republic should take steps to avoid mosquito bites. (more information)
There has been an increase in reports of dog and cat bites among travelers to Punta Cana, Dominican Republic. These animals can have rabies, which is nearly 100% fatal without timely and appropriate medical treatment.
- Be aware of the risk of rabies. Do not approach or try to pet dogs, cats, or other animals in the Dominican Republic. Animals can spread rabies before showing signs of being sick. Animals of any age (including puppies and kittens) can have the disease.
- If bitten or scratched, wash all wounds thoroughly with soap and running water and seek medical attention immediately.
- Appropriate preventive treatment for rabies is not always available in the Dominican Republic.
- Consider buying a travel insurance policy that will allow you to return to the United States early to get medical care, if needed.
Travel Health Notices
Stay aware of current health issues in the Dominican Republic in order to advise your patients on additional steps they may need to take to protect themselves.
Warning Level 3, Avoid Nonessential Travel
- New Global COVID-19 Pandemic Notice March 27, 2020 Widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring globally. CDC recommends that travelers avoid all nonessential international travel.
- New COVID-19 and Cruise Ship Travel March 17, 2020 CDC recommends that travelers defer all cruise travel worldwide.
Watch Level 1, Practice Usual Precautions
- Updated Dengue in the Americas March 17, 2020 Dengue is a risk in many parts of Central and South America, Mexico, and the Caribbean. Some countries are reporting increased numbers of cases of the disease. Travelers to the Americas can protect themselves by preventing mosquito bites.
The following diseases are possible risks your patients may face when traveling in the Dominican Republic. 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.
Counsel your patients on actions they can take on their trip to stay healthy and safe.
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.
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.
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
- Using Insect Repellents Safely (EPA)
- Insect Repellent Use and Safety (CDC)
- National Pesticide Information Center
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.
Schistosomiasis and leptospirosis are endemic in the Dominican Republic. Travelers should avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.
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.
People traveling for relief work may be at increased risk for bites from stray animals. Consider rabies vaccine for these travelers.Hide
People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.Hide
Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.
- 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) Hide
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.
Travelers may think they can find cheaper antimalarial drugs at their destination. To ensure medication quality, urge them to have their prescriptions filled in the United States.
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.Hide
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 the Dominican Republic.
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 the Dominican Republic 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.
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.
Encourage your patients to look up the information provided under Travel and Transportation on US Department of State's country-specific information for the Dominican Republic.
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.Hide
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.
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.Hide
Healthy Travel Packing List
Remind your patients to pack health and safety items. Use the Healthy Travel Packing List for Dominican Republic for a list of health-related items they should consider packing.
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:
- American Society of Tropical Medicine and Hygiene (ASTMH)
- International Society of Travel Medicine (ISTM)
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.
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.