Chapter 10 Popular Itineraries The Americas & the Caribbean
The Republic of Cuba is located between the Caribbean Sea and the North Atlantic Ocean, approximately 93 miles (150 km) south of Key West, Florida. The largest country in the Caribbean, it has a population of 11 million people. The official language is Spanish. The climate is tropical, with a dry season from November to April and a rainy season from May to October. Originally inhabited by a native Amerindian population, the Spanish colonized the island in the 15th century.
In 1898, Cuba gained independence from Spain, with the assistance of the United States. It then gained independence from the United States in 1902. In 1959, a revolutionary army under Fidel Castro overthrew the existing Cuban government and established a communist state. In response, the United States put in place an embargo against Castro and Cuba in 1961. More recently, the United States initiated efforts to reestablish diplomatic relations, reopening the US embassy in Havana on July 20, 2015. Although tourist travel to Cuba is still prohibited under US law, 12 categories of travel are now authorized, including family visits, professional research and meetings, and humanitarian projects.
Out of reach of most US citizens for years, Cuba has long been a popular travel destination for Canadians and Europeans. The largest and most popular resort area is in Varadero, a peninsula with a vast, 13-mile stretch of sandy beach and more than 50 hotels. Those seeking to experience Cuban culture often travel to the capital city of Havana to explore the streets of La Habana Vieja (Old Havana) and to walk along the sea wall, the Malecon. Another popular destination is Trinidad, a colonial city known for its cobblestone streets (see Map 10-06). Throughout the country, tourists can enjoy the sight of vintage cars and sample Cuban cigars, rum, and mojitos.
Map 10-06. Cuba destination map
Travelers should confirm that routine vaccinations are up-to-date, including seasonal influenza vaccine. Hepatitis A vaccine is recommended for non-immune travelers. Strongly encourage travelers anticipating blood or body fluid exposures—people intending to do medical work and those seeking medical treatment—to be vaccinated against hepatitis B. Travelers who obtain tattoos or piercings, users of injection drugs, and anyone who has sexual contact with the local population is also at risk for hepatitis B; because exposures such as these are often unanticipated, pretravel hepatitis B vaccination is a prudent choice for adult travelers.
Typhoid vaccination is recommended for most travelers, especially those visiting friends and relatives, people traveling to rural areas, and “adventurous eaters” (see Chapter 4, Typhoid & Paratyphoid Fever). Rabies vaccine is recommended for travelers who may be in contact with dogs, bats, or other mammals at high risk for the disease; travelers who expect to have occupational exposure to animals; and long-term travelers.
Chikungunya, dengue, and Zika are mosquitoborne diseases that are present (or potentially present) in Cuba (see sections on chikungunya, dengue, and Zika in Chapter 4 for details on each). Travelers to this island nation should therefore take precautions against mosquitoes, using insect repellents and wearing pants and long-sleeved shirts (see Chapter 2, Mosquitoes, Ticks & Other Arthropods). Despite the large chikungunya outbreak that started in late 2013 and involved the entire Caribbean, Cuban authorities did not report any cases of local transmission. Dengue is a known risk, and the first cases of local vectorborne Zika virus transmission were reported in Cuba in 2016. Because of the risk of birth defects in infants born to women infected with Zika during pregnancy, women who are pregnant or trying to become pregnant should research the most recent travel recommendations at www.cdc.gov/zika.
Other Health and Safety Risks
FOOD AND WATER
Visitors to Cuba are at risk of developing travelers’ diarrhea, even when staying at resorts. Remind travelers to refrain from eating raw or undercooked meat and seafood and any unpasteurized dairy products (see Chapter 2, Food & Water Precautions). Salads and uncooked vegetables should also be avoided, and fruit eaten only if washed in clean water or peeled by the traveler. Travelers should know to drink only bottled water or water that has been boiled and filtered or otherwise treated. Consider prescribing an antibiotic for self-treatment of moderate to severe diarrhea (see Chapter 2, Travelers’ Diarrhea); these drugs are not readily available in Cuba.
Ciguatera fish poisoning is found in tropical and subtropical areas surrounded by coral reefs and is known to occur in Cuba. Counsel travelers to avoid or limit consumption of large reef fish, including their viscera, especially species such as grouper, snapper, barracuda, jack, sturgeon, sea bass, and moray eel (see Chapter 2, Food Poisoning from Marine Toxins).
SUN, SAND, AND WATER HAZARDS
Care should be taken to avoid excess sun exposure: sunscreen of SPF ≥15 protects against both UVA and UVB; wearing protective clothing and seeking shade provide some respite from the tropical heat and sun (see Chapter 3, Sun Exposure).
In the Caribbean (and not unique to Cuba), travelers are at risk of a variety of other dermatological hazards. Cutaneous larva migrans is caused by dog and cat hookworms (see Chapter 4, Cutaneous Larva Migrans). Lying or walking on contaminated soil, including sandy beaches, exposes humans to hookworm larvae. Risk can be minimized by wearing shoes and by not lying directly on sand. Envenomation from jellyfish, microscopic cnidarians (sea bather’s eruption), sea urchins, and stingrays can occur in the warm shallow waters surrounding many resort areas.
SAFETY AND SECURITY
Road conditions are often dangerous (see Chapter 8, Road & Traffic Safety). The Carretera Central (main east–west highway) is in good condition, but hazards include unfenced livestock and farm vehicles. As many roads are unlit, travelers should avoid driving at night. Cars in Cuba are often old and may lack basic safety features such as turn signals. Tourist company buses and radio-dispatched taxis are generally safe and reliable; unlicensed taxis and yellow 3-wheeled “coco taxis” should be avoided. Advise travelers to fasten seat belts when riding in cars and to wear a helmet when riding bicycles or motorbikes. Petty theft may occur, especially in crowded tourist areas such as beaches and Old Town Havana. Typically nonviolent, there is some concern that violent crime is on the rise; travelers should not resist if confronted (see Chapter 3, Safety & Security Overseas).
Health care does not meet American standards. Medical professionals are generally competent but medical supplies and certain medications may be in short supply or unavailable. Travelers should plan to bring adequate supplies of both prescription and nonprescription medications.
- Boggild AK, Geduld J, Libman M, Ward BJ, McCarthy AE, Doyle PW, et al. Travel-acquired infections and illnesses in Canadians: surveillance report from CanTravNet surveillance data, 2009–2011. Open Med. 2014 Feb 11;8(1):e20–32.
- Central Intelligence Agency. The World Factbook; 2017. [cited 2018 Mar 20]. Available from: www.cia.gov/library/publications/the-world-factbook/index.html.
- Fillion K, Mileno MD. Cholera in travelers: shifting tides in epidemiology, management, and prevention. Curr Infect Dis Rep. 2015 Jan;17(1):455.
- Morrison K, Aguiar Prieto P, Castro Domínguez A, Waltner-Toews D, FitzGibbon J. Ciguatera fish poisoning in La Habana, Cuba: a study of local social–ecological resilience. EcoHealth. 2008 Sep;5(3):346–59.
- U.S. Department of State – Bureau of Consular Affairs. Country Information: Cuba. 2017. [cited 2018 Mar 20]. Available from: https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages/Cuba.html.