Chapter 10 Popular Itineraries The Americas & the Caribbean

Nelson Arboleda, Luis Bonilla

DESTINATION OVERVIEW

The Dominican Republic—the second-largest Caribbean nation, both by area and population—covers the eastern two-thirds of the Caribbean island of Hispaniola; Haiti comprises the western third. The capital city, Santo Domingo, is located on the southern coast of the island (see Map 10-07). Although English is spoken in most tourist areas (and approximately 250,000 US citizens call the Dominican Republic home), Spanish is the official language. Average temperatures range from 73.5°F (23°F) in January to 80°F (26.5°F) in August. The island receives more rain from May through November, and tropical storms or hurricanes are a possibility.

In 2017, more than 5 million foreign tourists (including approximately 3 million from the United States and Canada) visited the Dominican Republic, making it the most visited destination in the Caribbean. The Dominican Republic offers a diverse geography of beaches, mountain ranges (including the highest point in the Caribbean, Pico Duarte [10,164 ft; 3,098 m]), sugar cane and tobacco plantations, and farmland. Most tourism is concentrated in the east of the country around Bavaro and Punta Cana, which offer all-inclusive beach resorts. Whale watching is popular seasonally near the northeastern area in Samana, and kite- and wind-surfing attract visitors to the northern areas of Puerto Plata, Sosua, and Cabarete. Santo Domingo has an attractive colonial district that contains many historical sites dating back to Christopher Columbus’s arrival in the New World. A small number of travelers visit other parts of the country, where tourist infrastructure is limited or nonexistent.

HEALTH ISSUES

Vaccine-Preventable Diseases

All travelers should be up-to-date on routine vaccinations, including seasonal influenza. Cases of vaccine-preventable diseases have been reported among the local population and unvaccinated tourists from Europe and other parts of the world.

Travelers should be vaccinated against hepatitis A and, depending upon itinerary and activities, typhoid—especially anyone staying with friends or family (see Chapter 4, Typhoid & Paratyphoid Fever). Hepatitis B vaccine is recommended for people who might be exposed to blood through needles or medical procedures, or body fluids during sexual intercourse with a new partner.

Reports of animal and human rabies in the Dominican Republic are not uncommon. In 2017, there were 41 cases of animal rabies and 1 human rabies case. Consider rabies preexposure vaccination for travelers potentially at risk for animal bites (those spending extended time outdoors or anyone who handles animals).

Cholera was reintroduced in 2010, although areas of active transmission are evolving. Visit the Active cholera transmission has been reported in the Dominican Republic in recent years. Check the destination page at www.cdc.gov/travel for current recommendations.

HIV and Other Sexually Transmitted Infections

Commercial sex workers (CSW) can be found throughout the Dominican Republic; Samana, Sosua, and Puerto Plata are known sex tourism destinations. HIV prevalence among female CSW is as high as 6% in some areas; syphilis (12%), hepatitis B virus (2.4%), and hepatitis C virus (0.9%) are also concerns. Among men who have sex with men, HIV prevalence is as high as 6.9% and active syphilis as high as 13.9%. Travelers should avoid sexual intercourse with CSW and always use condoms with any partner whose HIV or sexually transmitted disease status is unknown (see Chapter 9, Sex & Travel).

Vectorborne Diseases

Malaria, dengue, Zika, and chikungunya are potential concerns for travelers to the Dominican Republic, and all travelers should take precautions to prevent mosquito bites by wearing long-sleeved shirts and long pants and using insect repellent (see Chapter 2, Mosquitoes, Ticks & Other Arthropods). Malaria is endemic to the Dominican Republic (see Chapter 4, Malaria). During 2017, a total of 395 cases of malaria were reported; 1 was fatal. Unless travelers are restricting their visit to the urban areas of Santiago or Santo Domingo only, CDC recommends taking malaria prophylaxis. This includes travel to the resort areas of Bavaro and Punta Cana; in 2015, several malaria cases were reported in US travelers returning from beach resort holidays. The malaria species found in the Dominican Republic (Plasmodium falciparum) remains sensitive to all known anti­malarial drugs.

Dengue is also widespread; 1,359 cases were reported in 2017 with 1 death. Although cases of dengue are reported year-round, transmission frequently increases during the rainy season from May through November. The principal mosquito vector (Aedes aegypti) of the dengue virus is found in both urban and rural areas (see Chapter 4, Dengue).

Zika is a risk in the Dominican Republic (see Chapter 4, Zika). 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 recommendations at www.cdc.gov/zika.

Food and Water

Remind travelers to drink only purified, bottled water. Ice served in well-established tourist locations is usually made from purified water and safe to consume. However, ice may not be safe in remote or nontourist areas. Food hygiene at large, all-inclusive, and popular tourist locations has improved over the last few years. However, travelers’ diarrhea continues to be the most common problem for visitors to the Dominican Republic (see Chapter 2, Travelers’ Diarrhea). Food purchased on the street or sold on beaches by informal sellers presents a higher risk of illness (see Chapter 2, Food & Water Precautions). Advise travelers not to eat raw or undercooked seafood.

Leptospirosis is prevalent on the island, with 792 cases and 79 deaths reported in 2017. Leptospirosis contamination can be attributed to climatic conditions (heavy rainfall, flooding) and environmental factors (agricultural practices, animal husbandry, inadequate disposal of waste, poor sanitation). Travelers should avoid recreational activities in rivers and lakes or other unprotected exposures to fresh water bodies potentially contaminated with animal urine (see Chapter 4, Leptospirosis).

Sun and Heat

Visitors to the Dominican Republic often underestimate the strength of the sun and the dehydrat­ing effect of the humid environment. Encourage travelers to take precautions to avoid sunburn by wearing hats and suitable clothing, along with proper application of a broad-spectrum sunscreen with an SPF ≥15 that protects against both UVA and UVB (see Chapter 3, Sun Exposure). Travelers should be sure to drink plenty of hydrating fluids throughout the day.

SAFETY AND SECURITY

Driving in the Dominican Republic is hazardous (see Chapter 8, Road & Traffic Safety). Traffic laws are rarely enforced, and drivers commonly drive while intoxicated, text while driving, exceed speed limits, do not respect red lights or stop signs, and drive without seatbelts or helmets. The Dominican Republic has among the highest number of traffic deaths per capita in the world (29.3 per 100,000 population in 2013). Many fatal or serious traffic crashes involve motorcycles and pedestrians. Motorcycle taxis, used throughout the country (including tourist areas), frequently carry 2 or more passengers riding without helmets. Remind visitors to avoid motorcycle taxis, to use only licensed taxis, and to always wear a seatbelt.

The risk of crime is similar to that of major US cities. Although most crime affecting tourists involves robbery or pickpocketing, more serious assaults occasionally occur, and perpetrators may react violently if resisted (see Chapter 3, Safety & Security Overseas). Visitors to the Dominican Republic should follow normal safety precautions such as going out in groups, especially at night; using only licensed taxi drivers; drinking alcohol in moderation; and being cautious of strangers. Criminal activity is often higher during the Christmas and New Year season. Additional caution during that time is warranted.

MEDICAL TOURISM

The market for medical tourism, including plastic surgery and dental care, is growing in the Dominican Republic. It attracts thousands of patients each year who access medical services that cost a fraction of what they do in the United States. Several companies and clinics offer package deals that include postsurgical recovery at local tourist resorts. Most health care facilities catering to medical tourists have not met the standards required by international accrediting bodies, however.

Substandard quality of care, health care–associated infections, and deaths have been the experience of some medical tourists to the Dominican Republic. Anyone considering the Dominican Republic as a destination for medical procedures should consult with a health care provider before travel, and research whether foreign health care providers meet accepted standards of care (see Chapter 9, Medical Tourism).

BIBLIOGRAPHY

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2. CDC. Dengue fever among US travelers returning from the Dominican Republic—Minnesota and Iowa, 2008. MMWR Morb Mortal Wkly Rep. 2010 Jun 4;59(21):654–6.
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7. Millman AJ, Esposito DH, Biggs HM, Decenteceo M, Klevos A, Hunsperger E, et al. Chikungunya and dengue virus infections among United States community service volunteers returning from the Dominican Republic, 2014. Am J Trop Med Hyg. 2016 Jun 1;94(6):1336–41.
8. World Health Organization Global Health Observatory data repository. Road traffic deaths: Data by country. [cited 2018 Aug 22]. Available from: http://apps.who.int/gho/data/node.main.A997.