Chapter 10 Popular Itineraries The Americas & the Caribbean

Clive M. Brown

DESTINATION OVERVIEW

Jamaica (called Xaymaca, “the land of wood and water,” by the Arawak Indians who originally inhabited the island) is situated in the Caribbean Sea about 90 miles south of Cuba. Introduced to Spain and the rest of Europe by Christopher Columbus in 1494, Jamaica was colonized by Britain in 1655. Port Royal became the most important commercial center in the English colonies and a strategic British military and naval base. It was reputed to be the wickedest city in the world, most likely because it was also a strategic base for pillage and plunder by pirates such as Henry Morgan and “three-fingered” Jack Rackham. The central two-thirds of the island is mountainous, and the highest point, Blue Mountain Peak, reaches 7,402 ft (2,256 m). The beaches on the flat coastal strip are among the most popular in the Caribbean. Jamaica recorded nearly 3 million tourist arrivals in 2014, and the United States accounted for more than 60% of stop-over visitors. While you lie back and enjoy the sea breeze and reggae music, here are a few tips to help you stay safe, healthy, and “irie” (having an ultimate positive feeling) while in Jamaica. Yeh Mon!

HEALTH ISSUES

Immunizations

In addition to routine vaccines, typhoid vaccine is recommended for some travelers to Jamaica, especially if they are staying long-term; staying with friends or relatives; or visiting smaller cities, villages, or rural areas where exposure might occur through food or water. Hepatitis A vaccine is recommended for all travelers, and hepatitis B vaccine is recommended especially for travelers who will have close contact with local residents or who could be exposed to blood or injections, including those who will be working in health care.

Malaria

Rare cases of autochthonous malaria transmission have been reported in Kingston, Jamaica, since an outbreak was reported in 2006. The risk for acquiring malaria among US travelers is estimated to be very low, and there are currently no recommendations for malaria chemoprophylaxis.

Dengue and Chikungunya

Dengue is endemic in Jamaica. Reports of dengue and severe dengue have increased in recent years. Chikungunya is now endemic in Jamaica, having first been reported in the Americas in 2013. The Pan American Health Organization reported, as of July 3, 2015, that there were >1.5 million cases of chikungunya reported thus far from the Caribbean. The illness presents with fever and joint pain and the typical course is about 1 week, though joint symptoms may be persistent.

Travelers to Jamaica should take measures to protect themselves from daytime mosquito bites to prevent these illnesses (see Chapter 3, Mosquitoes, Ticks, & Other Arthropods).

Travelers’ Diarrhea and Food-Related Diseases

Travelers to Jamaica will want to experience the spicy local fare, choosing from jerked chicken, ackee, salt fish (the national dish), curries (goat, chicken, shrimp, or lobster), escovitch (spicy fried) fish, and much, much more. While enjoying the cuisine, travelers should be reminded to select food and beverages carefully (see Chapter 2, Food & Water Precautions). Travelers’ diarrhea is one of the most common travel-related illnesses, and Jamaica has attack rates of 8%–20%. Jamaica is unique among tourist destinations for having a hotel-based surveillance system of illness and injuries in travelers and for doing occasional exit surveys among travelers at its airport to estimate the risk of travelers’ diarrhea. Since interventions to prevent and control diarrhea in visitors were implemented, Jamaica reported a 72% reduction in diarrhea in the visitor population from 1996 to 2002.

During 2000, an outbreak of eosinophilic meningitis was reported among travelers to the island associated with the roundworm Angiostrongylus cantonensis. The source of infection was likely contaminated salad.

Ackee is a red-skinned fruit with golden flesh. Although ackee is generally safe, it should only be eaten if prepared by a reliable source because if picked unripe, it produces hypoglycin, a toxin that causes a drop in blood sugar, vomiting, and in rare cases, convulsions, coma, and death. In 2011 the Jamaican Health Ministry reported >200 suspected cases and >20 deaths. All the ackee poisoning cases involved ackees cooked at home, and none occurred among visitors.

Physical Concerns for the Traveler

Crime and Drugs

The crime rate is high in Jamaica, particularly in Kingston and Montego Bay. Tourists are typically victims of theft; however, the situation may turn violent when victims resist handing over valuables. Criminals have also targeted Jamaican foreign nationals returning to resettle permanently in Jamaica. Visitors to the island should pay extra attention to their surroundings when traveling, avoid walking alone, avoid secluded places or situations, go out in groups and watch out for each other, exercise special care after dark, and always avoid areas known for high crime rates. Travelers should be reminded that possession or use of marijuana and other illicit drugs is illegal in Jamaica. Each year, many American citizens are arrested and incarcerated for drug-related crimes in Jamaica.

Traffic

Drivers drive on the left in Jamaica, which ranks in the top 10 for estimated traffic death rates in countries frequently traveled by US residents.

Natural Disasters

Jamaica lies in the path of Atlantic hurricanes and is often subject to flooding with high winds, impassable roads, and unsafe travel conditions. Jamaica has also been subject to major earthquake activity. In 1692, Port Royal was destroyed by an earthquake, seen by some as divine intervention based on its reputation as the wickedest city in the world. In 1907, the city and Port of Kingston were destroyed by an earthquake that caused >800 deaths. The last major destructive earthquake (magnitude 8.0) hit the western end of the island in 1957.

Beaches, Rafting, Diving, and Snorkeling and Mountain Climbing

The average temperature in Jamaica is 81°F (27.1°C) with much warmer temperatures (high 80s to low and mid-90s) from June through November. The coolest temperatures (low 70s) occur in January and February. Because of abundant sunshine, even in the cooler months travelers are at risk for sunburn.

Many travelers visit Jamaica to experience its stunning aquatic attractions. Visitors should be advised of potential risks associated with both saltwater and freshwater sources. The Jamaican reefs are among the most species-rich in the Caribbean, and some resorts provide diving instruction. In the event of decompression sickness, Jamaica has a decompression facility in Discovery Bay on its north coast near many of the diving areas.

Leptospirosis is common in freshwater in Jamaica; a major outbreak was reported in 2007 after flooding rains, and travelers going to areas with flooding are at highest risk.

Hiking overnight to catch the sunrise on the Blue Mountain Peak is a majestic, exhilarating, and exhausting experience. The rise to the peak from the coastal plain is one of the steepest gradients in the world. A mountain trek should not be done within 24 hours of diving to avoid the risk of decompression sickness. For safety, travelers should use known tour operators or hike with guides familiar with the trail. Jamaica has many endemic flowering plant species; >40% of the flowering plants in the Blue Mountains are found nowhere else in the world. Travelers may also encounter wild and endangered animal species. Although Jamaica is warm, the temperature at the peak can be cold, especially between December and June; the coldest temperature is around 40°F (5°C).

BIBLIOGRAPHY

1. Ashley DV, Walters C, Dockery-Brown C, McNab A, Ashley DE. Interventions to prevent and control food-borne diseases associated with a reduction in traveler’s diarrhea in tourists to Jamaica. J Travel Med. 2004 Nov–Dec;11(6):364–7.
2. Pan American Health Organization. Dengue. Washington, DC: Pan American Health Organization; 2012 [cited 2012 Sep 26]. Available from: http://new.paho.org/hq/index.php?option=com_content&view=article&id=264&Itemid=363&lang=en.
3. Rawlins SC, Hinds A, Rawlins JM. Malaria and its vectors in the Caribbean: the continuing challenge of the disease forty-five years after eradication from the Islands. West Indian Med J. 2008 Nov;57(5):462–9.