3.3 Central
America
(Belize, Costa Rica, El Salvador, Guatemala, Honduras,
Mexico, Nicaragua, Panama)
3.3.1 Disease risks
Food and water-borne diseases
including amoebic and bacillary dysentry, other diarrhoeal diseases
and typhoid fever are common throughout the area. Hepatitis A
occurs throughout the area and hepatitis E has been reported in
Mexico. Helminth infections are also common. All countries except
Panama have reported cholera in recent years.
Malaria
present in all countries - see individual entries below
Other arthropod-borne diseases (see Chapter 7):
- Yellow
fever - the South American endemic zone extends into Panama
- Cutaneous and mucocutaneous
leishmaniasis in all countries
- Visceral leishmaniasis
- El Salvador, Guatemala, Honduras, Mexico and Nicaragua
- Onchocerciasis (river
blindness) in two small foci in the south of Mexico and four dispersed
foci in Guatemala
- American trypanosomiasis
(Chagas' disease) in localised foci in rural areas in all
countries
- Dengue fever and Venezuelan
equine encephalitis may occur in all countries
- Rocky
Mountain spotted fever.
Diseases of close association:
In
1994, an international commission certified the eradication of
endemic wild poliovirus from the Americas. Ongoing surveillance
in formerly endemic Central and South American countries confirms
that poliovirus transmission remains interrupted.
- Tuberculosis
endemic.
Sexually transmitted and blood-borne infections:
Hepatitis B of low prevalence in most countries (intermediate
prevalence in Guatemala and Honduras); HIV endemic throughout
the area.
Other hazards could include:
- Leptospirosis.
- Rabies in animals (usually
dogs and bats).
- Snakes
and scorpions in some areas.
3.3.2 Recommendations
for
immunisations
and
malaria
chemoprophylaxis
(see
later
chapters
for
general
health
precautions)
FOR
ALL
COUNTRIES
Check
routine
immunisations
including
tetanus.
Immunisation
against
hepatitis
A
and
typhoid
generally
advised.
For
longer
stays,
consider
immunisation
against
diphtheria,
hepatitis
B
and
check
BCG
status;
for
longer
rural
travel,
out
of
reach
of
medical
attention,
consider
immunisation
against
rabies.
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3.3.3 Country by country variations and malaria
chemoprophylaxis:
Belize
Yellow fever vaccination certificate required from
travellers coming from infected areas.
Malaria risk (predominantly P.vivax)
throughout the year.
Recommended prophylaxis: chloroquine.
Costa Rica
Malaria risk (almost exclusively P.vivax)
throughout the year in rural areas below 700m in Alajuela, Guanacaste,
Limon and Heredia provinces.
Recommended prophylaxis: for the rural areas above
only, chloroquine.
El Salvador
Yellow fever vaccination certificate required from
travellers over six months of age coming from infected areas.
Malaria risk (almost exclusively P.vivax)
throughout the year in Santa Ana province.
Recommended prophylaxis: for the risk area, chloroquine.
Guatemala
Yellow fever vaccination certificate required from
travellers over one year of age coming from countries with infected
areas.
Malaria risk (predominantly P.vivax)
throughout the year below 1,500m in several Departments.
Recommended prophylaxis: chloroquine.
Honduras
Yellow fever vaccination certificate required from
travellers coming from infected areas.
Malaria risk (predominantly P.vivax)
throughout the year in most areas.
Recommended prophylaxis: chloroquine.
Mexico
Malaria risk (almost exclusively P.vivax)
throughout the year largely in rural areas. There is a significant
risk of transmission in the states of: Campeche, Chiapas, Guerrero,
Michoacan, Oaxaca, Quintana Roo, Sinaloa and Tabasco and moderate
risk in the states of Chichuahua, Durango, Hidalgo, Jalisco, Nayarit,
Sonora and Veracruz.
Recommended prophylaxis: for the risk areas, chloroquine;
in other areas none but bear in mind the remote possibility of
malaria.
Nicaragua
Yellow fever vaccination certificate required from
travellers over one year of age coming from infected areas.
Malaria risk (predominantly P.vivax)
throughout the year in most areas.
Recommended prophylaxis: chloroquine.
Panama
Yellow fever vaccination certificate recommended
for all travellers going to Chepo Darien and San Blas.
Malaria risk (predominantly P.vivax)
throughout the year in three provinces: Bocas de Toro in the west,
and Darien and San Blas in the east where chloroquine resistant
P.falciparum
has been reported. The canal area itself is considered malaria
free.
Recommended prophylaxis: for above areas, chloroquine
west of the canal; chloroquine plus proguanil east of the canal.
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