(Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Cuba, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Montserrat, Netherlands Antilles, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Turks and Caicos Islands, and the Virgin Islands (USA)).

3.4.1  Disease risks

Food and water-borne diseases:

Bacillary and amoebic dysentery are common and hepatitis A reported, particularly in the northern islands. No cholera has been reported in recent years.

Biointoxication may occur from raw or cooked fish or shellfish.

Malaria: only in Haiti and the Dominican Republic

Other arthropod-borne diseases (see Chapter 7):

•   Outbreaks of dengue fever and some dengue haemorrhagic fever.

•   Diffuse cutaneous leishmaniasis recently reported from Dominican Republic.

•   Bancroftian filariasis in Haiti and some other islands.

•   Other filariases occasionally found.

•   Fasciola hepatica endemic in Cuba.

•   Yellow fever reported in wildlife in Trinidad.

Diseases of close association:

•   In 1994, an international commission certified the eradication of endemic wild poliovirus from the Americas including the Caribbean. Ongoing surveillance in formerly endemic Central and South American countries confirms that poliovirus transmission remains interrupted, although an outbreak of vaccine-derived poliovirus type 1 occurred in the Dominican Republic and Haiti in July 2000.

•   Tuberculosis incidence similar to western Europe, although higher in Haiti and the Dominican Republic.

Sexually transmitted and blood-borne infections:

Hepatitis B of low or intermediate prevalence; HIV endemic.

Other hazards could include:

•   Schistosomiasis (bilharziasis) in the Dominican Republic, Guadeloupe, Martinique, Puerto Rico and Saint Lucia; may occur sporadically in other islands.

•   Spiny sea urchins, corals and jellyfish, snakes and scorpions.

•   Animal rabies, particularly in the mongoose, reported from several islands.

3.4.2  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 usually advised (less important for short stays in tourist hotels). Immunsation against typhoid occasionally advised for longer stays where food and water hygiene standards may be in doubt. For longer stays consider immunisation against hepatitis B and diphtheria and check BCG status.

3.4.3  Country by country variations and malaria chemoprophylaxis:

Anguilla, Antigua and Barbuda, Bahamas, Barbados, Dominica

Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

Dominican Republic

Malaria - low risk throughout the year. Because the malaria is almost exclusively of the more severe falciparum type and still sensitive to chloroquine it is wise for travellers to take prophylaxis.

Recommended prophylaxis: chloroquine.

Grenada, Guadeloupe

Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

Haiti

Yellow fever vaccination certificate required from travellers coming from infected areas.

Malaria risk (almost exclusively P.falciparum) throughout the year below 300m in suburban and rural areas.

Recommended prophylaxis: chloroquine.

Jamaica

Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

Netherlands Antilles

Yellow fever vaccination certificate required from travellers over six months of age coming from infected areas.

Saint Kitts and Nevis, Saint Vincent and the Grenadines

Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas.

Trinidad and Tobago

Yellow fever vaccination certificate required from travellers over one year of age coming from infected areas. Yellow fever vaccination usually advised for visits to rural or forested areas of Trinidad (not for solely city or beach holidays or for Tobago).