Insect and tick protection (rural and forested areas only):

When visiting rural or forested areas, travelers should keep themselves fully covered (long sleeves, long pants, hats, etc.) and apply insect repellents containing 25-35% DEET (N,Ndiethylmetatoluamide). For children between 2 and 12 years of age, use preparations containing no more than 10% DEET and apply sparingly. DEET-containing compounds should not be used on children less than two years of age. For further protection, apply permethrin-containing repellents to clothing, shoes, and bed nets. Don’t sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. At the end of each day, travelers should also perform a thorough tick check with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

Food and water:

The safest course is not to drink tap water unless it has been boiled, filtered, or chemically disinfected, and not to drink any unbottled beverages or drinks with ice. Fruits and vegetables should not be eaten unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked, including barracuda, red snapper, grouper, amberjack, sea bass, and many tropical reef fish.

General advice:

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician’s letter documenting their medical necessity. If you wear glasses or contacts, bring an extra pair. Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars.

Pack a personal medical kit, customized for your trip. The kit should include an antibiotic and an antidiarrheal drug, to be started promptly if significant diarrhea occurs (defined as five or more loose stools in a 24-hour period). On long flights, consider isometric muscle contractions, walking, drinking plenty of fluids, and wearing elastic compression stockings to prevent blood clots in the legs.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.