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Portugal
Summary of recommendationsImmunizationsRecent outbreaks
Other infectionsFood and water precautionsInsect and Tick Protection
General advicePhysicians and hospitalsMedical facilities
MapsEmbassy/Consulate LocationSafety information

 

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Summary of recommendations:

No special immunizations or medications are necessary for most trips to Portugal.


Vaccinations:

Hepatitis A

Recommended for extended travel to rural areas where food hygiene is questionable

Hepatitis B

Recommended for all travelers

Yellow fever

Required for travelers only if destined for the Azores or Madeira and only if arriving from a yellow-fever-infected country in Africa or the Americas

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria

Revaccination recommended every 10 years

Influenza

Recommended for all travelers from November through April

Immunizations

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for Portugal:

Hepatitis A vaccine is recommended for extended travel to rural areas where food hygiene is questionable. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Travelers who require protection against hepatitis A and are less than two years old, are pregnant, or have less than two weeks before departure should receive a single intramuscular dose of gammaglobulin (see hepatitis A for dosage) instead of vaccine.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Yellow fever vaccine is required for travelers over one year of age only if destined for the Azores or Madeira and only if arriving from a yellow-fever-infected country in Africa or the Americas. The vaccine is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. No certificate is required from passengers in transit at Funchal, Porto Santo and Santa Maria. Yellow fever vaccine should not in general be given to those younger than nine months of age, pregnant, immunocompromised, or allergic to eggs.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.

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Recent outbreaks

An outbreak of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, was reported from the Portuguese island of Madeira in October 2012, causing more than 2000 cases by February 2013, including 78 cases in travelers. The city of Funcha was particularly affected. Cases were also reported from Porto Santo, which is the other inhabited island in the archipelago. The outbreak was uncer control by March 2013 (see ProMED-mail and Eurosurveillance). Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. To prevent dengue, travelers to Madeira should apply insect repellent and keep themselves covered when outdoors.

A single case of variant Creutzfeldt-Jakob disease (CJD) has been identified in Portugal. The disease is acquired by eating beef from cows with a related infection known as bovine spongiform encephalopathy (mad cow disease). At present, the risk of acquiring variant CJD from European beef appears to be extraordinarily low, at most about one in 10 billion servings. The Centers for Disease Control does not advise against eating European beef, but suggests that travelers who wish to reduce their risk may either abstain from beef while in Europe or eat only solid pieces of muscle meat, such as steak, rather than products like sausage or chopped meat that might be contaminated. There is no evidence of any risk from pork, lamb, milk or milk products. For recent updates, go to ProMED-mail.

An outbreak of leptospirosis was reported in 2001 from the Azores, especially the islands of Terceira and Sao Miguel. Rats were the main source of infection. The chief symptoms were fever, chills, body aches, headaches, and jaundice. A number of cases have been fatal. See the Weekly Epidemiological Record (PDF) for further details. Leptospirosis is acquired by exposure to water contaminated by the urine of infected animals. Travelers to the Azores should avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers.

An outbreak of murine typhus was reported from Porto Santo Island in 1996 (see Eurosurveillance for details).

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Other infections

For disease statistics and updates on recent outbreaks, go to the Ministerio da Saude website (in Portuguese).

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Food and water precautions

Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. 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. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

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Insect and Tick Protection

Wear long sleeves, long pants, and boots, with pants tucked in. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing and shoes. Permethrin-treated clothing appears to have little toxicity. Perform a thorough tick check at the end of each day 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.

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General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal 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. Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

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.

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Physicians and hospitals

For an on-line list of physicians and hospitals in Portugal, go to the United States Embassy website. The Embassy website also offers a separate list of physicians in the Azores.

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Medical facilities

(reproduced from the U.S. State Dept. Consular Information Sheet)

Medical facilities are available in Portugal, but in some cases they may not meet U.S. standards. The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. U.S. medical insurance plans seldom cover health costs incurred outside the United States unless supplemental coverage is purchased. Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. However, many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas including emergency services such as medical evacuations.

When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the U.S. may cost well in excess of $50,000. Uninsured travelers who require medical care overseas often face extreme difficulties. When consulting with your insurer prior to your trip, ascertain whether payment will be made to the overseas healthcare provider or if you will be reimbursed later for expenses that you incur. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State, Bureau of Consular Affairs brochure, Medical Information for Americans Traveling Abroad, available via the Bureau of Consular Affairs home page at http://travel.state.gov.

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Maps

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

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Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living or traveling in Portugal are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within Portugal. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, you'll make it easier for the Embassy or Consulate to contact you in case of emergency. The Embassy is located on Avenida das Forcas Armadas, Sete Rios, telephone: (351)(21) 727-3300, fax: (351)(21) 726-9109, Internet home page: http://www.american-embassy.pt. The U.S. Consulate is located in Ponta Delgada on the island of San Miguel in the Azores. The address is Av. Principe do Monaco, 6-2F, Ponta Delgada, phone: (351)296-282-216, fax: 351-296-28-72-16. There is also a Consular Agency located in Funchal, Madeira, on Rua Alfandega, no 10-2, Room A-B, Funchal, phone: (351)291-235-636, fax: (351)-291-229-630, open Monday through Friday from 10:00 a.m. to 12:00 noon.

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Safety information

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.

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