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Honduras
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionSwimming and bathing precautionsAir pollution
General adviceAmbulance and Emergency ServicesMedical facilities
PharmaciesTraveling with childrenTravel and pregnancy
MapsEmbassy/Consulate LocationSafety information

 

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Summary of recommendations:

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

Malaria: Prophylaxis with chloroquine, Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycyline is recommended for all areas below 1000 m (3281 ft) and for Roatán and other Bay Islands
Vaccinations:

Hepatitis A

Recommended for all travelers

Typhoid

Recommended for all travelers

Yellow fever

Required for travelers arriving from a yellow-fever-infected area in Africa or the Americas (except for Panama) and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission. Not recommended otherwise.

Hepatitis B

Recommended for all travelers

Rabies

For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats

Measles, mumps, rubella (MMR)

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

Tetanus-diphtheria

Revaccination recommended every 10 years

Medications

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. 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 associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

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.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Honduras: prophylaxis is recommended for all areas below 1000 m (3281 ft) and for Roatán and other Bay Islands. Historically, the highest incidence rates have occurred in the swampy regions in the east, but the number of cases reported from the north has risen dramatically over the last several years. An increased number of cases was reported from the department of Colon in March 2012.

For many years, the drug of choice has been chloroquine, which is inexpensive and generally well-tolerated. The recommended dosage is 500 mg weekly, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Chloroquine may cause mild adverse reactions, including gastrointestinal disturbance, headache, dizziness, blurred vision, and itching, but severe reactions are uncommon. Other choices include mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), doxycycline, or primaquine. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics. Primaquine may cause hemolytic anemia in those with G6PD deficiency, so a blood test documenting normal G6PD levels must be obtained before starting primaquine. In those with normal G6PD levels, the main side-effect of primaquine is gastrointestinal disturbance, which can be minimized by taking the medication with food..

Insect protection measures are essential, as below.

There is no malaria risk in Tegucigalpa and San Pedro Sula.

For further information about malaria in Honduras, including maps showing the risk of malaria in different parts of the country, go to the World Health Organization and the Pan American Health Organization.

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Immunizations

The following are the recommended vaccinations for Honduras.

Hepatitis A vaccine is recommended for all travelers over one year of age. 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.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

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.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

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.

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas (with the exception of Panama), and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission, but 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. The vaccine should not in general be given to anyone who is less than nine months old, pregnant, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos).

Cholera vaccine is not recommended. Only one case of cholera was reported for the year 2001 and none for 2002.

Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. Polio has been eradicated from the Americas, except for a small outbreak of vaccine-related poliomyelitis in the Dominican Republic and Haiti in late 2000.

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Recent outbreaks

Outbreaks of dengue fever, a flu-like illness which may be complicated by hemorrhage or shock, are reported annually from Honduras. The worst dengue outbreak in 30 years began in June 2010, causing more than 66,000 cases and 83 deaths by the end of December. The highest incidence was reported from the departments of Francisco Morazan, El Paraiso, Comayagua, Olancho, and Cortes. The outbreak had subsided by the end of the year. Only 680 cases were reported during the first two months of 2011, much lower than the 2880 cases reported for the time period the previous year. Dengue fever 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. Insect protection measures are strongly advised, as outlined below.

A total of 6000 cases were reported nationwide for the first nine months of 2009, including three deaths. A major dengue outbreak was reported in the summer of 2007, causing more than 33,000 cases and eight deaths by the end of the year. The greatest number of cases were reported from the Central District, which includes the capital city of Tegucigalpa, followed by the departments of Cortez, in the north along the Guatemalan border, and El Paraiso y Olancho, both in the eastern part of the country, along the Nicaraguan border. An outbreak in June 2002 resulted in more than 4000 cases, chiefly in the regions of Francisco, Morazan, La Paz, Cortes, Olancho, Comayagua, Choluteca, El Paraiso, Yoro, Santa Barbara, and Copan (see the World Health Organization).

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Other infections

  • Melioidosis (two cases reported in 2005 after visiting or residing in Atlantida province; see MMWR; caused by bacteria known as Burkholderia pseudomallei found in contaminated soil and water, especially in agricultural fields during the rainy season; causes wound infections or pneumonia, which may progress rapidly and be life-threatening)
  • Venezuelan equine encephalitis (scattered foci; see ProMED-mail, March 20,2002)
  • Eastern equine encephalitis (scattered foci)
  • Chagas disease (American trypanosomiasis; one positive case of Chagas disease in El Negrito and three suspected cases in Santa Rita in October 2012) (rural areas; highest concentration in the central region of Honduras; transmitted by reduviid bugs in substandard housing)
  • Cutaneous leishmaniasis (found country-wide; highest incidence in the department of Olancho; transmitted by sandflies)
  • Visceral leishmaniasis (uncommon; chiefly in southern rural areas)
  • Leptospirosis (reported after Hurricane Mitch in 1998)
  • Tick-borne relapsing fever
  • Brucellosis (the chief animal source is infected pigs)
  • Paragonimiasis (oriental lung fluke)

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

For in-depth public health information, go to the Pan-American Health Organization. For further information, go to the the PAHO Country Office.

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Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. 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, including ceviche. 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, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. 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, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, 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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Swimming and bathing precautions

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Swimming in the ocean or a chlorinated swimming pool carries no risk of schistosomiasis.

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Air pollution

Air pollution is often severe throughout the country during the dry season, largely because of widespread forest fires and agricultural burning. Travelers with respiratory or cardiac conditions and those who are elderly or extremely young are at greatest risk for complications from air pollution, which may include cough, difficulty breathing, wheezing, or chest pain. The risk may be minimized by staying indoors, avoiding outdoor exercise, and drinking plenty of fluids.

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General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary 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.

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. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

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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Ambulance and Emergency Services

For an ambulance in Honduras, call the Red Cross Ambulance at 195 or 227-9344, 227-8023, 227-7474, 227-7575, or a private ambulance service called Rescate Medico Movil at 239-9999 (emergency only) or 232-6999, 232-0840, and 239-7087 (non-emergencies). Ambulance services are limited in the cities and virtually non-existent elsewhere. Both organizations provide well-equipped vehicles with trained staff. When calling an ambulance, ask for the ambulance with "pre-hospital service" ("ambulancia con servicio pre-hospitalario"). The Red Cross Ambulance will require a fee paid by the patient at time of transport. The Rescate Medico Movil is paid for on a membership basis with a low monthly fee. A fee of approximately Lps 5,000.00 per trip is charged to non-members.

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Medical facilities

Medical care in Tegucigalpa and San Pedro Sula is adequate for routine problems, but medical resources elsewhere are extremely limited. Many physicians are well-trained, but ambulances and hospitals may lack critical supplies and the quality of the support staff is variable. In Tegucigalpa, many travelers go to Hospital Viera (Barrio La Ronda, 5 Calle, 11-12 Ave, near U.S. Embassy; tel. 504-238-0736, 238-0697, 237-7136, or 237-3160; Dr. Eduardo Talavera in charge). Other options include Hospital Centro Medico Hondureño (3ra Avenida Nro 202, Barrio La Granja; tel. 504-225-0028, 225-0035) or Hospital La Policlinica (3a Ave. Entre 7 y 8 Calles, No 701; tel. 504-237-3211/12/13; 24-hour service). In San Pedro Sula, a preferred facility is Centro Medico Cemesa (Col. Altmira Blvd. del Sur San Pedro Sula 488; tel. 504-556-7401).

For a list of other hospitals, go to the Embassy website at http://honduras.usembassy.gov/english/mission/sections/con_21.htm. There are no hospitals on the islands of Roatan, Utila, and Guanaja, though Roatan and Utila have decompression chambers for divers. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

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Pharmacies

Most pharmacies are well-supplied. In the major cities, the pharmacies take turns staying open 24 hours (the pharmacy on duty is denoted by a green cross in the window).

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Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

The recommendations for malaria prophylaxis are the same for young children as for adults, except that the dosage of chloroquine is lower. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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Travel and pregnancy

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary (see the U.S. Embassy website). In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

As a rule, pregnant women should avoid visiting areas where malaria occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, chloroquine must be taken once a week and insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

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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 in or visiting Honduras are encouraged to register at the Consular Section of the U.S. Embassy in Tegucigalpa and to obtain updated information on travel and security within Honduras. Travelers can register in person, or fill out the form available on the Embassy website and fax it to the Embassy. Please include a copy of the data page of your passport and emergency contact information.

The U.S. Embassy and Consulate are located at: Avenida La Paz in Tegucigalpa, Honduras; Fax: 011-504-238-4357; Web site: http://www.usmission.hn/ Telephone: 011-504-236-9320 or 011-504-238-5114. For information on services for U.S. citizens, please ask for ext. 4400.

The Consular Agency in San Pedro Sula is located at: Banco Atlantida Building - 8th Floor; San Pedro Sula, Honduras; Telephone: 011-504-558-1580. The Consular Agent is available during limited hours to accept U.S. passport applications for adjudication at the Embassy in Tegucigalpa, perform notarial services and assist U.S. citizens with emergencies. Please call for office hours. The Consular Agent does not provide visa information or services.

For more details about all U.S. Embassy and consular services in Honduras, please see the Embassy web site at: http://www.usmission.hn/, or visit the Bureau of Consular Affairs web site at: http://travel.state.gov/.

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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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