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Trinidad and Tobago
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionGeneral adviceAmbulance and Emergency Services
Medical facilitiesPharmaciesMaps
Embassy/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.


Vaccinations:

Hepatitis A

Recommended for all travelers

Yellow fever

Recommended for most travelers visiting Trinidad, but not recommended for Tobago

Hepatitis B

Recommended for all travelers

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.

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Immunizations

The following are the recommended vaccinations for Trinidad and Tobago.

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.

Yellow fever vaccine is recommended for all travelers greater than nine months of age traveling to the island of Trinidad, except for travelers whose itinerary is limited to the urban areas of Port of Spain, cruise ship passengers who do not disembark from the ship, and airplane passengers in transit, unless they have reason to expect a large number of mosquito bites. The vaccine is not recommended for travelers whose itineraries are limited to the island of Tobago. Yellow fever vaccine is not recommended for those visiting only Tobago. The vaccine is required for all travelers over one year of age arriving from a yellow-fever-infected country in Africa or the Americas. 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 be given to anyone who is younger than nine months old, pregnant, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos).

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.

Typhoid vaccine is recommended for those planning an extended stay in rural areas or expecting to consume potentially contaminated food. Typhoid is uncommon in most Caribbean countries. Most travelers do not require typhoid immunization.

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.

Cholera vaccine is not recommended. Cholera outbreaks are not reported from the Caribbean.

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

Monkey cases of yellow fever were reported in January 2009 from the districts of Mayaro and Nariva, located in southern and southeastern Trinidad, respectively. Monkey cases were also reported from Trinidad in 1988, 1995, and 1999. No human cases of yellow fever have been reported from Trinidad since 1979, but the recent monkey deaths indicate that yellow fever virus is circulating in the forested areas of the island. Yellow fever vaccine is recommended for travelers who will be going to Trinidad (see above). Port of Spain has lower risk of transmission than rural or forested areas. Cruise ship passengers who do not disembark from the ship or travelers visiting only the urban area of Port of Spain (including passengers in-transit only) may consider foregoing vaccination. Yellow fever vaccine is not recommended for those visiting only Tobago.

Cases of dengue fever, a flu-like illness which may be complicated by hemorrhage or shock, are reported each year from Trinidad and Tobago. The most recent outbreak was reported in July 2010, causing 600 suspected cases, three of them fatal. In March 2009, an increased number of cases was observed in central Trinidad. A dengue outbreak was reported from south Trinidad in January 2008, resulting in more than 100 cases by late February. About 30 cases were also diagnosed in the Central Borough of Chaguanas. 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 advised, as outlined below.

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Other infections

Oropouche fever, another mosquito-borne infection, has been reported.

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.

Marine hazards include corals, jellyfish, sharks, and sea urchins. Do not bathe at unmarked, unpatrolled beaches.

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

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Food and water precautions

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, sea bass, and a large number of tropical reef fish.

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.

When visiting undeveloped areas, do not drink tap water unless it has been boiled, filtered, or chemically disinfected, and do not drink unbottled beverages or drinks with ice.

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Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). 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.

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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 a public ambulance in Trinidad and Tobago, call 990, but service is extremely limited and response may be slow. For a private ambulance, call one of the following:

  • North Trinidad: 868-624-4343
  • South Trinidad: 868-653-4343
  • Tobago: 868-639-4444

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Medical facilities

The largest facilities on each island are the Port of Spain General Hospital (169 Charlotte Street, Port of Spain; tel. 809-623-2951) and the Tobago Regional Hospital (Fort King George, Scarborough; tel. 868-639-2551), both which are public. Many travelers go to St. Claire Medical Center, a private clinic in Port of Spain (18 Elizabeth Street, Port of Spain; tel. 809-628-1451). Dialysis services are available at Eric Williams Medical Sciences Complex in Mt. Hope (tel. 868-645-2640).

Medical care in Trinidad and Tobago is limited. There may be shortages of critical supplies and medications. Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Patients may be expected to prove their ability to pay before service is provided, even in emergency situations. 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, though not all medications sold in the United States will be available in Trinidad and Tobago.

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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 Trinidad and Tobago are encouraged to register at the Consular Section of the U.S. Embassy in Trinidad and obtain updated information on travel and security within Trinidad and Tobago. The U.S. Embassy is located at 15 Queen's Park West, telephone 868-622-6371, Consular Section fax 868-628-9036, web site http://usembassy.state.gov/trinidad/. Hours of operation are 7:30 AM - 12:00 PM, and 1:00 PM through 4:00 PM Monday - Friday, except U.S. and Trinidad and Tobago national holidays. Not all embassy services are provided at all times, and some appointments are required.

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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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