2. Health and Vaccinations

2.1 General Health

General safety and sanitary standards in Latin America are often not as high as those in Europe. Public health facilities are available, but these are often only rudimentary. In most countries, private facilities are both modern and of an excellent standard, and many private doctors have had training in Europe or the United States. It is therefore essential that you take out comprehensive health insurance so you can make use of private health care.

In isolated places, there are few facilities of any kind, and if you are going to travel off the beaten track, you should take with you a well-equipped first-aid kit. Virtually all first-aid posts, surgeries, health centres and hospitals now use only disposable needles which the staff will unwrap in front of you, so it is not necessary to come armed with these.

Pharmacies in Latin America are well stocked and most products (even antibiotics) can be bought over the counter. Check the validity dates on the packaging.

2.2 Vaccinations and Inoculations

There's an important distinction between a recommendation (advice) and a requirement (you may be refused entry to the country without proof of inoculation).

All the inoculations/vaccinations you will need (with the common exception of yellow fever), are available from your local GP or from a travel clinic (these centres will make a charge). Your GP will normally require notice to acquire them. In the UK, GPs usually refer to www.fitfortravel.nhs.uk

Yellow fever vaccinations are available at yellow fever vaccination clinics and occasionally at GPs' surgeries. There often appears to be a shortage of the yellow fever vaccine, so you should guard against this by having the vaccination as early as possible before travelling. The charge does vary but on average costs about £45.

The following travel clinics provide inoculation services as well as advice on healthcare whilst abroad. Please call to make an appointment.

Nomad Travel Clinics: Full details can be found at www.nomadtravel.co.uk/pages/nomadtravel-clinics

MASTA Travel Clinics: For details of all MASTA Travel Clinics look at their website www.masta-travel-health.com, or email enquiries@masta.org

For the latest information on endemic diseases, like malaria, dengue fever and vaccination requirements for Latin America you can check the NHS Fit for Travel website: www.fitfortravel.nhs.uk or the websites of the National Travel Health Network and Centre (NaTHNaC) at: www.nathnac.org/travel/index

Period of validity of recommended vaccines

- Yellow fever 10 years
- Typhoid 3 years
- Hepatitis A 10-20 years (depending on the vaccine)
- Polio 10 years
- Tetanus 10 years

Always carry with you your International Certificate of Vaccination, signed by a doctor and validated with an official stamp, as you may be required by local health authorities to prove that you have been inoculated against yellow fever.

British GPs are now routinely recommending inoculation against hepatitis B (if you are in a high-risk group) and rabies (if you are likely to be more than 24 hours' travel away from medical attention).

2.3 Yellow fever

You should take precautions at all times against being bitten by mosquitoes. The best widely available insect repellent (in the UK) is the Jungle Formula range. The effectiveness of repellents depends on the percentage of diethyl toluamide (deet), the active ingredient. If you prefer something natural, Mosiguard can be effective. Many other brands, e.g. Boots' own or Autan, have only 10-15% deet and are therefore not very effective. Some repellents have up to a 95% concentration - this is very powerful and should not be used for long periods. It also has a deleterious effect on leather, plastics and Lycra.

Argentina
The yellow fever vaccination is recommended for those travelling to the regions of Argentina bordering Paraguay and Brazil in the provinces of Chaco, Corrientes, Formosa, Salta province and to all areas of Misiones province, including Iguazú Falls.

Bolivia
Foreigners entering areas which have been designated ‘high risk' for yellow fever require a valid yellow fever certificate. These areas include all of the lowland regions of Santa Cruz, Pando and Beni, and much of Cochabamba, Tarija and northern La Paz departments. The highland region of the country, including the cities of La Paz, Potosí and Oruro, Lake Titicaca and the Uyuni salt flats, is not affected. The Bolivian authorities require that all travellers from Brazil or Paraguay, as well as those intending to travel to the risk areas above, show valid yellow fever vaccination certificates.

Brazil
If you have recently visited a country which is known to suffer from outbreaks of yellow fever, you are required to show that you have been vaccinated against the disease. Travellers are strongly urged to get the yellow fever vaccine before travelling to an area of Brazil with risk of yellow fever transmission, including: Acre, Amazonas (Manaus), Amapá, Distrito Federal (Brasilia), Goiás, Maranhão (São Luís), Minas Gerais (Ouro Preto, Belo Horizonte), Mato Grosso do Sul (Pantanal), Mato Grosso, Pará (Belém), Rondônia, Roraima, Tocantins.

Vaccination against yellow fever is also recommended for travellers when visiting rural areas in the states of Bahia, Espírito Santo, Paraná, Piauí, Rio Grande do Sul, Santa Catarina and São Paulo. This does not apply to the cities of São Paulo, Rio de Janeiro, Salvador, Fortaleza or Recife. Vaccination is recommended if visiting Iguaçu Falls.

Vaccination must take place at least 10 days prior to the date of entry to Brazil for the certificate to become valid. There are inconsistencies in Brazil's own advice, depending which country you live in, but here's what their UK site says: www.brazil.org.uk/tourism/visasvaccinations.html

Colombia
There is a risk of yellow fever transmission for visitors travelling to the middle valley of the Magdalena river; eastern and western foothills of the Cordillera Oriental; Uraba; foothills of the Sierra Nevada; eastern plains (Orinoquía) and Amazonia - vaccinations are recommended for travellers to these regions. This does not apply to cities such as Bogotá, Cali or Medellín.

Ecuador
Yellow fever vaccination is recommended for those intending to travel in the Amazon Basin provinces of Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios and Zamora-Chinchipe, and all other areas east of the Andes. This does not include the cities of Quito and Guayaquil or the Galápagos Islands.

Guianas
Guyana and Suriname: vaccination against yellow fever is strongly recommended for those passengers visiting any area outside of the narrow coastal strip. A yellow fever vaccination certificate is required from visitors arriving from countries deemed to present a risk of yellow fever transmission including Belize, but with the exception of Trinidad and Tobago, Paraguay and Argentina. French Guiana: a yellow fever vaccination certificate is required from all visitors.

Panama
There is a risk of yellow fever transmission in the provinces of Comarca Emberá, Darien and Kuna Yala, and in eastern Panama. This does not include Panama City and the Canal Zone. Visitors should seek specialist advice about the need for a yellow fever vaccine if travelling to these areas. A yellow fever vaccination certificate is required if arriving from countries with a risk of yellow fever transmission.

Paraguay
A yellow fever inoculation is recommended if you intend to travel to Paraguay. A yellow fever vaccination certificate is required from all travellers arriving from countries with a risk of yellow fever transmission.

Peru
There is a risk of yellow fever in areas east of the Andes Mountains and jungle areas below 2,300m (Chachapoyas, Iquitos, Tambopata). This does not include the city of Cusco, nor Machu Picchu, even though the latter is at about 2,000m. If you plan to travel from Peru to other countries in South America, these may require you to show evidence of a valid yellow fever vaccination.

Venezuela
A yellow fever vaccination certificate is not a requirement to enter Venezuela, but there have been cases where officials have illegally fined travellers who have been unable to produce such a certificate. Some airlines travelling to Venezuela will insist you have a yellow fever vaccination before boarding the plane unless you can produce your vaccination certificate. We therefore recommend vaccination before travel to Venezuela.

There have also been cases of yellow fever in all areas except the northern coastal region, Margarita Island, and the cities of Caracas and Valencia. Many countries in the region, such as Brazil, require those arriving from Venezuela to have proof of a yellow fever vaccination. Central America, excluding Panama There is no risk of yellow fever in the Central American countries of Belize, Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua. ravellers arriving from countries with a risk of yellow fever transmission are required to have a current international certificate of vaccination for yellow fever.

2.4 Malaria

Malaria is passed by mosquitoes; you should take extra precautions against being bitten (see 2.3). If you are travelling to coastal and jungle regions within the tropics, you may enter infected zones and should take an appropriate preventative measure. Which antimalarials to take depends on a number of variables, such as current illnesses and medication, previous illnesses, pregnancy, previous travel and duration of intended stay, so seek advice from your GP or health centre before travelling.

2.5 Dengue Fever

Dengue fever occurs in Latin America and the Caribbean throughout the year. There has been a marked increase in the number of reported cases in recent years. Dengue fever is passed by mosquitoes; you should take extra precautions against being bitten (see 2.3).

2.6 Altitude Sickness

At altitudes over 2500m you will probably start to feel breathless. Above 3000m, marked breathlessness, pins and needles and palpitations are a common response. A minority of people may experience dizziness, headache, slight nosebleed, nausea or vomiting.

The likelihood of experiencing these symptoms can be minimised by slow ascent, resting upon arrival for at least a few hours, avoiding alcohol and eating lightly for a day or so. Local remedies are available. They include various local drugs and 'maté de coca' (an infusion of coca leaves). Please note that on no account should you attempt to bring these tea bags back to the UK, or across any border - they contain coca leaves, which are prohibited. Oxygen is available in good hotels and on trains, if necessary.

Our advice is to take some of your usual headache pills with you and to simply take it easy. Should the symptoms be severe and prolonged, you must descend to a lower altitude. Acetazolamide (commonly known as Diamox) can be used to treat altitude sickness and is obtainable locally. Previous clients have found this to be helpful.

The thin, dry air at altitude also exposes travellers to the risk of sunburn, skin cracking, sore eyes and bunged-up noses. Wear a hat in direct sunlight and use high factor sun cream (minimum sun protection factor of 20). Some people prefer not to wear their contact lenses at altitude. There is also a marked difference in temperature between sun and shade at high altitudes.

2.7 Traveller's Diarrhoea

Traveller's diarrhoea can be caused by change of climate, water and food. You can reduce the risk of contracting it by drinking only bottled or sterilised water (never tap water), avoiding ice in drinks and fruit juices to which water has been added, peeling all fruit, not eating salad or seafood and avoiding ice-cream not of a recognised brand. If suffering from diarrhoea, it is advisable to eat little but to drink plenty of clean water with mineral replacement supplements, or fizzy drinks (no fruit juice or milk). Rehydration products, such as Dioralyte, should be taken to replenish lost salts. If it does not clear up or is accompanied by a fever, you should seek medical advice as you may need to take a course of antibiotics. Take with you some anti-diarrhoea tablets such as Lomotil or Imodium, but we don't recommend these be used as a preventative.

2.8 General

Water-purifying tablets, e.g. Sterotabs, are a useful standby in the jungle - or when trekking off the beaten track - but are ineffective against amoebae and give the water an unpleasant taste. Boiling water for 10 minutes will kill amoebae.

Mineral water is available at most jungle lodges that we book. It is important to ensure that you have a high intake of liquids in tropical and semi-tropical regions. You should also be aware of the fact that the sun is much stronger than at temperate latitudes and sunstroke is a danger. Avoid midday sun on tropical beaches, especially in the summer. Take plenty of high-factor sunscreen lotion and sun block.

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