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Immunizations for travel to Costa Rica

Wondering what exotic viruses and infections to be wary of? Here’s some important info on which vaccinations are needed before visiting Costa Rica, as well as some basic travel health info. Read this section carefully and take these inportant precautions. Your trip is pointless if you end up sick, or come home with a nasty bug.

First of all, you should visit your personal physician or a travel health clinic 4-8 weeks before your departure. What you require in terms of immunization will depend on where you plan to go within the country.

Hepatitus A: All visitors to Costa Rica

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.

Hepatitus B: All visitors to Costa Rica

Hepatitis B vaccine is recommended for travelers who will have intimate contact with local residents or potentially need blood transfusions or injections while abroad, especially if visiting for more than six months. It is also recommended for all health care personnel. 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: All visitors to Costa Rica

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

Yellow Fever: Visitors planning to stay 6 months or longer, or will have intimate contact with locals

Yellow fever vaccine is required for travelers arriving from one of the following yellow-fever-infected countries: Africa: Angola, Benin, Burkina Faso, Cameroon, Democratic Republic of the Congo, Gabon, Gambia, Ghana, Guinea, Liberia, Nigeria, Sierra Leone, and Sudan. Americas: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Venezuela.

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 those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a history of thymus disease or thymectomy. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.

Tetanus-Diptheria: Recommended for visitors born after 1956, or if vaccination has expired (10 yrs)

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

Malaria: Visitors to the provinces of Limon (except Limon city), Alajuela, Guanacaste, and Heredia:

Prophylaxis with Chloroquine is strongly recommended for travelers to high risk areas. The areas of greatest risk of contracting Malaria are in the cantons of Los Chiles (Alajuela Province) and Matina and Talamanca (Limon Province). The drug of choice is chloroquine, taken once weekly in a dosage of 500 mg, 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. Insect protection measures are advised.

Update: An outbreak of malaria was reported in November 2006 from the province of Limon, chiefly the town of Batan on the Caribbean slope. The cases were caused by Plasmodium falciparum, which causes more severe disease and is not generally seen in Costa Rica (see ProMED-mail; November 16, 2006). All travelers to Limon province, except Limon City, should take chloroquine once weekly and follow insect protection measures to prevent malaria.

For further information about malaria in Costa Rica, 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.

All travelers should be up-to-date on the following routine immunizations:

Measles vaccine: Recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.

Chickenpox Vaccine (Varicella): Recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.

The following vaccine are not needed for visiting Costa Rica:

Cholera vaccine is not recommended. No cases of cholera have been reported since 1997.

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.

Rabies vaccine is not recommended. Only two cases of rabies have been recorded in the last 30 years. For further information, go to Emerging Infectious Diseases.

Check with your doctor - tell him/her that the surf guru sent you and have a great trip!

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