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viernes, 17 de febrero de 2012

Health Information for Travelers to Dominican Republic


Preparing for Your Trip to the Dominican Republic

Before visiting the Dominican Republic, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)
To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.
Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.
CDC recommends that you see a health-care provider who specializes in Travel Medicine.  Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.
If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.
Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.
Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.
Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.

Vaccine-Preventable Diseases

Vaccine recommendations are based on the best available risk information. Please note that the level of risk for vaccine-preventable diseases can change at any time.
Vaccination or Disease Recommendations or Requirements for Vaccine-Preventable Diseases
Routine  Recommended if you are not up-to-date with routine shots, such as measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc.
Hepatitis A or immune globulin (IG) Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors.
Hepatitis B  Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map), especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
Typhoid  Recommended for all unvaccinated people traveling to or working in the Caribbean, especially if staying with friends or relatives or visiting smaller cities, villages, or rural areas where exposure might occur through food or water.
Rabies  Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking. Also recommended for travelers with significant occupational risks (such as veterinarians), for long-term travelers and expatriates living in areas with a significant risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats, carnivores, and other mammals. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. 

Malaria


Areas of the Dominican Republic with Malaria: All areas (including resort areas), except none in the cities of Santiago and Santo Domingo.
If you will be visiting an area of the Dominican Republic with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
  • Taking a prescription antimalarial drug
  • Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
  • Sleeping in air-conditioned or well-screened rooms or using bednets
All of the following antimalarial drugs are equal options for preventing malaria in the Dominican Republic: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine. For detailed information about each of these drugs, see Table 3-11: Drugs used in the prophylaxis of malaria. For information that can help you and your doctor decide which of these drugs would be best for you, please see Choosing a Drug to Prevent Malaria.
To find out more information on malaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, cities, and place names for more specific malaria risk information and the recommended prevention medicines for that area.

Malaria Contact for Health-Care Providers
For assistance with the diagnosis or management of suspected cases of malaria, call the CDC Malaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For emergency consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician..


More Information About Malaria

Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.
Travelers to malaria risk-areas in the Dominican Republic, including infants, children, and former residents of Dominican Republic, should take one of the antimalarial drugs listed in the box above.

Symptoms

Malaria symptoms may include
  • fever
  • chills
  • sweats
  • headache
  • body aches
  • nausea and vomiting
  • fatigue
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
A Special Note about Antimalarial Drugs
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.

Items to Bring With You

Medicines you may need:
  • The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
  • Antimalarial drugs, if traveling to a malaria-risk area in Dominican Republic and prescribed by your doctor.
  • Medicine for diarrhea, usually over-the-counter.
Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.
Other items you may need:
  • Iodine tablets and portable water filters to purify water if bottled water is not available. See A Guide to Water Filters, A Guide to Commercially-Bottled Water and Other Beverages, and Safe Food and Water for more detailed information.
  • Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Basic Information about Skin Cancer for more information.
  • Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
  • To prevent insect/mosquito bites, bring:
    • Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
    • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
    • Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
See other suggested over-the-counter medications and first aid items for a travelers' health kit.
Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.


Other Diseases Found in the Caribbean
Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies.

The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available.
Dengue epidemics have occurred on many of the Caribbean islands.  Most islands are infested with Aedes aegypti, so these places are at risk for introduction of dengue.  Protecting yourself against insect bites (see below) will help to prevent this disease.
In 2006, malaria (falciparum) was confirmed in travelers to Great Exuma, Bahamas, and Kingston, Jamaica, areas where malaria transmission typically does not occur.  An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis occurred in travelers to Jamaica.
Cutaneous larval migrans is a risk for travelers with exposures on beaches and leptospirosis is common in many areas and poses a risk to travelers engaged in recreational freshwater activities.  Such activities may include whitewater rafting, kayaking, adventure racing, or hiking. Endemic leptospirosis is reported in Jamaica. Travelers to regions in Jamaica can reduce their risk to leptospirosis by avoiding activities which expose them to contaminated fresh surface water. Outbreaks of ciguatera poisoning, which results from eating toxin-containing reef fish, have occurred on many islands.
Endemic foci of histoplasmosis are found on many Caribbean islands, and outbreaks have occurred in travelers.
Anthrax is hyperendemic in Haiti but has not been reported on most of the other islands.  Haiti also has a high incidence rate of tuberculosis and high HIV prevalence rates.


Staying Healthy During Your Trip

Prevent Insect Bites

Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:
  • Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
  • Wearing long-sleeved shirts, long pants, and a hat outdoors.
  • Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
  • Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
  • Spraying rooms with products effective against flying insects, such as those containing pyrethroid.
For detailed information about insect repellent use, see Insect and Arthropod Protection.

Prevent Animal Bites and Scratches

Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.
  • Be sure you are up to date with tetanus vaccination.
  • Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
  • Help children stay safe by supervising them carefully around all animals.
  • If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away. 
  • After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.
For more information about rabies and travel, see the Rabies chapter of the Yellow Book or CDC's Rabies homepage. For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards.

Be Careful about Food and Water

Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:
  • Wash your hands often with soap and water, especially before eating.  If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
  • Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles.  Avoid tap water, fountain drinks, and ice cubes.  If this is not possible, learn how to make water safer to drink.
  • Do not eat food purchased from street vendors.
  • Make sure food is fully cooked.
  • Avoid dairy products, unless you know they have been pasteurized.
Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.

Avoid Injuries

Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:
  • Not drinking and driving.
  • Wearing your seat belt and using car seats or booster seats in the backseat for children.
  • Following local traffic laws.
  • Wearing helmets when you ride bikes, motorcycles, and motor bikes.
  • Not getting on an overloaded bus or mini-bus.
  • Hiring a local driver, when possible.
  • Avoiding night driving.

Other Health Tips

  • To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections.
  • To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms.
  • To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, especially on beaches where animals may have defecated.


After You Return Home

If you are not feeling well, you should see your doctor and mention that you have recently traveled. Also tell your doctor if you were bitten or scratched by an animal while traveling.
If you have visited a malaria-risk area, continue taking your chloroquine for 4 weeks after leaving the risk area.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.
Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.