The most common types of illnesses are caused by contaminated food and water. You should even consider using bottled water to brush your teeth. Make sure food has been thoroughly cooked and is served to you fresh and hot; avoid vegetables and fruits that you haven't washed (in bottled or purified water) or peeled yourself. If you have problems, mild cases of traveler's diarrhea may respond to Imodium (known generically as loperamide) or Pepto-Bismol. Be sure to drink plenty of fluids; if you can't keep fluids down, seek medical help immediately.
Infectious diseases can be airborne or passed via mosquitoes and ticks and through direct or indirect physical contact with animals or people. Some, including Norwalk-like viruses that affect your digestive tract, can be passed along through contaminated food. Condoms can help prevent most sexually transmitted diseases, but they aren't absolutely reliable and their quality varies from country to country. Speak with your physician and/or check the CDC or World Health Organization Web sites for health alerts, particularly if you're pregnant, traveling with children, or have a chronic illness.
Specific Issues in Puerto Rico
An outbreak of dengue fever, a mosquito-borne disease, hit the island in both 2007 and 2010. Virulent forms of the virus can cause high fever, joint pain, nausea, rashes, and occasionally death, but the strain that spread through the island's urban areas was mild, causing mostly flulike symptoms. Most cases were reported in urban areas far from the usual tourist destinations. As a precaution, the U.S. Centers for Disease Control and Prevention advises the use of an insect repellent with DEET and clothing that covers the arms and legs.
Health care in Puerto Rico is among the best in the Caribbean, but expect long waits and often a less-than-pleasant bedside manner. At all hospitals and medical centers you can find English-speaking medical staff, and many large hotels have an English-speaking doctor on call.
Tap water on the island is generally fine for drinking, but avoid drinking it after storms (when the water supply can become mixed with sewage). Thoroughly wash or peel produce you buy in markets before eating it.
Do not fly within 24 hours of scuba diving.
All the U.S. brands of sunscreen and over-the-counter medicines (for example, Tylenol, Advil, Robitussin, and Nyquil) are available in pharmacies, supermarkets, and convenience stores.
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