Most travelers to Costa Rica do not get any vaccinations or take any special medications. However, according to the U.S. Centers for Disease Control, travel to Costa Rica poses some risk of malaria, hepatitis A and B, dengue fever, typhoid fever, and rabies. The CDC recommends getting vaccines for hepatitis A and B and typhoid fever, especially if you are going to be in remote areas or plan to stay for more than six weeks.
Check with the CDC for detailed health advisories and recommended vaccinations. In areas with malaria and dengue, both of which are carried by mosquitoes, bring mosquito nets, wear clothing that covers your whole body, and apply repellent containing DEET in living and sleeping areas. There are some pockets of malaria near the Nicaraguan border on the Caribbean coast. You probably won't need to take malaria pills before your trip unless you are staying for a prolonged period in the north, camping on northern coasts, or crossing the border into Nicaragua or Panama. You should discuss the option with your doctor. Children traveling to Central America should have current inoculations against measles, mumps, rubella, and polio.
Specific Issues in Costa Rica
Malaria is not a problem in Costa Rica except in some remote northern Caribbean areas near the Nicaraguan border. Poisonous snakes, scorpions, and other pests pose a small (often overrated) threat. The CDC marks Costa Rica as an area infested by the Aedes aegypti (dengue-carrier) mosquito, but not as an epidemic region. A few thousand cases in locals are recorded each year; the numbers had been dropping, but dramatic spikes in 2005 and 2007 did spur major eradication efforts. Cases of fatal hemorrhagic dengue are rare. The highest-risk area is the Caribbean, and the rainy season is peak dengue season elsewhere. You're unlikely to be felled by this disease, but you can't take its prevention too seriously: repelente (insect repellent spray) and espirales (mosquito coils) are sold in supermarkets and small country stores. U.S. insect repellent brands with DEET are sold in pharmacies and supermarkets. Mosquito nets are available in some remote lodges; you can buy them in camping stores in San José. Mild insect repellents, like the ones in some skin softeners, are no match for the intense mosquito activity in the hot, humid regions of the Caribbean, Osa Peninsula, and Southern Pacific. Repellents made with DEET or picaridin are the most effective. Perfume, aftershave, and other lotions and potions can actually attract mosquitoes.
It's unlikely that you will contract malaria or dengue, but if you start suffering from high fever, the shakes, or joint pain, make sure you ask to be tested for these diseases when you go to the local clinic. Your embassy can provide you with a list of recommended doctors and dentists.
Costa Rica has experienced cases of H1N1 influenza, the so-called "swine flu." Even its former president was laid low by a week of the illness, to date, the world's only head of state to be affected. Standard precautions, such as washing hands regularly and getting vaccinated yourself, can minimize the risk.
Government facilities—the so-called Caja hospitals (short for Caja Costarricense de Seguro Social, or Costa Rican Social Security System)—and clinics are of acceptable quality, but notoriously overburdened, a common complaint in socialized-medicine systems anywhere. Private hospitals are more accustomed to serving foreigners. They include Hospital CIMA, Clínica Bíblica, and Clínica Católica, which all have 24-hour pharmacies. Outside San José most major towns have pharmacies that are open until at least 8 or 9 pm, but usually the nearest hospital emergency room is the only after-hours option. The long-established and ubiquitous Fischel pharmacies are great places for your prescription needs, and usually staff a doctor who can help with minor ailments. Antibiotics and psychotropic medications (for sleep, anxiety, or pain) require prescriptions in Costa Rica. Little else does. But plan ahead and bring an adequate supply with you from home; matches may not be exact.
Most food and water is sanitary in Costa Rica. In rural areas you run a mild risk of encountering drinking water, fresh fruit, and vegetables contaminated by fecal matter, which in most cases causes a bit of turista (traveler's diarrhea) but can cause leptospirosis (which can be treated by antibiotics if detected early). You can stay on the safe side by avoiding uncooked food, unpasteurized milk (including milk products), and ice—ask for drinks sin hielo (without ice)—and by drinking bottled water. Mild cases of turista may respond to Imodium (known generically as loperamide) or Pepto-Bismol (not as strong), both of which can be purchased over the counter. Drink plenty of purified water or tea; chamomile (manzanilla in Spanish) is a good folk remedy. In severe cases, rehydrate yourself with a salt-sugar solution (½ teaspoon salt and 4 tablespoons sugar per quart of water).
Ceviche, raw fish cured in lemon juice—a favorite appetizer, especially at seaside resorts—is generally safe to eat. Buy organic foods whenever possible; chemicals, many of which have been banned elsewhere, are sprayed freely here without regulation.
Heatstroke and dehydration are real dangers, especially for hikers, so drink lots of water. Take at least 1 liter per person for every hour you plan to be on the trail. Sunburn is the most common traveler's health problem. Use sunscreen with SPF 30 or higher. Most pharmacies and supermarkets carry sunscreen in a wide range of SPFs, though it is relatively pricey.
The greatest danger to your person actually lies off Costa Rica's popular beaches—riptides are common wherever there are waves, and tourists run into serious difficulties in them every year. If you see waves, ask the locals where it's safe to swim; and if you're uncertain, don't go in deeper than your waist. If you get caught in a rip current, swim parallel to the beach until you're free of it, and then swim back to shore. Avoid swimming where a town's main river opens up to the sea. Septic tanks aren't common. Do not fly within 24 hours of scuba diving.
Farmacia is Spanish for "pharmacy," and the names for common drugs aspirina, Tylenol (acetaminofina), and ibúprofen are basically the same as they are in English. Pepto-Bismol is widely available. Many drugs for which you need a prescription back home are sold over the counter in Costa Rica. Pharmacies throughout the country are generally open from 8 to 8, though it's best to consult with your hotel's staff to be sure. Some pharmacies in San José affiliated with clinics stay open 24 hours.
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