Despite concerns raised by the H1N1 influenza outbreak of 2009, in Mexico the biggest health risk is turista (traveler's diarrhea), caused by consuming contaminated fruit, vegetables, or water. To minimize risks, avoid questionable-looking street stands and bad-smelling food even in the toniest establishments; and if you're not sure of a restaurant's standards, pass up ceviche (raw fish cured in lemon juice) and raw vegetables that haven't been peeled (or that can't be peeled, like lettuce and tomatoes).
Drink only bottled water or water that has been boiled for at least 20 minutes, even when you're brushing your teeth. Agua mineral or agua con gas means mineral or carbonated water, and agua purificada means purified water. Hotels with water-purification systems will post signs to that effect in the rooms; even then, it's best not to drink the stuff.
Despite these warnings, keep in mind that Puerto Vallarta, Nuevo Vallarta, and the Costalegre have virtually no industry beyond tourism and are unlikely to kill (or seriously distress) the geese that lay their golden egg. Some people choose to bend the rules about eating at street stands and fresh fruits and chopped lettuce or cabbage, as there's no guarantee that you won't get sick at a five-star resort and have a delicious, healthful meal at a shack by the sea. If fish or seafood smells or tastes bad, send it back and ask for something different.
Don't fret about ice: Tourist-oriented hotels and restaurants, and even most of those geared toward the locals, use purified water for ice, drinks, and washing vegetables. Many alleged cases of food poisoning are due instead to hangovers or excessive drinking in the strong sun. But whenever you're in doubt, ask questions about the origins of food and water and, if you feel unsure, err on the side of safety.
Mild cases of turista may respond to Imodium (known generically as loperamide), Lomotil, or Pepto-Bismol (not as strong), all of which you can buy over the counter; keep in mind, though, that these drugs can complicate more serious illnesses. You'll need to replace fluids, so drink plenty of purified water or tea; chamomile tea (te de manzanilla) is a good folk remedy, and it's readily available in restaurants throughout Mexico.
In severe cases, rehydrate yourself with Gatorade or a salt-sugar solution (½ teaspoon salt and 4 tablespoons sugar per quart of water). If your fever and diarrhea last longer than a day or two, see a doctor—you may have picked up a parasite or disease that requires prescription medication.
Mosquitoes are most prevalent during the rainy season, when it's best to use mosquito repellent daily, even in the city; if you're in jungly or wet places and lack strong repellent, consider covering up well or going indoors at dusk (called the "mosquito hour" by locals).
An excellent brand of repelente de insectos (insect repellent) called Autan is readily available; do not use it on children under age 2. Repellents that are not at least 10% DEET or picaridin are not effective here. If you're hiking in the jungle or boggy areas, wear repellent and long pants and sleeves; if you're camping in the jungle, use a mosquito net and invest in a package of espirales contra mosquitos, mosquito coils, which are sold in farmacias, or tlalpalerías (hardware stores).
According to the CDC, there's a limited risk of malaria and other insect-carried or parasite-caused illnesses in certain areas of Mexico (largely but not exclusively rural and tropical coastal areas). In most urban or easily accessible areas you need not worry about malaria, but dengue fever is found with increasing frequency. If you're traveling to remote areas or simply prefer to err on the side of caution, check with the CDC's International Travelers' Hotline. Malaria and dengue are both carried by mosquitoes; in areas where these illnesses are prevalent, use insect-repellant coiling, clothing, and sprays/lotion. Also consider taking antimalarial pills if you're doing serious adventure activities in tropical and subtropical areas.
Make sure polio and diphtheria-tetanus shots are up-to-date well before your trip. Hepatitis A and typhoid are transmitted through unclean food or water. Gamma-globulin shots prevent hepatitis; an inoculation is available for typhoid, although it's not 100% effective.
Caution is advised when venturing out in the Mexican sun. Sunbathers lulled by a slightly overcast sky or the sea breezes can be burned badly in just 20 minutes. To avoid overexposure, use strong sunscreens, sit under a shade umbrella, and avoid the peak sun hours of noon to 3 PM. Sunscreen, including many American brands, can be found in pharmacies, supermarkets, and resort gift shops.
National Centers for Disease Control & Prevention. 800/232–4656; 877/394–8747 international travelers' health line. www.cdc.gov/travel.
World Health Organization. www.who.int.
Cornerstone Hospital accepts various types of foreign health insurance and traveler's insurance and is American owned. The other recommended, privately owned hospital is Hospital San Javier Marina. Although most small towns have at least a clinic, travelers are usually more comfortable traveling to the major hospitals than using these clinics.
Farmacias (pharmacies) are the most convenient place for such common medicines as aspirina (aspirin) or jarabe para la tos (cough syrup). You'll be able to find many U.S. brands (e.g., Tylenol, Pepto-Bismol), but don't plan on buying your favorite prescription or nonprescription sleep aid, for example. The same brands and even drugs aren't always available. Prescriptions must be issued by a Mexican doctor to be legal; you can often get prescriptions inexpensively from local doctors located near the pharmacy. The Sanborns chain stores also have pharmacies, as do the Cornerstone and San Javier Marina hospitals.
Pharmacies are usually open daily 9 am to 10 pm; on Sunday and in some small towns they may close several hours earlier. In neighborhoods or smaller towns where there are no 24-hour drug stores, local pharmacies take turns staying open 24 hours so that there's usually at least one open on any given night—it's called the farmacia de turno. The CMQ chain is found throughout the Riviera Nayarit and Puerto Vallarta, and most are open 24 hours; the Web site provides a full list of all branches.
Cornerstone Hospital. Av. Los Tules 136, next to Plaza Caracol, Zona Hotelera Norte, Puerto Vallarta, 48333. 322/226–3700.
Hospital San Javier Marina. Blvd. Francisco M. Ascencio 2760, at María Montessori, Zona Hotelera Norte, Puerto Vallarta, 48333. 322/226–1010.
Consider buying trip insurance with medical-only coverage. Neither Medicare nor some private insurers cover medical expenses anywhere outside of the United States. Medical-only policies typically reimburse you for medical care (excluding that related to pre-existing conditions) and hospitalization abroad, and provide for evacuation. You still have to pay the bills and await reimbursement from the insurer, though.
Another option is to sign up with a medical-evacuation assistance company. Membership gets you doctor referrals, emergency evacuation or repatriation, 24-hour hotlines for medical consultation, and other assistance. International SOS Assistance Emergency and AirMed International provide evacuation services and medical referrals. MedjetAssist offers medical evacuation.
AirMed International. www.airmed.com.
MedjetAssist. 800/527–7478 or 205/595–6626. www.medjetassist.com.
International Medical Group. 800/628–4664. www.imglobal.com.
International SOS. www.internationalsos.com.
Wallach & Company. 800/237–6615 or 540/687–3166. www.wallach.com.