CR Health Issues
 

In todays A.M. Costa Rica english language newspaper there are reports of an increase in Dengue and Malaria in Costa Rica. The majority of the cases are on the Caribbean side. The Costa Rican government is recommending the diligent use of repellant. I am not sending this to panic anyone. I just returned from a month down there with no problems and very few tourists to other parts have had many problems. I would just like to reaffirm my warnings to all of you to bring your deet and use it. At least 20% is recommended from what I have read in the past.

Besides deet is there anything else that is precautionary such as immunizations? I've heard of anti-malarial drugs but don't think a dr. would give for trip.

There are quite a few people that do take the anti malarial drugs. I never have but may think about it before my next trip next year if it continues to be a potential problem. If you really wanted to take it there is no reason why a Dr would not prescribe it for you unless he thinks you personally would have a problem taking it.

What is deet? And what does 20% mean?

Deet is the chemical that gives the repellant its effectiveness. The % just means, of course, the amount of DEET contained in the spray or lotion. Sometimes hunters use 100% DEET, which I bought the first time we were going thinking "I don't want to take any chances". Come to find out, it isn't all that healthy to use the 100% (because it IS a pesticide) and we never used that high concentration. Most of the sprays you will see on the shelf contain between 25% and 28% DEET. These should be strong enough to keep you safe. Avon's "Skin So Soft" oil or lotion is effective as well, I understand. I usually take both.

Our family of four (12 & 17 year old boys) is leaving tomorrow for our first time to Costa Rica. I am not a risk-taker and had concerns regarding the various illnesses that we could acquire there. There seems to be much controversy over how much precaution is necessary.

However, our daughter just finished her coursework on infectious diseases in med school, and she said that she strongly recommended taking antimalarials as long as there were no harsh side effects. The CDC recommends either chloroquine or hydroxychloroquine for malaria prevention in Costa Rica. Our doctor readily prescribed chloroquine for us and our insurance covered it. We took our first tablet 5 days ago and no one has had any side effects. It must be started one week before for maximum effectiveness. Some people will start 2 weeks before so that if they develop unpleasant side effects, they have the chance to switch to another med before their vacation. We continue to take one tablet each week while we are gone, and then for 4 weeks after we return.

We also got the Hepatitis A immunization (needed at least 1 month before departure), and our tetanus boosters.

The antimalarials do not offer 100% protection, plus I am also worried about Dengue, so we will use bug spray with atleast 25% DEET. And I am going to spray the clothes that we will be hiking in with Permethrin, a product that applies insect repellant to clothing. It supposedly provides protection for at least 2 weeks, even after washings.

I'll report back after our return and let you know how we did with the meds over the long term.

WE didn't go to the Caribbean side, but travelled around Arenal, Manuel Antonio and Osa peninsula and never saw a moquito! This was during the last two weeks - very dry. We never had to use our repellant or any nets or screens. The locals we asked said no problems with leaving everythinhg open. Of course, that can change for different locations and conditions.

Keep in mind that such precautions are not needed at the higher altitudes; e.g., Monteverde.

Go to: http://www.cdc.gov/travel/camerica.htm. You can check on the latest recommendations for immunizations, medications, etc. Then, look around your area for a Travel Clinic. We have 3 here in our tiny city, so no one else should have any problems.

Everyone will indicate that the best defense against Malaria is not to get bitten. That having said, no one I know goes to a sunny, warm tropical clime and wears long-sleeve shirts, long pants and a mosquito net over their head. And, in addition, sprays all of these with Permethrin and uses DEET on any unexposed surfaces. REI has time-release, 8-hour DEET preparations for anyone who is interested. The usual sprays last 2/3 hours and must be re-applied.

To make a long story short: you must have Hep A + B immunizations; Tetanus; Typhoid (the tablets are a pain, but last twice as long as the shots); MMR if you've never had clinical signs. Dengue and Yellow fever are less critical unless you intend to spend a long time in densely jungled areas. We took Malarone because it is the most effective anti-malarial (though very expensive) and has the fewest side-effects. Since their is the possibility that there may be resistant strains of malaria in CR, the other choice would be Lariam. But, I would urge anyone interested in reading eh CDC site and talking to the folks in their local clinic. We also took a Rx of Cipro along in the event of exposure to some GI bug.

The travel clinics are usually run by RN's with special training and can give you the shots and anti-biotics on their own without prescriptions from your PCP's.

We leave Monday - Can't wait.

Insurance covered our travel clinic visit. We made sure we were up-to-date w/ MMR, Hep A and B, and Tetnus (a great idea for living in America theses day as well). We chose not to take chloroquine, weighing risk vs likely GI issues. The doc at MGH advised that the risk (liklihood) of Dengue was higher than that of Malaria, and also advised that Dengue carriers were day biters, so DEET should be used during the daytime. We have several cans of 30% DEET. We have filled scripts for Cipro (adults) and Azithromycin (kids). Wide brimmed hats, sunscreen, and sunglasses are probably just as inportant as all the other precautions.

With all that said, we have several sets of friends that travelled to CR without any particular medical precautions, and were fine.

Safe travel to all!

Didn't realize Hep B was a problem--our health dept. advised against getting Hep B immunizations. Said it wasn't necessary unless we were intervenous drug users or into anonymous or professional sex. Not that I couldn't be very successful in the professional sex trade, but I chose a different career path.

Hepatitis B vaccine is a 'required for entry into kingergarten' vaccine here in Iowa.

It is a blood born/sexually transmitted disease, but what if you were in an accident, or needed to render first aide to another person who had been injured?

Jean

I agree. I've heard the blood supply in deveolping countries isn't tested as well as here in the U.S. I'd hate to need a transfusion and end up with Hep B. I just got my tetnus booster and my first series of Hep A and Hep B. I decided to get these because I travel quite a bit, but also because we will be going to CR and Panama this summer. I'm also due for another Typhoid shot. I'm considering doing the pills this time since they last longer than the shot. We haven't decided if we are going to take anti-malirials or not. It's a tough choice.

Yes, it's recommended for infants here, too, but not adults.