Costa Rica Staying Healthy

Common sense is the simplest prescription for good health while you travel. Drink lots of fluids to prevent dehydration and constipation and wear sturdy, broken-in shoes and clean socks. Adequate fluid intake is especially important for travelers dealing with (aptly named) traveler’s diarrhea, but the contaminated water that makes this issue a widespread problem for Costa Rican travelers also makes it imperative to approach all fluid intake with care; do not drink tap water, drinks with ice, or fruit and vegetables that have not been peeled or cooked. Visitors should stay away from unpasteurized dairy products and avoid purchasing beverages from street vendors.

Environmental Hazards

Heat exhaustion and dehydration: Heat exhaustion leads to nausea, excessive thirst, headaches, and dizziness. Avoid it by drinking plenty of fluids, eating salty foods (e.g., crackers), abstaining from dehydrating beverages (e.g., alcohol and caffeinated beverages), and always wearing sunscreen. Continuous heat stress can eventually lead to heatstroke, characterized by a rising temperature, severe headache, delirium and cessation of sweating. Victims should be cooled off with wet towels and taken to a doctor.
Sunburn: Always wear sunscreen (SPF 30 or higher) when spending excessive amounts of time outdoors. If you get sunburned, drink more fluids than usual and apply an aloe-based lotion. Severe sunburns can lead to sun poisoning, a condition that can cause fever, chills, nausea, and vomiting. Sun poisoning should always be treated by a doctor.
High Altitude: Allow your body a couple of days to adjust to less oxygen before exerting yourself. Note that alcohol is more potent and UV rays are stronger at high elevations.

Insect-Borne Diseases

Many diseases are transmitted by insects—mainly mosquitoes, fleas, ticks, and lice. Be aware of insects in wet or forested areas, especially while hiking and camping. Wear long pants and long sleeves, tuck your pants into your socks, and use a mosquito net. Use insect repellents such as DEET and soak or spray your gear with permethrin (licensed in the US only for use on clothing). Mosquitoes —responsible for malaria, dengue fever, and yellow fever—can be particularly abundant in wet, swampy, or wooded areas. In Costa Rica, there is risk of malaria in Alajuela, Limón, Guanacaste, and Heredia.

Malaria: Transmitted by Anopheles mosquitoes that bite at night. The incubation period varies anywhere between 10 days and 4 weeks. Early symptoms include fever, chills, aches, and fatigue, followed by high fever and sweating, sometimes with vomiting and diarrhea. See a doctor for any flu-like sickness that occurs after travel in a high-risk area. To reduce the risk of contracting malaria, use mosquito repellent, particularly in the evenings and when visiting forested areas. Make sure you see a doctor at least 4-6 weeks before a trip to a high-risk area to get up-to-date malaria prescriptions and recommendations. A doctor may prescribe oral prophylactics, like mefloquine or doxycycline. Be aware that mefloquine can have some very serious side effects, including paranoia, psychotic behavior, and nightmares.
Dengue fever: An “urban viral infection” transmitted by Aedes mosquitos, which bite during the day (rather than at night) and favor densely populated areas. The incubation period is 3-14 days, usually 4-7 days. Early symptoms include a high fever, severe headaches, swollen lymph nodes, and muscle aches. Many patients also suffer from nausea, vomiting, and a pink rash. If you experience these symptoms, see a doctor immediately, drink plenty of liquids, and take a fever-reducing medication like Tylenol. Never take aspirin to treat dengue fever. There is no vaccine available for dengue fever. Dengue is endemic to Costa Rica, and 35,000 cases were identified in 2005.
Yellow fever: A viral disease transmitted by mosquitos; derives its name from one of its most common symptoms, the jaundice caused by liver damage. While most cases are mild, the severe ones begin with fever, headache, muscle pain, nausea, and abdominal pain before progressing to jaundice, vomiting of blood, and bloody stools. While there is no specific treatment, there is an effective vaccine that offers 10 years of protection.
Other insect-borne diseases: Lymphatic filariasis is a roundworm infestation transmitted by mosquitos. Infection causes enlargement of extremities and has no vaccine, though it can be fairly easily treated. Within Costa Rica, the risk is greatest in Limón. Leishmaniasis, a parasite transmitted by sand flies, is an issue is some cattle-raising areas in the northwest as well as some coastal regions (Limón and Golfito). Common symptoms are fever, weakness, and swelling of the spleen, as well as skin sores weeks to months after the bite. There is a treatment but no vaccine. CHAGAS disease (American trypanomiasis) is another relatively common parasite transmitted by the cone nose and kissing bug, which infests mud, adobe, and thatch. The disease is particularly prevalent in Alajuela, Liberia, and Puntarenas. Its symptoms are fever, heart disease, and enlarged intestines. There is no vaccine and treatment options are limited, but risk to travelers is generally quite low.

Food- And Water-Borne Diseases

Prevention is the best cure: be sure that your food is properly cooked and the water you drink is clean. Watch out for food from markets or street vendors that may have been cooked in unhygienic conditions. Though Costa Rica’s street markets offer an amazing selection of fresh produce—everything from Asian water apples to zapote (like a sweet potato with an avocado pit)—this produce should be carefully purchased and prepared: it should be obtained unpeeled, or else only consumed once cooked. Other culprits are raw shellfish, unpasteurized milk, and sauces containing raw eggs. Buy bottled water or purify your own water by bringing it to a rolling boil or treating it with iodine tablets; note, however, that boiling is more reliable.

Traveler’s diarrhea: Results from drinking fecally contaminated water or eating uncooked and contaminated foods. Symptoms include nausea, bloating, and urgency. Try quick-energy, non-sugary foods with protein and carbohydrates to keep your strength up. Over-the-counter anti-diarrheals (e.g., Imodium®) may counteract the problem. The most dangerous side effect is dehydration; drink 8 oz. of water with ½ tsp. of sugar or honey and a pinch of salt, try uncaffeinated soft drinks, or eat salted crackers. If you develop a fever or your symptoms don’t go away after 4-5 days, consult a doctor. Consult a doctor immediately for treatment of diarrhea in children.
Dysentery: Results from an intestinal infection caused by bacteria in contaminated food or water. Common symptoms include bloody diarrhea, fever, and abdominal pain and tenderness. The most common type of dysentery generally lasts a week, but it is highly contagious. Seek medical help immediately. Dysentery can be treated with the drugs norfloxacin or ciprofloxacin (commonly known as Cipro). If you are traveling in high-risk (especially rural) regions, consider obtaining a prescription before you leave home.
Cholera: An intestinal disease caused by bacteria in contaminated food. Symptoms include diarrhea, dehydration, vomiting, and muscle cramps. See a doctor immediately; if left untreated, cholera can be lethal within hours. Antibiotics are available, but the most important treatment is rehydration. No vaccine is available in the US.
Hepatitis A: A viral infection of the liver acquired through contaminated water or shellfish from contaminated water. Symptoms include fatigue, fever, loss of appetite, nausea, dark urine, jaundice, vomiting, aches and pains, and light stools. The risk is highest in rural areas and the countryside, but it is also present in urban areas. Ask your doctor about the Hepatitis A vaccine or an injection of immune globulin.
Giardiasis: Transmitted through parasites and acquired by drinking untreated water from streams or lakes. Symptoms include diarrhea, cramps, bloating, fatigue, weight loss, and nausea. If untreated, it can lead to severe dehydration. Giardiasis occurs worldwide.
Typhoid fever: Caused by the salmonella bacteria; common in villages and rural areas in Costa Rica. While mostly transmitted through contaminated food and water, it may also be acquired by direct contact with another person. Early symptoms include high fever, headaches, fatigue, appetite loss, constipation, and a rash on the abdomen or chest. Antibiotics can treat typhoid, but a vaccination (70-90% effective) is recommended.

Other Infectious Diseases

The following diseases exist all over the world. Travelers should know how to recognize them and what to do if they suspect they have been infected.

Hepatitis B: A viral infection of the liver transmitted via blood or other bodily fluids. Symptoms, which may not surface until years after infection, include jaundice, appetite loss, fever, and joint pain. It is transmitted through unprotected sex and unclean needles. A 3-shot vaccination sequence, 6 months before traveling, is recommended for sexually active travelers and anyone planning to seek medical treatment abroad.
AIDS and HIV: For detailed information on Acquired Immune Deficiency Syndrome (AIDS) in Costa Rica, call the 24hr. National AIDS Hotline at ☎+1-800-342-2437.
Sexually transmitted infections (STIs): Gonorrhea, chlamydia, genital warts, syphilis, herpes, HPV, and other STIs are easier to catch than HIV and can be just as serious. Though condoms may protect you from some STIs, oral or even tactile contact can lead to transmission. If you think you may have contracted an STI, see a doctor immediately.

Other Health Concerns

Medical Care On The Road

Costa Rica provides free, universal health care to its citizens. The quality of medical care is high in both public and private hospitals. The number of facilities may be limited outside of the more urban areas. Most doctors have received training in the US, Europe, or Canada, and a large number speak English.

If you are concerned about obtaining medical assistance while traveling, you can employ special support services. The MedPass from GlobalCare, Inc., 6875 Shiloh Rd. East, Alpharetta, GA 30005, USA (☎+1-800-860-1111; www.globalcare.net), provides 24hr. international medical assistance, support, and medical evacuation resources. The International Association for Medical Assistance to Travelers ( IAMAT; US ☎+1-716-754-4883, Canada 519-836-0102; www.iamat.org) has free membership, lists English-speaking doctors worldwide, and offers detailed information on immunization requirements and sanitation. If your regular insurance policy does not cover travel abroad, you may want to purchase additional coverage .

Those with medical conditions (such as diabetes, allergies to antibiotics, epilepsy, or heart conditions) may want to obtain a MedicAlert membership (US$40 per year), which includes, among other things, a stainless-steel ID tag and a 24hr. collect-call number. Contact the MedicAlert Foundation International, 2323 Colorado Ave., Turlock, CA 95382, USA (☎+1-888-633-4298, outside US 209-668-3333; www.medicalert.org).

Women’S Health

Costa Rica is considered to be one of the most sanitary countries in Central America, but women should still take caution, especially in rural areas. Women traveling in unsanitary conditions are vulnerable to urinary tract (including bladder and kidney) infections. Vaginal yeast infections may flare up in hot and humid climates. Wearing loosely-fitting trousers or a skirt and cotton underwear will help, as will over-the-counter remedies like Monostat® or Gynelotrimin®. Bring supplies from home if you are prone to infection, as they may be difficult to find on the road. And, since tampons, pads, and reliable contraceptive devices are sometimes hard to find when traveling, bring supplies with you. Abortion is illegal in Costa Rica, unless the mother’s life is in danger.