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The following may pose a risk or require preventive measures based on this itinerary. See the report sections below for details. Vaccine-Preventable Diseases: hepatitis A, hepatitis B, influenza, meningococcal meningitis, rabies, typhoid, yellow fever
Other Diseases: altitude sickness, American trypanosomiasis, bartonellosis, brucellosis, dengue fever, hantavirus, leishmaniasis,
Lyme disease, schistosomiasis, traveler's diarrhea, tuberculosis
Is yellow fever vaccine an official requirement for this itinerary?
YES. An official vaccination certificate is required for entry by a country on this itinerary sequence. See "YF Requirement Table" below
for details.
Visa application: Proof of YF vaccination may be required for certain visa applicants. Travelers should contact the appropriate
embassy or consulate with questions and, if it is required for their visa, carry the YF certificate with their passport on the day of
travel.
Yellow Fever Requirement Table for this Itinerary
The following values result in the "YES" requirement result shown above (based on a round trip with Canada as the home country):
Yellow Fever Requirement Table
Transm. Risk Required if Coming From Applies to Ages See Note
Note 1: Additional conditions pertain for this country's requirement. Please refer to the Individual Country Requirements
Individual Country Requirements
A vaccination certificate is required for travelers over 1 year of age coming from countries with risk of YF transmission. Also required for nationals and residents of Ecuador on their departure to an area with risk of YF transmission. Note: Ecuadorian authorities may require a vaccination certificate for travel to the Amazon region (areas east of the Andean highlands); travelers should carry their certificate with them. Guatemala, Nicaragua, Paraguay
A vaccination certificate is required for travelers over 1 year of age coming from countries with risk of YF transmission. Panama, Uruguay
A vaccination certificate is required for travelers coming from countries with risk of YF transmission. Recommendation Information (for health protection) Is yellow fever vaccine a recommended protective measure for this itinerary?
YES. Vaccination is recommended for travel to areas of one or more countries on this itinerary.
Individual Country Recommendations
Recommended for travelers over 9 months of age: the states of Acre, Amapá, Amazones, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, Tocantins, and designated areas (see map) of the following states: Piauí, Bahia, São Paulo, Paraná, Santa Catarina [8], and Rio Grande do Sul [9]. Vaccination is also recommended for travelers visiting Iguaçu Falls. Daytime insect precautions are essential for unvaccinated travelers. Not recommended: itineraries limited to the cities of Rio de Janeiro, São Paulo, Salvador, Recife, or Fortaleza, or any other areas not listed above. Colombia
Recommended for travelers over 9 months of age: areas below 2,300 m (7,500 ft) (see map) in the departments of Amazonas, Antioquia [9], Arauca [11], Atlántico [2], Bolívar [6], Boyacá [13], Caldas [15], Caquetá, Casanare [12], Cauca [22], Cesar [4], Córdoba [8], Cundinamarca [14], Guainía, Guaviare [26], Huila [24], Magdalena [3], Meta, Norte de Santander [5], Putumayo [25], Quindio [18], Risaralda [16], San Andrés y Providencia, Santander [10], Sucre [7], Tolima [20], Vaupés, and portions of Chocó [17] and La Guajira [1]. Daytime insect precautions are essential for unvaccinated travelers. Not recommended except for highly risk-averse travelers and long-stay travelers: itineraries limited to the cities of Barranquilla, Cartagena, Cali, or Medellín; areas west of the Andes below 2,300 m (see map) in the departments of Nariño [23], Cauca [22], or Valle de Cauca [21]; or portions of Chocó [17]. No human cases of YF have ever been reported from these areas, and data analysis by WHO indicates extremely low potential for YF virus exposure. Not recommended: itineraries limited to areas above 2,300 m, the city of Bogotá, or northeastern La Guajira [1] (see map). Recommended for travelers over 9 months of age: areas east of the Andes Mountains below 2,300 m (7,500 ft) (see map). Daytime insect precautions are essential for unvaccinated travelers. Not recommended except for highly risk-averse travelers and long-stay travelers: itineraries limited to areas west of the Andes Mountains below 2,300 m except Guayaquil (see map). No human cases of YF have ever been reported from these areas, and data analysis by WHO indicates extremely low potential for YF virus exposure. Not recommended: itineraries limited to the cities Guayaquil, Quito, Cuenca, or Otavalo, the Cotopaxi Volcano, areas above 2,300 m, or the Galápagos Islands. Recommended for travelers over 9 months of age: all mainland areas east of the Canal Zone (see map). Daytime insect precautions are essential for unvaccinated travelers. Transmission does not occur on the San Blas Islands, but it is necessary to transit areas with known transmission risk en route to the islands. Not recommended: itineraries limited to Panama City, the Canal Zone, areas west of the Canal Zone (see map), or the Balboa Islands. Paraguay
Recommended for travelers over 9 months of age: all areas except Asunción. Daytime insect precautions are essential for unvaccinated travelers. Not recommended except for highly risk-averse travelers and long-stay travelers: itineraries limited to Asunción. Data analysis by WHO indicates extremely low potential for YF virus exposure. Recommended for travelers over 9 months of age: areas below 2,300 m (7,500 ft) east of the Andes Mountains (see map), and eastern Piura [2]. Daytime insect precautions are essential for unvaccinated travelers. Not recommended except for highly risk-averse travelers and long-stay travelers: itineraries limited to areas below 2,300 m west of the Andes (see map) in the regions of Tumbes [1], Lambayeque [3], western Piura [2], or west-central Cajamarca [4]. Data analysis by WHO indicates extremely low potential for YF virus exposure. Not recommended: itineraries limited to the cities of Lima, Cusco, Puno, or Arequipa, areas above 2,300 m (see map), areas west of the Andes not mentioned above, Lake Titicaca, Colca Canyon, Machu Picchu, or any intermediate tourist points in the Urubamba Valley (the only route between Cusco and Machu Picchu). Hepatitis A
Brazil, Colombia, Ecuador, Guatemala, Nicaragua, Panama, Paraguay, Peru, Uruguay
Ecuador, Guatemala, Nicaragua, Panama, Peru
Brazil, Colombia, Paraguay, Uruguay
Recommended for: adventurous dietary habits; prolonged stays; travel (especially in rural areas) outside of common tourist packages and other pre-arranged fixed itineraries. Consider for all risk-averse travelers desiring maximum pre-travel preparation. Hepatitis B
Brazil, Colombia, Ecuador, Peru
Risk is especially high in the Amazon region. Recommended for: prolonged stays; frequent short stays in this or other high risk countries; adventure travelers; the possibility of acupuncture, dental work, or tattooing; all health care workers; the possibility of a new sexual partner during stay; and travelers with high potential to seek medical care in local facilities. Consider for short stays in travelers desiring maximum pre-travel preparation. Increased awareness is recommended regarding safe sex and body fluid/blood precautions. Guatemala
Recommended for: prolonged stays; frequent short stays in this or other high risk countries; adventure travelers; the possibility of acupuncture, dental work, or tattooing; all health care workers; the possibility of a new sexual partner during stay; and travelers with high potential to seek medical care in local facilities. Consider for short stays in travelers desiring maximum pre-travel preparation. Increased awareness is recommended regarding safe sex and body fluid/blood precautions. Nicaragua, Panama, Paraguay, Uruguay
Recommended for: prolonged stays; all health care workers; the possibility of a new sexual partner during stay. Increased awareness is recommended regarding safe sex and body fluid/blood precautions. Risk exists in much of the country and is highest in Bahia, Ceara, Maranhao, Pará, and Pernambuco states; risk from bat exposure is highest in Parana, Sao Paulo, Rio Grande do Norte, and Minas Gerais states. Very high risk exists in and around Fortaleza in Ceara State. Recommended for: Prolonged stays: all travelers with a priority for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Significant risk from bat exposure exists in most jungle areas. Domestic animals are at high risk. Recommended for: Prolonged stays: all travelers with a priority for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. The Galapagos Islands only: Risk from bat exposure is presumed to exist throughout the islands. Considered to be rabies-free in terrestrial animals. Recommended for: travelers likely to have contact with bats. Bat bites and scratches should be taken seriously and postexposure prophylaxis sought even in Paraguay
Risk exists in most of the country and is highest in Central Department. Recommended for: Prolonged stays: all travelers with a priority for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Risk exists in many parts of the country, primarily from bat exposure; risk is highest in jungle areas and in Amazonas, Cusco, Puno, Piura, and San Martin regions. Recommended for: Prolonged stays: all travelers with a priority for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Colombia
Risk exists in most of the country, primarily from bat exposure, and is highest in coastal areas. Recommended for: Prolonged stays: all young children and all travelers to rural areas where risk exists. Shorter stays: occupational exposure; adventure travelers, hikers, cave explorers, and backpackers, especially at locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; and all travelers involved in any activity that might bring them into direct contact with bats. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Nicaragua
Risk exists in most of the country. Risk from bat exposure exists throughout the country. Recommended for: Prolonged stays: all young children and all travelers to rural areas where risk exists. Shorter stays: occupational exposure; adventure travelers, hikers, cave explorers, and backpackers, especially at locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; and all travelers involved in any activity that might bring them into direct contact with bats. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Risk is presumed to exist in most of the country. No canine cases have been reported since 1972. Recommended for: occupational exposure and all travelers involved in any activity that might bring them into direct contact with bats. Bat and other mammal bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Guatemala
Risk exists in much of the country but is highest in Baja Verapaz, Huehuetenango, Izabal, Quetzaltenango, Sacatepéquez, San Marcos, and Totonicapán provinces. Recommended for: Prolonged stays: all travelers with a priority for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours' travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Risk is limited to Rivera and Tacuarembo departments. Recommended for: occupational exposure and all travelers involved in any activity that might bring them into direct contact with bats. Dog and bat bites or scratches should be taken seriously and postexposure prophylaxis sought even in those already immunized. Meningococcal meningitis
Conjugated C vaccine (not available in the U.S.) is a routine childhood vaccine in this country. Recommended on arrival if not previously given for: Long-stay children 2 months to 10 years of age usually according to local dosing regimens, even if they have received MCV4 previously. Children aged 11-18 years and university students who will be living in dormitories or residence halls should receive MCV4 if not given previously. Conjugated C vaccine does not replace the need for quadrivalent (A-C-Y-W135) vaccine in the event of subsequent travel to Africa or to the Hajj in Saudi Arabia. Influenza
Brazil, Colombia, Ecuador, Guatemala, Nicaragua, Panama, Peru
Flu is transmitted throughout the year in the tropics, and all travelers are at increased risk. Recommended for: all travelers. Not all isolates are matched to the current vaccine strains. Consider oseltamivir as standby therapy, especially for those who are at high risk for complications from influenza. Paraguay, Uruguay
Flu is transmitted from April to September (although off-season transmission can occur), and all travelers are at increased risk. Recommended for: all travelers during flu season. Not all isolates are matched to the current vaccine strains. Consider oseltamivir as standby therapy, especially for those who are at high risk for complications from influenza. Routine vaccinations (adults only)
Tetanus/diphtheria/pertussis (all countries)—Adequate primary series plus booster within the last 10 years (Tdap or
Td). Those who have not received a previous dose of an acellular pertussis-containing vaccine in adulthood should receive a
one-time dose of Tdap vaccine, regardless of interval since last tetanus/diphtheria-containing vaccine.
Measles/mumps/rubella
Brazil, Colombia, Ecuador, Guatemala, Nicaragua, Panama, Paraguay, Peru, Uruguay
Indicated for those born in 1957 or later (1970 or later in Canada) without a history of disease, laboratory evidence of disease, or of 2 adequate doses of live vaccine at any time during their life. Many countries (including the U.K.) recommend that adults need to have had only 1 countable dose at any time during their life. Pneumococcal (all countries)—All adults over 65 and those with chronic disease or compromising conditions.
Brazil, Colombia, Ecuador, Guatemala, Nicaragua, Panama, Paraguay, Peru, Uruguay
Adult polio boosters are unnecessary for travel to this country. Varicella (all countries)—Indicated for all persons born outside the U.S. or born in the U.S. after 1979, except not indicated
for persons with an adequate vaccination history (2 lifetime doses), reliable evidence of previous infection, or laboratory
confirmation of immunity.
General information: predominantly P. vivax. Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: throughout the states of Roraima, Amapá, Pará, Amazonas, Acre, and Rondónia; portions (see map) of the states of Maranhão, Tocantins, and Mato Grosso; all Amazon cruises; all cities and towns within these areas except the central urban area of Belém. Insect precautions only are recommended (negligible transmission is reported): portions of the states of Maranhão, Tocantins, Mato Grosso, and Mato Grosso do Sul; the central urban area of Belém; typical tourist itineraries and -accommodations in the Pantanal; all cities and towns within these areas. No protective measures are necessary (no evidence of transmission exists): the cities of São Paulo, Rio de Janeiro, Salvador, Recife, Fortaleza, and Porto Alegre; the island of Fernando de Noronha; typical tourist itineraries and -accommodations around Iguaçu Falls that are limited to Brazil; all other areas not mentioned above. Colombia
General information: predominantly P. vivax. Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: throughout the departments of Amazonas, Vaupés, Guainía, -Vichada, Sucre [7], and Guaviare [26]; altitudes below 1,700 m (5,600 ft) in La Guajira [1], Norte de Santander [5], Bolívar [6], Córdoba [8], Antioquia [9], Caldas [15], Risaralda [16], Chocó [17], Quindío [18], Valle del Cauca [21], Cauca [22], Nariño [23], and Putumayo [25], Caqueta, and Meta departments (see map); all cities and towns within these areas except Cartegena, Sincelejo, Cúcuta, Montería, Medellín, Manizales, Pereira, Armenia, Cali, and the central urban areas of Ríohacha, Popayán and Florencia. Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): altitudes below 1,700 m in Cesar [4], Casanare [12], Boyacá [13], and Huila [24] departments; all cities and towns within these areas except the central urban areas of Valledupar, Yopal, and Neiva. Insect precautions only are recommended (negligible transmission is reported): the department of Atlántico [2]; altitudes below 1,700 m in Magdalena [3], Santander [10], Arauca [11], Cundinamarca [14], and Tolima [20] departments; all cities and towns within these areas except Santa Marta, Barranquilla, Bucaramanga, and Ibagué; the central urban areas of Ríohacha, Valledupar, Yopal, Villavicencio, Neiva, and Florencia. No protective measures are necessary (no evidence of transmission exists): the cities of Bogota, Medellín, Cali, -Barranquilla, Cartagena, Sincelejo, Manizales, Pereira, Armenia, Santa Marta, Ibagué, Cúcuta, and Bucaramanga; the island department of San Andrés y Providencia; altitudes above 1,700 m; all other areas not mentioned above. General information: predominantly P. vivax. Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: altitudes below 1,500 m (4,900 ft) in the provinces of -Esmeraldas, Sucumbios, Orellana, and Cañar [13] (see map); portions of Pastaza, Guayas [11], El Oro [15], and Morona-Santiago; all cities and towns within these areas except the central urban area of Esmeraldas. Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): portions of Manabí, Guayas [11], Pastaza, Morona-Santiago, and El Oro [15] provinces; altitudes below 1,500 m in Santo Domingo de las -Tsáchilas [3], Bolivar [9], and Los Ríos [10] provinces; all cities and towns within these areas except Santo Domingo de los Colorados, Manta, and Guayaquil, and the central urban areas of Portoviejo, Babahoyo, and Machala. Insect precautions only are recommended (negligible transmission is reported): throughout the province of Santa Elena [12]; altitudes below 1,500 m in the province of Pichincha [4]; portions of Manabi, Guayas [11], and Loja [16] provinces; all cities and towns within these areas; the central urban areas of Esmeraldas, Portoviejo, Babhoyo, and Machala. No protective measures are necessary (no evidence of transmission exists): the cities of Quito, Santo Domingo de los Colorados, Manta, and Guayaquil; the Galapagos Islands; altitudes above 1,500 m; all other areas not mentioned above. Guatemala
General information: predominantly P. vivax. Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: southern areas in the province of Petén (see map); throughout the province of Retalhuleu [18]; altitudes below 1,500 m (4,900 ft) in the provinces of Alta Verapaz, Baja Verapaz [7], Izabal, Zacapa [9], Escuintla [16], and Suchitepéquez [17]; all cities and towns in these areas except the central urban areas of Escuintla, Cobán, and Puerto Barrios. Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): northern areas in the -province of Petén (including Tikal National Park); portions of the following provinces: Quiché, San Marcos [2], Quetzaltenango [3], and Chiquimula [10]; all cities and towns within these areas. Insect precautions only are recommended (negligible transmission is reported): altitudes below 1,500 m in the -provinces of Huehuetenango [1], Quetzaltenango [3], Sololá [5], Chimaltenango [6], El Progreso [8], Jalapa [11], Jutiapa [12], Santa Rosa [13], Guatemala [14], and Sacatepéquez [15]; portions of Quiché and Chiquimula [10] provinces; all cities and towns within these areas except Jalapa; the central urban areas of Escuintla, Cobán, and Puerto Barrios. No protective measures are necessary (no evidence of transmission exists): the cities of Guatemala City and Jalapa; tourist areas of the central highlands (e.g., Lake Atitlan, Panajachel, Antigua Guatemala, and Chichicastenango); altitudes above 1,500 m; all other areas not mentioned above. Nicaragua
General information: almost exclusively P. vivax (P. falciparum transmission is minimal and limited to northern and
western Atlántico Norte). Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: throughout the departments of Atlántico Norte and Atlántico Sur (including offshore islands); most of Matagalpa Department (see map); southeastern Río San Juan; coastal portions of Chinandega, Léon, and Managua departments; all cities and towns within these areas except Léon and the central urban areas of Puerto Cabezas, Rama, Bluefields, El Bluff, Matagalpa, Corinto, and Puerto Sandino. Insect precautions only are recommended (negligible transmission is reported): portions of the following departments: Jintogega, Nueva Segovia [1], Léon, Chinandega, Managua [4], Masaya [5], Granada [7], Rivas [8], Río San Juan, Chontales, and Boaco; all cities and towns within these areas except Chinandega; the central urban areas of Puerto Cabezas, Rama, Bluefields, El Bluff, Matagalpa, Corinto, and Puerto Sandino. No protective measures are necessary (no evidence of transmission exists): the city of Managua; all other areas not mentioned above. General information: almost exclusively P. vivax (P. falciparum transmission is minimal and limited to areas east of the
Canal Zone). Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: throughout the provinces and comarcas of Darién, San Blas and San Blas Islands (Kuna Yala), Kuna de Madugandi, Kuna de Wargandi, Embará, and eastern Panamá (see map); all cities and towns in these areas except the central urban area of Coco Solo. Insect precautions only are recommended (negligible transmission is reported): rural areas within certain municipalities in the provinces and comarcas of Bocas del Toro, Chiriquí, Ngöbe Buglé, Veraguas, Colón, Coclé, and western Panamá (see map); the city of Coco Solo (see map inset). No protective measures are necessary (no evidence of transmission exists): the former Canal Zone (see map inset), including Panama City; all other areas not mentioned above. Paraguay
General information: almost exclusively P. vivax. Transmission occurs throughout the year and is highest from January
through June.
Protective recommendations:
Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): certain municipalities (see map) in the departments of Caaguazú and Alto Paraná; all cities and towns within these areas except the central urban area of Ciudad del Este. Insect precautions only are recommended (negligible transmission is reported): all other municipalities in the departments of Caaguazú and Alto Paraná not mentioned above; all cities and towns within these areas; the central urban area of Ciudad del Este. No protective measures are necessary (no evidence of transmission exists): visits to Iguaçu Falls (in Brazil); all other areas not mentioned above. General information: predominantly P. vivax (P. falciparum is limited to the northern half of Peru, however isolated cases
of P. falciparum have been reported from the department of Madre de Dios). Transmission occurs throughout the year.
Protective recommendations:
Chemoprophylaxis is recommended for all travelers: altitudes below 2,000 m (6,600 ft) in portions of the following departments (see map): Tumbes [1], Piura [2], Lambayeque [3], Cajamarca [4], San Martín [6], La Libertad [7], Loreto, Ucayali, Pasco [10], Junin, and Madre de Dios; all cities and towns within these areas except Tumbes, Piura, and the central urban areas of Iquitos, Tarapoto, and Pucallpa. Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): altitudes below 2,000 m in portions of the following departments: Piura [2], San Martín [6], Loreto, Ucayali, Ayacucho [14], Cusco [16], and Madre de Dios; all cities and towns within these areas. Insect precautions only are recommended (negligible transmission is reported): altitudes below 2,000 m in portions of the following departments: Piura [2], Lambayeque [3], Cajamarca [4], Amazonas [5], San Martín [6], La Libertad [7], Huánuco [9], and Lima [11] (near the ruins at Caral). No protective measures are necessary (no evidence of transmission exists): the city of Lima and vicinity; Lake Titicaca; the city of Cusco; Machu Picchu; intermediate points in the Urubamba Valley (the only route between Cusco and Machu Picchu); altitudes above 2,000 m; all other areas not mentioned above. Malaria Prophylaxis Drug choice depends on personal factors discussed between the traveler and medical provider. No preventive measure is 100% effective. Immediate medical attention is necessary for fever or flu-like illness within 3 months after travel in a malaria risk area. Include mention of travel history.
Protective measures: Evening and nighttime insect precautions are essential in areas with any level of transmission.
Atovaquone/proguanil, doxycycline, and mefloquine are protective east of the Canal Zone. For the exceptional case of a
vulnerable traveler with underlying medical conditions and/or the potential for an especially adverse outcome from malaria,
chloroquine and other antimalarials (atovoquone/proguanil, doxycycline, and mefloquine) are protective west of the Canal
Zone.
Brazil, Colombia, Ecuador, Peru
Protective measures: Evening and nighttime insect precautions are essential in areas with any level of transmission.
Atovaquone/proguanil (Malarone or generic), doxycycline, and mefloquine are protective in this country.
Guatemala, Nicaragua, Paraguay
Protective measures: Evening and nighttime insect precautions are essential in areas with any level of transmission.
Chloroquine and other antimalarials (atovaquone/proguanil, doxycycline, and mefloquine) are protective in this country.
Issues for Medical Providers to Consider
Factors favoring chemoprophylaxis
Factors against chemoprophylaxis
♦ Risk-averse and vulnerable travelers ♦ Areas subject to infrequent epidemics ♦ Immigrants visiting friends and relatives ♦ Travel longer than 1 month ♦ Unreliable medical expertise and/or treatment See the Technical Explanation of Malaria Mapping document for more information.
Brazil is a developing nation but is in the upper half of the world's economies. Located in eastern South America, its climate is mostly tropical, but temperate in the south. High risk throughout the country including deluxe accommodations. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever presents significant risk in urban and rural areas. Almost all cases are reported from January to June; risk is greatest
in northeastern and southeastern states and risk is significant in Rio de Janeiro and Sao Paulo. Minimal risk in Santa Catarina and
Rio Grande do Sul. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous, mucocutaneous, and visceral), transmitted by sandflies, is common. Cutaneous and mucocutaneous
disease occurs primarily in the Amazon basin (Amazonas, Minas Gerais, Mato Grosso, and Para states) and the north and northeast
regions. Visceral disease occurs primarily in the semi-arid rural northeast and southeast regions, where both rural and urban
transmission occurs. Insect precautions (primarily evening and nighttime) are recommended.
Chagas': Brazil was declared free of natural Chagas' disease (American trypanosomiasis) domiciliary transmission (thatch, mud,
and adobe huts) by WHO in 2006. Oral transmission can occur; travelers should avoid freshly prepared fresh fruit and cane juices
from unsanitary sources.
Lyme disease reports in São Paulo, Rio de Janeiro, and Mato Grosso del Sul states have yet to be confirmed by the detection of the
bacteria from ticks in this country. Risk to travelers is presumed to be absent.
Schistosomiasis, transmitted by waterborne larvae that penetrate intact skin, presents significant risk in the states of Bahia and
Minas Gerais, and in coastal regions of Sergipe, Alagoas, Pernambuco, Paraiba, and Rio Grande do Norte states. Additional localized
foci occur in other eastern states and the Federal District. Travelers should avoid freshwater exposure in these areas.
Hantavirus causing hantavirus pulmonary syndrome, transmitted by rodents, occurs throughout the country but especially in the
southern and southeastern regions, and throughout the Central Plateau in the midwestern region. Risk to most travelers is minimal.
Avoid contact with mice and rats in rural areas.
Marine hazards may include jellyfish, coral, and sea urchins. Dangerous (potentially deadly) jellyfish are present year-round, but
particularly during the rainy season. Children are especially at risk, and adults wading, launching boats, or fishing.
A high level of medical care comparable to that in industrialized countries is available in São Paulo, Rio de Janeiro, and Salvador, although sophisticated cases are best referred to São Paulo. Adequate private medical care is available in other major cities but is not up to the standards of industrialized countries. Medical care is substandard outside major cities. For emergency services in Brasilia and São Paulo, dial 190 for police, 192 for ambulance, and 193 for fire. The São Paulo Tourist Police (Delegacia de Protecao ao Turista) numbers are 11-3120-4447 and 3151-4167. The Rio de Janeiro tourist police numbers are 21-2332-2924, 21-2332-2511, and 21-2332-5112. Recompression chambers are located in or near major cities and resort towns where scuba diving is popular. Before diving, check that facilities are operational. Cash payment may be required prior to treatment, including emergency care. There is no clear information as to whether credit cards are accepted for medical care. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Brazil. Consider Avoiding
Border areas, including the states of Amazonas, Acre, Rondonia, and Mato Grosso, are dangerous due to drug trafficking. Other risk areas include the tri-border area of Argentina, Brazil, and Paraguay, where criminal activities (such as trafficking of illicit goods) occur. Incidents of gang-related violence pose a threat to the safety of travelers in large urban centers. Serious crime is high in most urban centers. The use of firearms is common. Express kidnappings and carjackings occur throughout the country. Street crime, including pickpocketing, mugging, and purse snatching, is common, especially during public festivities such as the annual Carnival. Civil Unrest
Travelers should avoid political and labor strikes, protests and demonstrations. Piracy occurs in Brazilian coastal waters. Miscellaneous Safety
Travel in the Amazon border regions and the Pantanal wetlands should be undertaken with trained guides. These areas are largely uninhabited and dangerous. Road Conditions and Hazards
Road conditions in Brazil vary widely throughout the country. State roads are often excellent, while federal, interstate roads are often very poor due to lack of maintenance. Highway travel should be avoided after dark due to aggressive driving habits, a significant number of trucks, excessive speeds, poorly marked lanes, construction, and poorly maintained roads. Brazil has one of the highest road accident rates in the world. Driving Laws
Consumption of any alcoholic beverages prior to driving is illegal in Brazil. Public Transportation
There are few railroads and passenger train travel is almost nonexistent. Bus travel between and in major cities is relatively safe. Natural Disasters and Climate
The rainy seasons extend from January to July in the north, January to May in the northeast, September to January in the southeast (Rio de Janeiro and Sao Paulo), and September to January in the south. Hot, dry weather conditions during the dry season, which lasts from May to September, may lead to wildfires in the central areas of Brazil, including the capital of Brasilia. FAA Advisory
The U.S. Federal Aviation Administration has determined that the civil aviation authority of this country oversees its air carriers in accordance with minimum international safety standards. Other Laws
It is a legal requirement in Brazil to carry proof of identity at all times. Availability of Basic Infrastructure and Tourist Facilities
Tourist facilities are excellent in major cities, but vary in quality in remote areas. Currency
The currency is the real (BRL). Credit cards are widely accepted. Import and Export Information
Brazilian customs authorities may enforce strict regulations concerning temporary importation into or export from Brazil of items such as firearms, antiquities, mineral samples, tropical plants, medications, and business equipment. Consular Information
Selected Embassies or Consulates in Brazil U.S. Embassy: Tel: [+55] 61-3312-7000, brazil.usembassy.gov. Consulates: (Boa Vista) Tel: [+55] 81-3416-3050, brazil.usembassy.gov; (Rio de Janeiro) Tel: [+55] 21-3823-2000, portuguese.riodejaneiro.usconsulate.gov; (Sao Paulo), Tel: [+55] 11-5186-7000, saopaulo.usconsulate.gov Canadian Embassy: Tel: [+55] 61-3424-5400, www.brazil.gc.ca U.K. Embassy: Tel: [+55] 61-3329-2300, www.ukinbrazil.fco.gov.uk Australian Embassy: Tel: [+55] 61-3226-3111, www.brazil.embassy.gov.au/bras/home.html Brazil's Embassies or Consulates in Selected Countries In the U.S.: www.consbrasdc.org/english/index.asp Colombia is a developing nation but is in the upper half of the world's economies. Located in northwestern South America along the Pacific Ocean and Caribbean Sea, its climate is tropical on the coasts and eastern plains and cooler in the highlands. Minimal risk exists in deluxe accommodations but high risk elsewhere. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever presents significant risk in urban and rural areas except no risk in Amazonas and Vaupes. Minimal risk in Bogota.
Daytime insect precautions are recommended.
Leishmaniasis (cutaneous, mucocutaneous, and visceral), transmitted by sandflies, is common. Cutaneous and mucocutaneous
disease occur in all rural areas below approximately 2,500 m (8,200 ft). Visceral disease occurs in the Magdalena Valley. Insect
precautions (primarily evening and nighttime) are recommended.
Lyme disease reports have yet to be confirmed by the detection of the bacteria from ticks in this country. Risk to travelers is
presumed to be absent.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Altitude sickness: Chemoprophylaxis with acetazolamide should be considered for travelers anticipating rapid ascent to sleeping
altitudes above 2,800 meters (9,200 feet). The elevation of Bogota is 2,600 meters.
Marine hazards may include jellyfish (often causing sea bather's eruption), coral, and sea urchins. Dangerous (potentially deadly)
jellyfish are present year-round, but particularly during the rainy season. Children are especially at risk, and adults wading,
launching boats, or fishing.
A high level of medical care comparable to that in industrialized countries is available in Bogota. Medical care is substandard outside major cities. Emergency rooms, even at top-quality facilities, are frequently overcrowded. For emergency services, dial 123. Operators usually speak only Spanish. Injured or seriously ill travelers may prefer to take a taxi or private vehicle to the nearest major hospital rather than wait for an ambulance. A recompression chamber is located in Cartagena. Before diving, check that facilities are operational. Cash payment may be required by private health care providers prior to treatment, including emergency care; in major cities, some providers may accept credit cards, but those that do not may request advance payment in cash. Uninsured travelers without financial resources may be unable to obtain care, or must seek treatment in public hospitals. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Consular Travel Warning
Due to ongoing security concerns, a Canadian consular warning currently advises against all travel to the departments of Antioquia
(excluding Medellin), Arauca, Cauca, Caqueta, Choco, Cordoba (excluding Monteria), Guaviare, Huila, Meta, Narino (excluding Pasto),
Norte de Santander (excluding Cucuta), Putumayo, Santander (excluding Bucaramanga), Tolima, Valle del Cauca, Vichada, and southern
parts of La Guajira; all travel to the city of Buenaventura; all travel to most rural areas of Colombia; and all non-essential travel to Cali.
Other governments limit their travel warning to Santander, Putumayo, Arauca, Cauca, Caqueta, Guaviare, Valle de Cauca, Narino, Norte
de Santander, and Meta; and all non-essential travel to the provinces of Cesar, La Guajira, Antioquia (excluding Medellin), the cities of Cali
and Popayan, and most rural areas.
Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. According to the U.S. Department of State, Colombia has imposed HIV/AIDS travel restrictions on all travelers with HIV/AIDS except those with PLHIV. A waiver may be requested from the Colombian embassy. Terrorism Risk
Drugs, organized crime, and terrorism are inextricably linked in Colombia. Control of the drugs trade is a major driver of much of the armed conflict. Both Colombia's illegal armed groups and other criminal groups are heavily involved in the drugs trade and in other serious crime. Consider Avoiding
There is a high risk from land mines and unexploded ordnance in rural areas of Colombia. Not all mined areas are marked. National parks, wildlife refuges, and city outskirts are often convenient hideouts for illegal groups and should be avoided, as armed clashes are frequent in such areas. In some rural areas, illegal armed groups may set up roadblocks for robbery or kidnapping for ransom. Petty and violent crime (including pickpocketing, assault, robbery, car bombing, hijacking, and murder) is prevalent in both urban and rural regions of Colombia. Visitors should exercise extreme caution. In tourist resort areas of San Andres Island, Providencia Island, and Cartagena, criminal activity and violence directed at tourists is low. Colombia's kidnapping rate is among the highest in the world. While kidnapping is primarily aimed at Colombians, travelers can be targeted by guerrilla groups in all parts of the country. Express kidnappings are frequent. Civil Unrest
Demonstrations, major strikes, and acts of violence by terrorist groups may occur. Roadblocks may disrupt local transportation and affect travel to and from airports. For security reasons, it is preferable to arrive at Medellin's Jose Maria Cordova International Airport during the day to avoid the road from the airport to the city after dark. Border closures could occur at short notice. Road Conditions and Hazards
Road travel in Colombia, including Bogota, is extremely dangerous, and roads are usually congested. Most roadways are in poor condition. Traffic laws are not enforced by police, traffic signs and controls are ignored, and traffic is aggressive and dangerous. It is recommended to carry a cellular telephone and park vehicles in a guarded parking lot. Visitors are advised to travel by air when covering long distances and not to enter or leave Colombia over land borders. Any road travel should be done using main roads only, and always during daylight hours. Driving Laws
An International Driving Permit (IDP) is required. Seat belts are mandatory for front-seat passengers in a private vehicle. Car seats are mandatory for children, and a child under age 10 is not permitted to ride in a front seat. It is against the law to talk on a cellular phone while driving in Colombia, and violators may be fined. While driving outside major cities, it is mandatory to drive with headlights on. In the event of an accident, the drivers involved must remain at the scene and not move their vehicles until the authorities arrive. Public Transportation
Public transportation is not safe. Buses and, to a lesser extent, taxis are frequent targets for criminals. Rural buses are often stopped by guerrillas. Taxis should be booked through hotels or through authorized and controlled taxi centers. Many taxi drivers are armed. Natural Disasters and Climate
Colombia is subject to various Natural Disasters and Climate such as earthquakes, volcanic eruptions, torrential rains, floods, and mudslides. Rainy seasons normally last from March to June and from September to November. The hurricane season extends from June to the end of November. FAA Advisory
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it licenses and oversees air carriers in accordance with aviation safety standards established by the International Civil Aviation Organization. Exit Fees
An airport tax is charged for international departures. Other Laws
Sentences for drug-related offenses are severe. Travelers should monitor luggage closely at all times. Never transport other people's packages or change money for strangers. Homosexuality is legal but not widely socially accepted, especially in rural areas. Photography of military or strategic sites is not permitted. Availability of Basic Infrastructure and Tourist Facilities
Tourist facilities in Colombia vary in quality and safety, according to price and location. Currency
The currency is the Colombian peso (COP). U.S. currency and traveler's checks are widely accepted. Import and Export Information
Colombian law prohibits travelers from bringing firearms into Colombia. Penalties for illegal importation or possession include heavy jail sentences. It is prohibited to export certain cultural patrimony artifacts. Individuals leaving Colombia are only entitled to carry up to U.S.$10,000 in cash. Anything in excess of this may be confiscated. Consular Information
Selected Embassies or Consulates in Colombia U.S. Embassy: Tel.: [+57] 1-275-2000, bogota.usembassy.gov. Consulate: (Atlantico) Tel.: [+57] 5-353-2001 Canadian Embassy: Tel.: [+57] 1-657-9800, www.canadainternational.gc.ca/colombia-colombie U.K. Embassy: Tel.: [+57] 1-326-8300, ukincolombia.fco.gov.uk/en Australian Embassy: Travelers can obtain limited consular services from the Canadian Embassy in Bogota (see above). Colombia's Embassies or Consulates in Selected Countries Ecuador is a developing nation but is in the upper half of the world's economies. Located along the equator on the west coast of South America, its climate is tropical along the coast and in jungle lowlands, and cooler inland at higher elevations. Minimal risk exists in deluxe accommodations but high risk elsewhere. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever occurs in urban and rural areas, including on the Galapagos Islands. Highest risk exists in the western coastal region
and the low highland areas of the Sierra (central region). No risk in Quito. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous and mucocutaneous), transmitted by sandflies, is common on both sides of the Andes below
approximately 2,000 m (6,600 ft), especially in Amazonian regions and additional patchy foci in the Andes between approximately
2,300 and 2,500 m. Insect precautions (primarily evening and nighttime) are recommended.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Altitude sickness: Chemoprophylaxis with acetazolamide should be considered for travelers anticipating rapid ascent to sleeping
altitudes above 2,800 meters (9,200 feet). The elevation of Quito is 2,900 meters.
Sun: Elevated UV levels are frequently reported in higher altitude areas, including in Quito. Travelers should take sun precautions,
especially from 10 a.m to 3 p.m.
Marine hazards may include jellyfish, coral, and sea urchins.
Adequate medical care is available in Quito and Guayaquil but is not up to the standards of industrialized countries. Medical care is substandard outside major cities. For emergency services, dial 911. Operators typically speak Spanish only. Ambulances, with or without trained emergency staff, are in critically short supply. Recompression chambers are located in Puerto Ayora, Santa Cruz Island (Galapagos Islands), and the Ecuadorian Navy base (San Eduardo Naval Base) in Guayaquil. Before diving, check that facilities are operational. Travelers to the Galapagos Islands should be aware of limited facilities for decompression sickness. Acute surgical and cardiac services are not available; serious cases must be evacuated to the mainland for treatment. Cash payment is expected prior to treatment, including emergency care. There is no clear information as to whether credit cards are accepted for medical care. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Consular Travel Warning
Due to ongoing security concerns and civil unrest, a Canadian consular warning currently advises against all travel to the areas
immediately bordering Colombia (namely both provinces of Carchi and Sucumbíos, with the exception of the city of Tulcan), the town of
San Lorenzo, located in the north of Esmeraldas province, and all travel south of Cuenca, including the provinces of Zamora-Chinchipe,
Morona-Santiago, and El Oro near the Peruvian border. Other governments advise against all travel to Carchi, Orellana, Sucumbios and
Napo provinces in northeastern Ecuador bordering Colombia and Peru and to the antennas of Pichincha volcano.
Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ecuador. Consider Avoiding
Travel to some areas bordering Colombia is dangerous due to the presence of drug traffickers and criminal organizations and the risk of violence (including during demonstrations), kidnappings, armed assaults, and extortion. There have been reports of tourists and foreign oil workers being held against their will in these areas. Armed robberies have also been reported at jungle lodges in the areas of Lower Rio Napo and Cuyabeno National Reserve. There are land mines and unmarked minefields in the Cordillera del Condor, near the Peruvian border. Crime is a severe problem in Ecuador. Street crimes, including purse snatching, car break-ins, thefts, pickpocketing, and violent carjackings, are daily occurrences in major cities. Thieves, including children, often work in teams. Sexual assaults and armed robberies have been reported near the Pichincha volcano. Travelers should not walk outside the limits of the Teleferico or its pathways, and avoid hiking to the antennas of the volcano via Cruz Loma, west of Quito. Robberies at gunpoint have also been reported along the hiking trail up Cerro Mandango near Vilcabamba Loja. Those robbed, often foreigners, report being accosted by a group of masked, armed men while hiking along the trail. Armed assaults can occur in public parks in and around transportation terminals, especially in Guayaquil, Quito, Manta, and Cuenca. In Quito, exercise caution in the areas of El Panecillo, Carolina Park, Guapulo, Old Quito, South Quito, and particularly the popular tourist sector of Mariscal Sucre. Sexual assaults can also occur in the Mariscal Sucre district. There have been reports of criminals using incapacitating drugs such as scopolamine on unsuspecting tourists in order to rob and/or assault them. In Guayaquil, tourists should be vigilant when visiting the downtown area, the waterfront (El Malecón), the market area, and the Christ Statue (Sagrado Corazón de Jesús) on Cerro del Carmen. Avoid wandering on deserted beaches, especially at night. Random attacks at gunpoint, robberies, and sexual assaults involving foreigners have occurred in the Riobamba area. Luggage theft is common at airports, bus terminals, buses (city and regional), and other transit points. A common scam involves squirting liquids (ketchup, mustard, water, etc.) onto the victim and then stealing their bag while ‘helping' to clean up. This technique is used across Ecuador. Robberies and assaults against taxi passengers, known locally as “secuestro express” continue to present a significant safety concern, especially in Guayaquil and Manta, but also with increasing regularity in Quito. Shortly after the passenger enters a taxi, the vehicle is typically intercepted by armed accomplices of the driver, who threaten passengers with weapons, rob passengers of their personal belongings, and force victims to withdraw money from ATMs. Increasingly, victims have been beaten or raped during these incidents. In urban centers, thieves target cars stopped in traffic for break-ins. The hotel zones in Quito, which are frequented by a high number of foreign tourists who are believed to carry valuables, are often targeted by thieves and muggers. Both Ecuadorians and foreigners are regularly robbed when leaving banks in Quito and other major cities. Backpackers are also targeted. Most of the criminals in and around Quito use weapons. Civil Unrest
Public transportation is often disrupted during demonstrations. Protesters may burn tires, throw rocks and Molotov cocktails, engage in destruction of private and public property, and detonate small improvised explosive devices during demonstrations. Police response may include water cannons and tear gas. Strikes and disturbances by local fishermen in the Galapagos Islands sometimes impact the movement of tourists and access to some sites. Curfews and states of emergency may be declared in regions affected by civil unrest, natural disasters, or other disruptions. During states of emergency, authorities have expanded powers to restore order, including suspension of some constitutional rights and expanded detention powers. Foreigners are prohibited from protesting in Ecuador and may be subject to arrest for participating in any demonstrations. Miscellaneous Safety
Treks and hiking excursions into Ecuador's mountains should be undertaken in groups, with experienced, certified tour guides only. Road Conditions and Hazards
The Puente Internacional de Rumichaca border crossing, located between Ipiales, Colombia, and Tulcan, Ecuador, is closed from 10 p.m. to 6 a.m. Travelers should allow enough time for border-crossing formalities. Road travel is slow due to poor conditions, unmarked speed bumps, and frequent military or police roadblocks. Heavy rain and mudslides often close or wash out roads. Heavy fog occasionally poses hazards in mountainous areas. Driving in Ecuador is hazardous and unpredictable. There are all types of vehicles on the road that do not meet the acceptable safety standards. Driving Laws
An International Driving Permit (IDP) is required. Drivers involved in accidents causing physical injury are immediately detained. In many cases, detention lasts until responsibility has been assigned and all parties are satisfied. Public Transportation
Robberies and assaults are reported regularly on intercity and urban Guayaquil buses, especially after dark. Bus drivers often make illegal stops to pick up new passengers on express routes, especially on the routes between Guayaquil and Cuenca and between Guayaquil and Riobamba. Travel after dark, either by long-distance or international coaches, must be avoided. Natural Disasters and Climate
Ecuador has many active and potentially active volcanoes, including around the capital of Quito and other popular tourist destinations. Other potential environmental threats include flooding, forest fires, earthquakes, and tsunamis. Severe flooding occurs in many areas of the western provinces of Manabí, Los Rios and Guayas, particularly in Chone, Portoviejo, and parts of Guayaquil. The hurricane season extends from early June to the end of November. Other Laws
Pedestrians should cross streets only at designated crosswalks. By law, jaywalking and walking off the sidewalk are punishable by a fine. Travelers in Ecuador are required to carry identification, including proof of citizenship, at all times. A photocopy of one's passport and photograph page and Ecuadorean immigration entry stamp will suffice. Availability of Basic Infrastructure and Tourist Facilities
In general, tourist facilities are adequate but vary in quality. Dual Citizenship
Dual citizens may enter Ecuador on an Ecuadorian passport and stay indefinitely. Currency
The currency is the U.S. dollar (US$). Credit cards are accepted by many businesses, and U.S. traveler's checks are easily changed in tourist areas and in major hotels. It is useful to have smaller denominations, especially $1 notes, as many smaller shops and taxi drivers do not change large notes. Credit card fraud is increasing in Ecuador. Credit card magnetic strips have been duplicated, particularly at restaurants and bars where swiping one's own card may not always be possible. Consular Information
Selected Embassies or Consulates in Ecuador U.S. Embassy: Tel.: [+593] 2-398-5000, ecuador.usembassy.gov. Consulate: (Guayaquil) Tel.: [+593] 4-232-3570, guayaquil.usconsulate.gov Canadian Embassy: Tel.: [+593] 2-245-5499, www.canadainternational.gc.ca/ecuador-equateur U.K. Embassy: Tel.: [+593] 2-2970-800, 2970-801, ukinecuador.fco.gov.uk/en Australian Consulate: Tel.: [+593] 4-601-7529 Ecuador's Embassies or Consulates in Selected Countries In Canada: Tel.: [+1] 613-563-8206, 563-4286 In the U.K.: www.consuladoecuador.org.uk Guatemala is a developing nation in the lower half of the world's economies. Located south of Mexico in Central America, its climate is tropical but varies by location. Minimal risk exists in deluxe accommodations in Guatemala City but high risk elsewhere. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Enteric diseases, including amebic and bacillary dysenteries, are extremely common. Cyclospora cayetanensis-contaminated raspberries from Guatemala have been widely exported. Prevalence of this pathogen within Guatemala is not known. HIV: 9% of sex workers in the capital city are estimated to be HIV positive. Travelers should clearly understand STD concepts and
risks for HIV transmission.
Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever occurs in urban and rural areas including Guatemala City. Risk is highest in lowland coastal areas. Daytime insect
precautions are recommended.
Leishmaniasis (cutaneous and rarely mucocutaneous), transmitted by sandflies, occurs in jungle areas, notably Peten, and at all
the Mayan ruin sites. Insect precautions (primarily evening and nighttime) are recommended.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Marine hazards may include jellyfish (often causing sea bather's eruption). Dangerous (potentially deadly) jellyfish are present
year-round, but particularly during the rainy season. Children are especially at risk, and adults wading, launching boats, or fishing.
Adequate private medical care is available in Guatemala City but is not up to the standards of industrialized countries. Medical care is substandard in the rest of the country. Adequate evacuation coverage for all travelers is a high priority. In the event of a serious medical condition, medical evacuation to Los Angeles or Miami is likely to be necessary. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered. In the event of a vehicle accident, contact police by dialing 110 or 120; for fire department or paramedics, dial 122 or 123. Cash payment may be required prior to treatment, including emergency care. Although credit cards are widely accepted in the general economy, there is no clear information as to whether credit cards are accepted for medical care. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Guatemala. Consider Avoiding
In southeastern districts close to the borders with El Salvador and Honduras, and in northern districts along the border with Mexico, drug-related violence has led to a number of armed attacks. Travelers should exercise caution in the Guatemala/Belize border area because of the ongoing border dispute between the two countries. Violence related to drug trafficking has also been reported in Guatemala City as well as other major cities in the country. Military and police forces are deployed along the border with Mexico to combat organized crime and improve security conditions. Guatemala has one of the highest rates of violent crime in Latin America. Travelers are often targets of robbery, carjacking, sexual assault and rape, and armed assaults. Pickpockets and purse-snatchers are active in all major cities and tourist sites. Civil Unrest
Incidents of violence, roadblocks, strikes, and demonstrations occur periodically throughout the country. Miscellaneous Safety
When visiting volcanoes and other tourist sites, travel in groups and with a reputable tour company. Road Conditions and Hazards
Roads between the main tourist locations are of acceptable quality. Secondary streets and rural roads are poorly lit. Winding and steep mountain roads and the lack of road signs present additional dangers. Driving Laws
All drivers involved in accidents resulting in injury may be detained and held in protective custody pending investigation. Public Transportation
Local and intercity public buses are mechanically unreliable, use unlicensed drivers, and are often involved in major road accidents. Natural Disasters and Climate
The hurricane season extends from June 1 to November 30. The rainy season extends from May to October, and may continue into November. Guatemala is located in an active seismic zone. There are several active volcanoes. Roadblocks
Roadblocks erected by armed gangs are common, particularly in the northern and western departments of San Marcos, Huehuetenango, El Quiché, Alta Verapaz, El Petén, and Escuintla. FAA Advisory
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it licenses and oversees air carriers in accordance with aviation safety standards established by the International Civil Aviation Organization. Exit Fees
An exit tax must be paid when departing Guatemala by air. There is an additional airport security fee that all travelers must pay at the airport. Currency
The currency is the Guatemalan quetzal (GTQ). U.S. currency and traveler's checks are readily convertible to local funds at most major banks. Do not accept torn notes as they can be difficult to exchange. Import and Export Information
Importation into or export from Guatemala of items such as antiquities and artifacts may be subject to strict regulations. Consular Information
Selected Embassies or Consulates in Guatemala U.S. Embassy: Avenida La Reforma 7-01, Zone 10, Guatemala City, Tel.: 502-2-326-4000, After Hours Tel.: 502-2331-2354, Web: guatemala.usembassy.gov Canadian Embassy: Edyma Plaza Building, 8th Floor, 13 Calle 8-44, Zona 10, PO Box 400, Guatemala City, Tel.: 502-2363-4348, E-Mail: gtmla@international.gc.ca, Web: www.canadainternational.gc.ca/guatemala U.K. Embassy: Edificio Torre Internacional, Nivel 11, 16 Calle 0-55, Zona 10, Guatemala City, Tel.: 502-2380-7300, E-mail: embassy@intelnett.com, Web: ukinguatemala.fco.gov.uk Australian Embassy: Australia does not have an Embassy or Consulate in Guatemala. By agreement between the Canadian and Australian governments, the local Canadian Embassy provides consular assistance to Australians in Guatemala. Edyma Plaza 8 Nivel, 13 calle 8-44 zona 10, Guatemala City, Guatemala, Tel.: 502-2363-4348 Guatemala's Embassies or Consulates in Selected Countries In the U.S.: 2220 R Street, NW, Washington, DC 20008, Tel.: 202-745-4952, ext. 102, E-mail: info@guatemala-embassy.org In Canada: 130 Albert Street, Suite 1010, Ottawa, ON, K1P 5G4, Tel.: 613-233-7237, Web: www.embaguate-canada.com In the U.K.: 13A Fawcett Street, London SW10 9HN, Tel.: 020-7351-3042 Nicaragua is a developing nation in the lower half of the world's economies. Located north of Costa Rica and bordering both the Caribbean Sea and Pacific Ocean in Central America, its climate is tropical in the lowlands and cooler in the highlands. High risk throughout the country including deluxe accommodations in major cities. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever occurs in urban and rural areas. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous and mucocutaneous), transmitted by sandflies, occurs in forested areas in Atlántico Norte, Atlántico Sur,
Boaco, Chontales, Esteli, Jinotega, Madriz, Matalgapa, Nueva Segovia, and Rio San Juan departments. Insect precautions (primarily
evening and nighttime) are recommended.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Marine hazards may include jellyfish (often causing sea bather's eruption), coral, and sea urchins. Dangerous (potentially deadly)
jellyfish are present year-round, but particularly during the rainy season. Children are especially at risk, and adults wading,
launching boats, or fishing.
Medical care is substandard throughout the country, even in the best private medical facilities. Adequate evacuation coverage for all travelers is a high priority. In the event of a serious medical condition, medical evacuation to the United States is likely to be necessary. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of some routine medications and supplies may be encountered. Emergency ambulance services are not available. In an emergency, individuals are taken to the nearest available hospital. This is usually a public hospital unless the individual or someone acting on their behalf indicates that he or she can pay for a private hospital. Physicians and hospital personnel often do not speak English, and medical reports are written in Spanish. Cash payment may be required prior to treatment; some private hospitals accept major credit cards. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Consular Travel Warning
Due to military conflict and ongoing security concerns, an Australian consular warning currently advises against all travel to the North
Atlantic Autonomous Region, northeastern Nicaragua, and remote areas of the Nicaraguan Caribbean coast.
Visa/HIV Testing
The U.S. Department of State is unaware of any HIV/AIDS-related entry restrictions for visitors to or foreign residents of Nicaragua. Consider Avoiding
There may be active land mines in isolated areas of the country. There are boundary disputes in the Caribbean coastal waters between Nicaragua and neighboring Honduras. Boats and fishing vessels have been detained and impounded. The Atlantic coastal area of Nicaragua is a known transit zone for illegal drugs. Armed banditry occurs in areas near Bonanza, La Rosita, and Siuna in northeastern Nicaragua. Incidents of carjacking have also been reported between Managua and Puerto Cabezas. Violent crime, including armed robbery and sexual assault, can occur in Managua, Granada, and San Juan del Sur, and also occurs in Bonanza, La Rosita, Siuna, and on Little Corn Island. Remain alert when walking in markets, in the vicinity of the old cathedral in Managua, near Tica bus (the terminal for lines coming from Honduras and Costa Rica), at public transportation terminals and in poorer areas. Avoid the Mercado Oriental in Managua. Travelers may be targeted by criminals posing as Nicaraguan police officers who pull over their vehicles–including those operated by reputable hotels–for inspection and then rob them. Street crime such as pickpocketing and purse snatching is common. Express kidnappings occur. Police presence is extremely sparse outside of major urban areas. Travel should be restricted to tourist areas and to daylight hours only. Civil Unrest
Demonstrations occur occasionally and may cause traffic disruptions. Periodic violence may occur on the streets, particularly in Managua, as a result of protests. Access to the Managua International Airport and to the area of Carretera a Masaya (where universities, shopping malls and restaurants are located) may be affected. Miscellaneous Safety
Travelers to the Island of Ometepe have been victims of fraudulent tour guides. Hotels and local authorities can provide information on reputable tour guides. Strong currents off sections of Nicaragua's Pacific coast have resulted in a number of drownings. Road Conditions and Hazards
Driving standards are fair. Except for the Pan-American Highway, most roads lack shoulders, are narrow, potholed and poorly lit. Road signs are usually non-existent, and most streets are unnamed. Detours are common but are often not marked. Traffic accidents are a common cause of death and injury. Driving Laws
Drivers involved in road accidents resulting in death or injury are subject to arrest and/or detention until responsibility has been established by the courts. Drivers suspected of driving while intoxicated will be taken into custody. Police spot checks are frequent. Public Transportation
Vehicles, especially taxis and buses, are poorly maintained. Public transportation buses are overcrowded, unreliable, and often targeted by pickpockets, and should be avoided as much as possible. There have been incidents of passengers being robbed, sometimes with violence, by taxi drivers or by people posing as taxi drivers using unauthorized taxi signs on their cars. Travelers should only take taxis from hotels and main entrances of shopping malls and make detailed arrangements for the return trip. Natural Disasters and Climate
The hurricane season extends from June to the end of November. Flooding is common during this period. Landslides also occur throughout the year. Nicaragua is located in an active seismic zone. Volcanic activity also occurs. San Cristobal and Cerro Negro volcanoes are particularly active. FAA Advisory
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it does not provide safety oversight of its air carrier operators in accordance with the minimum safety oversight standards established by the International Civil Aviation Organization. Exit Fees
An airport tax is charged upon departure. Other Laws
Penalties for possession, use, or trafficking of illegal drugs are strict. Convicted offenders can expect jail sentences and heavy fines. It is illegal to photograph official buildings in Nicaragua. Availability of Basic Infrastructure and Tourist Facilities
Nicaragua lacks an extensive tourism infrastructure. Cell phone coverage outside urban areas is fair in the central and Pacific areas, but can be lacking, especially in mountainous terrain and in the Caribbean. Power blackouts in all parts of the country are frequent, especially during the dry season from July to August. Currency
The currency is the cordoba (NIO). Most restaurants and hotels in Managua accept credit cards. U.S. dollars are widely used. There have been reports of credit card fraud. Foreign currency should only be changed at banks or official exchange houses. Consular Information
Selected Embassies or Consulates in Nicaragua U.S. Embassy: Kilometer 5 1/2, 5.5 Carretera Sur, Managua, Tel.: 505-2252-7100, After Hours Tel.: 505-8886-1495, E-mail: consularmanagu@state.gov, Web: nicaragua.usembassy.gov Canadian Embassy: De Los Pipitos, 2 Blocks West, El Nogal Street No.25, Bolonia, PO Box 25, Managua, Nicaragua, Tel.: 505-2268-0433, 3323, E-Mail: mngua@international.gc.ca U.K. Consulate: (There is no British Embassy in Nicaragua), Apartado Postal (P O Box) 2382 Managua, Nicaragua, Tel.: 505-2254-5454, E-mail: jose.taboada-honcon@fconet.fco.gov.uk Australian Embassy: Australia does not have an Embassy or Consulate in Nicaragua. Travelers can obtain consular assistance from the nearest Australian Embassy which is in Mexico: Ruben Dario 55, Col. Polanco, Mexico City 11580, Mexico, Tel.: 52-55-11012200, Email: consularpassports.mexico@dfat.gov.au Nicaragua's Embassies or Consulates in Selected Countries In the U.S.: 1627 New Hampshire Avenue, NW, Washington DC 20009, Tel.: 202-939-6531 In the U.K.: 2nd, Floor 36 Upper Brook Street, London, WIY 1PE, Tel.: 44-1-409-2536, E-mail: emb.ofnicaragua@virgin.net Panama is a developing nation but is in the upper half of the world's economies. Located on the isthmus connecting Central and South America, its climate is tropical marine. Moderate risk exists in deluxe accommodations but high risk elsewhere. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever occurs in urban and rural areas. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous), transmitted by sandflies, occurs throughout the country, especially along the Atlantic coast.
Mucocutaneous disease is uncommon. Insect precautions (primarily evening and nighttime) are recommended.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Hantavirus causing hantavirus pulmonary syndrome is transmitted by rodents and occurs in Los Santos and Herrera provinces.
Risk is minimal for most travelers. Avoid contact with mice and rats (including their excreta) in rural areas.
Marine hazards may include jellyfish (often causing sea bather's eruption), coral, and sea urchins. Dangerous (potentially deadly)
jellyfish are present year-round, but particularly during the rainy season. Children are especially at risk, and adults wading,
launching boats, or fishing.
Adequate medical care is available in private medical facilities in Panama City but is not up to standards of industrialized countries. Medical care is substandard in the rest of the country. A recompression chamber is located in Panama City. Before diving, check that facilities are operational. Cash payment may be required prior to treatment, including emergency care. Most hospitals accept credit cards for hospital charges, but not for doctors' fees. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Consular Travel Warning
Due to ongoing security concerns, a Canadian consular warning currently advises against all travel beyond Yaviza located in Darien
Province (the danger zone begins at the end of the Pan American Highway at Yaviza, about 230 km southeast of Panama City, and ends at
the Colombian border). Other governments concur.
Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. According to the U.S. Department of State, some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Panama. Panamanian immigration does not require an HIV/AIDS test, but Panamanian law does allow for deportation upon discovery by immigration. The U.S. Department of State is not aware of any U.S. citizens who have been deported due to HIV/AIDS. Verify with Panama's embassy before travel. Consider Avoiding
All along the Panama-Colombia border area the presence of Colombian terrorist groups, drug traffickers and other criminals is common, increasing the danger to travelers. Sections of the Panamanian north coast are frequently used for narcotrafficking and other illegal activities. On the Pacific and Atlantic coasts, boaters should be wary of vessels that may be transporting narcotics, illicit materials, and illegal immigrants to and from Colombia. The Revolutionary Armed Forces of Colombia (FARC) operates in Panama's Darien Province, including in areas far removed from the immediate vicinity of the Panamanian-Colombian border. Crime is common in rural and urban areas of Panama, especially in Panama City and Colón. Crimes are typical of those that plague metropolitan areas and include shootings, rapes, armed robberies, muggings, purse-snatchings, thefts from autos, thefts of unsecured items, petty theft, and "express kidnappings" from ATM banking facilities. Civil Unrest
Demonstrations and protest marches over various social and political issues occasionally occur in Panama City near the university, and on main streets and highways. Road Conditions and Hazards
Poor road conditions, dangerous driving habits, and poorly lit streets and vehicles are hazards. Night construction on the Pan-American Highway is frequent. Driving Laws
By law, seat belts must be worn by drivers and front seat passengers, and children younger than 5 must travel in the back in fitted child seats. Talking on a cell phone or drinking an alcoholic beverage while driving is illegal. hird party liability auto insurance is mandatory, but many drivers are uninsured. Public Transportation
Registered taxis are a safe way to travel in urban centers. Local buses do not follow a permanent route, and are relatively unsafe. Natural Disasters and Climate
The hurricane season extends from June to the end of November. The rainy season extends from April to December. Western Panama is located in an active seismic zone. FAA Advisory
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it licenses and oversees air carriers in accordance with aviation safety standards established by the International Civil Aviation Organization. Exit Fees
An airport tax is charged upon departure, although it is often included in the price of the airline ticket. Other Laws
Panamanian law requires all individuals to carry official identification documents at all times. Failure to produce identification upon request may result in travelers being taken to jail and charged a fine. Under the Panamanian penal code, knowingly infecting others with a sexually transmitted disease is a crime. There may be curfews for minors under 18 years of age in Panama City. Availability of Basic Infrastructure and Tourist Facilities
Outside the Panama City area, which has many first-class hotels and restaurants, tourist facilities vary in quality. Currency
The official currency in Panama is the Balboa (PAB), which is used interchangeably with the U.S. dollar (USD). ATMs are widely available and accept most major credit and debit cards. Because of problems with counterfeit U.S.$50 and U.S.$100 bills, travelers are encouraged to carry small denominations of U.S. dollars. Import and Export Information
Panamanian customs authorities may enforce strict regulations concerning temporary importation into or export from Panama of items such as firearms and ammunition, cultural property, endangered wildlife species, narcotics, biological material, and food products. Consular Information
Selected Embassies or Consulates in Panama U.S. Embassy: Avenida Demetrio Basilio Lakas, Building No.783, in the Clayton section, Tel.: 507-207-7000, E-mail: Panama-ACS@state.gov, Web: panama.usembassy.gov Canadian Embassy: Torres de Las Americas, Tower A, 11th Floor, Punta Pacifica, Apartado 0832-2446, Panama City, Tel.: 507-294-2500, E-mail: panam@international.gc.ca, Web: www.panama.gc.ca U.K. Embassy: MMG Tower, Calle 53, Apartado 0816-07946, Panama City, Tel.: 507-269-0866, E-mail: britemb@cwpanama.net, Web: ukinpanama.fco.gov.uk/en Australian Embassy: Australia does not have an Embassy or Consulate in Panama. By agreement between the Canadian and Australian governments, the local Canadian Embassy (see above) provides consular assistance to Australians in Panama; the nearest Australian Embassy is in Mexico. Ruben Dario 55, Col. Bosques de Chapultepec, C.P. 11580, Mexico D.F., Tel.: 52-55-1101-2200, E-mail: consularpassports.mexico@dfat.gov.au Panama's Embassies or Consulates in Selected Countries In the U.S.: 2862 McGill Terrace, NW, Washington, DC 20009, Tel.: 202-483-1407, Web: www.embassyofpanama.org In Canada: 130 Albert Street, Suite 300, Ottawa, ON, K1P 5G4, Tel.: 613-236-7177, E-mail: info@embassyofpanama.ca, Web: www.embassyofpanama.ca In the U.K.: 40 Hertford Street, London W1J 7SH, Tel.: 020-7493-4646, E-mail: panama1@btconnect.com, Web: www.panamaconsul.co.uk Paraguay is a developing nation in the lower half of the world's economies. Located northeast of Argentina in South America, its climate varies by region, ranging from subtropical to temperate to semiarid. High risk throughout the country including deluxe accommodations. Food and beverage precautions are essential in order to reduce chance of illness. Travelers should carry loperamide and/or a quinolone antibiotic for presumptive self-treatment of diarrhea if it occurs. Current Health Bulletin - posted January 17, 2013
Dengue Fever: According to Paraguay's Ministry of Health, more than 1,600 cases of dengue fever, a significant increase over the
average incidence, have been reported primarily from Central and Asunción departments so far this year. Travelers are advised to
practice daytime insect precautions.
Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in
the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months
should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should
be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever
possible. Domestic help should be screened for TB.
Dengue fever occurs in urban and rural areas, most notably in the departments of Central, Concepcion, Amambay, and the cities
of Asuncion and Ciudad del Este. Minimal risk in Alto Paraguay. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous and mucocutaneous), transmitted by sandflies, occurs throughout the country. Insect precautions
(primarily evening and nighttime) are recommended.
Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible.
Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
Hantavirus causing hantavirus pulmonary syndrome is transmitted by rodents and occurs mostly in western departments. Risk is
minimal for most travelers. Avoid contact with mice and rats (including their excreta) in rural areas.
Adequate medical care is available in Asuncion. Highly specialized cases or complex emergencies may require evacuation to Sao Paulo. For emergency services in Asuncion, dial 911; dial 131 or 132 for the fire department or rescue of accident victims. Immediate cash payment may be expected for medical services. There is no clear information as to whether credit cards are accepted for medical care. The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.smartraveller.gov.au). Standard safety precautions that apply to all international travel are not included in this advisory. Please refer to the "Safety and Security" handout for standard precautions. Visa/HIV Testing
Visa applicants may need to meet specific requirements. Review the application and contact the appropriate embassy or consulate with questions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Paraguay. Consider Avoiding
Individuals and organizations providing financial support to extremist groups operate in Ciudad del Este and along the tri-border area between Paraguay, Brazil, and Argentina. A small, armed anti-government militant group known as the Ejercito del Pueblo Paraguayo (EPP) operates in the northern San Pedro and southern Concepcion Departments. Drug trafficking and associated violence remains a serious concern in Amambay Department. Incidents of kidnapping for ransom have been reported, especially in the department of Alto Parana, but foreigners have not specifically been targeted. Armed robbery, car theft, and burglary occur. Street and other petty crimes such as pickpocketing are prevalent in cities and on public buses. A common tactic is the use of motorcycles by robbers to quickly approach their victims and then brandish a weapon and demand a wallet or purse. Checked luggage has been pilfered at airports. Police are frequently involved in various criminal activities and actively solicit bribes. There have been incidents of drugs being used (including scopolamine) to incapacitate travelers in order to rob or attack them. Miscellaneous Safety
Visits to the Chaco wilderness area should be undertaken with an experienced guide because of the harsh environment and risk of encountering dangerous animals. Staying at an estancia (ranch property) is recommended. Because of heavy rainfall and limited infrastructure, hiking trips to remote areas should be carefully planned. Visiting most areas populated by indigenous peoples should present no danger for travelers, with the exception of the northern area of the Paraguayan Chaco, close to the Mennonite colonies, where the Ayoreo woodland group lives. Some Ayoreos may perceive outsiders as a threat. Road Conditions and Hazards
Traffic laws are frequently ignored. Tourists traveling outside Asuncion should avoid night travel, because stray animals and poorly lit vehicles often pose threats. Road signs indicating hazards are often lacking. Roads in rural areas are generally unpaved. During rainy periods, they may become impassable. The number of traffic accidents tends to increase during the holiday season. It may be difficult to obtain service in English or French from the local police. Bicycle travel may not be safe because of traffic and other road hazards. Driving Laws
Police checkpoints are common, especially at night. Carry identification and vehicle registration at all times. Road accidents are frequent. Roadside assistance is non-existent on most highways. In the event of an accident, the municipal police should be contacted to obtain a police report for insurance purposes. If there are injuries, the police report must be obtained from the national police. Local police will often detain 1 or both parties to an accident. An International Driving Permit (IDP) is required. Public Transportation
Public transportation is readily available for urban and intercity travel. Buses vary in maintenance condition. Unauthorized ticket vendors also reportedly operate at the Asuncion bus terminal, badgering travelers into buying tickets for substandard or non-existent services. Taxis can be hailed on the street or found at ranks. After dark, they should be ordered by phone. Very few taxi drivers speak English or French. Natural Disasters and Climate
The rainy season extends from December to March, and can affect the accessibility or reliability of intercity transit. During the rainy season, the roads in the northern part of the Chaco region are impassable, except for the Mennonite Colonies. FAA Advisory
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it does not provide safety oversight of its air carrier operators in accordance with the minimum safety oversight standards established by the International Civil Aviation Organization. Exit Fees
An airport tax must be paid upon departure from the Asuncion airport. Other Laws
It is against the law to hunt animals in or remove certain plant species from nature reserves. Availability of Basic Infrastructure and Tourist Facilities
Tourist facilities are good in the capital but may be limited or unavailable in other areas. Mobile telephone services outside urban areas are sparse and poor. In rural areas of Chaco Paraguayo, there is no cellular phone coverage outside of most Mennonite towns. Dual Citizenship
Paraguay does not recognize dual nationality for its citizens. Currency
The currency is the guarani (PYG). U.S. dollars can be exchanged in every casa de cambio (exchange agency) and at most banks. Credit cards are accepted in most hotels, restaurants, and shops. Import and Export Information
There are strict regulations against the temporary import or export of items such as firearms, medications, toys resembling weapons, or protected species. Consular Information
Selected Embassies or Consulates in Paraguay U.S. Embassy: 1776 Mariscal Lopez Avenue, Asuncion, Tel.: 11-595-21-213-715, E-mail: paraguayconsular@state.gov, Web: paraguay.usembassy.gov Canadian Embassy: 3 Profesor Ramrez at Juan de Salazar, between Peru and Padre Pucheu, Asuncion, Tel.: 595-21-227-207, E-mail: honconpy@tigo.com.py U.K. Consulate: Eulogio Estigarribia, 4846 C/Monsenor Bogarin, Asuncion, Tel.: 595-21-210-405, E-mail: guillermo.peroni@pstbn.com.py Australian Embassy: Australia does not have an Embassy in Paraguay. Australians may obtain consular assistance from the nearest Australian Embassy. This is in Argentina at: Villanueva 1400, Buenos Aires C1426BMJ, Argentina, Tel.: 54-11-4779-3500, Web: www.argentina.embassy.gov.au Paraguay's Embassies or Consulates in Selected Countries In the U.S.: 2400 Massachusetts Avenue, NW, Washington, DC 20008, Tel.: 202-483-6960, E-mail: secretaria@embaparusa.gov.py, Web: www.embaparusa.gov.py

Source: http://www.muleskinner.ca/wp-content/uploads/2013/02/SA-Traveler.pdf

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