Health & safety
For further information, see Lonely Planet’s Healthy Travel Central & South America. If you’re traveling with children, Lonely Planet’s Travel with Children may be useful. The ABC of Healthy Travel, by E Walker et al, is another valuable resource.
If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In many countries doctors expect payment in cash.)
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There is a wealth of travel health advice on the Internet. For further info, the Lonely Planet website (www.lonelyplanet.com) is a good place to start. The World Health Organization (www.who.int/ith) publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel-health recommendations for every country and is updated daily.
It’s usually a good idea to consult your government’s travel health website before departure, if one is available:
acetaminophen (Tylenol) or aspirin
adhesive or paper tape
antibacterial ointment (eg Bactroban; for cuts and abrasions)
antidiarrheal drugs (eg loperamide)
antihistamines (for hay fever and allergic reactions)
anti-inflammatory drugs (eg ibuprofen)
bandages, gauze, gauze rolls
DEET-containing insect repellent for the skin
iodine tablets (for water purification)
oral rehydration salts
permethrin-containing insect spray for clothing, tents and bed nets
scissors, safety pins, tweezers
steroid cream or cortisone (for poison ivy and other allergic rashes)
syringes and sterile needles
Bring medication in its original, clearly labeled container. A signed, dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.
For tourists, Argentina is probably the safest country in Latin America. This isn’t to say you should skip down the street drunk with your money belt strapped to your head, but, with a little common sense, you can visit Argentina’s big cities as safely as you could London, Paris or New York. That said, crime has been on the rise.
Deep Vein Thrombosis (DVT)
Blood clots may form in the legs (deep vein thrombosis or DVT) during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they could cause life-threatening complications.
The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually – but not always – on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty breathing. Travelers with any of these symptoms should immediately seek medical attention.
To prevent the development of DVT on long flights, you should walk about the cabin, perform isometric contractions of the leg muscles (ie flex the leg muscles while sitting), drink plenty of fluids and avoid alcohol and tobacco.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones, resulting in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of (nonalcoholic) fluids and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. An herbal alternative is ginger, which works like a charm for some people.
Do not attempt to pet, handle or feed any animal, with the exception of domestic animals known to be free of any infectious disease. Most animal injuries are directly related to a person’s attempt to touch or feed the animal.
Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, followed by application of an antiseptic such as iodine or alcohol. The local health authorities should be contacted immediately for possible post-exposure rabies treatment, whether or not you’ve been immunized against rabies. It may also be advisable to start an antibiotic, since wounds caused by animal bites and scratches frequently become infected. One of the newer quinolones, such as levofloxacin (Levaquin), which many travelers carry in case of diarrhea, would be an appropriate choice.
Snakes and leeches are a hazard in some areas of South America. In the event of a bite from a venomous snake, place the victim at rest, keep the bitten area immobilized, and move the victim immediately to the nearest medical facility. Avoid tourniquets, which are no longer recommended.
To prevent mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Bring along a good insect repellent, preferably one containing DEET, which should be applied to exposed skin and clothing, but not to eyes, mouth, cuts, wounds or irritated skin. Products containing lower concentrations of DEET are as effective, but for shorter periods of time. In general, adults and children over 12 years should use preparations containing 25% to 35% DEET, which usually lasts about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last about three hours. Neurologic toxicity has been reported from DEET, especially in children, but appears to be extremely uncommon and generally related to overuse. DEET-containing compounds should not be used on children under the age of two.
Insect repellents containing certain botanical products, including oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours. DEET-containing repellents are preferable for areas where there is a high risk of malaria or yellow fever. Products based on citronella are not effective.
For additional protection, you can apply permethrin to clothing, shoes, tents and bed nets. Permethrin treatments are safe and remain effective for at least two weeks, even when items are laundered. Permethrin should not be applied directly to skin.
Don’t sleep with the window open unless there is a screen. If sleeping outdoors or in accommodations that allows entry of mosquitoes, use a bed net, preferably treated with permethrin, with edges tucked in under the mattress. The mesh size should be less than 1.5mm. If the sleeping area is not otherwise protected, use a mosquito coil, which will fill the room with insecticide through the night. Repellent-impregnated wristbands are not effective.
To protect yourself from tick bites, follow the same precautions as for mosquitoes, except that boots are preferable to shoes, with pants tucked in. Be sure to perform a thorough tick check at the end of each day. You’ll generally need the assistance of a friend or mirror for a full examination. Ticks should be removed with tweezers, grasping them firmly by the head. Insect repellents based on botanical products, described above, have not been adequately studied for insects other than mosquitoes and cannot be recommended to prevent tick bites.
Tap water is generally not safe to drink. Vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 2000m, boil for three minutes.
Another option is to disinfect water with iodine. You can add 2% tincture of iodine to 1L of water (five drops to clear water, 10 drops to cloudy water) and let stand for 30 minutes. If the water is cold, longer times may be required. Or you can buy iodine pills such as Globaline, Potable-Aqua and Coghlan’s, available at most pharmacies. Instructions are enclosed and should be carefully followed. The taste of iodinated water may be improved by adding vitamin C (ascorbic acid). Iodinated water should not be consumed for more than a few weeks. Pregnant women, those with a history of thyroid disease, and those allergic to iodine should not drink iodinated water.
A number of water filters are on the market. Those with smaller pores (reverse osmosis filters) provide the broadest protection, but they are relatively large and are readily plugged by debris. Those with somewhat larger pores (microstrainer filters) are ineffective against viruses, although they remove other organisms. Manufacturers’ instructions must be carefully followed.
Dengue fever is a viral infection found throughout South America. In Argentina, dengue occurs in Salta province in the northwestern part of the country. Dengue is transmitted by Aedes mosquitoes, which prefer to bite during the daytime and are usually found close to human habitations, often indoors. They breed primarily in artificial water containers, such as jars, barrels, cans, cisterns, metal drums, plastic containers and discarded tires. As a result, dengue is especially common in densely populated, urban environments.
Dengue usually causes flu-like symptoms, including fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. The body aches may be quite uncomfortable, but most cases resolve uneventfully in a few days. Severe cases usually occur in children under the age of 15 who are experiencing their second dengue infection.
There is no treatment for dengue fever except to take analgesics such as acetaminophen/paracetamol (Tylenol) and drink plenty of fluids. Severe cases may require hospitalization for intravenous fluids and supportive care. There is no vaccine. The cornerstone of prevention is insect protection measures.
Hepatitis A is the second most common travel-related infection (after traveler’s diarrhea). It’s a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. The illness occurs throughout the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though hepatitis A occasionally causes severe liver damage. There is no treatment.
The vaccine for hepatitis A is extremely safe and highly effective. If you get a booster six to 12 months later, it lasts for at least 10 years. You really should get it before you go to Argentina. The safety of the hepatitis A vaccine has not been established for pregnant women or children under two years; instead, they should be given a gammaglobulin injection.
Like hepatitis A, hepatitis B is a liver infection that occurs worldwide but is more common in developing nations. Unlike hepatitis A, the disease is usually acquired by sexual contact or by exposure to infected blood, generally through blood transfusions or contaminated needles. The vaccine is recommended only for long-term travelers (on the road more than six months) who expect to live in rural areas or have close physical contact with the local population. Additionally, the vaccine is recommended for anyone who anticipates sexual contact with the local inhabitants or a possible need for medical, dental or other treatments while abroad, especially if a need for transfusions or injections is expected.
The hepatitis B vaccine is safe and highly effective. However, a total of three injections are necessary to establish full immunity. Several countries added the hepatitis B vaccine to the list of routine childhood immunizations in the 1980s, so many young adults are already protected.
Malaria occurs in every South American country except Chile, Uruguay and the Falkland Islands. It’s transmitted by mosquito bites, usually between dusk and dawn. The main symptom is high spiking fevers, which may be accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may involve the central nervous system and lead to seizures, confusion, coma and death.
For Argentina, taking malaria pills is strongly recommended for travel to rural areas along the borders with Bolivia (lowlands of Salta and Jujuy provinces) and Paraguay (lowlands of Misiones and Corrientes provinces). There is a choice of three malaria pills, all of which work about equally well. Mefloquine (Lariam) is taken once weekly in a dosage of 250mg, starting one to two weeks before arrival and continuing through the trip and for four weeks after return. The problem is that a certain percentage of people (the number is controversial) develop neuropsychiatric side effects, which may range from mild to severe. Atovaquone/proguanil (Malarone) is a newly approved combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side effects are typically mild. Doxycycline is a third alternative, but may cause an exaggerated sunburn reaction.
In general, Malarone seems to cause fewer side effects than mefloquine and is becoming more popular. The chief disadvantage is that it has to be taken daily. For longer trips, it’s probably worth trying mefloquine; for shorter trips, Malarone will be the drug of choice for most people.
Protecting yourself against mosquito bites is just as important as taking malaria pills, since none of the pills are 100% effective.
If you do not have access to medical care while traveling, you should bring along additional pills for emergency self-treatment, which you should take if you can’t reach a doctor and you develop symptoms that suggest malaria, such as high spiking fevers. One option is to take four tablets of Malarone once daily for three days. However, Malarone should not be used for treatment if you’re already taking it for prevention. An alternative is to take 650mg quinine three times daily and 100mg doxycycline twice daily for one week. If you start self-medication, see a doctor at the earliest possible opportunity.
If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.
Rabies is a viral infection of the brain and spinal cord that is almost always fatal. The rabies virus is carried in the saliva of infected animals and is typically transmitted through an animal bite, though contamination of any break in the skin with infected saliva may result in rabies. Rabies occurs in all South American countries.
The rabies vaccine is safe, but a full series requires three injections and is quite expensive. Those at high risk for rabies, such as animal handlers and spelunkers (cave explorers), should certainly get the vaccine. In addition, those at lower risk for animal bites should consider asking for the vaccine if they might be traveling to remote areas and might not have access to appropriate medical care if needed. The treatment for a possibly rabid bite consists of the rabies vaccine with rabies immune globulin. It’s effective, but must be given promptly. Most travelers don’t need rabies vaccine.
All animal bites and scratches must be promptly and thoroughly cleansed with large amounts of soap and water and local health authorities contacted to determine whether or not further treatment is necessary.
Typhoid fever is caused by ingestion of food or water contaminated by a species of salmonella known as Salmonella typhi. Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. Either diarrhea or constipation may occur. Possible complications include intestinal perforation, intestinal bleeding, confusion, delirium or (rarely) coma.
Unless you expect to take all your meals in major hotels and restaurants, a typhoid vaccine is a good idea. It’s usually given orally, but is also available as an injection. Neither vaccine is approved for use in children under two years.
The drug of choice for typhoid fever is usually a quinolone antibiotic such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), which many travelers carry for treatment of traveler’s diarrhea. However, if you self-treat for typhoid fever, you may also need to self-treat for malaria, since the symptoms of the two diseases may be indistinguishable.
Yellow fever is a life-threatening viral infection transmitted by mosquitoes in forested areas. The illness begins with flu-like symptoms, which may include fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting. These symptoms usually subside in a few days, but one person in six enters a second, toxic phase characterized by recurrent fever, vomiting, listlessness, jaundice, kidney failure and hemorrhage, leading to death in up to half of the cases. There is no treatment except for supportive care.
The yellow fever vaccine is strongly recommended for all travelers greater than nine months of age who visit the northeastern forest areas near the border with Brazil and Paraguay. For an up-to-date map showing the distribution of yellow fever in Argentina, go to the Center for Disease Control (CDC) website at www.cdc.gov/travel/diseases/maps/yellowfever_map2.htm.
The yellow fever vaccine is given only in approved yellow fever vaccination centers, which provide validated International Certificates of Vaccination (yellow booklets). The vaccine should be given at least 10 days before any potential exposure to yellow fever and remains effective for approximately 10 years. Reactions to the vaccine are generally mild and may include headaches, muscle aches, low-grade fevers, or discomfort at the injection site. Severe, life-threatening reactions have been described but are extremely rare. In general, the risk of becoming ill from the vaccine is far less than the risk of becoming ill from yellow fever, and you’re strongly encouraged to get the vaccine.
Taking measures to protect yourself from mosquito bites is an essential part of preventing yellow fever.
Argentine hemorrhagic fever occurs in the pampas, chiefly from March through October. The disease is acquired by inhalation of dust contaminated with rodent excreta or by direct rodent contact.
Brucellosis is an infection of domestic and wild animals that may be transmitted to humans through direct animal contact or by consumption of unpasteurized dairy products from infected animals. Symptoms may include fever, malaise, depression, loss of appetite, headache, muscle aches and back pain. Complications may include arthritis, hepatitis, meningitis and endocarditis (heart-valve infection).
Chagas’ disease is a parasitic infection that is transmitted by triatomine insects (reduviid bugs, which look like long-legged beetles), which inhabit crevices in the walls and roofs of substandard housing in South and Central America. In Argentina, Chagas’ disease occurs north of latitude 44° 45’. Transmission is greatest during late spring (November and December). The triatomine insect lays its feces on human skin as it bites, usually at night. A person becomes infected when he or she unknowingly rubs the feces into the bite wound or any other open sore. Chagas’ disease is extremely rare in travelers. However, if you sleep in a poorly constructed house, especially one made of mud, adobe or thatch, you should be sure to protect yourself with a bed net and a good insecticide.
Cholera is extremely rare in Argentina. A cholera vaccine is not recommended.
Hantavirus pulmonary syndrome is a rapidly progressive, life-threatening infection acquired through exposure to the excretions of wild rodents. Most cases occur in those who live in rodent-infested dwellings in rural areas. In Argentina, hantavirus infections are reported from the north-central and southwestern parts of the country.
HIV/AIDS has been reported from all South American countries. Be sure to use condoms for all sexual encounters.
Leishmaniasis occurs in the mountains and jungles of all South American countries except for Chile, Uruguay and the Falkland Islands. The infection is transmitted by sandflies, which are about one-third the size of mosquitoes. In Argentina, most cases occur in the northeastern part of the country and are limited to the skin, causing slowly growing ulcers over exposed parts of the body. A more severe type of Leishmaniasis disseminates to the bone marrow, liver and spleen. The disease may be particularly severe in those with HIV. There is no vaccine. To protect yourself from sandflies, follow the same precautions as for mosquitoes, except that netting must be finer mesh (at least 18 holes per 2.54cm or to the linear inch).
Louse-borne typhus occurs in mountain areas, and murine typhus, which is transmitted by rat fleas, occurs in warmer rural and jungle areas in the north.
Tick-borne relapsing fever, which may be transmitted by either ticks or lice, is caused by bacteria that are closely related to those which cause Lyme disease and syphilis. In Argentina, tick-borne relapsing fever occurs in the northern part of the country. The illness is characterized by periods of fever, chills, headaches, body aches, muscle aches and cough, alternating with periods when the fever subsides and the person feels relatively well. To minimize the risk of relapsing fever, follow tick precautions and practice good personal hygiene at all times.
Traveling with children
When traveling with young children, be particularly careful about what you allow them to eat and drink, because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever are not approved for use in children under two years.
In general, children under nine months should not be brought to northeastern forest areas near the border with Brazil and Paraguay, where yellow fever occurs, since the vaccine is not safe in this age group.
Chloroquine, which is the main drug used to prevent malaria, may be given to children, but insect repellents must be applied in lower concentrations.
Availability & cost of health care
Good medical care is available in Buenos Aires but may be variable elsewhere, especially in rural areas. Most doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance.
The US Embassy website at http://usem bassy.state.gov/posts/ar1/wwwhdoctors.html has an extensive list of physicians, dentists, hospitals and emergency services. If you’re pregnant, be sure to check this site before departure to find the name of one or two obstetricians in the area you’ll be visiting.
If you develop a life-threatening medical problem, you’ll probably want to be evacuated to a country with state-of-the-art medical care. (For an ambulance, call 107.) Since this may cost thousands of dollars, be sure you have insurance to cover this before you depart. You can find a list of medical evacuation and travel-insurance companies on the US State Department website at www.travel.state.gov/medical.html.
Most pharmacies in Argentina are well supplied. Many medications that require a prescription in the USA and Canada are available over the counter, though they may be relatively expensive. If you’re taking any medication on a regular basis, be sure you know its generic (scientific) name, since many pharmaceuticals go under different names in Argentina.
To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine); only eat fresh fruits or vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors.
If you develop diarrhea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.
You can find an English-speaking obstetrician in Argentina by going to the US Embassy website at usembassy.state.gov/posts/ar1/wwwhdoctors.html. However, medical facilities will probably not be comparable to those in your home country. In general, it’s safer to avoid travel to Argentina late in pregnancy.