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Costa Rica

Health & safety

Before you go

Further reading

For further information, see Healthy Travel Central & South America, also from Lonely Planet. If you’re traveling with children, Lonely Planet’s Travel with Children will be useful. The ABC of Healthy Travel, by E Walker et al, is another valuable resource.

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Insurance

Most doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance or not. 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. As this may cost tens of thousands of dollars, be sure you have insurance to cover this before you leave home. A list of medical evacuation and travel insurance companies is on the website of the US State Department (www.travel.state.gov/medical.html).

If your health insurance does not cover you for medical expenses while you are abroad, you should consider supplemental insurance. It might pay to find out in advance if your insurance plan will make payments directly to providers or if they reimburse you later for any overseas health expenditures.

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Internet resources

There is a wealth of travel health advice on the Internet. A superb book called International Travel and Health, which is revised annually and is available online at no cost, is published by the World Health Organization (www.who.int/ith). Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country, updated daily, also at no cost.

It’s usually a good idea to consult your government’s travel health website before departure, if one is available:

Australia (www.dfat.gov.au/travel)

Canada (www.phac-aspc.gc.ca/tmp-pmv/pub_e.html)

UK (www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en)

USA (www.cdc.gov/travel)

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Medical checklist

Acetaminophen (Tylenol) or aspirin

Adhesive or paper tape

Antibacterial ointment (eg Bactroban) for cuts and abrasions

Antibiotics

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

Pocket knife

Scissors, safety pins, tweezers

Steroid cream or cortisone (for poison ivy and other allergic rashes)

Sun block

Syringes and sterile needles

Thermometer

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Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received. This is mandatory for countries that require proof of yellow fever vaccination upon entry, but it’s a good idea to carry it wherever you travel.

Bring medications in their original containers, clearly labeled. A signed, dated letter from your physician describing all 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.

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Dangers & annoyances

For the latest official reports on travel to Costa Rica see the websites of the US State Department (www.travel.state.gov/travel) or the UK Foreign & Commonwealth Office (www.fco.gov.uk).

Earthquakes & Volcanic Eruptions

Costa Rica lies on the edge of active tectonic plates, so it is decidedly earthquake prone. Recent major quakes occurred in 1990 (7.1 on the Richter scale) and 1991 (7.4). Smaller quakes and tremors happen quite often – particularly on the Península de Nicoya – cracking roads and knocking down telephone lines. The volcanoes in Costa Rica are not really dangerous as long as you stay on designated trails and don’t try to peer into the crater of an active volcano. As a precaution, always check with park rangers before setting out in the vicinity of active volcanoes.

Hiking Hazards

Hikers setting out into the wilderness should be adequately prepared for their trips. Most importantly, don’t bite off more than you can chew. If your daily exercise routine consists of walking from the fridge to the TV, don’t start your trip with a 20km trek. There are plenty of 3km and 5km trails that are ideally suited to the less active.

In addition, carry plenty of water, even on very short trips. The hiking is hot and dehydration sets in quickly. In Corcovado, at least one hiker dies every year of heat exhaustion on the scorching trail between San Pedrillo and Sirena. Hikers have also been known to get lost in rain forests, so carry maps, extra food and a compass. Let someone know where you are going, so they can narrow the search area in the event of an emergency.

There is also wildlife to contend with. Central America’s most poisonous snakes, the fer-de-lance (the ‘Costa Rican landmine’) and the bushmaster, are quite assertive, and crocodiles are a reality at many estuaries. As if these creatures weren’t enough to make you worried, it’s also worth mentioning that bull sharks love to lounge at the mouth of Río Sirena in Corcovado.

Ocean Hazards

Approximately 200 drownings a year occur in Costa Rican waters, 90% of which are caused by riptides, which are strong current that pulls the swimmer out to sea. Many deaths in riptides are caused by panicked swimmers struggling to the point of exhaustion. If you are caught in a riptide, do not struggle. Simply float and let the tide carry you out beyond the breakers, after which the riptide will dissipate, then swim parallel to the beach and allow the surf to carry you back in.

River-Rafting Hazards

River-rafting expeditions may be particularly risky during periods of heavy rain – flash floods have been known to capsize rafts. Reputable tour operators will ensure conditions are safe before setting out.

Thefts & Muggings

The biggest danger that most travelers face is theft, primarily from pickpockets. There is a lot of petty crime in Costa Rica so keep your wits about you at all times and don’t let your guard down.

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In transit

Deep vein thrombosis (dvt)

Blood clots (deep vein thrombosis) may form in the legs 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 the one side. When a blood clot travels all the way to the lungs, it may cause chest pain and difficulty in breathing. Travelers with any of these symptoms should immediately seek out medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids and avoid alcohol and tobacco.

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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 fluids (nonalcoholic) 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. The herbal alternative ginger works like a charm for some people.

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While you're there

Animal bites

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 postexposure 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.

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Insect bites

No matter how much you safeguard, getting bitten by mosquitoes is part of every traveler’s experience in the country. While there are occasional outbreaks of dengue in Costa Rica, for the most part the greatest worry you will have with bites is the general discomfort that comes with them, namely itching.

The best prevention is to stay covered up – wearing long pants, long sleeves and a hat, and shoes (rather than sandals). Unfortunately, Costa Rica’s sweltering temperatures might make this a bit difficult. Therefore, the best measure you can take is to invest in a good insect repellent, preferably one containing DEET. (These repellents can also be found in Costa Rica.) This should be applied to exposed skin and clothing (but not to eyes, mouth, cuts, wounds or irritated skin).

In general, adults and children over 12 can 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 age two.

Insect repellents containing certain botanical products, including oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours.

A particularly good item for every traveler to take is a bug net to hang over beds (along with a few thumbtacks or nails with which to hang it). Many hotels in Costa Rica don’t have windows (or screens) and a cheap little net will save you plenty of nighttime aggravation. The mesh size should be less than 1.5mm.

Dusk is the worst time for mosquitoes, so take extra precautions once the sun starts to set.

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Snake bites

Costa Rica is home to all manner of venomous snakes and any foray into forested areas will put you at (a very slight) risk for snake bite.

The best prevention is to wear closed, heavy shoes or boots and to keep a watchful eye on the trail. Snakes like to come out to cleared paths for a nap, so watch where you step.

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.

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Sun

To protect yourself from excessive sun exposure you should stay out of the midday sun, wear sunglasses and a wide-brimmed sun hat, and apply sunscreen with SPF 15 or higher, with both UVA and UVB protection. Sunscreen should be generously applied to all exposed parts of the body approximately 30 minutes before sun exposure and should be reapplied after swimming or vigorous activity. Travelers should also drink plenty of fluids and avoid strenuous exercise when the temperature is high.

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Water

It is generally safe to drink the tap water everywhere in Costa Rica, other than in the most rural and undeveloped parts of the country. However, if you prefer to be cautious, buying bottled water is your best bet. If you have the means, vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 2000m (6500ft), boil for three minutes. Another option is to disinfect water with iodine pills: add 2% tincture of iodine to one quart or liter 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.

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Chagas’ disease

Chagas’ disease is a parasitic infection that is transmitted by triatomine insects (reduviid bugs), which inhabit crevices in the walls and roofs of substandard housing in South and Central America. In Costa Rica most cases occur in Alajuela, Liberia and Puntarenas. 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. Symptoms of the disease include fever and swelling of the spleen, liver and lymph nodes. 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.

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Dengue fever (breakbone fever)

Dengue fever is a viral infection found throughout Central America. In Costa Rica outbreaks involving thousands of people occur every year. Dengue is transmitted by Aedes mosquitoes, which bite preferentially 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 real treatment for dengue fever except for you 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.

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Hepatitis A

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 Costa Rica or any other developing nation. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under the age of two, they should instead be given a gammaglobulin injection.

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Hepatitis B

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.

Hepatitis B vaccine is safe and highly effective. However, a total of three injections are necessary to establish full immunity. Several countries added hepatitis B vaccine to the list of routine childhood immunizations in the 1980s, so many young adults are already protected.

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HIV/AIDs

This has been reported from all Central American countries. Be sure to use condoms for all sexual encounters.

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Leishmaniasis

Leishmaniasis occurs in the mountains and jungles of all Central American countries. The infection is transmitted by sand flies, which are about one-third the size of mosquitoes. Most cases occur in newly cleared forest or areas of secondary growth. The highest incidence is in Talamanca. In Costa Rica the disease is generally limited to the skin, causing slow-growing ulcers over exposed parts of the body, but more severe infections may occur in those with HIV. There is no vaccine for leishmaniasis. To protect yourself from sand flies, follow the same precautions as for mosquitoes, except that netting must be finer mesh (at least 18 holes to the linear inch).

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Leptospirosis

Leptospirosis is acquired by exposure to water contaminated by the urine of infected animals. Whitewater rafters are at particularly high risk. In Costa Rica most cases occur in Limón, Turrialba, San Carlos and Golfito. Cases have been reported among residents of Puerto Limón who have bathed in local streams. Outbreaks can occur at times of flooding, when sewage overflow may contaminate water sources. The initial symptoms, which resemble a mild flu, usually subside uneventfully in a few days, with or without treatment, but a minority of cases are complicated by jaundice or meningitis. There is no vaccine. You can minimize your risk by staying out of bodies of fresh water that may be contaminated by animal urine. If you’re engaging in high-risk activities, such as river running, in an area where an outbreak is in progress, you can take 200mg of doxycycline once weekly as a preventative measure. If you actually develop leptospirosis, the treatment is 100mg of doxycycline twice daily.

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Malaria

Malaria occurs in every country in Central America. 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.

Taking malaria pills is recommended for the provinces of Alajuela, Limón (except for Puerto Limón), Guanacaste and Heredia. The risk is greatest in the cantons of Los Chiles (Alajuela Province), and Matina and Talamanca (Limón Province).

For Costa Rica the first-choice malaria pill is chloroquine, taken once weekly in a dosage of 500mg, starting one to two weeks before arrival and continuing through the trip and for four weeks after departure. Chloroquine is safe, inexpensive and highly effective. Side effects are typically mild and may include nausea, abdominal discomfort, headache, dizziness, blurred vision or itching. Severe reactions are uncommon.

Protecting yourself against mosquito bites is just as important as taking malaria pills, since no pills are 100% effective.

If you may 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. If you start self-medication, you should try to 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.

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Rabies

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 Central American countries. However, in Costa Rica only two cases have been reported over the last 30 years. Rabies vaccine is therefore recommended only for those at particularly high risk, such as spelunkers (cave explorers) and animal handlers.

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.

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Typhoid

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 the age of two.

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.

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Traveling with children

In general, it’s safe for children and pregnant women to go to Costa Rica. However, because some of the vaccines listed previously are not approved for use by children or during pregnancy, these travelers should be particularly careful not to drink tap water or consume any questionable food or beverage. Also, when traveling with children, make sure they’re up-to-date on all routine immunizations. It’s sometimes appropriate to give children some of their vaccines a little early before visiting a developing nation. You should discuss this with your pediatrician.

Lastly, if pregnant, you should bear in mind that should a complication such as premature labor develop while abroad, the quality of medical care may not be comparable to that in your home country.

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Availability & cost of health care

Good medical care is available in most major cities, but may be limited in rural areas. For a medical emergency, you should call one of the following numbers:

CIMA San José (208 1000; Próspero Fernández Fwy, San José) It’s 500m west of the tollbooths on the highway to Santa Ana.

Clínica Bíblica (257 0466, 257 5252; cnr Calle 1 & Av 14, San José)

Hospital Nacional de Niños (222 0122; Calle 14, Av Central, San José) Only for children under 12.

Poison Center (223 1028)

Red Cross Ambulance (911, in San José 221 5818)

San Juan de Dios Hospital (257 6282; cnr Calle 14 & Av Central, San José)

For an extensive list of physicians, dentists and hospitals go to the US embassy website (usembassy.or.cr). If you’re pregnant, be sure to check this site before departure to find the name of one or two obstetricians, just in case.

Most pharmacies are well supplied and the pharmacists are licensed to prescribe medication. 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 Costa Rica. Pharmacies that are open 24 hours include the following:

Farmacia Clínica Bíblica (257 5252; cnr Calle 1 & Av 14, San José)

Farmacia Clínica Católica (283 6616; Guadalupe, San José)

Farmacia el Hospital (222 0985)

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Traveler’s diarrhea

To prevent diarrhea, you should avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets); 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 begin taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours, or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.

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