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Honduras

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 may be useful. The ABC of Healthy Travel, by E Walker et al, and Medicine for the Outdoors, by Paul S Auerbach, are other valuable resources.

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Insurance

Honduran medical treatment is generally inexpensive for common diseases and minor treatment, but if you suffer a serious medical problem or emergency, it is highly recommended you go to a private hospital or even fly home (if your condition allows it). Unfortunately, public hospitals in Honduras are extremely overcrowded and understaffed. Travel insurance can typically cover the costs. Some US health-insurance policies stay in effect (at least for a limited time) if you travel abroad, but it’s worth checking exactly what you’ll be covered for in Honduras. For people whose medical insurance or national health systems don’t extend to Honduras – which includes most non-Americans – a travel policy is advisable. Check out the travel services section of this website for more information.

You may prefer a policy that pays doctors or hospitals directly rather than one requiring you to pay on the spot and claim later. If you do have to claim later, keep all documentation. Some policies ask you to call collect to a center in your home country, where an immediate assessment of your problem is made. Check that the policy covers ambulances or an emergency flight home. Some policies offer lower and higher medical-expense options; the higher ones are chiefly for countries such as the US, which has extremely high medical costs. There is a wide variety of policies available, so be sure to check the small print.

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Internet resources

There is a wealth of travel-health advice on the Internet; www.lonelyplanet.com is a good place to start. The World Health Organization publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost at www.who.int/ith. Another website of general interest is www.mdtravelhealth.com, which provides complete travel health recommendations for every country, updated daily, also at no cost.

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Medical checklist

Antibiotics

Antidiarrheal drugs (eg loperamide)

Acetaminophen/paracetamol (Tylenol) or aspirin

Anti-inflammatory drugs (eg ibuprofen)

Antihistamines (for hay fever and allergic reactions)

Antibacterial ointment (eg Bactroban) for cuts and abrasions

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

Bandages, gauze, gauze rolls

Adhesive or paper tape

Scissors, safety pins, tweezers

Thermometer

Pocket knife

DEET-containing insect repellent for the skin

Permethrin-containing insect spray for clothing, tents and bed nets

Sun block

Oral rehydration salts

Iodine tablets or chlorine drops (for water purification)

Syringes and sterile needles

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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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Recommended immunizations

The only required vaccine is the one for yellow fever, and that’s only if you’re arriving in Honduras from a yellow-fever–infected country in Africa or South America. However, a number of vaccines are recommended.

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Dangers & annoyances

Hiking hazards

The greatest hazard while hiking is getting lost – at least two travelers have died in Parque Nacional Montaña de Celaque, evidently after getting off the trail and being unable to find it again. Even in a well-traveled park like Celaque, the trails can be overgrown in places, and secondary paths used by animals and hunters can easily lead hikers astray. Guides are readily available at most hiking areas, and it is strongly recommended you use them.

Although mostly found on the north coast and in La Moskitia, you should be alert for poisonous snakes throughout Honduras; coral snakes, rattlesnakes and barba amarilla (fer-de-lance; otherwise known as the lancehead) are among the most common types seen. Wear long pants and boots and be careful where you step.

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Thefts & muggings

Honduras has a very high crime and violence rate, though the vast majority of travelers experience no problems. Pickpocketing and petty theft are most common, and assault is possible. Take ordinary precautions, like not wearing flashy jewelry, walking around with your camera out or pulling out a wad of cash. Tegucigalpa and San Pedro Sula are the worst places for street crime; the downtown areas of both are fine during the day, but less-so after dark. Consider taking a cab when it gets late. If you are mugged, do not resist.

In general, small towns are much safer than the big cities. Watch yourself on the north coast, especially on the beach: avoid leaving items unattended and do not walk on the beach at night. It seems to be a favorite tactic of thieves to wait in the trees along a deserted stretch of beach, especially after dark, and wait for someone to happen by.

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In transit

Deep vein thrombosis (dvt)

Blood clots 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 of or pain in the foot, ankle or calf, usually but not always on one side. When a blood clot travels to the lungs, it may cause chest pain and breathing difficulties. 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 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. A herbal alternative is ginger, which 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. Contact the local health authorities immediately for possible postexposure 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, is an appropriate choice.

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Mosquito bites

To prevent mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Bring along 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. In general, adults and children over 12 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 should last about three hours. Neurological toxicity has been reported from DEET, especially in children, but appears to be extremely uncommon and generally related to overuse. Don’t use DEET-containing compounds on children under two years.

Insect repellents containing certain botanical products, including oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours. Where there is a high risk of malaria or yellow fever, use DEET-containing repellents. Products based on citronella are not effective.

For additional protection, 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 accommodation that allows entry of mosquitoes, use a bed net treated with permethrin, with edges tucked in under the mattress. The mesh size should be less than 1.5mm. Alternatively, use a mosquito coil, which will fill the room with insecticide through the night. Repellent-impregnated wristbands are not effective.

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Snake & scorpion bites

Venomous snakes in Central America include the bushmaster, fer-de-lance (common lancehead), coral snake and various species of rattlesnakes. The fer-de-lance is the most lethal. It generally does not attack without provocation, but may bite humans who accidentally come too close as its lies camouflaged on the forest floor. The bushmaster is the world’s largest pit viper, measuring up to 4m in length. Like all pit vipers, the bushmaster has a heat-sensing pit between the eye and nostril on each side of its head, which it uses to detect the presence of warm-blooded prey.

In the event of a venomous snake bite, place the victim at rest, keep the bitten area immobilized, and move them immediately to the nearest medical facility. Avoid tourniquets, which are no longer recommended.

Scorpions are a problem in many regions. If stung, you should immediately apply ice or cold packs, immobilize the affected body part and go to the nearest emergency room. To prevent scorpion stings, be sure to inspect and shake out clothing, shoes and sleeping bags before use, and wear gloves and protective clothing when working around piles of wood or leaves.

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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 hat, and apply sunscreen with SPF 15 or higher, providing both UVA and UVB protection. Sunscreen should be generously applied to all exposed parts of the body approximately 30 minutes before sun exposure and be reapplied after swimming or vigorous activity. Drink plenty of fluids and avoid strenuous exercise when the temperature is high.

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Tick bites

To prevent tick bites, follow the same precautions as for mosquitoes; boots, with pants tucked in, are preferable to shoes. 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. Remove ticks 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.

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Water

Tap water in Honduras 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. You can improve the taste of boiled water somewhat by pouring it back and forth between containers; it re-oxygenates the water.

Another option is to disinfect water with iodine pills. Instructions are usually enclosed and should be carefully followed. Or you can add 2% tincture of iodine to 1L (quart) of water (five drops to clear water, 10 drops to cloudy water) and let stand for 30 minutes. If the water is cold, a longer time may be required. The taste of iodinated water can be improved by adding vitamin C (ascorbic acid). Don’t consume iodinated water 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. Chlorine is also an effective way to purify water, and may be easier to find in Honduras – ask for ‘cloro’. Two drops per liter does the trick; there should be a slight swimming-pool smell. Always wait 10 minutes before drinking.

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.

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Cholera

Cholera is an intestinal infection acquired through ingestion of contaminated food or water. The main symptom is profuse, watery diarrhea, which may be so severe that it causes life-threatening dehydration. The key treatment is drinking oral rehydration solution. Antibiotics are also given, usually tetracycline or doxycycline, though quinolone antibiotics such as ciprofloxacin and levofloxacin are also effective.

A handful of cholera outbreaks have been reported in Honduras over the last few years. The vaccine is no longer mandatory, though many health workers still recommend it.

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Dengue fever

Dengue fever is a viral infection found throughout Central America. It is most prevalent during the rainy season, which peaks from September to November on the North Coast. Wet weather is possible year round, however, and outbreaks can occur at any time. Dengue is transmitted by Aedes mosquitoes, which bite preferentially during the day 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 are resolved uneventfully in a few days. Severe cases usually occur in children under 15 who are experiencing their second dengue infection.

There is no specific 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.

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Hepatitis A

Hepatitis A occurs throughout Central America. It’s a viral infection of the liver 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 worldwide, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases are resolved uneventfully, 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 Honduras or any other developing nation. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under two years, 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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Malaria

Malaria occurs in every country in Central America, and is especially prevalent in Honduras’ eastern coastal areas. It’s transmitted by mosquito bites, which usually occur 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 strongly recommended when visiting lowland rural areas and in the departments of Gracias a Dios, Colón, Olancho, Yoro, Alántida, Cortés and the Bay Islands.

For Honduras, the first-choice malaria pill is chloroquine, taken once weekly in a dosage of 500mg (be sure to check that the amount of ingredient is in each pill, not just the size of the pill itself), 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 anticipate not having access to medical care while traveling, bring along additional pills for self-treatment, which you should undertake if you develop symptoms that suggest malaria, such as high spiking fevers and can’t reach a doctor. One option is to take an anti-malarial (such as chloroquine). If you start self-medication, you should try to see a doctor at the earliest possible opportunity; also see a doctor if you are still developing the disease while taking an anti-malarial – it suggests resistance to the drug.

If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.

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Typhoid fever

Typhoid fever is caused by ingestion of food or water contaminated by a type 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, 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 travelers’ 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 can be indistinguishable.

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Yellow fever

Yellow fever no longer occurs in Central America, but many Central American countries, including Honduras, require yellow-fever vaccine before entry if you’re arriving from a country in Africa or South America where yellow fever occurs. If you’re not arriving from a country with yellow fever, the vaccine is neither required nor recommended. 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 departure 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.

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Other infections

Brucellosis: This is an infection occurring in 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 can include arthritis, hepatitis, meningitis and endocarditis (heart valve infection).

Chagas’ disease: This is a parasitic infection transmitted by triatomine insects (reduviid bugs), which inhabit crevices in the walls and roofs of substandard housing in South and Central America. In Honduras, most cases occur in lowland and coastal areas. 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 good insecticide.

Gnathostomiasis: This is a parasite acquired by eating raw or undercooked freshwater fish, and in ceviche, a popular lime-marinated fish salad. The chief symptom is intermittent, migratory swellings under the skin, sometimes associated with joint pains, muscle pains or gastrointestinal problems. The symptoms may not begin until many months after exposure.

Histoplasmosis: Caused by a soil-based fungus, this is acquired by inhalation, often when soil has been disrupted. Initial symptoms may include fever, chills, dry cough, chest pain and headache, sometimes leading to pneumonia.

HIV/AIDS: There have been reports from all Central American countries. Be sure to use condoms for all sexual encounters.

Leishmaniasis: This 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. Leishmaniasis may be limited to the skin, causing slowly-growing ulcers over exposed parts of the body, or (less commonly) disseminate to the bone marrow, liver and spleen. The disease may be particularly severe 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).

Onchocerciasis (river blindness) : This is caused by a roundworm invading the eye, leading to blindness. The infection is transmitted by black flies, which breed along the banks of rapidly flowing rivers and streams.

Typhus: This may be transmitted by lice in scattered pockets of the country.

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Children & pregnant women

In general, it’s safe for children and pregnant women to go to Honduras. However, because some of the vaccines listed previously are not approved for use in children, or pregnant women, 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. If pregnant, 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.

Since yellow-fever vaccine is not recommended for pregnant women or children younger than nine months old, obtain a waiver letter (if you are arriving from a country with yellow fever), preferably written on letterhead stationery and bearing the stamp used by official immunization centers to validate the International Certificate of Vaccination.

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Availability & cost of health care

There are a number of first-rate hospitals in Tegucigalpa (Honduras Medical Center) and San Pedro Sula (Hospital Centro Mêdico Betesda) In general, private facilities offer better care than public hospitals, though at greater cost.

Adequate medical care is available in other major cities, but facilities in rural areas may be limited.

Many doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance. 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. Since this may cost tens of 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 (www.travel.state.gov/medical.html).

Honduran pharmacies are identified by a green cross and a ‘Farmacia’ sign. Most are well supplied and the pharmacists well trained. Some medications requiring a prescription in the US may be dispensed in Honduras without a prescription. To find an after-hours pharmacy, you can look in the local newspaper, ask your hotel concierge, or check the front door of a local pharmacy, which will often post the name of a nearby pharmacy that is open for the night.

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Travelers’ diarrhea

To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets or chlorine drops); 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 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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