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Mexico

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

Mexican medical treatment is generally inexpensive for common diseases and minor treatment, but if you suffer some serious medical problem, you may want to find a private hospital or fly out for treatment. 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 Mexico. For people whose medical insurance or national health systems don’t extend to Mexico – which includes most non-Americans – a travel policy is advisable. US travelers can find links to information on medical evacuation and travel insurance companies on the Mexico page of the Bureau of Consular Affairs website (www.travel.state.gov).

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

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Internet resources

There is a wealth of travel health advice on the internet. MD Travel Health (www.mdtravelhealth.com) provides complete travel health recommendations for every country and is updated daily. The World Health Organization publishes a superb book, International Travel and Health (www.who.int/ith/), which is revised annually and is available free online.

It’s also a good idea to consult government travel health websites before departure:

Australia www.dfat.gov.au/travel/

Canada www.hc-sc.gc.ca

UK www.doh.gov.uk/traveladvice/

United States www.cdc.gov/travel/

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Medical checklist

- acetaminophen/paracetamol (Tylenol) or aspirin

- adhesive or paper tape

- antibacterial ointment (eg Bactroban) for cuts and abrasions

- antibiotics

- antidiarrheal drugs (eg ­loperamide)

- anti-inflammatory drugs (eg ­ibuprofen)

- antihistamines (for hay fever and allergic reactions)

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

- bandages, gauze, gauze rolls

- scissors, safety pins, tweezers

- thermometer

- pocket knife

- DEET-containing insect repellent

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

- sunblock

- oral rehydration salts

- iodine tablets (for water ­purification)

- syringes and sterile needles

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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 vaccinations

Since most vaccines don’t produce immunity until at least two weeks after they’re given, be sure to 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.

A number of vaccines are recommended; see the table on the next page.

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Dangers & annoyances

Despite often alarming media reports and official warnings, Mexico is generally a safe place to travel, and with just a few precautions you can minimize the risk of encountering problems.

Some cities, such as Mexico City, Acapulco, Monterrey and several places along the US border (such as Nuevo Laredo, Tijuana and Ciudad Juárez), have a crime problem, but tourists are rarely involved in the drug ­trade–related violence that brings such a lot of bad publicity.

Enjoy yourself along the coasts, but beware of undertows and riptides on any ocean beach, and don’t leave your belongings unattended on the beach while you swim. Run-and-grab thefts happen.

And everyone should be extremely careful with taxis in Mexico City.

Official information can make Mexico sound more alarming than it really is, and is not always up to date, but for a variety of useful information on travel to Mexico consult your country’s foreign affairs department:

Australia (www.smartraveller.gov.au)

Canada (www.voyage.gc.ca)

UK (www.fco.gov.uk)

USA (travel.state.gov)

If you’re already in Mexico, you can contact your embassy. Keep an ear to the ground as you travel. If you do become a crime victim, report the incident to the police and to your country’s nearest consulate, which should be able to offer useful advice.

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Highway robbery

Bandits occasionally hold up buses, cars and other vehicles on intercity routes, especially at night, taking luggage or valuables. Sometimes buses are robbed by people who board as passengers. The best ways to avoid highway robbery are to travel by day and to travel on toll highways as much as possible. Deluxe and 1st-class buses use toll highways, where they exist; 2nd-class buses do not. Hwy 200, along the Pacific coast through Michoacán and Guerrero states and as far south as Huatulco in Oaxaca, Hwy 199 between Palenque and Ocosingo in Chiapas, and Hwy 175 between Oaxaca city and Pochutla, have all been the scene of highway robberies over the years.

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In transit

Deep vein thrombosis (DVT)

Blood clots may form in the legs (deep vein thrombosis) 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 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. An herbal alternative is ginger, which works like a charm for some people.

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While you're there

Malaria

Malaria occurs in every country in Central America, including parts of Mexico. 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 strongly recommended when visiting rural areas in the states of Oaxaca, Chiapas, Sinaloa, Nayarit, Tabasco and Quintana Roo, and for an area between 24° and 28° north latitude and 106° and 110° west longitude, which includes parts of the states of Sonora, Chihuahua and Durango.

For Mexico, 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 it’s possible that you may not have access to medical care while traveling, bring along additional pills for emergency self-treatment, which you should take if you can’t reach a doctor and 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.

Malaria pills are not recommended for the major resorts along the Pacific and Gulf Coasts.

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Dengue fever

Dengue fever is a viral infection found in most parts of Mexico. An outbreak in 2007 resulted in at least 67, 000 cases. Dengue is transmitted by aedes mosquitoes, which usually bite 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 resolve uneventfully in a few days. Severe cases usually occur in children under age 15 who are experiencing their second dengue infection.

There’s 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.

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Hepatitis A

Hepatitis A occurs throughout Central America. It’s a viral liver infection 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 resolve uneventfully, though it 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 Mexico or any other developing nation. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under age two, they should instead be given a gamma-globulin 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 is 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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Typhoid fever

Typhoid fever is common throughout Central America. The infection is acquired 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 age 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 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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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. Most cases in Mexico are related to dog bites, but bats and other wild species also remain sources of infection.

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 are traveling to remote areas and might not have access to appropriate medical care if needed. The treatment for a possibly rabid bite consists of 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 should be contacted to determine whether or not further treatment is necessary.

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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.

Only a handful of cases have been reported in Mexico over the last few years. Cholera vaccine is no longer recommended.

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Gnathostomiasis

Gnathostomiasis is a parasite acquired by eating raw or undercooked freshwater fish, including ceviche, a popular lime-marinated fish salad. Cases have been reported from Acapulco and other parts of Mexico. 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.

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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. Leishmaniasis may be limited to the skin, causing slowly-growing ulcers over exposed parts of the body, or (less commonly) may disseminate to the bone marrow, liver and spleen. The disease may be particularly severe in those with HIV. The disseminated form is rare in Mexico and is limited chiefly to the Balsas River basin in the southern states of Guerrero and Puebla. 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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Chagas’ disease

Chagas’ disease 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 Mexico, most cases occur in southern 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.

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Histoplasmosis

Histoplasmosis is caused by a soil-based fungus and 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. An outbreak was recently described among visitors to an Acapulco hotel.

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Coccidioidomycosis

Coccidioidomycosis, also known as ‘valley fever, ’ is a fungal infection that is restricted to semiarid areas in the American southwest, nearby areas in northern Mexico, and limited foci in Central and South America. Valley fever is acquired by inhaling dust from contaminated soil. It begins as a lung infection, causing fever, chest pain and coughing, and may spread to other organs, particularly the nervous system, skin and bone. Treatment requires high doses of antibiotics for prolonged periods and is not always curative.

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Brucellosis

Brucellosis 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).

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Tick-borne relapsing fever

Tick-borne relapsing fever, transmitted by either ticks or lice, has been reported from the plateau regions in central Mexico. Relapsing fever is caused by bacteria that are closely related to those that cause Lyme disease and syphilis. 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 as outlined below and practice good personal hygiene.

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Tularemia

Tularemia, also known as ‘rabbit fever, ’ is a bacterial infection that primarily affects rodents, rabbits and hares. Humans generally become infected through tick or deerfly bites, or by handling the carcass of an infected animal. Occasional cases are caused by inhalation of an infectious aerosol. In Mexico, most cases occur in the northern rural areas. Tularemia may develop as a flu-like illness, pneumonia or cause skin ulcers with swollen glands, depending upon how the infection is acquired. It usually responds well to antibiotics.

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Rocky Mountain spotted fever

Rocky Mountain spotted fever is a tick-borne infection characterized by fever, headache and muscle aches, followed by a rash. Complications may include pneumonia, meningitis, gangrene and kidney failure, and may be life threatening. Cases have been reported from the central part of the country, the Yucatán Peninsula and Jalisco State.

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Onchocerciasis

Onchocerciasis (river blindness) 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. In Mexico, the disease is reported from highland areas in the states of Oaxaca, Chiapas and Guerrero.

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Typhus

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

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HIV/AIDS

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

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Children & pregnant women

In general, it’s safe for children and pregnant women to go to Mexico. However, as some of the vaccines listed previously are not approved for 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. 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 less than nine months old, if you are arriving from a country with yellow fever, obtain a waiver letter, 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 Mexico City. In general, private facilities offer better care, though at greater cost, than public hospitals.

Adequate medical care is available in other major cities, but facilities in rural areas may be limited. In many areas, the US consulate provides an online directory to local physicians and hospitals, such as the following:

Ciudad Juarez ciudadjuarez.usconsulate.gov/physicians-and-dentists.html

Guadalajara ­www.usembassy-mexico.gov/guadalajara/GeDoctors.htm

Merida ­merida.usconsulate.gov/merida/doctorlist.html

Nogales nogales.usconsulate.gov/doctors.html

Many doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance. If you develop a medical problem that’s life threatening, 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.

Pharmacies are identified by a green cross and a ‘Farmacia’ sign. Most are well supplied and the pharmacists well trained. Reliable pharmacy chains include Sanborns, Farmacia Guadalajara, Benavides and Farmacia Fenix. Some medications requiring a prescription in the US may be dispensed in Mexico without one. 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 (eg with 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 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.

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