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Health

There are no required vaccinations for Panama, but among those recommended are yellow fever, typhoid, rabies, and hepatitis A and B. See your doctor well ahead, since most vaccines don’t produce immunity until at least two weeks after being given. Request an International Certificate of Vaccination (aka the yellow booklet); it's mandatory for countries that require proof of yellow-fever vaccination.

Tap water is generally drinkable in Panama, except for in Bocas del Toro and the Comarca de Guna Yala. Visitors who have recently arrived may want to start with bottled water and minimal amounts of tap water.

A superb book called International Travel and Health, revised annually and 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), with complete travel-health recommendations for every country, updated daily, also accessible at no cost.

In Panama

Infectious Diseases

Malaria

Malaria is transmitted by mosquito bites, usually between dusk and dawn. High-spiking fevers may be accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may lead to seizures, confusion, coma and death.

Malaria pills are recommended for rural areas in the provinces east of the Panama Canal and Ngöbe-Buglé Comarca. There have been rare cases in the provinces of Bocas del Toro, Colón and Veraguas.

Protecting yourself against mosquito bites is the best prevention. If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.

Yellow Fever

A life-threatening viral infection, yellow fever is transmitted by mosquitoes in forested areas. Flu-like symptoms include fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting. Some patients enter a second, toxic phase, which can lead to death.

Vaccination is recommended for travelers visiting Chepo, Darién and continental Guna Yala.

Dengue Fever

A viral infection, dengue fever (breakbone fever) is transmitted by mosquitoes breeding in standing water. It is especially common in densely populated, urban environments. Flu-like symptoms include fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. Most cases resolve in a few days. Take analgesics such as acetaminophen/paracetamol (Tylenol) and drink plenty of fluids. Severe cases may require hospitalization. In recent times, Panama has reported cases nationally.

Hepatitis B

Hepatitis B is a liver infection usually acquired by sexual contact or by exposure to infected blood, generally through blood transfusions or contaminated needles. The hepatitis B vaccine is safe and highly effective. A total of three injections is necessary to establish full immunity.

Hepatitis A

The vaccine for hepatitis A is extremely safe and highly effective. 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. Symptoms 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.

Rabies

In Panama, rabies is transmitted mainly by vampire bats. If you are bitten by any animal, thoroughly wash the wound and visit a doctor to determine whether further treatment is necessary. A vaccine is recommended if you will be in wild areas, since Panama does not carry the immunoglobulin that bite victims without the vaccine need right away (getting it involves an urgent flight out).

Chikungunya

Chikungunya is a virus transmitted by mosquitoes. Common symptoms include fever and joint pain, though sufferers may experience headache, muscle pain, joint swelling or rash. Since there is no vaccine or treatment, travelers should prevent mosquito bites by using insect repellent, wearing long sleeves and pants, and staying indoors. Consult www.cdc.gov for up-to-date information.

Leptospirosis

Leptospirosis is acquired by exposure to water contaminated by the urine of infected animals. The greatest risk occurs at times of flooding, when sewage overflow may contaminate water sources. Initial symptoms resemble a mild flu and usually subside in a few days, but a minority of cases are complicated by jaundice or meningitis. Minimize your risk by staying out of bodies of fresh water that may be contaminated by animal urine.

Leishmaniasis

Leishmaniasis occurs in rural and forested areas throughout Panama, especially the eastern and south-central regions. The disease causes slow-growing ulcers on the body, but the infection may become generalized, especially in those with HIV. Leishmaniasis is transmitted by sand flies. To protect yourself, follow the same precautions as for mosquitoes, with finer-size mesh on mosquito netting (at least 18 holes to the linear inch).

Typhoid

Typhoid is caused by ingestion of food or water contaminated by 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 or bleeding, confusion, delirium and, rarely, coma.

The vaccine is usually given orally but is also available as an injection. The treatment drug is usually a quinolone antibiotic such asciprofloxacin (Cipro) or levofloxacin (Levaquin).

Traveler’s Diarrhea

To prevent traveler’s diarrhea, avoid untreated tap water, eat fresh fruits or vegetables that are cooked or peeled, and be highly selective when eating food from street vendors.

If you develop diarrhea, 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, seek medical attention.

Zika

Zika virus spreads through the bite of an infected Aedes species mosquito. Common symptoms include fever, rash, joint pain and conjunctivitis. Most victims experience mild illness with symptoms that last for several days to a week. Since Zika may cause brain damage in to infants in utero, pregnant women should avoid visiting a Zika hot spot. The virus may also be sexually transmitted by an infected partner. Since there is no vaccine or treatment, travelers should prevent mosquito bites by using insect repellent, wearing long sleeves and pants, and staying indoors. Consult www.cdc.gov for up-to-date information.

Availability & Cost of Health Care

Good medical care is widely available in Panama City and also David – it's even sought after, with the cities doing brisk business in medical tourism – though it's limited elsewhere. Most doctors and hospitals expect cash payment, regardless of whether you have travel health insurance.

Tap Water

Tap water in Panama City is safe to drink, as is the water in most other parts of the country. However, you’re better off buying bottled water or purifying your own water in the provinces of Bocas del Toro and Guna Yala.

If you have the means, vigorous boiling for one minute is the most effective method of water purification. 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.

Before You Go

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
  • Malaria pills – recommended for the Darién
  • 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)
  • Sunblock
  • Syringes and sterile needles
  • Thermometer

Recommended Vaccinations

VaccineRecommended forDosageSide effects
hepatitis Aall travelers1 dose before trip; booster 6-12 months latersoreness at injection site, headaches, body aches
typhoidall travelers4 capsules by mouth, 1 taken every other dayabdominal pain, nausea, rash
yellow feverall travelers1 dose lasts 10 yearsheadaches, body aches; severe reactions are rare
hepatitis Blong-term travelers in close contact with the local population3 doses over 6-month periodsoreness at injection site, low-grade fever
rabiestravelers who may have contact with animals and may not have access to medical care3 doses over 3- to 4-week periodsoreness at injection site, headaches, body aches
tetanus-diphtheriaall travelers who haven’t had a booster within 10 years1 dose lasts 10 yearssoreness at injection site
measlestravelers born after 1956 who have only had one measles vaccination1 dosefever, rash, joint pains, allergic reaction
chickenpoxtravelers who’ve never had chickenpox2 doses 1 month apartfever, mild case of chickenpox