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Venezuela

Health & safety

Before you go

Most vaccines don’t produce immunity until at least two weeks after they’re given, so 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.

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Insurance

If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.

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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)

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)

sunblock

syringes and sterile needles

thermometer

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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 available online at no cost, is published by the World Health Organization (www.who.int/ith/).

Another health website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides a complete set of travel-health recommendations for every country. The site is updated daily and is also available at no charge.

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

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

Canada (www.hc-sc.gc.ca/pphb-dgspsp/tmp-pmv/pub_e.html)

UK (www.doh.gov.uk/traveladvice/index.htm)

USA (www.cdc.gov/travel/)

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Further reading

For further information, see Healthy Travel Central & South America, published by Lonely Planet. If you’re traveling with children, Lonely Planet’s Travel with Children may also 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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Dangers & annoyances

Venezuela is a reasonably safe place to travel. However, theft, robbery and common crime are on the increase, particularly in major cities. Caracas is, far and away, the most dangerous place in the country, and you should take care while strolling around the streets, particularly at night.

The most common methods of theft are snatching your daypack, camera or watch; taking advantage of a moment’s inattention to pick up your gear and run away; or pickpocketing. Thieves often work in pairs or groups; one or more will distract you, while an accomplice does the deed. Theft from hotel rooms, cars and unattended tents are also potential dangers.

If you can, leave your money and valuables somewhere safe before walking the streets. In practice, it’s good to carry a decoy bundle of small notes, the equivalent of US$5 to US$10, ready to hand over in case of an assault; if you don’t have anything, robbers can become frustrated and unpredictable.

Armed hold-ups in the cities can occur even in upmarket suburbs. If you are accosted by robbers, it is best to give them what they are after. Don’t try to escape or struggle, and don’t count on any help from passers-by. There have been reports of armed robbery on remote hiking trails and deserted beaches or even in a few posadas in tourist towns, but they are considerably less frequent. Also be aware of your surrounding when withdrawing cash from an ATM at any time of the day.

When traveling around the country, there are plenty of alcabalas (checkpoints), though not all are actually operating. They check the identity documents of passengers, and occasionally the luggage as well. In the cities, police checks are uncommon, but they do occur, so always have your passport with you. If you don’t, you may end up at the police station. Police are not necessarily trustworthy (though many are), so do not blindly accept the demands of these authority figures.

If your passport, valuables or other belongings are stolen, go to the nearest Policía Técnica Judicial (PTJ) office to make a denuncia (report). The officer on duty will write a statement according to what you tell them. It should include the description of the events and the list of stolen articles. Pay attention to the wording you use, make sure you include every stolen item and document, and carefully check the statement before signing it to ensure it contains exactly what you’ve said. They will give you a copy of the statement, which serves as a temporary identity document, and you will need to present it to your insurer in order to make a claim. Don’t expect your things to be found, as the police are unlikely to do anything about it. Stolen cars and motorcycles should also be reported at the PTJ.

All said, your biggest dangers are the standard risks of international travel: sunburn, food-borne illness and traffic-related concerns.

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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 deep vein thrombosis (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 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, and can result 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 or 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

Availability & cost of health care

Good medical care is available in Caracas, but may be difficult to find in rural areas. Public hospitals are free, but the quality of medical care is better in private facilities. For an online list of physicians, dentists and other health-care providers, most of whom speak English, go to the US embassy website (embajadausa.org.ve/wwwh005.html). Many doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance.

For an ambulance in Venezuela, call 171. 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).

Venezuelan farmacias (pharmacies) are identifiable by a red light in the store window. The quality and availability of medication is comparable to that in most other countries. The pharmacies keep a rotating schedule of 24-hour availability, so that different pharmacies are open on different nights. To find a late-night pharmacy, you can either look in the local newspaper under ‘Turnos,’ call 800-88766 (that is, 800-TURNO), check the list posted on most pharmacy doors or search for a pharmacy with its red light still on.

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Brucellosis

This 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. In Venezuela, most human cases are related to infected cattle. Symptoms may include fever, malaise, depression, loss of appetite, headache, muscle ache and back pain. Complications may include arthritis, hepatitis, meningitis and endocarditis (heart-valve infection).

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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 an oral rehydration solution. Antibiotics are also given, usually tetracycline or doxycycline, though quinolone antibiotics such as ciprofloxacin and levofloxacin are also effective.

Cholera sometimes occurs in Venezuela, but it’s rare among travelers. Cholera vaccine is no longer required, and is in fact no longer available in some countries, including the US, because the old vaccine was relatively ineffective and caused side effects. There are new vaccines that are safer and more effective, but they’re not available in many countries and are only recommended for those at particularly high risk.

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Dengue fever (breakbone fever)

Dengue fever is a viral infection found throughout South America. In Venezuela, large numbers of cases are reported each year, especially from the states of Barinas, Amazonas, Aragua, Mérida, Táchira and Lara, and the Caracas district. 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 ache, joint pain, headache, 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 as yet 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 protecting against insect bites.

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Hepatitis a

Hepatitis A is the second most common travel-related infection (after travelers’ 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 Venezuela 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. A total of three injections however, 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 in all South American countries. Be sure to use condoms for all sexual encounters.

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Leishmaniasis

This disease occurs in the mountains and jungles of all South American countries except Chile, Uruguay and the Falkland Islands. In Venezuela it is widespread in rural areas, especially the west-central part of the country. The infection is transmitted by sand flies, which are about one-third the size of mosquitoes. Leishmaniasis may be particularly severe in those with HIV. There is no vaccine. 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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Malaria

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.

Taking malaria pills is strongly recommended for those visiting Angel Falls and for rural areas in the states of Apure, Amazonas, Barinas, Bolívar, Delta Amacuro, Sucre, Táchira and Zulia. In general, the risk of malaria is greatest between February and August, especially after the onset of the rainy season in late May.

There is a choice of three malaria pills, all of which work equally well. Mefloquine (Lariam) is taken once weekly in a dosage of 250mg, starting one to two weeks before arriving in Venezuela and continuing until four weeks after departure. 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; it’s taken once daily with food, starting two days before arrival and continuing until 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 Lariam and is becoming more popular. The chief disadvantage is that it has to be taken daily. For longer trips, it’s probably worth trying Lariam; 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.

Since you may not have access to medical care while traveling, you should bring along additional pills for emergency self-treatment; take these if you can’t reach a doctor and you develop symptoms that suggest malaria, such as high-spiking fevers. One self-treatment 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.

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Measles

All travelers should be sure they have had either two measles vaccinations or a blood test proving they’re immune. Although measles immunization usually doesn’t begin until the age of 12 months, children between six and 11 months should probably receive an initial dose of measles vaccine before traveling to Venezuela.

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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 South American countries. In Venezuela, most cases are related to dog bites.

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 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.

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Schistosomiasis

This parasitic infection is acquired by exposure to contaminated fresh water, and is reported from isolated spots in the north-central part of the country, including the areas around Caracas (but not Caracas) and the states of Aragua, Carabobo, Guárico and Miranda. When traveling in these areas, you should avoid swimming, wading, bathing or washing in bodies of fresh water, including lakes, ponds, streams and rivers. Salt water and chlorinated pools carry no risk of schistosomiasis.

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Tick-borne relapsing fever

This fever, which may be transmitted by either ticks or lice, is caused by bacteria that is closely related to those that cause Lyme disease and syphilis. The illness is characterized by periods of fever, chills, headache, body aches, muscle aches and coughs, 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.

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Typhoid fever

Typhoid 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, 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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Venezuelan equine encephalitis

This viral infection, transmitted by mosquitoes, reached epidemic levels in 1995 after unusually heavy rainfalls, especially in the northwestern states of Zulia, Lara, Falcón, Yaracuy, Carabobo and Trujillo. The greatest incidence was reported among the Warao population. Cases still occur, but in smaller numbers, chiefly in the west between the Península de la Guajira and the Río Catatumbo. This illness comes on suddenly and symptoms are malaise, fevers, rigors, severe headache, photophobia and myalgias. Possible complications can include convulsions, coma, and paralysis.

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Yellow fever

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.

Yellow fever is still present in Venezuela and the yellow-fever vaccine is strongly recommended for all travelers (except pregnant women), especially anyone traveling beyond Caracas and the northern coast.

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 headache, muscle ache, 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.

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Traveler’s diarrhea

To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets); only eat fresh fruit 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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Altitude sickness

Altitude sickness may develop in those who ascend rapidly to altitudes greater than 2500m. Being physically fit offers no protection. Those who have experienced altitude sickness in the past are prone to future episodes. The risk increases with faster ascents, higher altitudes and greater exertion. Symptoms may include headaches, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. Severe cases may be complicated by fluid in the lungs (high-altitude pulmonary edema) or swelling of the brain (high-altitude cerebral edema).

The best treatment for altitude sickness is descent. If you are exhibiting symptoms, do not ascend. If symptoms are severe or persistent, descent immediately.

One option for the prevention of altitude sickness is to take acetazolamide (Diamox). The recommended dosage ranges from 125mg (twice daily) to 250mg (three times daily). It should be taken 24 hours before ascent and continued for 48 hours after arrival at altitude. Possible side effects include increased urinary volume, numbness, tingling, nausea, drowsiness, myopia and temporary impotence. Acetazolamide should not be given to pregnant women or anyone with a history of sulfa allergy. For those who cannot tolerate acetazolamide, the next best option is 4mg of dexamethasone taken four times daily. Unlike acetazolamide, dexamethasone must be tapered gradually upon arrival at altitude, since there is a risk that altitude sickness will occur as the dosage is reduced. Dexamethasone is a steroid, so it should not be given to diabetics or anyone for whom steroids are contraindicated. A natural alternative is gingko, which some people find quite helpful.

When traveling to high altitudes, it’s also important to avoid overexertion, eat light meals and abstain from alcohol.

If your symptoms are more than mild or don’t resolve promptly, see a doctor. Altitude sickness should be taken seriously; it can be life threatening when severe.

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Mosquitoes

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 of age 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. Neurological toxicity has been reported from using 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. Citronella-based products 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 allow 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.

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Ticks

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 have not been adequately studied for insects other than mosquitoes and cannot be recommended to prevent tick bites.

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Snake bites

Snakes and leeches are a hazard in some areas of South America. In the event of a venomous snake bite, 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 sunblock with SPF 15 or higher, with both UVA and UVB protection. Sunblock 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

Tap water in Venezuela is not safe to drink – 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, boil for three minutes. Another option is to disinfect water with iodine pills: 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.

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Traveling with children

Children under nine months should not be taken to areas where yellow fever occurs, since the vaccine is not safe for this age group. Although measles immunization doesn’t begin until the age of 12 months, children between the ages six and 11 months should probably receive an initial dose of measles vaccine before traveling to Venezuela.

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 the age of two.

The two main malaria medications, Lariam and Malarone, may be given to children, but insect repellents must be applied in lower concentrations.

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Women’s health

There are English-speaking obstetricians in Venezuela, listed on the US embassy website (embajadausa.org.ve/wwwh005.html). However, medical facilities will probably not compare favorably to those in your home country. It’s safer to avoid travel to Venezuela late in pregnancy, so that you don’t have to deliver here. Yellow-fever vaccine should not be given during pregnancy because the vaccine contains a live virus that may infect the fetus.

Also it isn’t advisable for pregnant women to spend time at altitudes where the air is thin. If you need to take malaria pills, mefloquine (Lariam) is the safest during pregnancy.

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