Health & insurance
Travelers to Central America need to be vigilant about food- and mosquito-borne infections. Most of the illnesses most frequently caught while on holiday here are not life threatening, but they can certainly ruin your trip. Besides getting the proper vaccinations, it’s important to use a good insect repellent and exercise care in what you eat and drink.
Before You Go
High-risk adventure activities or water sports such as diving are not covered on all travel policies, so make sure you pay for the appropriate level of insurance coverage. Yours may cover basic activities, such as walking, but not ziplining or surfing; if diving, some companies may only cover you up to a certain number of dives or a certain depth. If unsure, check with your insurer before leaving your home country.
A list of medical-evacuation and travel-insurance companies can be found on the US State Department (www.travel.state.gov) website under the ‘Before You Go’ tab.
- Get necessary vaccinations 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 (Costa Rica only requires such proof if you are entering from a country that carries a risk of yellow fever).
- Birth-control pills are available at most pharmacies without a prescription.
- As with most countries in the world, sanitary products can be found at any pharmacy.
In Costa Rica
Availability & Cost of Health Care
- Good medical care is available in most major cities but may be limited in rural areas.
- For an extensive list of physicians, dentists and hospitals, visit https://cr.usembassy.gov and look under 'U.S. Citizen Services/Medical Assistance/Medical Practitioners List.'
- Most pharmacies are well supplied and a handful are open 24 hours. Pharmacists are licensed to prescribe medication. If you’re taking any medication on a regular basis, make sure you know its generic (scientific) name, since many pharmaceuticals go under different names in Costa Rica.
Dengue fever (breakbone fever) Dengue is transmitted by Aedes aegypti mosquitoes, which often bite during the daytime and are usually found close to human habitations, often indoors. Dengue is especially common in densely populated urban environments. It usually causes flu-like symptoms including fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. Most cases resolve uneventfully in a few days. There is no treatment for dengue fever except taking analgesics such as acetaminophen/paracetamol (Tylenol) and drinking plenty of fluids. Severe cases may require hospitalization for intravenous fluids and supportive care. There is no vaccine. The key to prevention is taking insect-protection measures.
Hepatitis A The second most common travel-related infection (after traveler’s diarrhea). It’s a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. 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.
Leishmaniasis This is transmitted by sand flies. Most cases occur in newly cleared forest or areas of secondary growth; the highest incidence is in Talamanca. It causes slow-growing ulcers over exposed parts of the body. There is no vaccine. To protect yourself from sand flies, follow the same precautions as for mosquitoes.
Malaria Malaria is very rare in Costa Rica, occurring only occasionally in rural parts of Limón Province. It’s transmitted by mosquito bites, usually between dusk and dawn. Taking malaria pills is not necessary unless you are making a long stay in the province of Limón (not Puerto Limón). Protection against mosquito bites is most effective.
Traveler's diarrhea Tap water is safe and of high quality in Costa Rica, but when you’re far off the beaten path it’s best to avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine tablets). To prevent diarrhea, 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 with an oral rehydration solution containing lots of salt and sugar. 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.
Typhoid 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. Possible complications include intestinal perforation, intestinal bleeding, confusion, delirium or (rarely) coma. A pretrip vaccination is recommended.
Zika virus At the time of research, pregnant women are advised against traveling to Costa Rica, as the virus may be linked to microcephaly, a birth defect that affects a baby's brain development. Zika is primarily transmitted by mosquitoes, but it can also be transmitted by a man to his sexual partner or by a woman to her fetus. Be aware that symptoms are usually mild in adults, and many people may not realize that they are infected.
Chikungunya virus The newest mosquito-borne viral disease was accidentally introduced to Costa Rica from Africa, and carried from Aedes albopictus or Tiger mosquitoes. The symptoms are similar to those of dengue fever (high fever, joint inflammation, a skin rash, headache, muscle aches, nausea), and so are the treatments – replace fluids, reduce fever and wait it out. Unlike dengue, it's very unlikely to be fatal, and once you get it you'll probably develop an immunity. The best prevention is to cover up with long sleeves and DEET.
Animal bites Do not attempt to pet, handle or feed any animal. Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, and an antiseptic such as iodine or alcohol should be applied. Contact a local health authority in the event of such an injury. Rabies cases are rare but do happen.
Insect bites No matter how much you safeguard yourself, getting bitten by mosquitoes is part of every traveler’s experience here. The best prevention is to stay covered up – wear long pants, long sleeves, a hat, and shoes, not sandals. Invest in a good insect repellent, preferably one containing DEET. Apply to exposed skin and clothing (but not to eyes, mouth, cuts, wounds or irritated skin). Compounds containing DEET should not be used on children under the age of two and should be used sparingly on children under 12. Invest in a bug net to hang over beds (along with a few thumbtacks or nails with which to hang it). Many hotels in Costa Rica don’t have windows (or screens), and a cheap little net will save you plenty of nighttime aggravation. The mesh size should be less than 1.5mm. Dusk is the worst time for mosquitoes, so take extra precautions then.
Sun Stay out of the midday sun, wear sunglasses and a wide-brimmed hat, and apply sunblock with SPF 15 or higher, with both UVA and UVB protection and reapply often, especially if getting in the sea or rivers. Drink plenty of fluids and avoid strenuous exercise when the temperature is high.
- It’s generally safe to drink tap water in Costa Rica, except in the most rural and undeveloped parts of the country. However, if you prefer to be cautious, buying bottled water is your best bet.
- If you have the means, vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 2000m, 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.
- Alternatively, carry a SteriPen that destroys most bacteria, viruses and protozoa with UV light.