Prevention is the key to staying healthy while in South America. Travelers who receive the recommended vaccines and follow common-sense precautions usually go away with nothing more than a little diarrhea.
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Before You Go
Bring medications in their original, clearly labeled containers. A signed and dated letter from your physician describing your 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.
If your health insurance doesn't cover you for medical expenses abroad, consider getting extra insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In many countries doctors expect payment in cash.)
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.
The only required vaccine is yellow fever, and that's only if you're arriving from a yellow-fever-infected country in Africa or the Americas. (The exception is French Guiana, which requires yellow-fever vaccine for all travelers.) However, a number of vaccines are recommended.
Travelers who've never had chickenpox
2 doses one month apart
Fever; mild case of chickenpox
One dose before trip; booster 6-12 months later
Soreness at injection site; headaches; body aches
Long-term travelers in close contact with the local population
3 doses over 6-month period
Soreness at injection site; low-grade fever
Travelers born after 1956 who've had only one measles vaccination
Fever; rash; joint pains; allergic reactions
Travelers who may have contact with animals and may not have access to medical care
3 doses over 3- to 4-week period
Soreness at injection site; headaches; body aches
Travelers who haven't had booster within 10 years
1 dose lasts 10 years
Soreness at injection site
4 oral capsules, 1 taken every other day
Abdominal pain; nausea; rash
Travelers to jungle areas at altitudes below 2300m
1 dose lasts 10 years
Headaches; body aches; severe reactions are rare
- Acetaminophen (Tylenol) or aspirin
- Acetazolamide (Diamox; for altitude sickness)
- Adhesive or paper tape
- Antibacterial ointment (eg Bactroban; for cuts and abrasions)
- Antibiotics for diarrhea (eg Norfloxacin, Ciprofloxacin or Azithromycin)
- Antihistamines (for hay fever and allergic reactions)
- Anti-inflammatory drugs (eg ibuprofen)
- Bandages, gauze, gauze rolls
- Diarrhea 'stopper' (eg loperamide)
- Insect repellent containing DEET 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)
There is a wealth of travel health advice on the internet. The World Health Organization (www.who.int/ith) publishes a superb book called International Travel and Health, which is revised annually and available online (as a downloadable pdf) for $12. Another resource of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country in the world; information is updated daily.
It's usually a good idea to consult your government's travel health website before departure, if one is available:
In South America
Availability & Cost of Health Care
Good medical care may be more difficult to find in smaller cities and impossible to locate in rural areas. 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 (http://travel.state.gov).
Dengue fever is a viral infection found throughout South America. 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 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.
There is 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 protection against insects.
Keep an eye out for outbreaks in areas where you plan to visit. A good website on the latest information is the CDC (wwwnc.cdc.gov/travel).
Hepatitis A is the second most common travel-related infection (after travelers' diarrhea). It's a viral infection of the liver that's 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 themselves 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 any developing nation.
Malaria occurs in every South American country except Chile, Uruguay and the Falkland Islands (Islas Malvinas). 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.
There is a choice of three malaria pills, all of which work about equally well. Mefloquine (Lariam) is taken once weekly in a dosage of 250mg, starting one to two weeks before arrival and continuing through the trip and for four weeks after your return. The problem is that a certain percentage of people (the number is disputed) develop neuropsychiatric side effects, which may range from mild to severe. Atovaquone/proguanil (Malarone) is a newly approved combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side effects are typically mild. Doxycycline is a third alternative, but may cause an exaggerated sunburn reaction.
Protecting yourself against mosquito bites is just as important as taking malaria pills, since none of the pills are 100% effective.
If you do 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 you develop symptoms that suggest malaria, such as high spiking fevers. One 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.
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.
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. 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 further treatment is necessary.
Typhoid fever 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, the typhoid vaccine is a good idea.
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 may be indistinguishable.
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 vaccine can be 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 headaches, muscle aches, 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, which is required if you're arriving from a yellow-fever-infected country in Africa or the Americas, or you are visiting French Guiana.
Taking measures to protect yourself from mosquito bites is an essential part of preventing yellow fever.
Zika virus is primarily transmitted by infected mosquitoes, typically active from dawn to dusk. It can be transmitted from a pregnant woman to her fetus. Human transmission can also occur through unprotected sex, and on occasion through saliva and urine. Symptoms include mild fever, headache, muscle and joint pain, nausea, vomiting and general malaise. Symptoms may present three to 12 days after being bitten.
The best prevention is to wear long sleeves, repellent with 20% to 30% DEET and avoid being outdoors at dawn and dusk when mosquitoes are most common. High-altitude destinations are not considered a risk.
Bartonellosis (Oroya Fever)
Bartonellosis (Oroya fever) is carried by sand flies in the arid river valleys on the western slopes of the Andes in Peru, Colombia and Ecuador between altitudes of 800m and 3000m. (Curiously, it's not found anywhere else in the world.) The chief symptoms are fever and severe body pains. Complications may include marked anemia, enlargement of the liver and spleen, and sometimes death. The drug of choice is chloramphenicol, though doxycycline is also effective.
Chagas disease is a parasitic infection that is transmitted by triatomine insects (reduviid bugs), which inhabit crevices in the walls and roofs of substandard housing in South and Central America. Chagas disease is extremely rare in travelers. However, if you sleep in a poorly constructed house, especially one made of mud, adobe or thatch, be sure to protect yourself with a bed net and a good insecticide.
Gnathostomiasis is an intestinal parasite acquired by eating raw or undercooked freshwater fish, including ceviche (marinated, uncooked seafood).
Leishmaniasis occurs in the mountains and jungles of all South American countries except for Chile, Uruguay and the Falkland Islands (Islas Malvinas). The infection is transmitted by sand flies, which are about one-third the size of mosquitoes. Leishmaniasis may be limited to the skin, causing slow-growing ulcers over exposed parts of the body or (less commonly) disseminate to the bone marrow, liver and spleen. 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).
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).
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.
Do not attempt to pet, handle or feed any animal, with the exception of domestic animals known to be free of any infectious disease.
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. The local health authorities should be contacted immediately for possible postexposure rabies treatment, whether or not you've been immunized against rabies.
Snakes and leeches are a hazard in some areas of South America. In the event of a bite from a venomous snake, 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.
Cold Exposure & Hypothermia
Cold exposure may be a significant problem in the Andes, particularly at night. Be sure to dress warmly, stay dry, keep active, consume plenty of food and water, get enough rest, and avoid alcohol, caffeine and tobacco.
Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. If you're trekking at high altitudes or simply taking a long bus trip over mountains, particularly at night, be prepared. In the Andes, you should always be prepared for cold, wet or windy conditions even if it's just for a few hours. It is best to dress in layers, and a hat is also important.
The symptoms of hypothermia include exhaustion, numbness, shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Watch out for the 'umbles' (stumbles, mumbles, fumbles and grumbles), which are important signs of impending hypothermia.
To treat mild hypothermia, first get people out of the wind or rain, remove their clothing if it's wet and give them something warm and dry to wear. Make them drink hot liquids – not alcohol – and some high-calorie, easily digestible food. Do not rub victims – instead allow them to slowly warm themselves.
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 sunscreen with SPF 15 or higher, with both UVA and UVB protection. Travelers should also drink plenty of fluids and avoid strenuous exercise when the temperature is high.
Insect Bites & Stings
To prevent mosquito bites, wear long sleeves, long pants, a hat 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 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. DEET-containing compounds should not be used on children under age 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. Products based on citronella 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.
Intestinal parasites occur throughout South America. Common pathogens include Cyclospora, amoebae and Isospora. A tapeworm called Taenia solium may lead to a chronic brain infection called cysticercosis. If you exercise discretion in your choice of food and beverages, you'll sharply reduce your chances of becoming infected. Choose restaurants or market stalls that are well attended. If there's a high turnover, it means food hasn't been sitting around that long.
A parasitic infection called schistosomiasis, which primarily affects the blood vessels in the liver, occurs in Brazil, Suriname and parts of north-central Venezuela. The disease is acquired by swimming, wading, bathing or washing in fresh water that contains infected snails. It's therefore best to stay out of bodies of fresh water, such as lakes, ponds, streams and rivers, in places where schistosomiasis might occur.
A liver parasite called Echinococcus (hydatid disease) is found in many countries, especially Peru and Uruguay. It typically affects those in close contact with sheep. A lung parasite called Paragonimus, which is ingested by eating raw infected crustaceans, has been reported from Ecuador, Peru and Venezuela.
To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected (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 markets and street vendors.
If you develop diarrhea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing salt and sugar. Gastrolyte works well for this. A few loose stools don't require treatment but you may want to take antibiotics if you start having more than three watery bowel movements within 24 hours, and it's accompanied by at least one other symptom – fever, cramps, nausea, vomiting or generally feeling unwell. Effective antibiotics include Norfloxacin, Ciprofloxacin or Azithromycin – all will kill the bacteria quickly. Note that an antidiarrheal agent (such as loperamide) is just a 'stopper' and doesn't get to the cause of the problem. Don't take loperamide if you have a fever or blood in your stools. Seek medical attention quickly if you don't respond to an appropriate antibiotic.
Tap water 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.
Other methods of treating water include using a handheld ultraviolet light purifier (such as a SteriPEN), iodine and water filters.
Argentina Generally safe to drink, but best to check in rural areas.
Bolivia Not safe to drink.
Brazil Generally safe to drink in major cities; not safe in rural areas.
Chile Tap water is generally safe to drink from Middle Chile down to Patagonia, but generally unwise in the Atacama Desert.
Colombia Not safe to drink, except in Bogotá and Cartagena.
Ecuador Not safe tor drink.
Guyana Not safe to drink.
French Guiana Not safe to drink.
Paraguay Not safe to drink.
Peru Not safe to drink.
Suriname Not safe to drink.
Uruguay Generally safe to drink; check rural areas.
Venezuela Not safe to drink. Shortages mean you should be prepared to treat water rather than relying on bottled water.