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Costa Rica Travellers' Diarrhea

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Description.

The term Travellers' Diarrhea is used to describe gastrointestinal infections affecting travellers caused by ingesting bacteria, viruses, and protozoa. These microorganisms are found worldwide and are typically transmitted from person to person via the fecal-oral route – an infected person who does not practice proper hand or body hygiene passes on the infection to another person when handling food and water. Travellers' Diarrhea is one of the most common illness among travellers.

Travellers' Diarrhea can happen when:

• Eating raw, under cooked, unwashed, or improperly handled meat, poultry products, dairy products, fruits, vegetables, shellfish, and seafood.
• Drinking contaminated water or beverages.
• Inadvertently ingesting fecal matter, protozoa eggs, or viruses by touching the mouth with dirty or improperly washed hands.
• Eating in restaurants, from buffets, or from street vendors where food handling and hygienic practices are not followed properly.

The golden rule to prevent gastrointestinal infections is: Boil it, Cook it, Peel it, or Forget it! However, it’s not just about what you eat, it’s also important to consider where you eat. It’s not always easy to know if a restaurant or food vendor follows proper food handling and hygienic practices (such as separating raw from cooked ingredients, properly cleaning cutting boards and utensils, washing their hands, and correctly refrigerating food). Avoid restaurants and food vendors that appear unclean or that don’t have many customers. Be cautious of food that has been stored uncovered, has been improperly refrigerated, or has been standing out for a long time such as buffets.

If you are unsure about the tap water quality, bring the water to a rolling boil. Boiling water destroys pathogens that can cause Travellers’ Diarrhea and other gastrointestinal infections. If you cannot boil your water, opt for treated or bottled water instead.

The risk of Travellers’ Diarrhea can also be minimized by following good hygiene practices. Make sure to wash your hands for at least 20 seconds with warm water and soap, especially before preparing or eating food and after using the bathroom. If water and soap are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Managing Travellers’ Diarrhea

At the first sign of diarrhea, drink an oral rehydration solution (ORS), a mixture of salt and sugar designed to replenish electrolytes and treat dehydration. Antimotility agents like loperamide can also be used to reduce symptoms, but they do not treat the gastrointestinal infection. Traveller’s diarrhea is usually a self-limiting infection (it resolves itself), but if it persists and becomes worse after 2 or 3 days, you may want to consider taking an antibiotic for treatment.

If you are on high blood pressure medication watch for signs of dehydration since it can become an emergency very quickly.

Before you go, consult your doctor for the best diarrhea treatment options. Travellers who have pre-existing health conditions and are more susceptible to gastrointestinal infections may consider taking preventive medication.

For more information on preventing Travellers' Diarrhea, check out these resources from IAMAT:

• Food and water safety
• How to prevent Travellers' Diarrhea
• How to prevent illness by washing your hands

Information last updated: February 23, 2021. 

• Velarde JJ, Levine MM, Nataro JP,Escherichia coli Diarrhea. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 9 th ed. New York: Saunders Elsevier; 2013: 442-447.
• Wolfe MS. Traveler’s Diarrhea. In: Jong, E; Stevens, D, eds. Netter’s Infectious Diseases. New York: Saunders Elsevier; 2012: 390-393.
• Virk A. Amebiasis, Giardiasis, and Other Intestinal Protozoan Infections. In: Jong, E; Sanford, C. eds. The Travel and Tropical Medicine Manual, 4 th ed. Waltham, Elsevier; 2008: 448-466. 
• Centers for Disease Control and Prevention: Yellow Book, Traveler’s Diarrhea
• Committee to Advice on Tropical Medicine and Travel, PHAC: Statement on Travellers' Diarrhea

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• Patient Care & Health Information
• Diseases & Conditions
• Traveler's diarrhea

Traveler's diarrhea may get better without any treatment. But while you're waiting, it's important to try to stay hydrated with safe liquids, such as bottled water or water with electrolytes such as an oral rehydration solution (see below). If you don't seem to be improving quickly, several medicines are available to help relieve symptoms.

Anti-motility agents. These medicines — which include loperamide and drugs containing diphenoxylate — provide prompt but temporary relief by:

• Reducing muscle spasms in your gastrointestinal tract.
• Slowing the transit time through your digestive system.
• Allowing more time for absorption.

Anti-motility medicines aren't recommended for infants or people with a fever or bloody diarrhea. This is because they can delay clearance of the infectious organisms and make the illness worse.

Also, stop using anti-motility agents after 48 hours if you have stomach pain or if your symptoms worsen and your diarrhea continues. In such cases, see a doctor. You may need blood or stool tests and treatment with an antibiotic.

• Bismuth subsalicylate. This nonprescription medicine can decrease the frequency of your stools and shorten the length of your illness. However, it isn't recommended for children, pregnant women or people who are allergic to aspirin.
• Antibiotics. If you have more than four loose stools a day or severe symptoms, including a fever or blood, pus or mucus in your stools, a doctor may prescribe a course of antibiotics.

Before you leave for your trip, talk to your doctor about taking a prescription with you in case you get a serious bout of traveler's diarrhea.

Avoiding dehydration

Dehydration is the most likely complication of traveler's diarrhea, so it's important to try to stay well hydrated.

An oral rehydration salts (ORS) solution is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose to enhance absorption in the intestinal tract.

Bottled oral rehydration products are available in drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration salts, labeled World Health Organization (WHO)- ORS , at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package.

If these products are unavailable, you can prepare your own rehydrating solution in an emergency by mixing together:

• 3/4 teaspoon table salt.
• 2 tablespoons sugar.
• 1 quart uncontaminated bottled or boiled water.
• Sugar-free flavor powder, such as Crystal Light (optional).

You or your child can drink the solution in small amounts throughout the day as a supplement to solid foods or formula, as long as dehydration persists. Small amounts reduce the likelihood of vomiting. Breastfed infants also can drink the solution but should continue nursing on demand.

If dehydration symptoms — such as dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness — don't improve, seek medical care right away. Oral rehydration solutions are intended only for urgent short-term use.

Lifestyle and home remedies

If you do get traveler's diarrhea, avoid caffeine, alcohol and dairy products, which may worsen symptoms or increase fluid loss. But keep drinking fluids.

Drink canned fruit juices, weak tea, clear soup, decaffeinated soda or sports drinks to replace lost fluids and minerals. Later, as your diarrhea improves, try a diet of easy-to-eat complex carbohydrates, such as salted crackers, bland cereals, bananas, applesauce, dry toast or bread, rice, potatoes, and plain noodles.

You may return to your normal diet as you feel you can tolerate it. Add dairy products, caffeinated beverages and high-fiber foods cautiously.

Preparing for your appointment

Call a doctor if you have diarrhea that is severe, lasts more than a few days or is bloody. If you are traveling, call an embassy or consulate for help locating a doctor. Other signs that you should seek medical attention include:

• A fever of 102 F (39 C) or higher.
• Ongoing vomiting.
• Signs of severe dehydration, including a dry mouth, muscle cramps, decreased urine output, dizziness or fatigue.

If you have diarrhea and you've just returned home from a trip abroad, share that trip information with your doctor when you call to make an appointment.

Here's some information to help you get ready, and what to expect.

Information to gather in advance

• Pre-appointment instructions. At the time you make your appointment, ask whether there are immediate self-care steps you can take to help recover more quickly.
• Symptom history. Write down any symptoms you've been experiencing and for how long.
• Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medicines, vitamins or supplements you're currently taking.
• Questions to ask your health care professional. Write down your questions in advance so that you can make the most of your time.

The list below suggests questions to ask about traveler's diarrhea.

• What's causing my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatment approach do you recommend?
• Are there any possible side effects from the medicines I'll be taking?
• Will my diarrhea or its treatment affect the other health conditions I have? How can I best manage these conditions together?
• What is the safest way for me to rehydrate?
• Do I need to follow any dietary restrictions and for how long?
• How soon after I begin treatment will I start to feel better?
• How long do you expect a full recovery to take?
• Am I contagious? How can I reduce my risk of passing my illness to others?
• What can I do to reduce my risk of this condition in the future?

In addition to the questions that you've prepared, don't hesitate to ask questions as they occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• Have you traveled recently?
• Where did you travel?
• Have you taken any antibiotics recently?
• Have your symptoms been getting better or worse?
• Have you noticed any blood in your stools?
• Have you experienced symptoms of dehydration, such as muscle cramps or fatigue?
• What treatments have you tried so far, if any?
• Have you been able to keep down any food or liquid?
• Are you pregnant?
• Are you being treated for any other medical conditions?
• Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.
• LaRocque R, et al. Travelers' diarrhea: Microbiology, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Ferri FF. Traveler diarrhea. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed April 28, 2023.
• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
• Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.
• LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Khanna S (expert opinion). Mayo Clinic. May 29, 2021.

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How to avoid traveller's diarrhoea (and what to do if it strikes)

Dec 17, 2019 • 9 min read

Traveller's diarrhoea can stop you in your tracks, so it's best to try and avoid it © ViewApart / Getty Images

Although it’s not inevitable that you will get diarrhoea while you are away, it is pretty likely in some destinations. Digestive upsets are the most common travel-related illnesses, affecting about 30-50% of travellers to tropical destinations, so you may as well be prepared.

What causes diarrhoea?

Your risk of getting ill mainly depends on how likely it is that the food and drink you are consuming is contaminated with disease-causing microorganisms. That said, roughly one third of cases are due to non-specific causes such as stress, jet lag and changes in eating habits. If you’re roughing it, and eating from small stalls and restaurants where hygiene is more likely to be a problem, you’re more likely to catch something. If you are away on a long trip, there’s a higher chance you will get ill at some stage.

Read more: 8  tips to stay healthy on vacation from celebrity trainer Harley Pasternak

Fact vs fiction

Not surprisingly, you’ll find diarrhoea a hot topic of conversation among travellers, and it can be hard to separate fact from fiction at times. Just remember: - Travellers diarrhoea is generally a short, mild illness lasting on average about three to five days - Replacing lost fluids and salts is the most important part of treating any watery diarrhoea, whatever the cause - You don’t usually need to get medical advice or antibiotic treatment for mild to moderate diarrhoea - There are certain situations when antibiotics need to be used – in these situations it’s best to get medical advice

Avoiding diarrhoea

Although we don’t want to deprive you of a fascinating talking point during your travels, it’s obviously best to avoid getting diarrhoea in the first place. Unhygienic food preparation practices and contaminated water are common causes of travellers diarrhoea. It sounds gross, but basically you get diarrhoea by eating other people’s faeces through contaminated food, water and eating utensils. Hands used to prepare food may not have been washed thoroughly after toilet duty. Flies carry dirt and microorganisms on their feet. In dusty, urban areas, tonnes of dry faecal matter floats around in the atmosphere, and this can land on food left sitting around.

You can also get diarrhoea from direct contact with an infected person (if you touch hands etc that haven’t been washed adequately) or from swimming in contaminated water (by swallowing small amounts). Some infective agents such as Giardia can survive even in chlorinated water, and rivers and oceans may be contaminated with sewage.

Types of diarrhoea

Different microorganisms cause different types of diarrhoeal illnesses, which may need to be treated in different ways. The most important things to look out for are: a high body temperature, blood in your faeces and how severe the diarrhoea is (ie how often you have to go to the toilet).

Watery diarrhoea This is the type of diarrhoea you’re most likely to get when you are away. The cause varies with your destination, but it’s usually bacterial, often a strain of a bacteria called Escherichia coli . Relatives of this microbe are normal residents of your gut, but this is a strain that has turned nasty.

The usual scenario is that the illness starts a few days after you arrive, and involves up to six episodes of loose faeces a day. You may feel sorry for yourself, but it doesn’t usually make you feel particularly unwell. If you get a fever with it, it’s usually low (less than 38°C). Nausea and vomiting are common, especially at the start, but it’s not a major feature of the illness (compare this with food poisoning). Stomach cramps, bloating and frequent gas are also common.

The illness generally resolves itself in a few days (on average three to five). It rarely causes severe dehydration, although the potential is always there and is more of a risk in children and older travellers. Don’t panic and start stuffing yourself with medications. The most important treatment measure is to avoid dehydration by replacing lost fluids and salts, which you should start doing straight away.

Read more : How the airport security lane could be bad for your health

Bloody diarrhoea (dysentery) Dysentery is any diarrhoea with blood in it. It can be more severe and protracted than the more common watery diarrhoea described earlier, and usually needs antibiotic treatment. Out of every 10 travellers who get diarrhoea, only about one will have dysentery. The most common cause is one of a number of bacteria, including various shigella and salmonella species.

Dysentery usually begins with nonspecific flu-like symptoms, and you often feel really rough, with headache, high fever (38°C and above), and aches and pains all over. To start with, the diarrhoea is often watery and in large quantities; later it gets less and you start to notice blood and mucus (slime) mixed in your faeces. Painful stomach cramps are often a feature of the illness, usually heralding a dash to the little room.

Get medical advice if you have dysentery, as you’ll need a laboratory test and a course of antibiotics. In the meantime, rest and make sure you drink plenty of fluids.

Read more: Want to stay healthy for the holidays? Avoid these airport and airplane surfaces

Vomiting & diarrhoea If you suddenly get an attack of nausea and profuse vomiting soon after eating, it’s probably due to food poisoning. This is a worldwide problem that is more likely when you’re eating food not prepared by yourself, especially where food preparation and storage procedures may be suspect.

Vomiting is the main symptom, often with stomach cramps and some watery diarrhoea later. You may have a suspicion that you’ve eaten something that wasn’t fresh (such as sea food); another clue is if everyone who ate the same thing comes down with the same illness.

No specific treatment is needed as a rule. You should rest, sip fluids if possible, and wait for it to settle down, which it should start doing in about 12 to 24 hours. Generally, it’s best to avoid anti-vomiting medication, as vomiting is your body’s way of getting rid of the bad stuff. You should seek medical help urgently if the illness doesn’t settle down within 24 hours, if it gets much worse, if there’s any blood in the vomit or diarrhoea, if you have a high fever or if you have very severe stomach pains or a severe headache.

How to deal with diarrhoea

If diarrhoea strikes, you don’t necessarily need to reach for your medical kit for "stoppers" (see 'Antidiarrhoeal remedies' below) which paralyses the gut and stops the flow, or for antibiotics; there are some simple measures it’s worth taking: - Rest, which gives your body the best chance to fight whatever is making you ill; in any case, being on the move with diarrhoea presents a few logistical problems - Drink plenty of fluids - Take your temperature and note what it is; repeat this to see how the illness is progressing - Examine what’s coming out of your guts to check for blood or mucus (slime) - Be aware of how often you’re passing urine and what colour it is, so you can check you’re not getting dehydrated - Note any other symptoms you may have: diarrhoea can occur in many other illnesses, including malaria and hepatitis - Remember that diarrhoea is contagious so be scrupulous about washing your hands after you use the toilet

Read more: Airline staff share their tips on how to keep healthy while flying

What to drink when you have diarrhoea

You need to replace what’s being lost through the diarrhoea and any vomiting: mainly salts (sodium, potassium and chloride) and water. Sachets of oral rehydration salts (ORS) are readily available worldwide and contain optimum amounts of glucose and salts. There’s no magic ingredient in ORS, but the relative quantities of salt and sugar are important. You can make up your own solution if necessary by adding six teaspoons of sugar (or honey) and half a teaspoon of table salt to 1L of boiled water. Make it more palatable by adding any flavour you like, for example lemon, ginger or orange juice.

Alcohol, strong tea, coffee and other caffeine-containing drinks (such as colas) are all best avoided because they can irritate the gut and promote fluid loss. It’s best to steer clear of dairy products while you have diarrhoea – you can get an intolerance to the sugar in milk when you have diarrhoea, which then exacerbates the problem.

Read more: 10 best fitness retreats for a healthier life

Antidiarrhoeal remedies

There are remedies you can take to stop the flow if you get diarrhoea, but as a general rule, you’re better off allowing the illness to run its course. Antimotility drugs (ie "stoppers") like loperamide (often sold as Imodium), diphen­oxylate (with atropine) and codeine phosphate slow down your guts, reducing the number of times you have to visit the little room. These are sold under a wide variety of brand names and are usually available without prescription. Stoppers can be useful if you have to travel on a toilet-less mode of transport or attend an important meeting, but you should treat them with a bit of respect. If you do need to take them, be careful not to take more than the recommended dose.

Bismuth subsalicylate (Pepto-Bismol) can be useful in treating diarrhoea, although it is less effective than the antimotility drugs. Bismuth shouldn’t be taken if you have asthma or if you are taking aspirin, are sensitive to aspirin or have been told to avoid aspirin for any reason. Alternatively, peppermint oil is an antispasmodic that may be helpful if you’re experiencing abdominal cramps. It has no serious side effects. Some herbal teas available locally may be helpful for soothing stomach cramps.

Antibiotics

If you are seriously ill or the diarrhoea just won’t go away, you’ll probably need antibiotic treatment. In this situation, you should seek medical advice on the most appropriate treatment and you may need a laboratory test to determine the cause of your illness. Remember that most cases of travellers diarrhoea do not need treatment with antibiotics, and will clear up on their own in a few days.

Whether or not to treat simple watery diarrhoea with antibiotics is much less clear-cut, and it’s an issue the experts can’t agree on. There’s plenty of evidence to show that taking a dose of an antibiotic (such as ciprofloxacin 500mg, single dose) with loperamide (an antimotility drug) can reduce the length of a diarrhoeal illness quite dramatically. Because of this, some doctors will advise you to carry a treatment dose of an antibiotic to take as soon as you develop diarrhoea. Others, however, argue that the benefits are not offset by the risks (including possible side effects of the antibiotic and the emergence of bacterial resistance) and that in any case diarrhoea in travellers is usually a mild illness that will clear up quickly enough on its own. On balance, it’s probably worth having a course of antibiotics with you, but keep it for a bad attack of watery diarrhoea (dashing to the toilet more than about six times a day).

Travel safely and diarrhoea-free!

This article was first published June 2012 and updated December 2019

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Costa Rica Travel Health Information

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Summary You can't Edit

Summary of recommendations

Most travelers to Costa Rica will need vaccinations for hepatitis A and typhoid fever , as well as medications for travelers' diarrhea . Malaria prophylaxis is recommended for certain provinces, in conjunction with insect repellents and other measures to prevent mosquito bites. Additional immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.

Malaria:Prophylaxis with chloroquine, Lariam (mefloquine), Malarone (atovaquone/proguanil), doxycyline, or primaquine is recommended for Limon province, but not Limon City.

Vaccinations:

Medications You can't Edit

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions , as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Costa Rica: prophylaxis is recommended for Limon province, but not Limon City. The risk is greatest in the cantons of Matina and Talamanca.

For many years, the drug of choice has been chloroquine , which is inexpensive and generally well-tolerated. The recommended dosage is 500 mg weekly, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Chloroquine may cause mild adverse reactions, including gastrointestinal disturbance, headache, dizziness, blurred vision, and itching, but severe reactions are uncommon. Other choices include mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF) , doxycycline , and primaquine . Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Atovaquone/proguanil (Malarone) is a 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, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics. Primaquine may cause hemolytic anemia in those with G6PD deficiency, so a blood test documenting normal G6PD levels must be obtained before starting primaquine. In those with normal G6PD levels, the main side-effect of primaquine is gastrointestinal disturbance, which can be minimized by taking the medication with food. Insect protection measures are essential, as below.

For other parts of the country, where malaria is rare, insect protection measures are advised, but malaria medications are not recommended.

For further information about malaria in Costa Rica, including maps showing the risk of malaria in different parts of the country, go to the World Health Organization and the Pan American Health Organization .

Immunizations You can't Edit

The following are the recommended vaccinations for Costa Rica.

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF) . Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF) . A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Yellow fever vaccine is required for travelers arriving from a country in Africa or the Americas with risk of yellow fever transmission, with the exception of Argentina, Panama, and Trinidad and Tobago, and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission. The vaccine is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center , which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to those who are younger than six months of age, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a malignant neoplasm and those with a history of thymus disease or thymectomy. Caution should be exercised before giving the vaccine to those who are between the ages of 6 and 8 months, age 60 years or older, pregnant, or breastfeeding. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.

All travelers should be up-to-date on routine immunizations, including

• Tetanus - diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.)
• Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.)
• Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)

Cholera vaccine is not recommended. No cases of cholera have been reported since 1997.

Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. Polio has been eradicated from the Americas, except for a small outbreak of vaccine-related poliomyelitis in the Dominican Republic and Haiti in late 2000.

Rabies vaccine is not recommended. Only two cases of rabies have been recorded in the last 30 years. For further information, go to Emerging Infectious Diseases.

Recent outbreaks of diseases You can't Edit

Recent outbreaks

Outbreaks of dengue fever have been reported annually from Costa Rica since 1993. An outbreak was reported from Limon province in August 2011, causing approximately 5000 cases. Dengue fever is a flu-like illness which may be complicated by hemorrhage or shock. The disease is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are strongly advised, as outlined below.

An outbreak of malaria was reported in November 2006 from the province of Limon, chiefly the town of Batan on the Caribbean slope. The cases were caused by Plasmodium falciparum, which causes more severe disease and is not generally seen in Costa Rica (see ProMED-mail ; November 16, 2006). All travelers to Limon province, except Limon City, should take chloroquine once weekly and follow insect protection measures to prevent malaria.

For the year 2007, more than 26,000 cases and eight deaths were recorded, mainly from the provinces of Guanacaste and Puntarenas, both on the Pacific coast, and the province of Limon on the Caribbean coast. A major dengue outbreak was reported in the summer of 2005, resulting in more than 30,000 cases by late October, chiefly from the central Pacific area and the Atlantic coast. Several cases were identified in American travelers. The outbreak was related to heavy rainfalls, which led to an increase in the mosquito population. Another major outbreak occurred in 2003, when 19,700 people were affected.

An outbreak of an intestinal illness characterized by vomiting, diarrhea, headaches and fever was reported from San Jose in mid-July 2001. More than 2500 people were affected. The outbreak appears to have been related to contamination of the local water supply. The cause of the illness has not been determined, though shigellosis is suspected. Although local authorities have announced that the water supply is now safe, it would be prudent not to drink tap water unless it is boiled, filtered, or chemically disinfected. For further information, see the U.S. Embassy website.

Other Infections You can't Edit

Other infections

For a detailed weekly update on communicable diseases in Costa Rica, including malaria, dengue fever, cholera, meningococcal meningitis, leptospirosis, and rabies, go to the Ministry of Health (Ministerio de Salud). For an overview of public health in Costa Rica, go to the Pan-American Health Organization .

An outbreak of leptospirosis was reported in 1996 among whitewater rafters in Costa Rica. Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals. In Costa Rica, the chief animal reservoirs are rats, pigs, goats and cattle. Symptoms may include fever, chills, headache, muscle aches, joint pains, conjunctivitis, and rash. Travelers who participate in activities which place them at risk for leptospirosis, such as swimming, wading, or rafting in potentially contaminated lakes or rivers, should consider taking doxycycline 200 mg once weekly as prophylaxis.

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

Other infections include

• Chagas disease (American trypanosomiasis) (rural areas, chiefly Alajuela, Liberia, and Puntarenas; transmitted by reduviid bugs in substandard housing)
• Cutaneous and mucocutaneous leishmaniasis (occurs chiefly in newly-cleared forest or areas of secondary growth; transmitted by sandflies)
• Leptospirosis (largest number of cases reported from Limon, Turrialba, San Carlos, and Golfito; most cases have occurred in cattle-raising areas in the northwest; cases also reported among residents of Puerto Limon who have bathed in local streams)
• Coccidioidomycosis (arid areas)
• Lymphatic filariasis (small number of cases reported from Puerto Limon)
• Venezuelan equine encephalitis (transmitted by mosquitoes)
• Rocky Mountain spotted fever
• Tick-borne relapsing fever
• Fascioliasis
• Paragonimiasis (oriental lung fluke) (rare)

Food and Water You can't Edit

Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected . Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish, including ceviche. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro) , levofloxacin (Levaquin), rifaximin (Xifaxan) , or azithromycin (Zithromax) . Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

Insect Tick Protection You can't Edit

Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

General Advice You can't Edit

General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit , customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag , discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

Ambulance You can't Edit

Ambulance and Emergency Services

For a medical emergency in Costa Rica, call Red Cross Ambulance at 911 , 128 , or 221-5818 . For a private ambulance, call Clinica Biblica at 257-0466 . For a pediatric emergency, call Hospital Nacional de Ninos at 222-0122 . The best-equipped ambulances are called “unidad avanzada.”

Medical Facilities You can't Edit

Medical facilities

Good medical care is available in San Jose, but may be limited elsewhere. Most travelers go to one of the private hospitals, usually Hospital Clinica Biblica (Calle central y primera, Avenidas 14 16, Apartado 1307-1000, San José; tel. 506-522-1000; website http://www.clinicabiblica.com) or Hospital Cima San Jose (located 500 m west of the tollbooths on Prospero Fernández Freeway; tel. 506-208-1000; emergency tel. 506-208-1144; website http://www.hospitalsanjose.net; affiliated with Baylor University Medical Center, Dallas, Texas). Both are relatively small, but include a 24-hour emergency room, an intensive care unit, surgical and maternity services, CAT scan and MRI, and a 24-hour pharmacy. Both accept a number of U.S. health insurance plans. For a list of physicians, dentists, and other hospitals, go to the U.S. Embassy website at http://sanjose.usembassy.gov/medical.html. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

Pharmacies You can't Edit

Most prescription and over-the-counter medications are available in San Jose (many that require a prescription in North America are available over-the-counter). Most pharmacies are well-supplied and the quality is generally reliable. The Fischel pharmacies are well-regarded (main branch across from the main post office in San José, tel. 223-0909; branches around San José and in Heredia, Alajuela, Cartago and Puntarenas). For a 24-hour pharmacy, go to one of the private hospitals above or the Farmacia del Este in San Pedro (tel. 253-5121).

Travel with children You can't Edit

Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics . Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

The recommendations for malaria prophylaxis are the same for young children as for adults, except that the dosage of chloroquine is lower. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions ), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever , which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Travel and pregnancy You can't Edit

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary (see the U.S. Embassy website). In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

As a rule, pregnant women should avoid visiting areas where malaria occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, chloroquine must be taken once a week and insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

Maps You can't Edit

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names .

Embassy You can't Edit

Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

The Department of State invites American citizens to register their travel on the Internet-Based Registration System (IBRS) on line at: http://travelregistration.state.gov/ibrs/ or http://travel.state.gov. IBRS provides a convenient means for American citizens traveling or residing overseas to provide important contact data, useful in the event of emergencies, and to instantly receive up-to-the-minute travel and safety information for the regions or countries on their travel itineraries, on the website or through optional email lists. Even American citizens who have registered previously but did not do it using the IBRS online program may now wish to register online to update their records. U.S. citizens may also register in person at the Embassy, which is located in Pavas, San Jose, and may be reached at (506) 519-2000; the extension for the Consular Section is 2453. The Embassy is open Monday through Friday, and is closed on Costa Rican and U.S. holidays. For emergencies arising outside normal business hours, U.S. citizens may call (506) 220-3127 and ask for the duty officer.

Safety Information You can't Edit

Safety information

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada , and the Australian Department of Foreign Affairs and Trade .

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Hotels near Costa Rica

• Hotel Quelitales Set in the mountains of Peñas Blancas de Cachí, this eco-friendly resort offers an organic farm and a fusion restaurant. Each stylish bungalow has an open-air waterfall shower and incredible rainforest views.
• Chalet Orosi Chalet Orosi is located in Paraíso and offers fully equipped kitchens and free continental breakfast. The chalets at this property have a seating area and a private terrace with views of the tropical gardens and surrounding nature.
• Hotel Boutique La Casona del Cafetal Offering a spa and wellness centre and a restaurant, Hotel Boutique La Casona del Cafetal is located on a coffee farm in Cachí. Free WiFi access and free private parking are available.
• Hotel Reventazon & Guesthouse Offer views of the surrounding hills, this comfortable hotel features free Wi-Fi and free on-site parking in Orosi. It is just 200 metres from the thermal hot springs.
• Orosi Lodge Orosi Lodge is located 5 minutes’ drive from Orosí mani square and 15 km from Cartago city centre. Free WiFi access is available in all areas.
• Rinconcito Verde Situated in the middle of a natural reserve, Rinconcito Verde offers panoramic views of Irazu Volcano site and Cachi Lagoon. The property offers free breakfast with the rate and Wi-Fi access is also free of charge.
• El Salto Inn Overlooking the Cachi lake, in front of the tallest waterfall in the beautiful Orosi Valley, the lodge El Salto Inn offers free Wi-Fi and free healthy breakfast.
• Sanchiri Mirador & Lodge Offering accommodation with views of the beautiful rainforest outside Paraiso, Sanchiri Mirador & Lodge is set in gardens. It features a restaurant and free Wi-Fi.
• Paraíso Quetzal Lodge Paraíso Quetzal Lodge features extensive gardens, wooden bungalows and a terrace with views of the cloud forest. It is located just 3 km from Los Quetzales National Park. Free Wi-Fi is available at the restaurant.
• Spanish by the River - Turrialba This tropical hostel is located within a 5-minute drive of Turrialba Town Centre and features free Wi-Fi and free on-site parking. It also boasts a shared kitchen and a terrace with hammocks.

More hotels from our Partner Booking.com

Points of Interest near Costa Rica

Looking for something to do or a place to go see near Costa Rica? Here is our list of options.

• Palmar Sur Airport (PMZ) Palmar Sur Airport (PMZ), Provincia de Puntarenas, Palmar Sur, Costa Rica 8.9544407 -83.4658556

Accommodation near Costa Rica

Looking for somewhere to stay near Costa Rica? Here is our list of options.

• Costa Rica Marriott Hotel San Jose No info yet.. Please go to this page and enter some.
• 256 street 800 mts south of Puerto Viejo on the way to Playa No info yet.. Please go to this page and enter some.
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• El Tular Santuario Natural No info yet.. Please go to this page and enter some.
• Cl. 52a #50-46 No info yet.. Please go to this page and enter some.
• Parrot Nest Lodge No info yet.. Please go to this page and enter some.

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Travel Advisory – Malaria in Costa Rica

A malaria outbreak has been reported in various regions of Costa Rica. Antimalarials are recommended.

Travel Vaccines and Advice for Costa Rica

Costa Rica has something for everyone. Beaches for a relaxing holiday. Rivers and jungles for adventure travellers. Mountain resorts for those who want something in-between. It is one of the most popular destinations in Central America and a favorite among travellers.

But even popular destinations need a little preparation before you’re ready to go.

Do I Need Vaccines for Costa Rica?

Yes, some vaccines are recommended or required for Costa Rica. The PHAC and WHO recommend the following vaccinations for Costa Rica: hepatitis A , hepatitis B , typhoid , yellow fever , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

See the bullets below to learn more about some of these key immunizations:

• Hepatitis A – Food & Water – Recommended for most travellers
• Hepatitis B – Blood & Body Fluids – Recommended for travellers to most regions.
• Typhoid – Food & Water – Recommended for travellers to most regions.
• Yellow Fever – Mosquito – Required if travelling from a country with risk of yellow fever transmission.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travellers and those who may come in contact with animals.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given seperately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Vaccine-preventable diseases are not the only threats. Dengue fever and chikungunya, two mosquito-borne diseases, are also present. Take proper precautions to avoid mosquitoes and mosquito bites such as using repellents and netting.

Traveller’s diarrhea is another threat. the PHAC estimates as many as 70 percent of travellers will fall ill to traveller’s diarrhea. Avoid questionable eateries and bring a remedy like DiaResQ or a traveller’s diarrhea kit.

To find out more about these vaccines, see our vaccinations page . Ready to travel safely? Book your appointment either call or start booking online now.

Customer Reviews

Passport health – travel vaccines for costa rica, do i need a visa for costa rica.

Costa Rica allows nationals of certain countries, including Canada, to enter the country and remain there for up to 90 days. Canadian citizens entering for tourism or business purposes do not need a visa for the duration of that time period. If you plan on staying for longer than a 90-day period, you will require either a business, multiple entry, or tourist visa.

Sources: Embassy of Costa Rica and Canadian Travel and Tourism

Visit the Canadian Travel and Tourism website for more information on entry and exit requirements.

What Is the Climate Like in Costa Rica?

Costa Rica is a warm and tropical country. The weather is usually consistent throughout the year. Different places in Costa Rica have different climates. For example, the capital city, San José, has a mild climate with temperatures between 20 and 25 degrees. It has a rainy season from May to November, with the heaviest rainfall in September and October.

Arenal is a popular tourist destination known for its volcano and hot springs. It is warm and humid with temperatures between 20 and 30. The rainy season runs from May to November, with the heaviest rainfall in September and October. Monteverde is a cloud forest region with cooler temperatures due to its high altitude. It has a rainy season from May to November, with the heaviest rainfall in October.

Manuel Antonio is a beach destination with hot and humid temperatures ranging from 25 to 30. The rainy season runs from May to November, with the heaviest rainfall in September and October. Guanacaste is a popular beach and surf destination with a dry climate. It has temperatures between 25 to 35. It has a dry season from December to April and a wet season from May to November.

How Safe Is Costa Rica?

Costa Rica is a particularly safe country, often referred to as the safest country in the Latin America.

Despite the lack of crime, it is still wise to practice caution in crowded places, keep all the valuables in a safe place and avoid going out after dark.

The roads in Costa Rica are in a bad condition, so it is necessary to the particularly careful when driving.

The biggest threats in Costa Rica are active volcanoes and venomous snakes and frogs. Make sure to find the most recent safety information before going near the volcanoes and be extremely cautious with the wild animals.

What Should I Take to Costa Rica?

Here are some essential items to consider for your trip to Nigeria:

• Hiking Boots -Costa Rica boasts 5% of the world’s species in its lush forests. Make sure to get out of the city and see the incredibly rich wildlife with your own eyes.
• Photo Camera – There is a lot to see in Costa Rica. Enjoy the sights to the fullest by taking a photo camera with you and capturing the sights you encounter. Best travel souvenirs are the photos you take.
• Rain Jacket – Since in some parts of the country it can rain all year long, it is a good idea to bring a light rain jacket with you. With proper clothing, the bursts of rain will pass by before you know it.
• Sunscreen – The sun in Costa Rica is very ruthless and can give you painful sunburns. Make sure to bring a sunscreen with a high factor of SPF to protect your skin from the sun.
• Bug Spray – To avoid mosquito-borne illnesses, it is best to carry your own bug spray. The stores in Costa Rica might not offer a high variety of repellents, leaving you with a limited selection of overpriced bug sprays.

Canadian Embassy in Costa Rica

There is only one Canadian Embassy in Costa Rica and no consulates. The embassy is located at:

Canadian Embassy San José La Sabana Executive Business Centre, Building No. 5, 3rd Floor behind the Contraloría General de la República, San José, Costa Rica Telephone: (506) 2242-4400

If you do have a serious issue, such as a lost passport, contact the Canadian Embassy in San José immediately.

Beach, jungle, adventure, Costa Rica has something for almost every type of traveller. Make sure your journey is protected by visiting your local Passport Health. Our travel health specialists will help you receive everything you need to help you stay healthy as you go. To schedule your appointment today, call or book online now.

On This Page: Do I Need Vaccines for Costa Rica? Do I Need a Visa for Costa Rica? What is the Climate Like in Costa Rica? How Safe is Costa Rica? What Should I Take To Costa Rica? Canadian Embassy in Costa Rica

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For those looking for the perfect holiday, look no further than the endless sandy beaches on both coasts, lush rainforests, and photogenic volcanic peaks of Costa Rica. With eco-tourism, outdoor adventures, and tropical resorts at the top of the menu, many people feel called to this gorgeous slice of Central America.

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Costa Rica Guide

Travel information and maps, traveler’s health tips.

Some basic planning and precautions can help keep you healthy and happy while traveling.

Where to Get Care

Emergencies Dial 911 toll free, and no coin required at a pay phone for emergency assistance. The Red Cross Rescue unit may be reached directly at 128 throughout the country (2221-5818 in San José). Tourism Care Medical Services has road and air paramedic and ambulance service throughout Costa Rica (2286-1818). Listings for private physicians are under Médicos in the yellow pages.

For non emergency care your first line of defense should be your own first aid kit . Second, you can turn to the local farmacia (pharmacy).

Drinking the Water

Costa Rica used to have uniformly excellent tap water and that’s mostly still true in the mountains and cities of the central valley.

Lack of planning, illegal wells, over development and El Niño induced drought lowered water levels many aquifers in Guanacaste and the Nicoya peninsula) and raised arsenic concentrations to dangerous levels.  All over Costa Rica wastewater is treated in unregulated septic systems (there’s no municipal sewage treatment) that are inadequate, full or broken and especially in the rainy season contaminate ground water with human waste.

The “Paacume” reservoir plan  was introduced to flood the Bebedero wetlands wildlife refuge and use a series of canals and pipelines to dilute the arsenic in the water for agriculture and residential use in Guanacaste and Nicoya. The plan is opposed by environmental groups both because of the destruction of habitat and because they say it will encourage further irresponsible development.

La Niña got the rainy season started early in 2022 and extended it in 2023 so Arsenic levels are dropping as the drought eases, aquifers refill and concentrations are diluted.

Because it used to be so good it’s a common misconception that you can always drink the tap water but bottled or filtered water may be advisable .

Municipal water supplies in most of Costa Rica are drinkable.  Especially in the mountains the water is probably higher quality than what comes out of the tap at home.

One of the reasons so much land is protected in parks and reserves is that Ticos recognize the importance of their watersheds. Water quality standards monitored and enforced by the AYA are similar to those followed in North America and Europe.

Water from rivers and streams is generally not safe to drink without purification.  As nearly anywhere in the world, free running water contains parasites and bacterial pathogens (including giardia).  When we trekked across the Talamanca mountains we found some streams several days from the nearest population that were safe to drink from but generally it’s a bad idea.

Downstream from San José and in the waters around Puntarenas pollution and contamination can be severe enough to make swimming unsafe in the rivers.

Sewage in the Rivers and Oceans

Only about 5% of Costa Rica’s sewage passes through a treatment plant and that only came on line in 2015.  Most sewage goes into septic systems many of which are inadequate or prone to leaking into the groundwater during rainy season.  A surprising amount of wastewater still simply gets dumped into the nearest river.

Generally the water quality of Costa Rica’s beaches is not monitored.  The ministry of health occasionally shuts down beaches due to high coliform bacteria counts (basically sewage in the water) even in supposedly pristine areas like Manuel Antonio National Park.

Red tides (phytoplankton and dinoflagellate algal blooms) are naturally caused by storm stirred upwellings of nutrients but are becoming more frequent as the ocean temperature rises and more fertilizer is carried out to sea in runoff.

The micro-organisms that turn the water red or rusty brown release brevetoxins which cause rash and skin irritation and should not be ingested.  The most common health threat from red tide is the wind and surf lifting the toxins into the air in the form of an aerosol which causes respiratory distress and can be dangerous for people with asthma or other conditions.

Shellfish concentrate another red tide poison (saxitoxin) in their tissues and eating them can cause fatal paralytic and neurotoxic shellfish poisoning in humans.

Large numbers of dead fish may wash up on the beaches during red tides but they are typically not the victims of algal toxins.  They die due to severe oxygen depletion.

Red tides in Costa Rica are more common on the Pacific coast and may last from a few days to several weeks.

Hot Springs & Waterfall Jumping

Amoebic Meningoencephalitis is extremely uncommon but Costa Rica’s hot spring resorts are a habitat for the microorganism ( Naegleria fowleri ) that causes it.  There have been three cases in the past 25 years but two of them were in early 2020.

The U.S. CDC assumes that Naegleria is present in any fresh water above 70°F which includes more or less all rivers, lakes, ponds and streams in Costa Rica.  However, it grows best up to 115°F (46°C) – precisely hot spring temperatures.

The only way to become infected is when water containing the amoeba enters the body through the nose. Waterslides are the most effective method of infection, followed by jumping.

In the past there was no cure and historically once symptoms were seen it was 97% fatal.  Prevention is easy.  Keep your nose above water or swim in the ocean – the amoeba cannot live in salt water.

It’s very difficult to diagnose and most doctors don’t look for it but if caught early there has been some success with drug treatments in conjunction with forced hypothermia and induced coma.

Washing your hands is one of the most effective ways of preventing disease transmission whether you are traveling or not.

Common sense is your best defense against digestive ailments. Wash any fruits and vegetables (especially ones you don’t peel), don’t eat food from stands or restaurants unless it’s as hot or cold as it should be, and don’t change your diet dramatically overnight.

A separate travel insurance policy might be a good idea. Your normal health insurance, Medicare or Medicaid will not be accepted and will not pay for any care you need.

Costa Rica’s Social Security Institute offers medical and emergency dental coverage by the week. It is available by the week through Tico travel agents, ask for the Instituto Nacional de Seguros travelers insurance.

Many multinational companies offer policies that cover trip cancellation, lost baggage, medical costs, and emergency evacuation. For what you get this insurance is relatively expensive so shop around , get details from the providers, and read the policy carefully before purchasing.

Inoculations

Your ultimate medical resource must be your physician. We have provided some general information, and daily updates by qualified medical professionals are available on the CDC and WHO web sites.

No inoculations are currently (2020) required for travelers from North America to Costa Rica. However, you may want to consider a gamma globulin injection to boost your general immunity and defenses against hepatitis – more vaccine info .

If you are from or have recently traveled to some regions of South America or Africa proof of inoculation against Yellow Fever may be required.  It is not present in Costa Rica and they want to keep it that way.

Use repellent and wear long sleeves and pants at dawn and dusk.  There are a couple of mosquito borne diseases in the tropics world wide and in Costa Rica which are very unpleasant – chikungunya , zika , and dengue fever.

Everyone should carry a basic first aid kit when traveling. Hikers, backpackers, campers, surfers and others who are likely to find themselves away from medical care should carry more extensive supplies.

A minimum kit includes pain relievers/fever reducers (Acetaminophen, Ibuprofen, or Aspirin) Imodium, band aids, tweezers, neosporin, tape, eye drops, insect repellent, sun screen. The benefits of having each of these items convenient should be apparent.

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I never thought I’d find myself playing grandmother’s footsteps with a puma. After a morning fruitlessly searching the trails surrounding SCP Corcovado Wilderness Lodge for big cats, we’ve returned to the lodge where head guide Mario Chavarria Fuentes has dropped a bombshell — a male puma was just seen outside guest villa number seven.

“It could still be here,” he reassures me, gesturing towards the rainforest surrounding the open lawns of the guest cabins. Walking back to mine — a puma-deficient number 11 — it’s difficult to shake off the feeling that if I turn around, I’ll come face-to-face with one of the world’s most elusive felines. It’s both exhilarating and terrifying in equal measure. It’s hard not to feel like you’re being watched when you’re in Costa Rica’s Osa Peninsula, whether by a puma or some other creature. The place is home to the world’s highest concentration of flora and fauna and some 2.5% of the world’s biodiversity — all in an area roughly the size of the Isle of Man. For unclear reasons, it continues to hover beneath many visitors’ radars, despite acting as a stronghold for half of Costa Rica’s animal and plant species, including one of the last tracts of untouched tropical lowland rainforest.  

The wildlife seems keen to be observed, too. Just outside my bedroom, a band of raccoon-like coatimundi mill around a palm, occasionally tumbling to the ground like drunk gymnasts, while high above, there’s a swallow-tailed kite, its white wings catching in the sun as it circles. A family of jaguars live nearby, while a bunch of Baird’s tapirs regularly ramble around the staff football pitch.

Recently, a guide encountered an incredibly rare harpy eagle. Over a single night, a trail camera has captured videos of an ocelot, a puma and a jaguar passing through the lodge’s 188 acres of primary rainforest. It sounds like the start of an improbable joke, but there’s nothing laughable about the bewildering array of wildlife crammed into the lodge’s private reserve and Corcovado National Park, just a little over a mile away.

My guide has been obsessed with the jungle for decades. “Since I was 12, learning the calls of animals and searching for them has been my hobby,” Mario tells me, as we head back out onto the trails. After his daytime guiding duties are completed, and despite years working here, he still takes himself for an evening walk through the forest. His encyclopedic knowledge of every animal call, paw print and plant is an extension of this obsession cultivated as a child.  

He tilts his head towards the rainforest canopy and makes four high-pitched chirrups. There’s an immediate squealing chatter from somewhere nearby and he turns to me with a wink. Whistling again, he tells me to listen carefully. “After a while, you learn to work out how far away they are and how high,” he explains, steering me along the path in hot pursuit of the noise. Soon, we spot the responders to our call. A troop of white-faced capuchin monkeys are balanced on narrow branches high above, squabbling shrilly among themselves. Beady black eyes peer out from a nun’s wimple of golden fur, while their prehensile tails hitch onto branches to demonstrate Olympic-worthy gymnastics that put the bumbling coatimundi to shame.

The noises of this rainforest, known by scientists as ecosystem soundscapes, are increasingly becoming an important means of diagnosing their health. The research group Crowther Lab has recorded them across Costa Rica, showing how human-damaged ecosystems are quieter, as well as how conservation can help restore many to their natural, cacophonous states. Thanks to a new partnership with SCP Corcovado Wilderness Lodge, the group is soon to start analysing soil samples from the old-growth rainforests surrounding the lodge and the wider Osa Peninsula, extracting DNA to delve into this staggeringly biodiverse microbiome. The research will help scientists understand what a rainforest microbiome should look like — and how primary forests can be restored elsewhere around the globe.

Offshore, there’s a similar story of epic biodiversity and the   need to protect it. Corcovado Bay, a short boat journey north, is a whale motorway. Humpbacks migrate south through these waters during the northern hemisphere’s summer and head in the opposite direction in winter, making for one of the longest whale-watching seasons on the planet.  

Out on a speedboat, it doesn’t take long for us to strike lucky: a curious mother and her calf swim towards our boat before melting away beneath the surface. Ahead, a pod of pan-tropical dolphins race through the water at breakneck speed.  

Our destination is Isla del Caño, an island and biological reserve whose waters teem with life.   Armed with a snorkel, I join the underwater party, watching as bicolour parrotfish dressed to impress in electric blue and phosphorescent purple dance past. Up next, a school of silvery almaco jacks with David Bowie-like streaks across their left eye spiral towards me, offering an invitation to join their choreographed routine. Further down, a hawksbill turtle is unmoved by the revelry, paddling languorously as it plucks at sea sponges clinging to the coral that lines the ocean floor.

Despite this abundance of marine life, an estimated 60% of the coral around the island has been bleached this year by an abnormally strong   El Niño, which raised both the ocean’s temperature and acidity. This triggers the coral to expel the vital microalgae living within its tissue, thus turning large swathes white. Local NGO Innoceana is trying to find ways to reverse this process through pioneering 3D coral reef mapping. This enables the organisation to analyse how this fragile marine ecosystem is responding to climate change in the hopes of identifying ‘super corals’ that are resistant to temperature increases. Once discovered, these corals will be propagated locally to regenerate the reef, while the research itself will act as a blueprint for identifying super corals around the world.

Through a new research lab also being built at SCP Corcovado Wilderness Lodge in partnership with Crowther Lab, Innoceana will also soon be contributing to groundbreaking research around cetacean communication — and hotel guests will be able to help. Using hydrophones, whale songs will be recorded and then fed into an AI algorithm to try and unpick a seemingly impossible conundrum — what exactly are they singing?  

Back on land, I take the trail to the San Pedrillo entrance of Corcovado National Park. Crossing into this protected area is mostly symbolic — after all, humans care far more for borders than other animals. Mud underfoot give a tantalising insight   into the vast array of creatures who have passed through here, while flashes of shimmering blue signal morpho butterflies ahead.

If I’d thought puma or the deadly fer-de-lance viper were the animals to fear, my guide, Juan Corella Camacho, quickly sets me straight. Herds of white-lipped peccary are uncommon, but still possible to see here — and his trademark, puppy-like curiosity doesn’t extend to wanting a tete-a-tete with a group of them. “If we see some, jump up into a tree and hang on,” he says. “They can be aggressive when threatened, but their pungent, sweaty stench gives you a good clue to their imminent arrival.”  

Our trail takes us to a small clearing, where Juan stops me to effuse over an inga tree, whose serpentine buttress roots provide anchorage in high winds. I’m distracted, however, by a pungent, musky smell that infuses the air and sours the throat. Juan assures me it’s just humidity, but, after our safety briefing, I’m feeling a little jittery.  

It turns out that white-lipped peccary aren’t the only creatures with a malodorous calling card. Some 65ft above is what appears to be a termite nest locked onto a horizontal branch. Suddenly, it moves, shifting rusty brown fur into a sunbeam. “Mono congos,” Juan whispers, the local name for golden-mantled howler monkeys; further above, more russet lumps yawn lazily. Their current peacefulness belies their self-appointed roles as jungle town criers — you can set your watch to their croaked, thundering shouts, with competing troops vociferously announcing their locations to the entire forest at dusk and dawn.  

They’re a key part of the Osa Peninsula’s unique soundscape — something science is doing its best to protect. I might have narrowly missed seeing a puma, but as I join the howlers in contemplative silence, my ears filled with the hum of the jungle’s endlessly rehearsed, yet still unpolished symphony, the moment feels exhilarating enough.  

Related Topics

• HABITAT PRESERVATION
• WILDLIFE CONSERVATION
• CLIMATE CHANGE

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• Section 1 - Perspectives : Why Guidelines Differ
• Section 1 - Improving the Quality of Travel Medicine Through Education & Training

Maps & Travel Medicine

Cdc yellow book 2024.

Author(s): Marielle (Ellie) Glynn, Jesse Blanton, R. Ryan Lash

For well over 50 years, the Centers for Disease Control and Prevention (CDC) has used maps to help communicate geographically nuanced information about travel-related disease risks and associated health and safety recommendations. The earliest editions of CDC Yellow Book, a slim pamphlet entitled Immunization Information for International Travel , included reprints of maps produced by the World Health Organization showing areas of risk for malaria ( Figure 1-01 ) and yellow fever ( Figure 1-02 ). Although the number and variety of maps in the CDC Yellow Book have grown over the past 11 editions, from 7 in 2000 to 58 in 2020 ( Figure 1-03 ), most still focus on identifying areas of risk for these same 2 diseases. Over time, as malaria prophylaxis and yellow fever vaccine recommendations for many destinations have become increasingly geographically specific, we have included additional country-specific reference maps in CDC Yellow Book (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ).

A well-designed map speaks for itself, even when depicting complex features of a disease. Public health maps must accurately reflect the subject matter expert’s judgment on best available evidence and clinical practices. CDC Yellow Book maps are subject to multiple constraints, including the spatial and temporal precision of reported disease surveillance data, variation in how data are reported, and the availability of corresponding environmental and demographic data. Decisions also must be made about whether including a map provides additional clarity. For some health risks, a table or textual description is adequate. When vaccination or prophylaxis recommendations apply to an entire country, for example, a map might be unnecessary. Conversely, when risk or recommendations vary based on geographic boundaries that are difficult to describe in words, maps can enhance risk communication, orienting the viewer more quickly and efficiently than a table or text.

Figure 1-01. Reprint of malaria map from Health Information for International Travel 1974 (CDC 1974)

View Larger Figure

For many years, CDC Yellow Book included World Health Organization global malaria maps, which generally followed the above design style. Small size and lack of labels made these maps difficult to interpret for specific travel itineraries.

Figure 1-02. Reprint of yellow fever endemic zones map from Health Information for International Travel 1977 (CDC 1977)

These World Health Organization maps highlight various ways that boundaries of vectorborne diseases (e.g., yellow fever) can be demarcated. Compare these maps to the most current yellow fever vaccine recommendations in this edition of CDC Yellow Book (see Section 5.2.26, Yellow Fever ).

Figure 1-03. Number of maps included in CDC Yellow Book (YB) print editions, 2000–2024 1,2

Over the past 11 editions, the number of CDC YB maps has increased by approximately 10-fold. Many new country-specific malaria and yellow fever risk maps aid in the interpretation of prophylaxis and vaccination recommendations.

1 YB2022 not published due to the coronavirus disease 2019 pandemic.

2 Created to supplement written information that appeared in the YB chapter, Yellow Fever Vaccine & Malaria Prevention Information, by Country, reference maps showed cities and provinces of selected countries. It was left to the reader to review these maps along with the written information in the chapter to determine where travelers could be at risk for yellow fever virus and/or malaria transmission. Starting in 2014, YB began replacing reference maps with disease-specific maps depicting risk areas for yellow fever virus and malaria transmission. The last reference map (China) appeared in YB2020.

In addition to providing vaccination and prophylaxis recommendations, other categories of CDC Yellow Book maps include destination maps, disease distribution maps, and risk maps. The destination maps in Section 10, Popular Itineraries , are included to provide information about the locations of national parks, game preserves, cities, and culturally significant gathering places. These maps serve as visual references to help clinicians understand their patients’ travel plans. Disease distribution maps found throughout Section 5, Travel-Associated Infections & Diseases , show the global or regional presence or burden of the diseases described. Disease mapping varies, however. In some cases, a disease prevalence map could be most useful to a clinician; in other instances, risk maps, depicting both disease distribution and other relevant factors (e.g., elevation or access to preventative measures) can help health care providers make specific recommendations. Diseases with complex geographic variation in both prevalence and preventative measures also might have corresponding prophylaxis recommendation maps.

All the static maps from the print edition of CDC Yellow Book are available on the Travelers’ Health website but advances in online mapping technology have created opportunities to deliver travel health information in novel ways. In March 2017, for example, CDC’s Travelers’ Health Branch launched a mapping application to aid in the communication of international Zika travel recommendations. This application allows users to search an interactive map; clicking on a destination opens a text box that provides travel health information for the specific location. CDC created a similar map for the coronavirus disease 2019 (COVID-19) pandemic. Efforts are under way to create interactive maps for the online version of CDC Yellow Book that will elucidate the geographic health risks associated with international travel, beyond malaria and yellow fever.

Bibliography

Center for Disease Control. Health information for international travel 1974: Supplement to the Morbidity and Mortality Weekly Report. MMWR Morb Mortal Wkly Rep. 1974;23(54):1–80.

Center for Disease Control. Health information for international travel 1977: Supplement to the Morbidity and Mortality Weekly Report. MMWR Morb Mortal Wkly Rep. 1977;26(55).

Centers for Disease Control and Prevention. CDC health information for international travel, 2008 edition. Arguin PM, Kozarsky PE, Reed C, editors. Atlanta: Elsevier Mosby; 2007.

Jentes ES, Poumerol G, Gershman MD, Hill DR, Lemarchand J, Lewis R, et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis. 2011;11(8):622–32. Jentes ES, Lash RR, Johansson MA, Sharp TM, Henry R, Brady OJ, et al. Evidence-based risk assessment and communication: a new global dengue-risk map for travelers and clinicians. J Travel Med. 2016;23(6):taw062.

Lash RR., Walker AT, Lee CV, LaRocque R, Rao SR. Ryan ET, et al. Enabling clinicians to easily find location-based travel health recommendations—is innovation needed? J Travel Med. 2018;25(1):tay035.

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