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Travel Health
To prepare this page we consulted with Pan American Health Organization consultant, immunologist Amiro Pérez Mera, British-trained gastroenterologist Alberto Santana, French-trained pediatrician Felipe Perdomo and U.S.-trained pathologist Dr. Yazmin Redondo, and documents produced by the World Health Organization and the US Government Center for Disease Control. 

We consulted with a panel of physicians to ensure that our advice was as thorough as possible, responding to questions asked on the DR1 Message Board. Note that these answers are provided as general guidelines for the traveler to discuss with their individual physician or reach their own conclusions. They are in no way absolute and should not be construed to apply to all travelers. 

Things to remember:

  • Bring lots of sunscreen/sun block with a high sun protection factor, or SPF. Dab it on all over, especially shoulders, noses and the tops of your feet, several times a day.
  • No vaccinations required to visit DR.
  • Do not overindulge in food and drink.
  • Drink lots of bottled water or other nonalcoholic liquids.
  • If you get diarrhea, let it pass. If it gets serious, see the resort doctor.

Click here to download a Microsoft Word Version 6.0 of this page.
Take a printout on vacation, you never know!

The Sun:

Preventing Stomach Upsets:

Vaccinations:

Other illnesses and health hazards:

Misc health questions:


The Sun:

Recommendations for taking sun?
Sun-related problems are the principal cause of tourist visits to resort doctor's offices in the Dominican Republic. It is the most common health hazard affecting travelers to the Caribbean.

The Caribbean sun is very strong, and you can burn even on a cloudy day. Don’t forget there is reflective light even in the shade. The sun is strongest from 10 am to 4 pm.

Note that lips and scalp can burn just like the skin on the body, therefore an SPF 15 or higher is recommended for everyone. Prefer a waterproof sunscreen as you will be most probably doing a lot of sweating or swimming. Ditto, use sunscreen on the upper part of your foot, which can easily burn, too.

For more complete sun protection, purchase a product that blocks both UVB and UVA. The only ingredients that will protect the skin are: titanium dioxide, zinc oxide, or avobenzone.

If you forget to bring your own, many leading world brands are available locally. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen or sun block lotions.

Children if outside from 10 to 4 pm should wear dark-colored t-shirts and hats, when possible, and sunscreen or sun block should be applied several times a day. Apply sunscreen regardless of the child using a t-shirt.

Babies under six months old should spend very little time in the sun. If they are out in the sun, they should wear protective clothing, including a hat with a brim that shades their face. For babies over six months and children, remember to apply sun screen half an hour before they go outside and reapply every two to three hours when they are in the sun or water, even if the label says the product is waterproof.

The blazing tropical sun should not be taken lightly. Sunstroke or heat stroke is a serious medical condition. It begins with a headache, dizziness and fatigue but can quickly lead to convulsions and unconsciousness or even to death.


Preventing Stomach Upsets:

What is traveler's diarrhea? What are the symptoms?
World Health Organization stats show that diarrhea affects an estimated 20-50% of all travelers, regardless of where they are traveling. While a mild case of stomach upset will last half a day, others can last two to seven days. The typical symptoms of the more severe traveler's diarrhea are diarrhea, nausea, bloating, urgency and malaise. It is rarely life threatening.

When should I see a doctor if I suspect traveler's diarrhea?
Antibacterial drugs are generally unnecessary in simple gastro-enteritis, even when a bacterial cause is suspected, because the complaint will usually resolve quickly without such treatment. Most problems are temporary and should pass after a day.
It is best to let the toxins flow from your body. But again, if necessary for sightseeing or travel, if suffering from moderately loose or frequent stools an antimotility drug can be used, such as Imodium, preferably over Bismuth subsalicylate preparations, such as Pepto Bismol. Do not use for more than 48 hours. If the diarrhea is violent or lasts longer than 36 hours, visit the on-site doctor. If diarrhea is accompanied by high fever, avoid taking anti-motility drugs. Most resorts and out-of-city hotels have on-site doctors that are experienced in treating traveler's diarrhea.

Should I bring Pepto Bismol, Lomotil, Imodium or any antibiotics?
This is unnecessary as they are readily available at hotel shops, pharmacies and hotel doctor offices.

If you do become ill with traveler's diarrhea, it is usually self-limited and treatment requires only simple replacement of fluids and salts lost in diarrhea stools. None of the above-mentioned preparations should be taken if the tourist has access to a toilet. During an attack, stop food intake only if vomiting has occurred; drink plenty of fluids (bottled water with minerals, soft drinks, clear soup); avoid fizzy drinks, tea or coffee; and return to a normal diet as quickly as possible, avoiding large amounts of milk or fats. Fresh bananas are recommended for the lost potassium, even if they go through you quick.

Consulted physicians only recommended taking Imodium and only if one cannot change scheduling of an excursion or travel plans. Note that Pepto Bismol, Lomotil nor Imodium will have an effect on the duration of the diarrhea.

What should I do if the diarrhea persists, is violent or there is blood in my stools?
If the diarrhea lasts more than two days or there is blood in your stools, see a doctor. Do not take penicillin or sulfa drugs on your own, as you may be at great risk for an allergic reaction. Studies have shown that the use of antibiotics may shorten the length of illness.

Frequently prescribed antibiotics are doxycycline, trimethoprim/sulfamethoxazole (Bactrim, Septra) or fluroquinolones (ciproflaxacin and norfloxacin). Erythromycin-type antibiotics are prescribed for those under 16 and those allergic to sulfa.

All said, it is better to have an on-site doctor prescribe the antibiotics and not use them beforehand. It is difficult to recommend an effective antibiotic without knowing the type and nature of the likely causative agents in the area to be visited. The on-site physician can also prescribe these and they can be purchased in the DR if necessary. The on-site physician will most likely have these available at the resort dispensary or they will be sold at the hotel store.

Do the same medicine recommendations apply if my child gets diarrhea?
Imodium is not recommended for young children. Erythromycin-type antibiotics may be prescribed for those under 16 and those allergic to sulfa. First line treatment is treatment of fluid and electrolyte depletion, with an increase in fluids with minerals or a commercial preparation such as Pedialyte.

What should I know to avoid getting traveler's diarrhea?
By drinking more water than you would at home, exercising moderation in alcoholic beverages and food, exercising moderation in sun-taking, and watching what you eat you can reduce the possibilities of being affected.

Furthermore, visitors to the DR can reduce the likelihood of getting sick by being aware of the simple matters that will be explained here.

One of the major problems is that people visit the DR with a prejudice against the water, so they end up drinking less water and this aggravates the problem. Most visitors find themselves in a hotter climate than what they are accustomed to and will dehydrate without even knowing it, especially if consuming alcoholic beverages. Contrary to myth, you become quickly de-hydrated even when consuming large amounts of these drinks; the ethyl alcohol prevents proper absorption of electrolytes to needed cellular bodies. To make things worse, one of the most popular beverages among tourists, the piña colada, has laxative properties.

You should be inflexible about consuming at least 10 glasses of water/non-alcoholic beverages a day. Carbonated soft drinks, soups, bottled water, UHT milk containers or fruit juice from reputable brands in containers that you open yourself, or even fruit juices that you prepare yourself are not subject to any contamination.

You can check whether you are getting dehydrated by noticing if you go more than two to three hours without having to urinate, and whether your urine is dark yellow.

Parents should be especially vigilant of their children that are likely to be even more out in the sun than the adults. Note that even when swimming in the sea/ocean you are losing body heat and can become dehydrated. Thus, by keeping an adequate consumption of liquids, your body will be in better condition to resist microbes to which your body is not immune.

Adequately hydrated persons are less likely to get seriously sick and will recover faster.

In the Dominican Republic, a frequent cause of mild stomach upset is over-indulgence in food as a result of taking advantage of the all-inclusive program. Food poisoning can also occur if there has been improper handling of food or drink by kitchen or serving personnel. By consuming cooked meals, food that have been recently cooked, or which has been handled by trained personnel, tourists can reduce the possibility of contamination. When possible eat food that is cooked right in front of you, or that comes freshly cooked from the restaurant's kitchen.

Note also that international travellers are subjected to various forms of stress inherent to the actual process of arriving and departing from a destination that may reduce their resistance to disease: crowding, long hours of waiting, disruption of eating habits, changes in climate and time zone. These factors may in themselves provoke nausea, indigestion, extreme fatigue, and insomnia.

Are there medicines or vaccines that can be taken beforehand to avoid being affected by diarrhea?
Note that there is no vaccine against "turista", some people are just more immune then others. Thus, two people could eat and drink the same things and only one get sick.

The World Health Organization says that prophylaxis of traveller's diarrhea with bismuth subsalicylate (Pepto Bismol) is impractical; it is difficult to recommend an effective antibiotic for prophylaxis without knowing the type and nature of the likely causative agents in the areas to be visited. Moreover, the World Health Organization is against the prophylactic use of antibiotics. This can lead to the development of drug resistance in the agents of diseases and these drugs are not without side-effects (including diarrhea).

What special precautions should those who are suspect of having sensitive stomachs take?
Persons most likely to get ill are persons who have rarely traveled outside their home area and thus have not been exposed to different microbes or even unknown allergens. These persons should take special care to maintain adequate levels of hydration, reduce the amount of sun taken and follow all recommendations given on this web page.

What foods should we avoid?
The US government travel health online service recommends not eating dairy products suspect of being unpasteurized and to eat fruit that you can peel yourself.

If the hotel has adequate kitchen handling techniques, there should not be a problem with eating salads and uncooked vegetables. If you suspect you have a sensitive stomach try a little and test yourself. Most cheese in the DR is imported or manufactured by large companies, such as Rica, and thus has been adequately pasteurized. Prefer food that is served hot. Whenever possible, eat fruit you have peeled yourself.

I like my meat medium-rare. Can I eat this meat? What about raw fish and seafood?
Yes. The process of cooking the outside of the meat should kill any contamination which will be on the outside not the inside of the meat. What is not recommended is to eat raw foods such as tartar steak. You should avoid raw meats and seafood (oysters), with the exception of "ceviche" which is fish that has been marinated (cured) in lemon/lime juice. Even if you have a hardy stomach, take the risk of eating fish and meat carpaccio only in restaurants with an excellent reputation.

Special recommendations for babies and children? Is there pasteurized milk available? 
Can I feed my baby the fruit? How safe are the dairy products served at resorts?

Pasteurized milk is available in UHT packaging in food stores. The leading brands are Parmalat, Nestlé and Rica. Companies that have high standards in fruit juices are Bon and Rica. Crystal, Santa Clara, Atlanta and Agua Orbis are leading bottled water brands readily available. Whenever possible, prefer bottled water which retains its minerals. Avoid water subject to the osmosis process.

Children tend to dehydrate faster than adults because they will spend more time outside and are usually more active. They are also less likely to be aware of the need to intake water. Parents should be especially vigilant that their children ingest at least 10 glasses of liquid a day. This can include soft drinks and juices.

I have been recommended to only drink bottled water, ice cubes made by machines, and to brush my teeth with bottled water. Why does the water have an effect on tourists and not the locals? Is food cooked in local water safe to eat? Can I drink coffee or tea? What about carbonated beverages?
With the exception of a very few hotels, tap water is not potable in the DR. Thus the recommendation to consume bottled water. Note, though, that this same water warning is given by tour operators nearly everywhere, regardless of the destination. The reason, according to doctors and other health experts, is that most of the time travellers to major cities and resorts get a reaction to unknown microbes in tap water and/or unknown allergens. So the bottled water warning is just a sensible precaution. Note it is very important to drink at least 10 glasses of water a day when visiting to not become dehydrated and to not lower your immune capacity against alien microbes. Whenever possible prefer water that is labeled as containing minerals, and not purified with an osmosis process.

The tap water does not affect the locals or foreign residents because their bodies are immune to the microbes found in the water. Even so, because tap water in the DR is not potable, residents are recommended to boil the water or buy bottled water for drinking. Most residents brush their teeth with tap water as they have already built up the needed immunity.

Food cooked in local water is safe to eat as boiling kills the bacteria. Coffee and tea are fine as they are made with boiling water. Carbonated beverages also are microbe free, because the process acts against bacteria.

What measures do Dominican hotels take to avoid food poisoning?
The Ministry of Public Health and the National Hotel & Restaurant Association (Asonahores) have worked together to raise food handling levels at Dominican hotels throughout the country. The Ministry of Tourism, in coordination with Asonahores and the World Tourism Organization, sponsors intensive courses on safe food handling in the tourism sector, to instruct hotel establishments to incorporate the Hazard Analysis Critical Control Point System (HACCP). A recent course was given at the PUCMM university in April 1999.
Likewise, most hotels working with the English market have signed on for the services of the Cristal Americas food hygiene systems. This has resulted in the ban on recycling of buffet food that in the past caused food contamination, as well as the implementing of high standards in food hygiene and handling.

Dominican hoteliers participate in extensive programs sponsored by international companies to maintain high levels of hygiene among kitchen and serving personnel. Most major hotels have water filter systems, but recommend their guests use bottled water as an extra precaution. Sick guests represent losses for the hotel as the level of satisfaction declines and hotels get bad reports from the tour operators that send the guests. So guests' health is logically a major concern for all.


Vaccinations:

What vaccinations should I get?
No particular immunization is required by law for traveling to the DR. You may decide to get the vaccinations based on the traveler's medical history, proposed itinerary, duration of stay and purpose for traveling.

If you haven’t been immunized since childhood, consider bolstering you tetanus vaccination. You should also be immunized against (or immune to) measles, mumps, rubella and chicken pox. US national health organizations recommend a diphtheria/tetanus booster (TD booster) every ten years as part of routine medical care, regardless of where you live or travel. Elderly people are more at risk as they may not have been immunized with the vaccinations during childhood, may not have completed the full course of immunization nor had boosters. Boosters are especially recommended if you will be camping, gardening or visiting rural communities.

In case of an acute injury or wound of more than 1 cm that may have been contaminated, the doctor may decide to treat it with TD booster or human tetanus immune globulin in the worse case scenario. Other medics may suggest antibiotic therapy (penicillin, metronidazole or erythromycin) to eradicate vegetative cells, the source of the toxin. If the wound is clean, and the patient has received 3 or more doses of the vaccine, none of these treatments will be necessary. If the child is younger than seven, DPT may be administered instead of TD.

For adventurous tourists that will stay for more than three weeks, will be taking excursions off the beaten track, that will be traveling beyond resort or tourist areas and eating at small cafes or visiting rural areas, in addition, look into getting a Twin Rix vaccine, which will immunize you against both Hepatitis A and B. Several persons are already immune, so a test should be done. Consulted physicians are contrary to the application of immune globulin before travel. There is a risk of contracting HIV, and the vaccine coverage is only of short term duration. If you will be residing in the DR for more than six months, you should also consider getting the Twin Rix vaccine. Dominican children are immunized with the Hepatitis B vaccine from early childhood.

Should I take malaria tablets or shots? I have told there can be side effects? Is the gain worth the risk?
The World Health Organization lists the Dominican Republic as a low malaria risk-exclusively in the malignant (P.falciparum) form-exists throughout the year especially in rural areas of the western provinces that border with Haiti such as Monte Cristi, Dajabón and Elías Piña. The WHO states that there is no evidence of P.falciparum resistance to any antimalarial drug, and thus malaria tablets/shots are not recommended. Note that most Dominican resorts are a 6+ hour drive from the frontier with Haiti.

The gain is not worth the risk of taking the medicine. In the very unlikely case you fall ill with malaria, the adequate dose of Chloroquine (common trade names: Aralen, Avloclor, Nivaquine, Resochin) will release the sickness in 24-72 hours, thus prophylaxis is not recommended.


Other illnesses and health hazards:

What is ciguatera and what is the likelihood of getting it? If I catch it, any recommendations? How frequently do tourists catch it?
Ciguatera affects few tourists at Dominican resorts because since their guests demand lots of fish they purchase these directly from offshore trawlers that fish in deep waters far from reefs. Fish caught offshores in the deep oceans rarely get poisonous, and most resorts buy their fish from offshore trawlers, as do the supermarkets.
Very briefly it is a serious illness caused by eating coral reef fish that have accumulated a high level of antural toxins through their diet. Over 500 different types of fish can get poisonous from ingesting certain dinoflagelates on the reefs, such as amberjack, barracuda, grouper, mackerel, moray eels, mullet, parrot fish, red snapper, sea bass and surgeon fish. The most risky are larger carnivorous fish that live near coral reefs. There is no way to identify such fish from non-poisonous ones, and the poison (tetradotoxin) is not destroyed by any cooking process. To reduce the risk, prefer the smaller, younger fish, and don't eat the heads or internal organs, which retain more toxins. Ciguaterra exists in the South Pacific (Hawaii), coastal areas of California, Florida and the US Gulf Coast.
Symptoms include vomiting, diarrhea, tingling of the extremities, and a reversal of sensations, cold feels hot & vice versa. Cases can range from very mild to serious. If you get any of these symptoms after eating fish it is advisable to contact a doctor immediately. The mortality rate of this illness is below 1%, though, with most tragically-ending cases going untreated. There is no certain antidote, but Mannitol is often injected as a first step.

What is dengue, the symptoms and is it prevalent among tourists?
Dengue is not known to affect tourists as the conditions under which it occurs are not those of tourist areas — such as open fresh water bins.Dengue (deng'ee) fever, caused by a mosquito-borne flavivirus, is found in tropical and subtropical regions of the Americas, Africa, Asia and Australia. In its acute form, dengue is characterized by flu-like symptoms including severe pain in the head, eyes, muscles and joints. Some patients, particularly infants and children, develop "dengue hemorrhagic fever", a severe and sometimes fatal variation involving circulatory failure and shock. The incidence of both forms of dengue infection has recently been increasing, as expanding urbanization enlarges the regions inhabited by the Aedes mosquito vector. Mosquitoes capable of transmitting this disease are also found within the United States.
Dengue fever is more prevalent when it has been raining constantly.
Victims typically experience a sudden high fever, headache and intense body pain about 5-8 days after being bitten by an infected mosquito. A measles-like rash near day 3 of the fever can help distinguish dengue from other tropical illnesses.
The acute illness usually concludes on its own after about a week, but fatigue and depression can last for weeks or months in some cases.
There is no vaccine against dengue. The best protection is to use repellents. While most mosquitos bite between dusk and dawn, Aedes mosquitos are most active during the day, especially in the early morning and late afternoon. They usually breed in urban areas in man-made containers filled with relatively clean water. The Dominican government carries out major public health campaigns to make people aware of the dangers of storaging uncovered water.

Misc health questions:

What is swimmer's ear?
Swimmer's ear (also known as external otitis) is very common among tourists. It occurs due to an excess in the time spent in the water (sea or pool). It is caused when warm water remains deposited in the ear canal and bacteria grows. It can be very painful. Preventive measures are ear plugs, rubbing alcohol (a few drops) into the ears after swimming (or at the end of the day), or by using "Agua-Sec" ear drops that are sold over the counter. If you are affected, the doctor will prescribe ear drops for a few days. If the infection includes the ear drum and doesn't subside in a few days, oral antibiotics may be needed.

How can I avoid being stung by a sea creature?
The most important rule of safe bathing in the sea is "Look but don't touch!"
If you step on a sea urchin, the spines should be removed with a fine sterile needle. Otherwise, leave them alone and they will gradually come out.

If you come in contact with a jelly fish, rinse with sea water, then apply vinegar. Some patients may need to take an antihistamine or apply cortisone cream.

Although very rare, if you are stung by a sting ray, the dart can be very painful because of the toxin that is injected. It is important to avoid contamination with sources of animal feces, clean your foot well, and put it in very hot water for a minimum of 30 minutes. The foot might need sutures, antibiotics. Avoid stepping on dirt, which might make tetanus prophylaxis necessary.

What about coral?
Contact with live coral reefs should be avoided since you can get a skin irritation or allergy. If contact occurs, a physician may recommend an antibiotic and anti-allergy cream be administered. Coral reef scarpes that are kept clean do not need to be treated for tetanus because the organism is not water-borne.

What if I am stung by a bee or a wasp?
If you know you are sensitive (allergic) to insect stings, carry a kit called Epi-pen (epinephrine injection) to be applied right after the puncture. Otherwise, if you are stung seek help if your skin swells significantly or if you are short of breath. 

Note that there are no lethal venomous animals in the DR.

Why do mosquitos bite humans?
Only female mosquitoes bite humans, because they need blood to develop fertile eggs. They require a "blood meal" for each of their many batches of eggs, but like their male counterparts, they rely on nectar as their main food source. The female mosquito tracks her human targets by following the carbon dioxide we exhale. When the female mosquito bites a human, she injects saliva into our skin before drawing blood. The saliva makes penetration easier for her, and it also serves to prevent blood clots from developing in her food canal.

The welts and itch that we experience after a being bitten by a mosquito are actually an allergic reaction to her saliva.

What can I do to avoid mosquito bites?
Mosquitos are not a major problem at resort hotels because the hotels fumigate regularly. Note, though that some people are more prone to be bitten then others. You may consider using Coppertone's Sun and Bug Lotion, especially if you will be taking excursions off the resort. What is important to note is to use a mosquito repellent that contains DEET. If you will be entering an area with many mosquitos, apply this lotion to your skin and clothing. Exercise caution when using repellents on children. The American Academy of Pediatrics recommends choosing a repellent made for children — containing no more than 10 percent DEET — and applying it to their clothing rather than skin when possible.

Can I get my prescription drugs in the DR?
Most prescriptions can be filled in the DR. If the brand name is not available, a substitute can be found. It is recommended, though to bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary so that valuable vacation time not be lost shopping for these.

Where should one go for the best medical treatment in the DR?
Most hotels have doctors on call or on site. Larger hotels have small dispensaries on site. The best medical care in the DR is available in the capital city, Santo Domingo.

If you are in need of visiting an emergency room:

Santo Domingo
Hospiten Santo Domingo. Alma Mater corner Bolivar. 809 541-3000.
Centro de Medicina Avanzada Abel González. Av. Abraham Lincoln.
Clínica Abreu. Calle Beller 42, esq. Independencia. Tel. 688-4411.
Corazones Unidos. Av. Fantino Falco 21, Naco. Tel. 567-4421

La Romana (Southeast)
Central Romana medical center. Tel. 523-3333
Centro Medico Dr. Canela. Av. Libertad 44, La Romana. Tel. 556-3135

Punta Cana/Bávaro
Clínica Perozo (Higüey). Calle Juan XXIII No. 157. Tel. 554-2893
Hospiten Bavaro. Carretera Higuey, Punta Cana (500 meters from the Cruce de Veron). Tel. 809 686-1414.

North Coast
Clínica Dr. Bournigal (Puerto Plata city). Calle Antera Mota. Tel. 320-0246
Policlínica Bahía Príncipe (Río San Juan-Playa Grande). Pueblito Bahía Príncipe. Tel. 226-1590

Are there reliable air or ground ambulance services available?
Movimed offers ambulance services in Santo Domingo and Santiago, the two larger cities.
Air ambulance services can be contracted to fly into the principal Dominican airports. 
Two companies are SOS at 530-4646 or Movimed at 1-200-0911.

Any web sites for further travel health information?

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