CDC’s Health Information for Travelers to GUATEMALA

Numero Uno health advice for Guatemala is not clearly visible when you first visit the CDC’s page. This is road safety. Motor vehicle accidents are the highest risk to personal safety when visiting anywhere in the developing world, where unmaintained roads, unmaintained vehicles, and unenforced traffic laws are the norm. Here’s the CDC advice on transportation:

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

In many places cars, buses, large trucks, rickshaws, bikes, people on foot, and even animals share the same lanes of traffic, increasing the risk for crashes.

When walking, be smart: · Use sidewalks and marked crosswalks. · Pay attention to the traffic around you, especially in crowded areas.

· Remember, people on foot do not always have the right of way in other countries.

When riding or driving:

· Choose a safe vehicle.

· Choose official taxis or public transportation, such as trains and buses.

· Ride only in cars that have seatbelts.

· Avoid overcrowded, overloaded, top-heavy buses and minivans.

· Avoid riding on motorcycles or motorbikes, especially motorbike taxis. (Many crashes are caused by inexperienced motorbike drivers.)

· Choose newer vehicles — they may have more safety features, such as airbags, and be more reliable.

· Choose larger vehicles, which may provide more protection in crashes.

Think about the driver.

· Do not drive after drinking alcohol or ride with someone who has been drinking.

· Consider hiring a licensed, trained driver familiar with the area.

· Arrange payment before departing.

Follow basic safety tips.

· Wear a seatbelt at all times.

· Sit in the back seat of cars and taxis.

· When on motorbikes or bicycles, always wear a helmet. (Bring a helmet from home, if needed.)

· Avoid driving at night; street lighting in certain parts of Guatemala may be poor.

· Do not use a cell phone or text while driving (illegal in many countries).

· Travel during daylight hours only, especially in rural areas.

· If you choose to drive a vehicle in Guatemala, learn the local traffic laws and have the proper paperwork.

· Get any driving permits and insurance you may need. Get an International Driving Permit (IDP). Carry the IDP and a US-issued driver’s license at all times.

· Check with your auto insurance policy’s international coverage, and get more coverage if needed. Make sure you have liability insurance.

Flying

· Avoid using local, unscheduled aircraft.

· If possible, fly on larger planes (more than 30 seats); larger airplanes are more likely to have regular safety inspections.

· Try to schedule flights during daylight hours and in good weather.

At the top of the CDC’s traveler’s page for Guatemala are outbreak alerts: Zika and chikungunya viruses are transmitted in Guatemala. CDC recommends that travelers to the Guatemala protect themselves from mosquito bites. How does one do this? Here is the CDC’s advice:

· Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.

· Use an appropriate insect repellent (see below).

· Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on skin.

· Stay and sleep in air-conditioned or screened rooms.

· Use a bed net if the area where you are sleeping is exposed to the outdoors.

What type of insect repellent should I use?

· FOR PROTECTION AGAINST TICKS AND MOSQUITOES: Use a repellent that contains 20% or more DEET for protection that lasts up to several hours.

More from CDC on Zika:

Zika outbreaks have been reported in Guatemala. Because of the risk of birth defects in babies born to women who were infected with Zika while pregnant, women who are pregnant should not travel to Guatemala.

Eat and drink safely: These rec.’s are extensive but summed up in the phrase “Boil it, Cook it, Peel it, or Forget it.” Nevertheless, studies have shown that 90% of travelers veer from the food safety recommendations within 48 hours in country!

Keep away from animals

Most animals avoid people, but they may attack if they feel threatened, are protecting their young or territory, or if they are injured or ill. Animal bites and scratches can lead to serious diseases such as rabies.

Follow these tips to protect yourself:

· Do not touch or feed any animals you do not know.

· Do not allow animals to lick open wounds, and do not get animal saliva in your eyes or mouth.

· Avoid rodents and their urine and feces.

· Traveling pets should be supervised closely and not allowed to come in contact with local animals.

· If you wake in a room with a bat, seek medical care immediately. Bat bites may be hard to see.

Avoid sharing body fluids

Diseases can be spread through body fluids, such as saliva, blood, vomit, and semen.

Protect yourself:

· Use latex condoms correctly.

· Do not inject drugs.

· Limit alcohol consumption. People take more risks when intoxicated.

· Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.

· If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Maintain personal security

Use the same common sense traveling overseas that you would at home, and always stay alert and aware of your surroundings.

Before you leave:

· Research your destination(s), including local laws, customs, and culture.

· Monitor travel warnings and tips from the US Department of State.

· Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.

· Pack as light as possible, and leave at home any item you could not replace.

While at your destination:

· Carry contact information for the nearest US embassy.

· Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.

· Follow all local laws and social customs.

· Do not wear expensive clothing or jewelry.

· Always keep hotel doors locked, and store valuables in secure areas.

· If possible, choose hotel rooms between the 2nd and 6th floors.

Vaccines and Medicines

Make sure you are up-to-date on routine vaccines before every trip. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot.

Hepatitis A: get vaccinated before you go unless you completed the 2-shot series in the past.

Hepatitis B: You have probably already been vaccinated for hepatitis B. If you haven’t previously done so, get your hepatitis B surface antibody tested to make sure the prior vaccines worked and are still effective.

Typhoid: Typhoid is a low risk for Guatemala. If you are a tourist and plan on following the above food and water precautions, you can probably forgo typhoid vaccine. If, however, you are visiting family and friends and/or plan to eat adventurously, you should be vaccinated for typhoid.

Malaria: Rural areas only at altitudes <1,500 m (4,921 ft) have malaria transmission in Guatemala. There is none in Antigua, Guatemala City, or Lake Atitlán. If you will be entering a malaria zone there, the best medicine to take is chloroquine. You only need a dose once a week, Sundays are easiest to remember. Start the Sunday before you leave and continue for 4 Sundays after you leave the malaria zone.

When you acquire malaria, it first infects your liver without symptoms. But malaria pills only kill the parasite in the blood. So, there is a slight chance that you will come down with malaria after you return. These late “relapse” cases never occur after 6 months, and they rare, but be on the lookout for this phenomenon.

Please see a previous Medium post for a handy travel checklist.

Have a safe trip!

Winkler G. Weinberg, MD

I have been an Infectious Disease physician for over 3 decades. I am the author of No Germs Allowed!. If you liked this article, check out the book on Amazon.