1. Limon Province:
There is a low risk of malaria. Advise mosquito bite avoidance.
2. Rest of the country:
There is a very low risk of malaria. Advise mosquito bite avoidance.
Special risk groups
In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [>70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).
Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.
Travellers should be up to date with routinely recommended vaccinations according to the routine UK immunisation programme.
Vaccination could be considered for travellers whose activities put them at increased risk, including those visiting friends and relatives, and frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor.
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.
International Certificate of Vaccination or Prophylaxis (ICVP) required if arriving from a country with a risk of yellow fever transmission (with the addition of Eritrea, Sao Tome and Principe, Somalia, Tanzania and Zambia, and with the exception of Argentina, Guyana, Panama, Paraguay and Suriname).
- applies to travellers from 9 months of age.
If a receiving country requires an ICVP as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption can be considered.
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.