The Caribbean
Travel To The Caribbean
* Anguilla * Antigua and Barbuda * Aruba * The Bahamas * Barbados * Bermuda * Cayman Islands * Cuba * Dominica * Dominican Republic * Grenada * Guadeloupe * Haiti * Jamaica * Martinique (France) * Montserrat * Netherlands Antilles (Bonaire, Curacao, Saba, St Eustatius) * Puerto Rico (US) * St. Kitts and Nevis * St. Lucia * St. VIncent and the Grenadines * Trinidad and Tobago * Turks and Caicos * British Virgin Islands * US Virgin Islands
Access to clean water and levels of sanitation are highly variable in the region.
More common infections in travellers include gastrointestinal infections; dengue fever is reported during periods of epidemic activity.
Vector-borne infections: Malaria is endemic in Haiti and is found in focal areas in the Dominican Republic, including a recent cluster in 2004. Dengue epidemics have occurred on many of the islands. Most islands are infested with Aedes aegypti, so these places are at risk for introduction of dengue. Lymphatic filariasis is endemic in focal areas of the Dominican Republic and Haiti. Spotted fever due to Rickettsia africae has been acquired in Guadeloupe. Transmission of cutaneous leishmaniasis occurs in the Dominican Republic.
Food- and waterborne infections: Risk of diarrhoeal illness varies greatly by island. Risk of diarrhoea and hepatitis A is high, especially on the island of Hispaniola, where an outbreak of typhoid fever occurred in 2003. An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis occurred in travellers to Jamaica. Intestinal helminths are common in local populations on some islands but are rare in short-term travellers.
Airborne and person-to-person transmission: The annual incidence of tuberculosis is estimated to exceed 300 per 100,000 population in Haiti. The rates are substantially lower on other islands.
Sexually transmitted and blood-borne infections: The prevalence of HIV infection in adults is estimated to be 2.3% in region. The highest prevalence of HIV infection is found in Haiti. The prevalence of chronic infection with hepatitis B is moderate (2%-7%) in Haiti and Dominican Republic but <2% on most of the islands. The prevalence of HTLV-I is 2%-4% on some of the islands.
Zoonotic infections: Anthrax* is hyperendemic in Haiti but has not been reported on most of the other islands.
Soil- and water-associated infections: Cutaneous larva migrans is a risk for travellers with exposures on beaches. Endemic foci of histoplasmosis are found on many islands, and outbreaks have occurred in travellers. Leptospirosis* is common in many areas and poses a risk to travellers engaged in recreational freshwater activities. Foci of schistosomiasis have been active in the past in the Dominican Republic, Puerto Rico, and other islands, but pose little risk to travellers.
Other hazards for travellers include ciguatera poisoning, which results from eating toxin-containing reef fish; outbreaks have occurred on many islands. Injury from motor vehicle accidents (including from motorized scooters) is a risk for travellers. Screening of blood before transfusion is inadequate in hospitals on many islands.
