Mexico and Central America
Travel To Mexico and Central America
* Belize * Costa Rica * El Salvador * Guatemala * Honduras * Mexico * Nicaragua * Panama
Vector-borne infections have focal distributions, and some are seasonal. Access to clean water and sanitary disposal of waste remain limited in many areas, so infections related to faecal contamination of food and water remain common. Levels of vaccine coverage are generally good and improving.
More common infections in travellers to the area include gastrointestinal infections, dengue fever, and myiasis. The risk of malaria is low in most countries; more than half of the cases of malaria in travellers to this region are caused by P. vivax. Chronic or latent infections with late sequelae in immigrants (and long-term residents) include cysticercosis, tuberculosis, Chagas disease, leishmaniasis, and strongyloidiasis.
Vector-borne infections: Malaria is present in focal areas of all these countries; it remains sensitive to chloroquine in all areas except for parts of Panama. Risk for travellers is low in most areas. Dengue epidemics have affected most of these countries in the past 5 years. Other vector-borne infections include rickettsial infections (spotted fever and murine typhus) and relapsing fever (tick borne). Foci of active transmission of leishmaniasis (predominantly cutaneous) are present in all countries. West Nile virus has now been found in Mexico and may spread in Central America. Localized foci of transmission of Chagas disease exist in rural areas. Risk to the usual traveller is low. Onchocerciasis is endemic in focal areas of Mexico and Guatemala; eradication efforts are in progress. Myiasis (primarily botfly) is endemic in Central America.
Food- and water-borne infections: Diarrhoea in travellers is common and may be caused by bacteria, viruses, and parasites. Diarrhoea caused by enterotoxigenic E. coli predominates, but other bacteria and protozoa (including Giardia, Cryptosporidia, and Entamoeba histolytica) cause diarrhoea. Risk of hepatitis A is high in many areas; epidemics of hepatitis E have occurred in Mexico. Other infections include brucellosis, typhoid fever, and amebic liver abscess. Nicaragua and Guatemala reported cholera in 2002-2003; however, risk for travellers is low. Gnathostomiasis has increased in Mexico, with many cases being reported from the Acapulco area; infection has been reported in travellers. Intestinal helminth infections are common in some local populations but are rare in visitors to the area. Central nervous system cysticercosis is a common cause of seizures in local residents.
Airborne and person-to-person transmission: The estimated annual incidence rate of tuberculosis per 100,000 population is 10-50 in most of the area, but 50-100 in Guatemala, Nicaragua, and Honduras.
Sexually transmitted and blood-borne infections: The estimated prevalence of HIV in adults is 0.1%-1%.
Zoonotic infections: Rabies is found throughout the region. Anthrax* is enzootic throughout the region and can infect humans; this disease is most common in El Salvador, Guatemala, Honduras, and Nicaragua. Cases of hantavirus pulmonary syndrome have been reported from Panama.
Soil- and water-associated infections: Outbreaks of leptospirosis have occurred in travellers to the area (including whitewater rafters in Costa Rica and U.S. troops training in Panama); haemorrhagic pulmonary leptospirosis* has occurred in Nicaragua. Sporadic cases and outbreaks of coccidioidomycosis and histoplasmosis have occurred in travellers to area. Risky activities include disturbing soil and entering caves and abandoned mines. Paracoccidioidomycosis is endemic in parts of Mexico and Central America. Hookworm infections are common in some local populations but rare in travellers. Cutaneous larva migrans occurs in visitors, especially those visiting beaches.
Other risks for travellers include scorpion and snake bites and motor vehicle accidents. Screening of blood before transfusion is inadequate in many hospitals.
