Immunizations
Required Vaccinations
No vaccinations are required to enter this country.
Recommended Vaccinations
Routine Immunizations
Your trip is a good occasion for a reminder to keep your routine immunizations updated; more than 80% of adults in developed countries have not maintained their immunization status. The following vaccinations are recommended for your protection and to prevent the spread of infectious diseases.
Tetanus-Diphtheria, Poliomyelitis, Measles, Mumps, Rubella should be reviewed and updated if necessary.
Seasonal influenza vaccine is recommended for children, persons over the age of 50, and those of any age suffering from chronic heart disease, emphysema, asthma, renal disorders, immuno-suppressive disorders, and organ transplant recipients. Note: Flu seasonal patterns are opposite in the southern and northern hemispheres. If the flu vaccine is not available at the time of departure, contact your doctor or travel health clinic regarding influenza anti-viral protection.
Pneumococcal vaccine is recommended for persons over the age of 65 and persons of any age suffering from cardiovascular disease, diabetes, renal disorders, liver diseases, sickle cell disease, asplenia, or immuno-suppressive disorders.
Hepatitis A
The Hepatitis A virus is primarily transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Prevention includes good personal hygiene, ensuring safe water supply, eating well cooked foods, and peeling your own fruits.
Vaccination is recommended for all travellers over one year of age. The vaccine is often combined with Hepatitis B and affords excellent long-term protection for both viral diseases.
Typhoid Fever
This intestinal infection, caused by Salmonella typhi bacteria, is transmitted from person to person primarily through ingestion of contaminated food and water in areas with poor sanitary and hygienic conditions. Prevention includes good personal hygiene such as washing your hands frequently, ensuring safe water supply, eating well cooked foods, and peeling your own fruits. Vaccination is also recommended for travellers' protection.
Vaccination is highly recommended for persons going outside the areas usually visited by tourists such as travelling extensively in the interior of the country (trekkers, hikers) and for persons on long-term working assignments in remote areas.
Selective Vaccinations
Hepatitis B
The Hepatitis B virus is transmitted through infected blood products, sexual intercourse, or infected items such as needles or razor blades, and may cause severe liver damage.
Vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or for those working in close contact with the local population (teachers, aid workers, missionaries), or persons foreseeing sexual relations with locals. This vaccine is often combined with the Hepatitis A vaccine and affords excellent long-term protection for both viral diseases.
The recommendations for vaccinations outlined above are intended as guidelines only. Your immunization needs depend on your health status, previous immunizations received, and your travel itinerary. Seek further advice from your doctor or travel health clinic.
Disease Risks
MALARIA
Infection is spread by the night-time - dusk to dawn - biting female Anopheles mosquito.
Malaria risk is absent in most of the country; risk exists only in specified areas:
Along the border with Haiti in urban and rural areas of the entire province of Monte Cristi; entire province of Dajabón; province of Elias Piña - municipalities of Bánica, Comendador and El Llano; province of Independencia - municipality of Jimaní; province of Barahona - municipalities of Barahona and Cabral; province of Pedernales - municipality of Pedernales.
Malaria cases have been reported from all parts of the country, including resort areas. An anti-malarial regimen of chloroquine is advised for travellers to the above described border areas with Haiti or when travelling in rural areas throughout the country. Recent outbreaks occurred in resorts in the province of Altagracia (Punta Cana, Bavero), and travellers are advised to follow an anti-malarial regimen.
Note: If you are vacationing in resort areas (Puerta Plata, San Pedro de Macoris, etc.), take meticulous anti-mosquito measures from dusk to dawn.
Malaria risk is present below the altitude of: 400 meters
High risk months for Malaria are: January - December
Malaria transmission vector(s): A. albimanus
Incidence of Plasmodium falciparum Malaria: 100%
Of the four species of human malaria parasites, Plasmodium falciparum is the most dangerous. The remaining percentage represents vivax group infections (benign forms of malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.)
Suppressive Medication Guide:
For details on anti-malarial drug side-effects, dosages for children and pregnant women, medications used around the world, and comprehensive protection measures, see: How to Protect Yourself Against Malaria (pdf)
SCHISTOSOMIASIS
Infection is transmitted by snails living in fresh water such as lakes, rivers, streams and ponds in the Caribbean, South America, Africa, and Southeast Asia.
Schistosomiasis risk is present absent from most of the country, risk exists only in restricted areas:
Risk is present throughout the country with the highest infection rates reported from the eastern interior regions in the provinces of Hato Mayor, El Seibo, and Altagracia (in the area of Higüey).
There is a risk of Schistosomiasis caused by: Schistosoma mansoni
The main intermediate host snail is: Biomphalaria glabrata.
Prevention Guidelines:
OTHER DISEASES OF INTEREST TO TRAVELLERS
Ciguatera Fish Poisoning
Ciguatera poisoning is caused by eating fish that has been contaminated by a dinoflagellate-produced toxin. Large fish become contaminated with the toxin when they eat reef fish that feed on these small organisms. Ciguatera is the most commonly reported marine seafood toxin poisoning. Any reef fish can cause ciguatera poisoning, but species such as barracuda, moray eel, grouper, red snapper, amberjack, parrotfish, sturgeon, ulua, and sea bass are the most commonly involved. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given area will be toxic.
Travellers need to be aware of the areas where the toxin exists and of the local fish that have been associated with the toxin. Outbreaks are seasonal but can also occur after major storms. Ciguatoxin does not affect the taste or smell of fish. It cannot be destroyed by cooking, smoking, freezing or any other method of food preparation. Large fish (over 6 lbs or 13.2 kg) are more likely to contain ciguatoxin. It is recommended not to eat large reef fish, as well as not eating fish liver, intestines, heads, and roe, where the toxin is concentrated.
For more information, see Centers for Disease Control and Prevention.
Cutaneous Larva Migrans
Cutaneous larva migrans (known as creeping eruption, caused by dog and cat hookworms) is contracted from walking barefoot on moist sandy beaches contaminated by animal feces containing hookworm larvae. Wear shoes or sandals. At the beach, always sit on a towel (washed after each use) and wash with soap and water after each barefoot walk.
Dengue Fever
Dengue is transmitted via the bite of an infected Aëdes aegypti mosquito. Aëdes aegypti mosquitoes feed predominantly in the daytime. Symptoms consist of sudden onset of fever, headache, muscle aches, and rash. Dengue hemorrhagic fever may occur particularly after a second infection with a different strain. Travellers at risk should take measures to prevent mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
Dengue fever is endemic in the Dominican Republic and outbreaks occur annually. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in the Caribbean and is the most common cause of fever in travellers returned from this region.
To date [20 April 2010] there have been nearly 2000 cases of dengue fever registered, and of that number 291 were the more extreme, hemorrhagic form of the illness, which caused the death of at least 14 people. [ProMED-mail. Dengue/DHF update 2010 (20). ProMED-mail 2010; 26 April: 20100426.1347. <www.promedmail.org>. Accessed 28 April 2010.]
Dengue cases have increased in the provinces of Duarte, San Cristobal, and Peravia. Other provinces under surveillance are Santiago, San Jose de Ocoa, and Santo Domingo. Up to the week ending 11 July 2010, the Dominican Republic has had 4591 cases of dengue fever, of which 536 are DHF. [ProMED-mail. Dengue/DHF update 2010 (33). ProMED-mail 2010; 13 July: 20100713.2342. <www.promedmail.org>. Accessed 15 July 2010.]
According to figures provided by the Health Ministry, at the beginning of the month [July 2010] the number of fatalities caused by dengue nationwide was 22, with a total of 4098 cases of dengue confirmed. [Dengue/DHF update 2010 (37). ProMED-mail. 2010; 20 July: 20100720.2435. <www.promedmail.org> Accessed 23 July 2010.]
Patients affected by dengue in the country exceed 15000 with 40 patient deaths, said the Dominican Medical Association's vice president. [Dengue/DHF update 2010 (41). ProMED-mail. 2010; 10 August: 20100810.2726. <www.promedmail.org> Accessed 11 August, 2010.]
Giardiasis
Giardiasis is a worldwide intestinal parasitic infection. Symptoms include chronic diarrhea, bloating, low-grade fever, nausea and headaches. It is caused through the ingestion of contaminated food and water by cysts of the protozoa Giardia lamblia, G. intestinalis and G. duodenalis. It occurs in areas with poor sanitation and areas where surface water is used for drinking. Person-to-person transmission occurs when Giardia cysts from the stool of an infected person are passed from hand-to-mouth and is the cause of outbreaks in daycare centers, dormitories and chronic care centers. Fresh water bodies (lakes, rivers, streams, ponds) which are open to human and animal fecal contamination are the source of infection for canoers, kayakers, campers and hikers . Prevention includes: meticulous personal hygiene, food safety precautions and purification of drinking water (boiling water or other methods).
Risk of food and water-borne disease exists in the Dominican Republic.
Leptospirosis
Leptospirosis is a worldwide bacterial disease affecting domestic and wild animals: cattle, dogs, cats, pigs, and rodents. Humans become infected through exposure to infected animals or through contact with water, soil and mud contaminated with the urine of infected animals. The bacteria can enter through skin and mucous membranes of the mouth, eyes, and nose. The disease is not known to spread from person to person.
Leptospirosis can occur sporadically, in epidemics (mostly after storms, heavy rainfalls and floods), or endemically (in agricultural areas with large livestock operations or rodent infestations). It is an occupational hazard for those who work outdoors or with animals (farmers, sewer workers, veterinarians, fish workers, rescue and military personnel). It is also a serious recreational risk for campers, hikers, swimmers, and outdoor sports enthusiasts who participate in whitewater rafting, kayaking, and canoeing.
The incubation period can range from 2 to 30 days. Most infections are relatively mild and include fever, myalgia, headache, red eyes, abdominal pain, and vomiting. Severe cases present with jaundice, hemorrhage, myocarditis, and renal failure. Prevention: Outdoor sports travellers may want to consult their doctor about taking preventive medication during their trip to avoid infection even through short-term exposure.
Sexually Transmitted Infections
Avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home.
Some countries have entry restrictions for travellers with HIV / AIDS. See The Global Database on HIV Related Travel Restrictions for details on this country.
Traveller's Diarrhea
Diarrhea is the most common cause of illness during travel. The source of illness is the ingestion of contaminated food or water, person-to-person transmission, or recreational exposure to water bodies. The infective agents can be bacteria, viruses, protozoa or toxins found in food. Good personal hygiene practices (including frequent and thorough hand washing), proper food handling, and water purification are the most effective methods to prevent infection.
Consult your doctor for the best treatment options tailored to your needs, including taking prescription medication on your trip in case you suffer from diarrhea. Travellers with chronic conditions are more susceptible to infections and should consider taking preventive medication.
See our Guide to Healthy Travel for prevention and treatment tips.
Tuberculosis
Tuberculosis is transmitted from person to person through inhalation of airborne infectious respiratory droplets. Travellers who have only casual contact with infected persons are at low risk.
However, travellers visiting friends and relatives (especially young children) in developing countries, persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), long-term travellers and those who have close and prolonged contact with the local population (teachers, missionaries, Peace Corps volunteers) are at risk. Travellers at risk should have a pre-departure TB skin test and be re-tested after leaving the country.
Tuberculosis is highly endemic in the Dominican Republic.
Food and Water Safety
All local water should be considered contaminated. All tap water used for drinking, brushing teeth, and making ice cubes should be boiled (bringing water to a good rolling boil is sufficient). Good brands of bottled water are available; check cap seal and ensure that the bottle is uncapped in your presence.
Milk should be boiled before consumption because of possible improper refrigeration during distribution. Powdered and evaporated milk are available and safe. Butter should not be used as a table food. Cream, ice cream, and whipped cream should not be consumed. Cheese, unless cured, is best avoided. Yoghurt is safe only if it is known to be made from pasteurized milk.
All meat, poultry, and fish must be well cooked and served while hot. Pork is best avoided; vegetables should be well cooked and served hot. Salads are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid raw and undercooked eggs, and dishes prepared with raw eggs (steak tartar, mayonnaise, and dressings). Avoid cold buffets, uncured cheeses, custards, and any frozen desserts.
First rate hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement.
Gastro-intestinal infections are the most common illnesses affecting travellers and can occur in any country you are visiting. Proper food handling, drinking purified water, and maintaining good personal hygiene are key to prevention. Below is a summary of the agents causing gastro-intestinal illnesses.
Bacterial Contamination
It is estimated that about 85% of traveller’s diarrhea is caused by bacteria of which the following are the most important agents:
Enterotoxigenic Escherichia coli (ETEC) and Enteroaggregative Escherichia coli (EAEC) account for most cases of traveller’s diarrhea associated with contaminated food and water world wide. They are the cause of large outbreaks in developed countries when food and water sanitation have not been properly maintained. Symptoms include watery stools, abdominal cramps, and possible vomiting lasting three to seven days.
Campylobacter jejuni is more prevalent in developing countries and is associated with contaminated water, undercooked food, and unpasteurized milk. Symptoms include diarrhea, abdominal cramps, and fever lasting from two to ten days.
Salmonella enteritidis is associated with contaminated eggs, poultry, milk, fruits, and uncooked vegetables. Symptoms include diarrhea, vomiting, abdominal cramps, and fever lasting from four to seven days. Infected persons can become asymptomatic carriers and shed the bacteria for years, becoming the source of infection for others through poor hygiene practices.
Shigellosis is a human infection caused by one of four species and transmitted by fecal-oral route due to unsanitary conditions, contaminated food and water, and overcrowded living conditions. Symptoms include diarrhea, abdominal cramps, fever, and may cause bloody diarrhea and mucous lasting four to seven days.
Vibrio cholera is associated with contaminated water, raw and undercooked seafood. Cholera infection in travellers is rare; symptoms include watery diarrhea and vomiting lasting three to seven days, but can lead to severe dehydration and death in undernourished persons. Vibrio parahaemolyticus is also related to the consumption of raw and undercooked seafood. Vibrio vulnificus is associated with contaminated shellfish and raw oysters in particular, and has caused septicemia in persons with liver disorders.
Viral Contamination
Gastro-intestinal infections caused by viruses account for about 5%. The main agents are Norovirus, associated with outbreaks at large gatherings and on cruise ships, and Rotavirus, which is more prevalent in developing countries. Symptoms include vomiting, diarrhea, fever, and myalgia lasting 12 to 60 hours.
Protozoal Contamination
Gastro-intestinal infections with protozoa account for about 10% of traveller’s diarrhea, but may cause prolonged illnesses (lasting weeks) and cause serious complications if not diagnosed in a timely manner.
Giardia lamblia (Giardiasis) and Entamoeba hystolytica (Amebiasis) are the most important agents in this category and both infections are acquired through contaminated food and water, as well as person to person transmission due to poor hygiene practices. Cryptosporidium and Cyclospora cayetanensis are implicated with contaminated food, water, and fresh produce (berries).
Toxins Causing Food Poisoning
Clostridium perfringens is the most important agent causing food poisoning in developed countries. The spores of the bacterium germinate on cooked food that is cooled and stored at room temperature over a prolonged period of time. After ingestion, the spores produce an enterotoxin in the small intestine causing abdominal pain, diarrhea, and vomiting. Foods implicated are meats and poultry.
Staphylococcus aureus enterotoxins are spread by unsanitary practices of infected persons. The foods implicated are custards, creamy desserts, meats, and salads.
Clostridium botulinum bacteria produce a very potent toxin. It is associated with improperly canned food, lightly preserved vegetables, salted fish, and meats. Symptoms include nausea, vomiting, and neurological symptoms such as blurred and double vision, paralysis of respiratory and motor muscles that may progress rapidly.
Seafood Poisoning
Fish and shellfish can be contaminated with the toxins produced by marine micro-organisms called dinoflagellates found in all oceans, especially in coral reef areas. Larger fish have usually more toxins accumulated in the skin, musculature, and organs, as these toxins are passed up through the food chain. The toxins are not destroyed through cooking, smoking, or freezing, they are odorless and tasteless, and do not alter the appearance of the fish.
Ciguatera Fish poisoning is the most common illness in this category. The most affected fish are amberjack, barracuda, grouper, kahala, parrotfish, sea bass, red snapper, surgeon fish, ulua. Symptoms usually appear within a few hours but can be delayed for a day or more and include nausea, vomiting diarrhea, muscle pain, itchiness, dizziness and temperature reversal (hot feels cold and cold feels hot). Symptoms can last for months. Persons who had a previous episode of ciguatera fish poisoning should avoid a second exposure as symptoms will be more severe. Prevention: Avoid large fish (more than 2.5 to 3 kilos [6 lbs]) or fillet of large fish, avoid head, roe, intestines and liver where the toxin is more concentrated.
Scombroid poisoning is the result of improper handling and refrigeration of fish containing high levels of natural occurring histidine (amino acid in protein). Contamination with bacteria will convert histidine to histamine-causing symptoms similar to allergic reactions, which occur very rapidly and include headache, abdominal cramps, diarrhea, itching, flushed face, and paralysis may occur. Scombroid poisoning occurs worldwide and affects fish from the Scombridae family: yellow tuna, mackerel, skipjack, and bonito. It can also affect other species such as herring, bluefish, sardine, anchovy, amberjack, and mahi-mahi. Prevention: Proper handling and immediate refrigeration of catch.
Shellfish poisoning is associated with the algal blooms (red tides) occurring in temperate and tropical areas. Shellfish – oysters, clams, cockles, mussels, crabs, lobsters – filter or ingest toxins produced by dinoflagellates micro-organisms. Each different toxin produces characteristic symptoms:
- Symptoms of diarrheic shellfish poisoning occur about 30 minutes to hours after ingestion and include nausea, vomiting, and diarrhea. Recovery occurs within two to three days.
- Symptoms of neurotoxic shellfish poisoning appear rapidly after ingestion and include tingling of mouth, arms and legs, stomach upset, and severe muscle pain. Recovery occurs within two to three days.
- Symptoms of paralytic shellfish poisoning appear rapidly after ingestion and include nausea, numbness of face arms and legs, headache, loss of coordination and dizziness, in severe cases respiratory failure and paralysis may lead to death.
- Symptoms of amnesic shellfish poisoning occur within 24 hours of ingestion and include vomiting, diarrhea, and disorientation. Permanent short-term memory loss has been observed, and in severe cases seizures, paralysis, and death may occur. Persons with kidney disease are especially vulnerable.
Puffer Fish poisoning (Fugu) is caused by a tetrodotoxin accumulating mainly in the liver, intestines and ovaries of puffer fish, ocean sunfish, globe fish, and porcupine fish. Symptoms appear between six and 20 hours and include profuse sweating, salivation, headache, hypothermia, and neurological symptoms of paralysis and respiratory failure. The mortality rate is very high.
