Travel health in Costa Rica

Health-wise, traveling in Costa Rica is generally very safe. Food tends to be hygienically prepared, so bugs and upsets are normally limited to the usual “traveler’s tummy”. Water supplies in most places are clean and bacteria-free, and outbreaks of serious infectious diseases such as cholera are rare.

In general, as in the rest of Latin America, it tends to be local people, often poor or without proper sanitation or access to healthcare, who contract infectious diseases. Costa Rica’s healthcare is of a high standard, but facilities at major public hospitals vary widely, so use private hospitals and clinics where possible – and get extensive health insurance before you travel . The capital’s two excellent private hospitals, CIMA San José and Clínica Biblica , are equipped to handle medical, surgical and maternity cases, and have 24-hour emergency rooms; the latter also has a good paediatric unit.

Inoculations

No inoculations are required before you enter Costa Rica unless you’re traveling from a country that has yellow fever, such as Colombia, in which case you must be able to produce an up-to-date inoculation certificate. You may, however, want to make sure that your polio, tetanus, typhoid, diphtheria and hepatitis A jabs are up to date, though none of the diseases is a major risk. Rabies, a potentially fatal illness, should be taken very seriously if you’re going to be spending a significant amount of time in the countryside. There is a vaccine comprising a course of three injections that has to be started at least a month before departure. If you’re not vaccinated, stay away from dogs, monkeys and any other potentially biting or scratching animals. If you do get scratched or bitten, wash the wound at once, with alcohol or iodine if possible, and seek medical help immediately.

The sun

Costa Rica is just eight to eleven degrees north of the Equator, which means a blazing-hot sun directly overhead. To guard against sunburn take at least factor 15 sunscreen (start on factor 30) and a good hat, and wear both even on slightly overcast days, especially in coastal areas. Even in places at higher altitudes where it doesn’t feel excessively hot, such as San José and the surrounding Valle Central, you should protect yourself. Dehydration is another possible problem, so keep your fluid levels up, and take rehydration salts (Gastrolyte is readily available) if necessary. Diarrhoea can be brought on by too much sun and heat sickness, and it’s a good idea to bring an over-the-counter remedy such as Imodium from home – it should only be taken for short periods, however, and only when really necessary (such as traveling for long periods on a bus) as extensive use leads to constipation and only serves to keep whatever is making you ill inside you.

Drinking water

The only areas of Costa Rica where it’s best not to drink the tap water (or ice cubes, or drinks made with tap water) are the port cities of Limón and Puntarenas. Bottled water is available in these towns; drink from these and stick with known brands, even if they are more expensive. Though you’ll be safe drinking tap water elsewhere in the country, it is possible to pick up giardia, a bacterium that causes stomach upset and diarrhoea, by drinking out of streams and rivers – campers should stock up on water from the national parks’ waterspouts, where it’s been treated for drinking.

The time-honored method of boiling will effectively sterilize water, although it will not remove unpleasant tastes. A minimum boiling time of five minutes (longer at higher altitudes) is sufficient to kill microorganisms. Boiling water is not always convenient, however, as it is time-consuming and requires supplies of fuel or a travel kettle and power source – chemical sterilization can be carried out using either chlorine or iodine tablets or (better) a tincture of iodine liquid; add five drops to one litre of water and leave to stand for thirty minutes. Pregnant women or people with thyroid problems should consult their doctor before using iodine sterilizing tablets or iodine-based purifiers. Inexpensive iodine-removal filters are recommended if treated water is being used continuously for more than a month or if it is being given to babies.

Malaria, dengue fever, Zika and Chikungunya

Although some sources of information – including perhaps your GP – will tell you that you don’t need to worry about malaria in Costa Rica, there is a small risk if you’re traveling to the southern Caribbean coast, especially Puerto Limón and south towards Cahuita and Puerto Viejo de Talamanca. In 2018, only 70 cases of malaria were reported, and according to the World Health Organization most of these were related to illegal gold mining, but if you want to make absolutely sure of not contracting the illness, and intend to travel extensively anywhere along the southern Caribbean, you should take a course of prophylactics (usually chloroquine rather than mefloquine), available from your doctor or a clinic.

Dengue fever is more of a concern: in 2018, a twenty-year low of 2735 dengue cases were reported in the country, although this number roughly doubled in 2019. Normally, the Nicoya Peninsula is one of the worst-affected areas. Numbers ebb and flow, but may well rise further in the future. Most cases occur during the rainy season when the mosquito population is at its height, and usually in urban or semi-urban areas; note that, unlike malaria, the dengue-carrying mosquito often bites during the day. The symptoms are similar to malaria, but with extreme aches and pains in the bones and joints, along with fever and dizziness. On rare occasions, the illness may develop potentially fatal complications, although this usually only affects people who have caught the disease more than once. The only cure for dengue fever is rest and painkillers.

There were well over a hundred Zika virus cases in Costa Rica in 2016, mostly in the Puntarenas and Guanacaste provinces, although up to early 2020 there had been no further outbreaks. For most people it results in a mild infection and is not harmful; it can, however, be dangerous for pregnant women, as there is evidence that it causes birth defects. Symptoms include a rash, itching all over the body, fever, headache, joint and muscle pain, conjunctivitis, lower back pain, and pain behind the eyes.

Another mosquito-borne virus to be aware of is Chikungunya fever, of which there were a number of reported cases in Costa Rica in 2019. Symptoms include fever, headache, fatigue, nausea, muscle and joint pain, and a rash. It usually resolves itself within a few days, and serious complications are not common.

For malaria, dengue fever, the Zika virus and Chikungunya fever, the best course of action is prevention: to avoid getting bitten by mosquitoes (zancudos), cover up with long sleeves and long trousers, use insect repellents (containing DEET) on exposed skin and, where necessary, sleep under a mosquito net. If you do get ill, seek medical attention as early as possible.

Snakes

Snakes abound, but the risk of being bitten is incredibly small – there has been no instance of a tourist receiving a fatal bite in recent years. Most of the victims of Costa Rica’s more venomous snakes – such as the fer-de-lance and the dreaded bushmaster – are field labourers who do not have the time or resources to get to a hospital (there are around five such deaths each year). Just in case, however, travelers hiking off the beaten track may want to take specific antivenins plus sterile hypodermic needles; if you’re worried, you can buy antivenin at the Instituto Clodomiro Picado, the University of Costa Rica’s snake farm in Coronado, outside San José (http://icp.ucr.ac.cr), where herpetologists (people who study reptiles) are glad to talk to visitors about precautions.

If you have no antivenin and are unlucky enough to get bitten, do not try to catch or kill the specimen for identification, as you only risk getting bitten again. Clean the wound with soap and water (do not try to suck out the venom), bandage it firmly, apply a splint to keep the limb immobile (do not apply a tourniquet) and get to the nearest hospital as soon as possible.

In general, prevention is better than cure. As a rule of thumb, you should approach rainforest cover and grassy uplands – the kind of terrain you find in Guanacaste and the Nicoya Peninsula – with caution. Always watch where you put your feet and, if you need to hold something to keep your balance, make sure the “vine” you’re grabbing isn’t, in fact, a surprised snake. Be particularly wary at dawn or dusk – before 5.30am or after 6pm – though note that many snakes start moving as early as 4.30pm, particularly in dense cloudforest cover. In addition, be careful in “sunspots”, places in thick rainforest where the sun penetrates through to the ground or onto a tree; snakes like to hang out here, absorbing the warmth. Above all, though, don’t be too alarmed: thousands of tourists troop through Costa Rica’s rainforests and grasslands each year without encountering a single snake.

Spiders

Most spiders in Costa Rica are harmless, but one species that’s definitely worth avoiding is the Brazilian wandering spider or banana spider, a large, aggressive arachnid covered in dark brown hair, and often with some bright red patches. It hides under logs and dried banana leaves and in other dark places during the daytime, coming out at night to stalk the forest floor in search of prey. It is recognized as the most venomous spider in the world, carrying a cocktail of toxins that can cause priapism, convulsions and paralysis; bites are rare in Costa Rica (banana plantation workers, rather than tourists, are most at risk), but if you are bitten, you should seek medical attention immediately.

Purrujas, chiggers, ants and bees

Costa Rica is home to a quarter of a million different species of insect (bicho), and while most are perfectly harmless there are a few that can give you a nasty bite or sting. In hot, slightly swampy lowland areas, such as the coastal Osa and southern Nicoya peninsulas, you may come across purrujas, similar to blackflies or midges. They can inflict itchy bites, as can the chiggers (colorados) that inhabit scrub and secondary-growth areas, attaching themselves to the skin, leech-like, in order to feed.

Of the country’s numerous species of ant, the ones to watch out for are the enormous bullet ants, which resemble moving blackberries. Prevalent in low-lying forests, they hold the distinction of causing the world’s most painful insect sting – their colloquial name of veinticuatro (“24”) refers to the fact that if you get bitten by one it will hurt for 24 hours.

Among Costa Rica’s many bee species (abejas) are aggressive Africanized bees, which migrated from Africa to Brazil and then north to Costa Rica, where they have colonized certain localities. Although you have to disturb their nests before they’ll bother you, people sensitive or allergic to bee-stings should avoid Parque Nacional Palo Verde.

Sharks

Sharks (tiburón) are generally found on beaches where turtles nest, especially along the northern Caribbean coast, on Playa Ostional in the Nicoya Peninsula (although not – so far – as far south as Playa Nosara) and in the waters surrounding Parque Nacional Corcovado. Bull sharks, an aggressive species and one of the few sharks that can live in both fresh water and sea water, have been known to enter the rivers in the areas mentioned above, as well as the Río San Juan on their way between Lago Nicaragua and the sea.

HIV and AIDS

HIV and AIDS (in Spanish, SIDA) are present in the country – there are an estimated 11,000 adults in Costa Rica are living with HIV – but aren’t prevalent. That said, the same common-sense rules apply here as all over the world: sex without a condom, especially in some of the popular beach towns, is a serious health risk. Condoms sold in Costa Rica are not of the quality you will find back at home; therefore it’s best to bring them with you. Though hospitals and clinics do use sterilized equipment in Costa Rica, you may also want to bring sealed hypodermic syringes with you anyway.

Medical resources

• Canadian Society for International Health Canada; http://csih.org. Extensive list of travel health centres.
• CDC US; http://cdc.gov/travel. Official US government travel health site.
• Hospital for Tropical Diseases Travel Clinic UK; Pre- and post-trip advice and help with the prevention, diagnosis and treatment of tropical diseases and travel-related infections.
• International Society for Travel Medicine US; http://istm.org. Has a full list of clinics specializing in international travel health. Publishes outbreak warnings, suggested inoculations, precautions and other background information for travellers.
• MASTA (Medical Advisory Service for Travellers Abroad) UK; http://www.masta-travel-health.com. Has a range of travel clinics across the UK.
• NHS UK; http://www.fitfortravel.nhs.uk. Information and advice on recommended inoculations, malaria risk and the general health situation in listed countries.
• The Travel Doctor http://traveldoctor.com.au. Lists travel clinics in Australia, New Zealand and South Africa.
• Tropical Medical Bureau Ireland; http://tmb.ie. Travel clinics in Dublin and 21 other locations across the Republic of Ireland.