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Bolivia



Capital: Sucre

Time Zone: -4 hours. No daylight saving time in 2008.
Tel. Country Code: 591
USADirect Tel.: 800
Electrical Standards: Electrical Current 110/50 or 220/50 (volts/hz). North American Style Adaptor Plugs and European Style Adaptor Plug. Grounding Adaptor Plug A.


Travel Advisory - Bolivia

Travelers to Central and South America and the Caribbean need to protect themselves against mosquito-transmitted viruses, such as dengue and Zika, as well as nighttime biting mosquitoes in countries where there is  the threat of malaria. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.

Dr. Rose Recommends for Travel to Bolivia


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies


U.S. Embassy

La Paz

U.S. Citizens Serices provides emergency help and other services to American travelers.

Entry Requirements

HIV Test: Not required.

Required Vaccinations: Yellow fever vaccination certificate is required for all travelers >1 year of age. Medical waivers must be translated into Spanish and accompany the International Certificate of Vaccination or Prophylaxis (ICVP). Travelers who do not have a valid ICVP will still be allowed to enter Bolivia if they agree to sign an affidavit exempting the Bolivian state from any liability in the event the traveler gets sick with yellow fever within the Bolivian territory. This last option may cause delays at the point of entry.

Passport Information

PASSPORT/VISA: U.S. passport valid for at least six months from the date of proposed entry into Bolivia is required to enter and depart Bolivia. Please visit the Embassy of Bolivia website for the most current visa information.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Typhoid: Recommended for all travelers.

Yellow Fever: The CDC recommends yellow fever vaccination for all travelers >9 months of age traveling to areas east of the Andes Mountains. Bolivia requires all travelers >1 year of age to present proof of yellow fever vaccination. Vaccination should be given 10 days before travel to this country.

Hospitals / Doctors

Medical facilities in the largest cities are good, and they are acceptable in the main tourist areas. In rural areas, good medical care may be entirely unobtainable. All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; may be counterfeit; or be of unreliable quality.
Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that cannot be treated locally, every effort should be made to arrange aeromedical evacuation to the mainland United States.

Listing of doctors and hospitals used by U.S. travelers


Medical facilities used by travelers include:

Clinica Del Sur
3539 Avenida Hernando Siles
La Paz

Excellent 45-bed facility.


High Altitude Pathology Institute
Av. Saavedra 2302
La Paz


Prof. Dr. Gustavo Zubieta-Castillo M.D. MBAS, MRAE and staff provide comprehensive medical examinations and specialize in high-altitude problems. They can also make referrals to other specialists.

Methodist Hospital
La Paz (113 beds)

Private hospital; limited emergency services.


Trauma Klinik
San Miguel Calle Claudio Aliaga
La Paz

17-bed facility provides above-average emergency care.


Centro Medico Quirurgico Boliviano Belga
Calle Antezana N-0455
Cochabamba

Private non-profit clinic. Capabilities include cardiology and cardiac surgery, including heart-valve replacement; treatment of angina and acute myocardial infarction.


Clinica Angel Foianini
Avenida Irala 468
Santa Cruz

44-bed private hospital with a well-equipped emergency room, operating room, and intensive care unit. The emergency room is staffed 24 hours a day by a surgeon and a pediatrician, each specialized in emergency care. This well-equipped facility is favored by travelers and corporate expatriates.


Centro Medico Foianini
Calle Chuquisaca
Santa Cruz

Private medical center.

Destination Health Info for Travelers

AIDS/HIV: More than half of Latin Americans living with HIV reside in the four largest countries: Brazil, Columbia, Mexico and Argentina. The most severe epidemics are found in smaller countries such as Honduras and Belize, which have HIV prevalence rates of 1.5% and 2.5% respectively. The majority of countries in the region have prevalence rates of less than 1%, but the prevalence among specific groups, such as men who have sex with men and sex workers, is often very high.
The HIV prevalence rate in Bolivia is 0.5%, which is one of the lowest in South America. (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids or blood of another person. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Altitude Sickness (AMS): La Paz is the highest capital city (3,500 m) in the world. The airport is at 4,100 meters elevation. Risk of altitude sickness is present for tourists arriving in La Paz and for those going to higher-altitude trekking destinations in the Cordillera Real or skiing at Chacaltaya. Arriving travelers should spend several days resting and acclimatizing before further travel. Chacaltaya is a glacierial mountain range with an elevation of 5421 m (17,785 feet) about 30 km from La Paz. The glacier on Chacaltaya serves as only ski resort in Bolivia. It is the highest lift-served ski area in the world and the northernmost ski area in South America.
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you have not had a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 - 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75% effective. It may also reduce the risk of HAPE.
• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE)-recognized by confusion, difficulty with balance and coordination, staggering gait. Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also will prevent HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent.

Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
Further advice:

Institute for High-Altitude Medicine
• Base Camp
• CDC
High-Altitude Illness (NEJM)

Travelers with any medical concerns may wish to contact the High Altitude Patholgy Institute for a medical check-up.

High Altitude Pathology Institute CLINICA IPPA
Av. Saavedra 2302, La Paz
Tel: [591] (2) 224-5394


This facility specializes in high-altitude illness and travel-related diseases. Travelers may wish to visit their website to obtain additional information about high-altitude illness in Bolivia.

Bartonellosis (Oroya fever): Transmitted by sandflies in arid river valleys on the western slopes of the Andes up to 3000 meters elevation. Transmission of bartonellosis is limited to the Andes Mountains at elevations of 1000-3000 meters. The sandflies that transmit this diseases are found only in this altitude range.

Chagas Disease (American Trypanosomiasis): This disease (also called American trypanosomiasis) is widely distributed in rural areas at elevations up to 3,600 meters, including portions of the Altiplano. In southcentral Cochabamba, up to 100% of villagers are seropositive for exposure to this disease. Risk of transmission occurs primarily in those rural-agricultural areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take precautions against nighttime bites, which typically occur on the face of the sleeping victim.
• Other methods of transmission are from; consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; from blood transfusions; by transmission in-utero.

Cholera: Sporadic cases of cholera are reported in this country, but the threat to tourists is low. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.

A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. 

Crime/Security/Civil Unrest: Updated Advisory is here: http://www.smartraveller.gov.au/zw-cgi/view/Advice/Bolivia

Dengue Fever: Update 2011: According to the Ministry of Health, 467 suspected cases of dengue fever, a significant increase over the average incidence, have been reported so far in 2011 from Beni Department. In 2009, an extensive outbreak was reported in four of Bolivia’s provinces – Santa Cruz, Beni, Pando and Cochabamba. Santa Cruz is particularly heavily affected. Outbreaks of dengue fever were reported from central Bolivia throughout 2008 and major dengue outbreaks also occurred in 2007. The rainy season floods in these areas have also led to a greater threat of disease.
Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in South America. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime 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.
• There is no vaccination or medication to prevent or treat dengue.

Dengue fever map 

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but levels are unclear. Sporadic cases may occur, but go unrecognized. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 1.6%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at high level with a prevalence of 11.2% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Leishmaniasis: Cutaneous and mucocutaneous leishmaniasis occurs year-round below 2,000 meters elevation. Risk is elevated in the Yungas region, the forested foothill valleys at 1,000 to 2,000 meters elevation east of the Andean Cordillera. A few cases of visceral leishmaniasis have been reported from the Yungas region, which is northeast of La Paz.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.

Note: Bolivia has the highest incidence of cutaneous leishmaniasis (CL) in Latin America (LA), with 33 cases per 100,000 population reported in 2006. CL is endemic in seven of the nine administrative departments. Visceral leishmaniasis (VL) is comparatively rare and is restricted to one single focus. Most CL cases are caused by Leishmania (Viannia) braziliensis (85% cases); VL is caused by L. infantum.
Transmission is associated with forest-related activities, but recently, cases of urban transmission have been reported. Per national guidelines, both CL and VL cases are microscopically diagnosed and treated with pentavalent antimony.

Malaria: There is no risk of malaria in the highlands of La Paz, the provinces of Oruro and Potosi (southwestern portions of the country), and the cities of Cochabamba and Sucre. All other rural areas of the country below 2,500 meters elevation (8,200 feet) in the departments of Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz, and Tarija. should be considered risk areas, especially the lowlands east of the Andean Cordillera and Pando Department. (Malaria affects more than 3.5 million people in Bolivia each year. The Amazon Basin regions of Beni and Pando have the highest infection rates.) Vivax malaria is common but chloroquine-resistant falciparum malaria is becoming more prevalent in the north and along the Brazilian border.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (requires G-6-PD test) is recommended in risk areas.

Malaria map shows malaria risk areas in Bolivia.

Another map of malarious areas in Bolivia and other countries in South America 

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon) to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.

Other Diseases/Hazards:

• AIDS (low incidence)
• Bolivian hemorrhagic fever (low risk, but potentially fatal; 3 cases, including 2 deaths reported in 2007. The cases had been in close contact with mice. The virus is transmitted by aerosolized rodent urine. Risk may be increased by sleeping in primitive shelters near rodent habitats. Person-to-person transmission can also occur)
• Brucellosis (often from infected cattle; humans acquire infection by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material)
• Coccidiomycosis (endemic near border with Paraguay)
• Cryptosporidiosis
• Echinococcosis (occurs primarily in sheep-raising regions of the Altiplano)
• Haantavirus pulmonary disease (viral infection transmitted by rodent excreta. Humans become infected through contact with urine, saliva or faeces from infected rodents, mainly via the aerosol route. In humans, clinical disease occurs in the form of two major syndromes: haemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS)
• Fascioliasis (liver fluke disease; high incidence in northwestern Altiplano sheep-raising areas; transmitted by contaminated water and contaminated aquatic plants, such as watercress)
• Hantavirus (as of January 2008, 3 confirmed cases of hantavirus reported, 2 of which were fatal)
• Leptospirosis (there have also been outbreaks of leptospirosis in rural areas of Chuquisaca)
• Lyme disease (may occur)
• Mayaro virus disease (transmitted by mosquitoes in tropical forests)
• Plague (transmitted by fleas. Reported from the La Paz Department in 1996-1997)
• Tuberculosis (a serious public health problem; highest incidence in South America)
• Strongyloidiasis and other helminthic infections
• Tick-borne relapsing fever
• Toxoplasmosis
• Typhoid fever
• Venezuelan equine encephalitis


Plague: Very low risk. Plague occurs only in very limited areas. Recent outbreaks of flea-borne plague occurred in Santa Cruz Department near the Cochabamba-Chuquisaca border and north of Lake Titicaca, along the border with Peru.

Rabies: Dogs are the primary source of human infection. Other sources include cats, vampire bats, and monkeys. Pre-exposure rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine.

Travelers' Diarrhea: High risk outside of first-class hotels and tourist resorts. Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. Outbreaks of diarrheal diseases increase during the rainy season. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, azithromycin, or rifaximin (Xifaxin), combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Cryptosporidiosis has been reported in the Bolivian Altiplano where the infection rate in children is over 30% in some communities.
Treatment: Nitazoxanide (Alinia) is a broad-spectrum antimicrobial agent with in vitro activity against a variety of protozoa, trematodes, cestodes, nematodes, and anaerobic bacteria. Nitazoxanide is approved for the treatment of infectious diarrhea caused by Giardia lamblia and Cryptosporidium parvum in patients 1 year of age and older. Nitazoxanide is used as treatment for giardiasis, amebiasis, cryptosporidiosis, and cyclosporiasis. Nitazoxanide is now available as a liquid preparation (100mg/5mL) for children 1 to 11 years of age. There is a 500 mg tablet for older children and adults. Spectrum of activity: Cryptosporidia, Entamoeba histolytica, Giardia lamblia, Cyclospora cayetanensis. For treating giardiasis, nitazoxanide is at least as effective as metronidazole.
Dosages:
Adult: 500 mg orally twice daily x 3 days.
Child 4-11years: 200 mg orally twice daily x 3 days.
Child 1-3years: 100 mg orally twice daily x 3 days.


Tuberculosis: Tuberculosis a major health problem in this country. Tuberculosis is highly endemic in Bolivia with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (except short-stay visitors and cruise ship passengers) traveling to or working in South America, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.

Yellow Fever: There have been a large number (>30) of cases of yellow fever in the Yungas (La Paz department) and in the Chapare (Tropic of Cochabamba). Following the heavy rains and flooding in early 2007, there have been outbreaks of yellow fever in the regions of Cochabamba, Santa Cruz and Beni.
A yellow fever vaccination is recommended for all travelers >9 months of age who are going to high-risk areas (the Departments of Beni, Cochabamba, La Paz, and Santa Cruz).
• Effective December 1, 2007, the Bolivian Consulate General in the U.S. has advised that all persons older than 12 months traveling to Bolivia must have a valid International Certificate of Vaccination or Prophylaxis (ICVP) to ensure protection against yellow fever.

A map of yellow fever risk areas is at: http://www.nathnac.org/travel/factsheets/images/clip_image004_000.jpg