Time Zone: -5 hours GMT. No daylight saving time in 2008.
Tel. Country Code: 57
USADirect Tel.: 1
Electrical Standards: Electrical current is 110/60 or 220/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug A.
Travel Advisory - Colombia
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 Colombia
Americans living or traveling in Colombia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department travel registration web site and to obtain updated information on travel and security in Colombia. Americans without Internet access may register in person with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The American Citizen Services office at the U.S. Embassy in Bogotá and the U.S. Consular Agency in Barranquilla both provide assistance to U.S. citizens in Colombia.
Colombia, the second most populous country in South America, is a medium-income nation with a diverse economy. Its geography is also diverse, ranging from tropical coastal areas and rainforests to rugged mountainous terrain. Tourist facilities in Colombia vary in quality and safety, according to price and location. Security is a significant concern for travelers.
HIV Test: Anyone suspected of being HIV positive (HIV positive persons are not admitted without a waiver from a Colombian consulate in the U.S.)
Required Vaccinations: No vaccinations are required for entry. Airport authorities have informed the Foreign and Commonwealth Office that yellow fever vaccination certificates are only needed if you are planning to visit jungle areas of Colombia.
If you intend to travel on to neighbouring countries in Latin America from Colombia, you may not be allowed to do so without production of a Yellow Fever Vaccination Certificate. You should confirm with the authorities of your next destination whether they require a certificate following your visit to Colombia.
ENTRY/EXIT REQUIREMENTS: All U.S. citizens who are not also Colombian citizens must present a valid U.S. passport to enter and depart Colombia, and to return to the United States. Dual U.S-Colombian citizens must present a Colombian passport to enter and exit Colombia, and must have a U.S. passport to return to the United States.
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 who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for 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 with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: Recommended for all travelers >9 months of age. Travelers whose itinerary is limited to the cities of Bogotá, Cali, or Medellín are at lower risk and may consider foregoing vaccination. Vaccination should be given at least 10 days before travel.
Hospitals / Doctors
Medical care is adequate in major cities but varies greatly in quality elsewhere.
• 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 or may be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Serious illness or injury may require medical evacuation to mainland U.S. or elsewhere for treatment in a more advanced medical facility.
U.S. Embasssy Listing of physicians & Dentists
Medical facilities used by travelers include:
San Ignacio University Hospital
Santa Fe de Bogota
Private hospital affiliated with Javeriana University School of Medicine, one of the leading medical schools in Colombia and Latin America. All specialties, including major trauma.
Fundacion Santa Fe de Bogota
Santa Fe de Bogota
General medical/surgical facility with good reputation; all specialties; 24-hour emergency services; renal dialysis; limited trauma capability.
Clinica Del Country
Carrera 16 No. 82-57
Multispecialty clinic with excellent reputation.
Destination Health Info for Travelers
AIDS/HIV: More than half of Latin Americans living with HIV reside in the four largest countries of the region: Brazil, Colombia, Mexico and Argentina. The most severe epidemics, however, 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 (MSM) and commercial sex workers, is often very high. In almost every Latin American country, the highest levels of HIV infection are found amongst MSM. This problem is largely hidden, since homophobia and a machismo culture are common throughout the region and sex between men is highly stigmatized. The extent of HIV infection amongst MSM is downplayed in many countries, and prevention campaigns often neglect this group. (Source: www.Avert.org)
• The estimated HIV/AIDS prevalence in Colombia is 0.6% of adults (15-49).
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 of another person or their blood. 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.
• 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.
Acute Mountain Sickness (AMS): Simon Bolivar and Pico Cristobal Colon (both are 5,776 m/18,947 ft) are the highest peaks in Colombia and lie in the north of the country in the Sierra Nevada de Santa Marta. Other peaks include Tolima (5,215 m), Nevado El Ruiz (5,335 m) and Ritacuba Blanco (5,493 m).
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you do not have 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.
• High-Altitude Illness (NEJM) http://content.nejm.org/cgi/content/extract/345/2/107
Animal & Marine Hazards: Animal hazards include snakes (vipers, coral snakes), centipedes, scorpions, and spiders (black widow, brown recluse, banana, wolf). Caimans and crocodiles are abundant and electric eels and poisonous frogs are found in the country’s freshwaters. Pumas, jaguars, wild boar, and large tropical rodents also occur in Colombia. Sea wasps, Portuguese man-of-war, and stingrays are found in the coastal waters of Colombia and could be a hazard to swimmers.
Bartonellosis (Oroya fever): This severe bacterial disease is transmitted by sandflies between 800 and 3,000 meters elevation in the southwestern areas. Treatment of the first phase of the disease (fever and anemia phase) is effective with chloramphenicol, penicillin, or tetracycline. The second phase (skin lesion phase) is best treated with rifampin or streptomycin. Travelers are advised to take insect-bite prevention measures to prevent sandfly bites.
Chagas Disease (American Trypanosomiasis): Chagas disease (also called American trypanosomiasis) is widely distributed below 2,700 meters elevation in northern and western areas (primarily west of the eastern Andean foothills). Elevated risk occurs in Norte de Santander Department. 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 possible, from; consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; from blood transfusions; from fetal transmission.
Cholera: This disease is active in this country but the threat to tourists is low. Two cases of cholera were reported from the Candelillas district in the municipality of Tumaco in July 2004. Sporadic cases may be underdiagnosed or underreported. Cholera vaccine is recommended only for relief workers or health care personnel who are working in high-risk endemic areas 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. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Crime/Security/Civil Unrest: The US Department of State continues to warn American citizens of the dangers of travel to Colombia where the potential for violence by terrorists and other criminal elements exists in all parts of the country.
On 5 September 2008, the United States Embassy issued a Warden Message advising that it had received information that the Revolutionary Armed Forces of Colombia (FARC) may be targeting large-scale chain superstores and other commercial establishments in Bogota, as well as Colombian government buildings and places of worship in the downtown area, for possible attack by improvised explosive devices, including the possibility of a vehicle-borne device. Government buildings, public transport and commercial and entertainment centres are potential targets for terrorist attacks. Terrorist attacks can occur anywhere and at any time.
In planning your activities, consider the types of places that are known to be terrorist targets. These include nightclubs, restaurants, hotels, bars and shopping centres as well as infrastructure associated with the government such as public buildings, public transport, airports and sea ports. Commercial interests of multinational companies may also be targeted.
• The provinces of Cesar and La Guajira, the cities of Cali and Popayan and most rural areas of Colombia: We advise you to reconsider your need to travel to the provinces of Cesar and La Guajira, the cities of Cali and Popayan and most rural areas of Colombia because of the uncertain security situation.
Do not travel areas: We advise you not to travel to the departments of Santander, Putumayo, Arauca, Cauca (excluding Popayan), Caqueta, Guaviare, Valle de Cauca (excluding Cali), Antioquia (excluding Medellin), Narino (excluding Pasto), Norte de Santander (excluding Cucuta), southern parts of Meta and the city of Buenaventura due to very high threat of terrorism from guerrilla organisations and presence of drug related criminal activity.
• Colombia has one of the highest rates of kidnappings in the world. Most kidnappings are for ransom, and are often perpetrated by groups such as the FARC and the National Liberation Army (ELN) in rural areas. There has been a reduction in the number of kidnappings in major cities but the risk remains. Foreigners, including children, have been kidnapped and murdered.
Crime: Violent crime, including robbery, is common. You should take particular care when travelling alone, using automatic teller machines (ATMs), or travelling in or near tugurios (slum areas). Criminals posing as police officers have robbed foreigners. The number of express kidnappings where victims are abducted and forced to withdraw funds from ATMs before being released, has increased. Victims have been killed or injured while resisting perpetrators. Foreigners have been robbed and assaulted after accepting spiked food, drinks, cigarettes, or chewing gum. Assaults and robberies have occurred after thieves have exposed travellers to incapacitating chemicals, either by aerosol spray or by paper handouts. Chemically treated paper can cause unconsciousness, especially if the chemicals contact your face (via your hand).
• Petty crime, such as pickpocketing and bag snatching, occurs in Colombia, including at the airport in Bogota and near hotels.
• Hikers, including on trails in and around Bogota, have been robbed at gunpoint recently. An experienced and reputable tour guide may reduce the risk of attack while hiking.
• You should not travel by road between major cities due to the high risk of armed robbery and kidnapping.
• You should avoid side trips when travelling between the city and the airport in Popayan, the capital of Cauca Department. Troops, protest groups and the FARC sometimes block side roads in the area.
• There is a risk of violence, kidnapping and being caught in road blocks set up by illegal armed groups when travelling by road outside major capitals, including to rural tourist destinations such as Ciudad Perdida (The Lost City). Consider the advice of local authorities before travelling to such areas. When travelling to Parque Nacional Tayrona, you should only visit beach areas and resorts advised as safe and not venture inland because of the presence of illegal armed groups. You should avoid travelling at night.
• There is a high risk from landmines and unexploded ordnance in rural areas of Colombia. Not all mined areas are marked. You should not stray from well-travelled roads.
• We recommend against hailing taxis in the street. Booking taxis by telephone, through hotels or authorised taxi centres, is a way to reduce risks.
• Driving in Colombia can be hazardous due to poorly maintained roads and vehicles, aggressive driving practices and inadequate road lighting.
Dengue Fever: An outbreak of dengue fever, sometimes complicated by hemorrhage or shock, was reported from Colombia in 2007, resulting in more than 40,000 cases and 19 deaths by the end of the year. There was a 10 per cent increase in the number of cases, with 42,536 cases reported compared to 38,842 cases 2006. The zones most affected were the cities of Yopal, Medellin, Cucuta, Villavicencio, Valledupar, Santa Marta, and Cartagena. Dengue fever is endemic to Latin America and the Caribbean and can occur throughout the year.
Dengue fever is prevalent on the north Caribbean coast, particularly in Choco, Antioquia, Cordoba, Sucre, Bolivar and Atlantico departments.
Dengue fever is a mosquito-transmitted, flu-like viral illness occurring throughout 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 (such as Ultrathon or Ben's 30) to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.
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 be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) 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 1.3% and as high as 20% in high-risk groups (e.g., commercial sex workers, drug addicts) and in the Amazon Basin. 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 with a prevalence of 1.0% 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.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for: all travelers over age 6 months.
Insect-Bite Prevention: There is the risk of insect-transmitted diseases in this country. You should take measures to prevent insect-bites, especially in rural areas. For maximum protection, apply a DEET-containing repellent (such as Ultrathon) to exposed skin, apply permethrin spray or solution (such as Sawyer 10-Garment Soak or Aerosol spray) to your clothing and gear, and sleep under a permethrin-treated bednet (if available).
• Until recently, DEET-based repellents have been the gold standard against mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin as an effective DEET alternative. You can achieve nearly 100% bite protection by using a properly-applied DEET or picaridin skin repellent and wearing permethrin-treated clothing.
Leishmaniasis: Risk of cutaneous leishmaniasis (the cause of 95% of cases) is widely distributed in many jungle and forested highland areas up to 1,500 meters elevation. Many cases are reported in the Pacific coastal region. Visceral leishmaniasis risk occurs below 900 meters elevation in the valleys of the Magdalena River and its tributaries in southern Cundinamarca County.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• 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.
Malaria: There is no risk of malaria in Bogota Department, the major urban areas, and the islands of San Andres and Providencia. Elsewhere, this disease is highly endemic countrywide year-round in rural areas below 800 meters elevation. Malaria activity varies markedly among regions and from year-to-year within specific areas. Risk may be elevated during and immediately following local rainy seasons. Vivax malaria accounts for 60% of cases overall, but in some Pacific coastal areas, P. falciparum accounts for 98% of cases.
Chloroquine-resistant falciparum malaria is reported in all malarious areas. In addition, there are now reports of chloroquine-resistant vivax malaria. Unconfirmed mefloquine resistance has been reported in the Amazonian region.
• Atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine prophylaxis is recommended when traveling to malaria risk areas.
A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Colombia page on the Destinations menu or A-Z Index.
Another map of malarious areas in South America is found at: http://www.paho.org/English/HCP/HCT/MAL/maps-cartagena.htm#COL
• Malaria is transmitted via the bite of an infected Anopheles mosquito. Anopheles mosquitoes feed predominantly duMalaria 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 malaria endemic areas of 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: Brucellosis (increased incidence in Uraba region of Antioquia Department).
• Cysticercosis (from ingestion of pork tapeworm eggs, not from eating undercooked or raw pork contaminated with pork larvae; neurocystercercosis common in Latin America and a frequent cause of seizures).
• Diphtheria (A diphtheria outbreak occurred in October 2000).
• Echinococcosis (polycystic echinococcosis caused by Echinococcus vogeli; humans usually become infected through exposure to canine feces and by eating food contaminated with tapeworm eggs).
• Fascioliasis (liver fluke disease; the mode of transmission is the faecal–oral route. Humans typically become infected by eating these aquatic or semi-aquatic plants, or drinking water contaminated by the parasites. Infection may also occur by ingesting larvae attached to the surface of food or kitchen utensils washed with contaminated water. Triclabendazole 10 mg/kg body weight single dose is the regimen of choice against fascioliasis)
• Filariasis (mosquito-borne; a small focus is reported near Cartegen).
• Mansonellosis (black-fly-borne; endemic areas limited to riverine valleys in extreme eastern and southern Colombia).
• Onchocerciasis (black-fly-borne; also called river blindness; endemic in the south-central Pacific coastal area).
• Paragonimiasis (lung fluke disease; transmitted by ingesting contaminated raw freshwater crabs or crayfish).
• Viral encephalitis (mosquito-transmitted; outbreak of Venezuelan equine encephalitis reported in the 1990s in La Guajira; Eastern equine encephalitis also reported).
• Strongyloidiasis and other helminthic (intestinal worm) infections.
Rabies: Rabies is a relatively minor health threat in this country, but there is risk. A rabies outbreak caused by large numbers of bat bites was reported in May-June 2004 from Birrinchao, along the Purricha river in the Choco region. Human rabies is usually transmitted by dog bites, but bats also transmit the disease.
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 or where the incidence of bat rabies is increased; for travelers desiring extra protection. 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, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.
Rocky Mountain Spotted Fever: This rickettsial disease occurs in many countries outside the U.S. Three cases were reported in Colombia 1994. In 1985 the disease killed 62 persons. All travelers should take precautions against tick bites.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Travelers' Diarrhea: Tap water is generally considered safe in large cities (Bogota, Medellin, and Cali), but all other water sources should be considered contaminated. Travelers should follow food and drink precautions. 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 helps prevent travelers’ diarrhea.
• 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.
Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels or resorts) 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: Yellow Fever affects the Magdalena, Cesar, La Guajira, Atlantico, Santander, Norte de Santander and Amazona areas. Yellow fever is transmitted via the bite of an infected Aedes mosquito (mainly Aedes aegypti). Aedes mosquitoes feed predominantly during daylight hours.
• Yellow fever vaccine is recommended for all travelers >9 months of age, except that travelers whose itinerary is limited to the cities of Bogota, Cali, and Medellin are at lower risk and may consider foregoing immunization.
• Yellow fever vaccination is not required to enter this country.