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Costa Rica



Capital: San Jose

Time Zone: -6 hours.
Tel. Country Code: 506
Electrical Standards: Electrical current 120/60 (volts/hz). North American Style Adaptor. Grounding Adaptor Plug A.


Travel Advisory - Costa Rica

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 Costa Rica


Resource Links

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

Embassies

U.S. Embassy
San Jose


U.S. Citizens Services:

Telephone: (506) 2519-2000 or (506) 2220-3127 | From the U.S.: 011-506-2519-2000 or 011-506-2220-3127

Note: Please note that visa inquiries cannot be answered at the above telephone numbers. Please call 4000-1976 within Costa Rica and (703) 745-5475 from the U.S. for any visa-related inquiry.

We are pleased to offer an online appointment system for your convenience. In case of an emergency, you can come to the Embassy Monday-Friday from 8:00AM-11:00AM and take a number (The Federal Benefits Unit, Consular Report of Birth Abroad services, and Notary services will not see anyone without an appointment). We will attend those with appointments first and then call numbers in the order of arrival. Please complete and print all forms and applications PRIOR to your appointment.

American Citizens Services (ACS): Passports, Notarials, Consular Reports of Births (CRBAs) with appointment only.

American Citizens walk-in service hours are Monday – Friday, from 8:00 a.m. to 11:00 a.m.

Entry Requirements

HIV Test: Not required.

Required Vaccinations: Travelers >1 year of age entering the country from an endemic area are required to present a certificate of immunization against yellow fever if traveling from the endemic zones listed below:

Africa: Angola, Benin, Burkina Faso, Cameroon, Democratic Republic of Congo, Gabon, Gambia, Ghana, Guinea, Liberia, Nigeria, Sierra Leone, and Sudan.

Americas: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Venezuela.

Passport Information

Passport/Visa: Costa Rica is a middle-income, developing country with a strong democratic tradition. Tourist facilities are extensive and generally adequate. The capital is San Jose. English is a second language for many Costa Ricans.

ENTRY/EXIT REQUIREMENTS: For entry into Costa Rica, U.S. citizens must present valid passports that will not expire for at least thirty days after arrival, and a roundtrip/outbound ticket. Some U.S. airlines may not permit passengers to board flights to Costa Rica without such a ticket. Passports should be in good condition; Costa Rican immigration will deny entry if the passport is damaged in any way. Costa Rican authorities generally permit U.S. citizens to stay up to ninety days; to stay beyond the period granted, travelers must submit an application for an extension to the Office of Temporary Permits in the Costa Rican Department of Immigration. Tourist visas are usually not extended except under special circumstances, and extension requests are evaluated on a case-by-case basis. There is a departure tax for short-term visitors. Persons traveling to Costa Rica from some countries in South America and Sub-Saharan Africa must provide evidence of a valid yellow fever vaccination prior to entry. The South American countries include Bolivia, Brazil, Colombia, Ecuador and Venezuela.


The most authoritative and up-to-date information on Costa Rican entry and exit requirements, including visa information, may be obtained from the Consular Section of the Embassy of Costa Rica at 2114 S Street, NW, Washington, DC 20008.

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.

Rabies: 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. 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.

Hospitals / Doctors

Medical care in San Jose is adequate, but is limited in areas outside of San Jose.
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 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. In the event of a serious illness or injury that can't be treated adequately in this country, the traveler should be flown by air ambulance to Miami or Houston.


The U.S. Emabassy maintains alsting of hospitals & Clinics in Costa Rica



There are two private hospitals in San Jose frequentlyy used by expatriates:


Hospital Clinica Biblica

San Jose

This is a private hospital with extensive medical/surgical capabilities, including cardiac surgery, 24-hour emergency room, and ambulance service. CT and MRI are available. The hospital-based physician group is English-speaking; many staff physicians have received advanced training in the United States. Hospital Clinica Biblica is used by embassy personnel, tourists, and expatriates.


Hospital Cima San Jose


Full service medical/surgical facility. Hospital CIMA San José is located in San José, Costa Rica and has medical and surgical patient units, an intensive care unit, and a neonatal intensive care unit.


Hospital CIMA Guanacaste

Hospital CIMA Guanacaste is located in the northwestern region of Costa Rica, 6.5 miles from Liberia International Airport, the hospital was inaugurated July 2012, serves 270,000 permanent area residents and some 500,000 tourists who visit Guanacaste each year.

CIMA Guanacaste is a first class hospital with cutting-edge medical equipment, laboratory, pharmacy, radiology department, 24-hour emergency room, and operating rooms.

Destination Health Info for Travelers

Zika Virus: The Zika virus was first reported in the Western Hemisphere in 2015 after thousands of babies were born in Brazil with abnormally small heads. Although most cases of Zika cause mild symptoms, or are asymptomatic, the virus can cause devastating effects on a fetus, especially when infection occurs in the first trimester. There is no vaccine.

The disease is now appearing in most other countries in Central and South America and the Caribbean; Mexico has just reported its first case.

Similar viral diseases transmitted by daytime-biting mosquitoes include dengue fever and chikungunya fever, which are also widespread below 2,500 meters elevation throughout these regions. They cause more serious illness, called “break-bone” fever because of severe muscle and joint pain, high fever, headache and a rash. Recovery can be prolonged and dengue is occasionally fatal. These diseases, however, do not cause fetal injury.

In all three diseases, the mosquitoes (Aedes aegypti) bite during the daytime, unlike the mosquitoes that transmit malaria (Anopheles species), that only bite in the evening and at night.

CDC Guidelines for Pregnant Women

Pregnant women and women of child-bearing age should consider the risk of exposure when making their travel plans. If you decide to travel, you should apply a repellent containing at least 30 percent DEET to exposed skin. DEET, still the gold standard, is a safe product and is often under-applied, due to fears about “DEET toxicity” which has never been proven (Don’t get in your eyes or mouth however; it can be irritating).

DEET is safe, even if used on very young children. The frequent application of a DEET repellent is the key to preventing Zika virus infection. Further protection is afforded by treating your clothes with permethrin, an insecticide that binds to fabric, even after several washings, and “knocks down” or kills mosquitoes on contact. It is totally safe to humans.

Here is a link to DEET and permethrin repellents at travmed.com http://www.travmed.com/collections/insect-bite-protection/deet

Visit a travel clinic to get your shots and preventive medicines. A travel medicine expert can review your travel plans and assess disease risks and their prevention or treatment.

For additional information on the latest warnings and updates about staying healthy before traveling, contact Dr. Stuart Rose at 413-584-9254, or email

AIDS/HIV: Although HIV prevalence (the percentage of a population living with HIV) in Latin American countries is relatively low compared to the rates found in many parts of Africa, the number of people affected is still substantial. What is more, the situation is likely to get worse in many Latin American countries. No country in the region has experienced a significant drop in HIV prevalence, and it is projected that the total number of people living with HIV in Latin America will increase in coming years.

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.
Costa Rica is proportionally less affected by HIV/AIDS than other countries in Central America, with 0.3% of the adult population living with HIV. (Source: 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 another person’s body fluids or 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. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Do not swim alone, at night, or if intoxicated.
• 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.

Cholera: Sporadic cases of this disease probably occur, but no cases have been reported recently. Cholera is a rare disease in international travelers from developed countries. Cholera vaccine (not available in the US) 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 that can cause life-thratenong dehydration.
A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also indicated for treating children.

Dengue Fever: Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in the Caribbean and is the most common cause of fever in travelers returned from this region. Symptoms of dengue include 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 during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Apply a DEET-containing repellent (30% minimum) to exposed skin and apply permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue. Maintain a high fluid intake plus meds for pain and fever, as needed.

Map of dengue fever risk reas:

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 with sporadic cases reported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals (primarily pigs) 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.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. 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 low levels with a prevalence of 0.3% 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.

Leishmaniasis: Focally endemic. Potential for transmission of cutaneous leishmaniasis occurs in most rural forested areas below 800 meters elevation. Increased transmission occurs from May through July. The officially reported incidence has been highest in areas bordering Panama.
• The parasites that cause leishmaniasis are transmitted by the bite of the female sand fly. Sandflies bite in the evening and at night. Sand flies are not found on beaches. They 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.

Leptospirosis: Reported in 1996 among whitewater rafters. Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals, and often occurs after flooding.

Malaria: An outbreak of falciparum malaria was reported in November 2006 from the province of Limon, on the Caribbean coast. The cases were caused by the falciparum species of parasite, which causes more severe disease but is not generally seen in Costa Rica. Most cases of malaria in Costa Rica, about 80–90%, are caused by the less severe Vivax species of parasite that, unfortunately, can cause delayed attacks of malaria, months, even a year later, despite taking anti-malarial medication while in-country.

According to recent information, malaria in Costa Rica has gone down 75% since 2001. In 2010 there were only eight registered cases. The vast majority of cases used to be in the province of Limon, but new prevention measures in that province have resulted in there being only a single case in 2011. There have been no cases of malaria in Tortuguero in the last few years.

All travelers to Limon province, except Limon City, should take measures to prevent evening and nighttime mosquito bite. There is no risk in the central highlands (Cartago and San Jose Provinces). Risk is increased during, and just after, the rainy season, May through November, peaking during September–October. No cases of chloroquine-resistant malaria have been reported.

Chloroquine prophylaxis, 500 mg weekly, or Malarone,1 tablet daily, can be considered by=risk-averse travelers. Evening and nighttime mosquito-bite prevention is the most important measure to take.

Note: Anti-malarial drugs will not prevent a delayed attack of the Vivax species of the malaria parasite. Some of these parasites can remain undeveloped in your liver, out of reach of antimalarial drugs..A delayed attack can occur months (even a year, or more later).

Note: The incubation period of malaria is 10-12 days, or longer, so if you were on a short trip and not on antimalarial pills the symptoms of malaria most likely would occur weeks, even months, later. Be sure to get checked for malaria immediately if you get an unexplained fever, and tell your doctor you had traveled to a country with malaria.

• 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 Costa Rica page on the Destinations menu or A-Z Index.
• Another map showing malaria risk areas is at: http://www.paho.org/Images/Hcp/HCT/malaria_16.gif

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 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.

Other Diseases/Hazards: Abdominal angiostrongyliasis (occurs in Latin America and Africa; zoonotic parasite Angiostrongylus costaricensis causes eosinophilic ileocolitis after the ingestion of fruits and vegetables contaminated with infective larvae in mollusk slime; children are at highest risk; consumption of raw mint, shrimp, and ceviche containing raw mint has been associated with transmission of illness; symptoms may be similar to appendicitis)
• Brucellosis (from consumption of unpasteurized dairy products)
• Chagas’ disease (occurs sporadically in rural areas of Alajuela, Guanacaste, Heredia, and San Jose Provinces at evations below 1,300 meters, but is not considered a major public health problem)
• Cysticercosis (transmitted by consumption of pork tapeworm eggs in contaminated food in farming areas)
• Fascioliasis (liver fluke disease, transmitted by contaminated watercress, water lettuce, mint, parsley, or khat. Humans typically become infected by eating these aquatic or semi-aquatic plants, or drinking water contaminated by the parasites)
• Filariasis (transmitted by blackflies, mosquitoes; endemic near Puerto Limon)
• Paragonimiasis (lung fluke disease. Acquired by ingesting raw freshwater crabs or crayfish; low incidence, not well documented.)
• Rabies (very low risk);
• Tick-borne rickettsioses (Rocky Mountain spotted fever reported from Limon Province
• Tick-borne relapsing fever;
• Strongyloidiasis and other helminthic infections (hookworm and roundworm)
• Venezuelan equine encephalitis (transmitted by mosquitoes)

Travelers’ Diarrhea: Low risk in most areas. Tap water in San Jose is potable. 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 risk 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.

Typhoid Fever: Typhoid vaccine is recommended by the CDC for all people traveling to or working in Central America, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water (with the exception of short-term visitors who restrict their meals to hotels or resorts). Current vaccines against Salmonella typhi are only 75-80% 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 has not been reported from Costa Rica but there is a certificate requirement for travelers arriving from an endemic area.