Time Zone: -4 hours GMT.
Tel. Country Code: 809
Electrical Standards: Electrical current is 110/60 (volts/hz). North American Sytle Adaptor Plug. Grounding Adaptor Plug A.
Travel Advisory - Dominican Republic
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 Dominican Republic
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Any person who can legally travel or reside in the United States, Canada and the European Union (including Great Britain) does not need a visa to visit the Dominican Republic for tourist purposes and can enter the Dominican Republic with a Tourist Card and a valid passport.
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.
Hospitals / Doctors
Medical care is limited, especially outside Santo Domingo, and the quality of care varies widely among facilities. There is an emergency 911 service within Santo Domingo, but its reliability is questionable. Outside the capital, emergency services range from extremely limited to nonexistent. Blood supplies at both public and private hospitals are often limited, and not all facilities have blood on hand even for emergencies. Many medical facilities throughout the country do not have staff members who speak or understand English.
- 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.
- 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 Miami or elsewhere for treatment in a more advanced medical facility.
The U.S. Embassy maintains a non-comprehensive list of providers of medical care in the Dominican Republic.
Medical facilities used by travelers include:
Calle Beller #42 y Ave. Independencia
Private hospital; 24-hour emergency room and broad range of specialty services. Frequently used by embassy personnel.
Hospital General de la Plaza de la Salud
Ortega y Gassette, Plaza de la Salud
Well-equipped medical center
Centro Medico Doctor Canella
Av. Libertad No. 44
Emergency and specialist care
Centro Médico Punta Cana
Destination Health Info for Travelers
Zika Virus: Travelers considering heading south for the winter in 2016 face a triple threat of diseases, according to the Center for Disease Control.
The Zika virus (transmitted by daytime-biting mosquitoes) was first reported to be a serious threat in this hemisphere in 2015 after thousands of babies were born in Brazil with abnormally small brains. Most cases of Zika are relatively mild, but 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 other countries; Mexico has just reported its first case. It has also spread to Barbados, Guadeloupe, Martinique, Ecuador and Bolivia. Other viral diseases transmitted by daytime biting mosquitoes include dengue fever and chikungunya fever. They are widespread throughout the Caribbean and Central and South America, but cause more serious illness, called “break bone” fever because of severe muscle and joint pain. Recovery can be prolonged and dengue is occasionally fatal. These diseases, however, do not cause fetal injury.
In all three diseases, the mosquitoes bite during the daytime, unlike the mosquitoes that transmit malaria, that only bite in the evening and at night. Warnings in the media that advise people to sleep under mosquito nets to prevent Zika are misleading, because of the fact that these bugs bite during the daytime. In addition, the usual advice to wear long-sleeve shirts and pants is often impractical during the day in warm climates, highlighting the need to apply generous amount of DEET to exposed skin.
Pregnant women and women of child-bearing age should consider the risk of exposure when making their travel plans. Travelers heading south should bring along a mosquito repellent containing at least 30 percent DEET. 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 young children. The application of a DEET repellent is the key to preventing all the diseases I have mentioned above.
Here is a link to DEET products at travmed.com http://www.travmed.com/collections/insect-bite-protection/deet
Visiting a travel clinic to get your shots and preventive medicines and where a travel medicine expert can review your travel plans and assess your travel risks as well as their prevention or treatment is a sensible start to any journey.
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: The Caribbean has the highest HIV prevalence of any region outside sub-Saharan Africa. HIV prevalence, however, has receded in the Dominican Republic. This decline is largely attributed to effective prevention campaigns, which have encouraged people to use condoms and reduce their number of sexual partners. In the capital city of Santo Domingo, sustained efforts to promote consistent condom use and safer sexual behaviour among sex workers and their clients have been linked to decreasing HIV prevalence among pregnant women. It is estimated that 1.1% of the adult population (15-49) is living with HIV/AIDS. (Source: www.Avert.org)
- 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.
- 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.
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) Don’t 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.
Chikungunya Fever: The number of chikungunya cases reported in the Western hemisphere increased by some 70 000 cases from last week, according to data released by the Pan American Health Organization (PAHO) in 2014. The total suspected and confirmed cases near 660 000.
Cholera: According to to the Ministry of Health, 9 confirmed cases of cholera have been reported in Venezuelan travelers who attended a wedding in eastern Dominican Republic in January 2011. Venezuelan media reports 37 cases in returnees. Lobsters originating from a coastal area bordering Haiti have been implicated. No widespread risk to travelers should be inferred from this apparent focal outbreak. Cases of cholera were also in the Dominican Republic November 16, 2010. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by untreated sewage. Food is often contaminated by water containing cholera bacteria or being handled by a person ill with cholera.
Although this disease is endemic, the threat to tourists is low. Cholera is an rare disease in travelers from developed countries. 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.
Cyclosporosis: Cases of gastroenteritis due to the parasite cyclospora cayatensis have been reported in British tourists. Symptoms include prolonged watery diarrhea, abdominal cramping, weight loss, anorexia, myalgia, and occasionally vomiting and/or fever. Symptoms generally begin approximately 1 week (5-8 days) after ingestion of the oocysts and these may persist for a month or more. Cyclospora is treatable with trimethoprim-sulfamethoxazole (Bactrim).
Dengue Fever: Outbreaks of dengue occur annually. More than 6000 cases of dengue fever, including 30 deaths, were reported for the first nine months of 20014. 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 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 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.
- The incubation period is You should consider the diagnosis of dengue if you develop an unexplained fever during or shortly after being in this country.
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 may be endemic but levels are unclear. Sporadic cases may occur. 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 5% to 7%. 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 2.4% 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.
Leptospirosis: An outbreak of leptospirosis was last reported in the Dominican Republic associated with Tropical Storm Noel which passed through the Caribbean in the beginning of November 2007. The areas most affected are the provinces of Santo Domingo, San Cristóbal, Barahona and the National District. The main tourist areas of Dominican Republic were not affected. Leptospirosis is caused by bacteria of the genus Leptospira. The bacteria are harboured in the kidneys of animal hosts, including rodents, dogs and cattle, and are then excreted in urine. Transmission to humans occurs when the bacteria penetrate skin or mucous membranes following contact with infected animals, or soil and water contaminated by animal urine. Travelers at higher risk include adventure travellers who participate in water sports including swimming or white water rafting.
- Travellers are advised to avoid exposure to freshwater or soil that may have been contaminated by rodent or other mammal urine. Antibiotic prophylaxis with doxycycline can be offered to travelers who may be unavoidably exposed to rodents or water.
Malaria: The CDC (2015) has received multiple reports of falciparum malaria among US travelers returning from the Dominican Republic. With the exception of the cities of Santiago and Santo Domingo, malaria transmission is country-wide, including the popular tourist resorts such as Punta Cana and Puerto Plata. The Centers for Disease Control as well as French and British authorities recommend malaria prophylaxis for all travelers to the Dominican Republic.
Chloroquine or malarone are the recommended prophylactic drugs for the Dominican Republic.
Malaria is transmitted via the bite of an infected 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 (such as Ultrathon) have been the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellent (20% formulation) is now recommended by the CDC as an acceptable alternative to DEET 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. Most cases of malaria will become symptomatic within 30 days after exposure in travelers not taking anti-malarial medication. Longer incubation periods have been reported.
Marine Hazards: Scuba Diving-Hyperbaric Chamber Referral: Divers‘ Alert Network (DAN) maintains an up-to-date list of all functioning hyperbaric chambers in North America and the Caribbean. DAN does not publish this list, since at any one time a given chamber may be non-functioning, or its operator(s) may be away or otherwise unavailable. Through Duke University, DAN operates a 24-hour emergency phone line for anyone (members and non-members) to call and ask for diving accident assistance. Dive medicine physicians at Duke University Medical Center carry beepers, so someone is always on call to answer questions and, if necessary, make referral to the closest functioning hyperbaric chamber. In a diving emergency, or for the location of the nearest decompression chamber, call 919-684-8111.
Ciguatera poisoning: Most reported cases of ciguatera poisoning have involved travelers who ate fish in the Caribbean while on holiday. These cases included consuming grouper in the Dominican Republic, kingfish in Jamaica, barracuda in Haiti and a fish casserole in Cuba.
- Any reef fish can cause ciguatera poisoning, but species such as barracuda, moray eel, grouper, red snapper, jack, sturgeon and sea bass are the most commonly involved. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given locality will be toxic. The ciguatoxin is not destroyed by cooking.
Case report: In August 2008, a French tourist to Puerto-Plata, Dominican Republic developed abdominal cramps and diarrhea with vomiting about four hours after eating fish (The species of ingested fish could not be specified; the patient remembered only that it was “a big fish.”) The gastro-intestinal symptoms persisted for three days. Generalized pruritus (itching) appeared 24 hours after the onset of the disease resulting in insomnia. The ptient also noted headache, arthralgia, myalgia and paraesthesias of mouth and extremities. After the patient returned to France he continued to have pruritus with with excoriations, muscle and joint pain, and weakness. The diagnosis of ciguatera poisoning was made on the basis of the epidemiological data and the association of gastrointestinal and neurological symptoms. Despite symptomatic treatment, pruritus and geeralized weakness were still present seven weeks after the exposure.
- Discussion: Ciguatera poisoning is the most common marine poisoning, endemic in tropical zones of the Atlantic, Pacific, and Indian oceans. The origin of ciguatoxins is gambiertoxins produced by marine dinoflagellates, in particular Gambierdiscus toxicus. Ciguatoxins are lipid-soluble, heat-stable and not destroyed by freezing and cooking. This class of polyether toxins acts by opening the sodium channels in the nerve cell membranes. Ciguatoxins are accumulated in the flesh and viscera of herbivorous fish, which in turn are ingested by larger carnivorous fish. Many reef fish species have been associated with the disease. Consumption of these fish may then cause ciguatera intoxication in humans.
- The Pacific ciguatoxin is much more toxic than the Caribbean one. In the absence of reliable tests, the diagnosis is based on the succession of gastro-intestinal and neurological symptoms. Gastrointestinal effects predominate in the Caribbean and neurological ones in the Indo-Pacific regions. Gastrointestinal manifestations (abdominal cramps, diarrhea, vomiting) start 6-12 hours after consumption of contaminated fish. Neurological and sometimes psychiatric symptoms appear 24-72 hours later, with weakness of the limbs, perioral paraesthesia and dysesthesia being the most common symptoms suggestive of the intoxication. Myalgia, arthralgia, headache, ataxia and dizziness can also be observed. Other manifestations include asthenia, pruritus, cutaneous rash, eye and dental pain, and dysuria. In severe cases, cardiovascular disorders (hypotension, bradycardia) can occur, mortality is low.
- The evolution of ciguatera poisoning is sometimes chronic, associated with depression and persistent aethenia.T reatment is only symptomatic and requires hospitalisation in severe cases. Mannitol therapy had been proposed as the treatment of choice, but this statement was not confirmed by a double-blind randomised trial.
- Preventive measures are essential in endemic areas in order to reduce the incidence of the intoxication. The main recommendation is to avoid consumption of large reef fish. Travellers visiting ciguatera-endemic areas should be warned by travel clinics and tour operators about the risk of fish poisoning and advised that the risk of ciguatera intoxication can be reduced by avoiding consumption of reef fish and large ocean predators (e.g. shark, barracuda).
Other Diseases/Hazards: Diffuse cutaneous leishmaniasis (focus reported in the eastern part of the country).
- Brucellosis (chief source is infected cattle).
- Eastern equine encephalitis (low risk).
- Lymphatic filariasis (chiefly the Santo Domingo area; also reported from the central valley and the north coast).
Rabies: Rabies is present in the Dominican Republic. 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.
Pre-travel 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.
- 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.
Schistosomiasis: Schistosoma mansoni (intestinal) is present in this country, mainly the eastern lowlands but reported as far west as Jarabaco. Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection.
- All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, or streams. There is no risk in chlorinated swimming pools or in seawater.
Travelers’ Diarrhea: High risk outside of deluxe resorts, but cases of shigellosis (dysentery) have also been reported in toursists staying in resort facilities. 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. 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.
Tuberculosis (TB): Tuberculosis is highly endemic in the Dominican Republic 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 (with the exception of short-term visitors who restrict their meals to hotels or resorts, or cruise ship passengers) traveling to or working in the Caribbean, 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.