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Ecuador



Capital: Quito

Time Zone: -5 hours. (Galapagos Islands are GMT -6)
Tel. Country Code: 593
USADirect Tel.: 1
Electrical Standards: Electrical current is 120/60 (volts/hz). North American Style Adaptor Plug. Grounding Adapotor Plug A.


Travel Advisory - Ecuador

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 Ecuador


Resource Links

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

Embassies


The U.S. Embassy 


The American Citizens Services (ACS) Section
 provides assistance with several services including:

Entry Requirements

HIV Test: Testing is required for foreign contractors or if staying over 30 days.

Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year arriving from yellow fever–infected areas.

Passport Information

Passport/Visa: Travelers from the U.S. do not need a visa for trips up to 90 days. 


Visit the Embassy of Ecuador in Washington, DC for additional visa information.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age.

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: Recommended for all travelers over 6 months of age.

Polio: Not recommended.

Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites, especially bites from dogs. 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 exposure, but does not eliminate the need for treatment with two extra booster doses of 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 Tdap vaccine (Tetanus, diphtheria, acellular pertussis) also boosts immunity against pertussis (whooping cough) and should be considered when a tetanus-diphtheria booster (Td) is indicated. Tdap is given a single lifetime dose.  The Td vaccine boosters are then resumed every 10 years after the Tdap vaccine is given.

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: In accordance with International Health Regulations, a yellow fever vaccination certificate is required from travellers >1 year of age coming from areas with risk of yellow fever transmission. The following countries and areas are regarded as areas with risk of yellow fever transmission; air passengers in transit coming from these countries or areas without a certificate will be detained in the precincts of the airport until they resume their journey:
• Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d‘Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, São Tomé and Príncipe, Senegal, Sierra Leone, Somalia, Sudan (south of 15°N), Togo, Uganda, Republic of Tanzania, Zambia.
• America: Belize, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, Venezuela.
Note. All arrivals from Sudan are required to possess either a vaccination certificate or a location certificate issued by a Sudanese official centre stating that they have not been in Sudan south of 15°N within the previous 6 days.

Hospitals / Doctors


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 for medical evacuation. 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, you should be evacuated by air ambulance to a hospital in Europe.


Medical facilities often used by travelers include:


Destination Health Info for Travelers

AIDS/HIV: The development of 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.

  1. AIDS/HIV: In almost every Latin American country, the highest levels of HIV infection are found amongst men who have sex with men (MSM). (Peru openly acknowledges that their epidemic is primarily driven by MSM.) Overall 0.6% of Peruvian adults are living with HIV, but studies have suggested much higher rates of infection among MSM. 


• 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.
• In 2007, 4 patients in less than 6 months were infected with HIV after receiving blood transfusions at public hospitals. The Ministry of Health has recently declared the blood banks to be in a state of emergency.

NOTE: Travelers should avoid all blood transfusions in this country.


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)/HACE/HAPE: 
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:

Centers for Disease Control

International Society for Mountain Medicine
Institute for Altitude Medicine


Animal Hazards: Animal hazards include snakes, centipedes, scorpions, black widow spiders, brown recluse spiders, banana spiders, and wolf spiders. Fatal bushmaster envenomations have occurred and ecotourists (e.g., birders) should have access to antivenin and air ambulance evacuation. 


Chagas Disease (American Trypanosomiasis): 
Widely distributed in rural areas.

• Chagasdisease occurs primarily in rural-agricultural areas where there are adobe-style huts and houses. These structures often harbor the night-biting triatomid (assassin) bugs which are responsible for transmitting Chagas• disease. Travelers sleeping in such structures should take precautions against nighttime bites. 
• Other modes of transmission include: consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; blood transfusions; in-utero transmission.


Cholera: 
A large outbreak occurred in the 1990s. Although this disease remins 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 (NEJM) is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children.


Dengue Fever: 
From January 2008 to the end of March 2008, over 4,000 dengue cases were reported, including many cases of dengue hemorrhagic fever. 
• Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Latin 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.


More dengue fever info and dengue fever map.


Fascioliasis (liver fluke disease): 
Fascioliasis is an infection caused by flukes (worms) of the class Trematoda, most often characterized by fever, eosinophilia, and abdominal pain. Humans are incidental hosts for Fasciola hepatica, commonly known as the sheep liver fluke; these flukes cause illnesses in patients who become infected by ingesting contaminated water or contaminated aquatic vegetables, such as watercress. The illness occurs worldwide, particularly in regions with intensive sheep or cattle production.

• Human fasciolosis is a serious problem in Ecuador, Peru and Bolivia.  These Andean countries are considered to be the area with the highest prevalence of human fasciolosis in the world. Well-known human hyperendemic areas are localized predominately in the high plain called Altiplano. In the Northern Bolivian Altiplano, prevalences detected in some communities were up to 72% and 100% in coprological and serological surveys, respectively. In Peru, F. hepatica in humans occurs throughout the country. The highest prevalences were reported in Arequipa, Mantaro Valley, Cajamarca Valley, and Puno Region.


Hepatitis: 
All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through 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. 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.
• 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 with a prevalence of 1.6% 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 from March to September in the Southern Hemisphere. The flu vaccine is recommended for all travelers over age 6 months who have not received a flu shot in the previous 12 months.


Leishmaniasis: 
Cutaneous leishmaniasis is endemic in Andean and inter-Andean valleys and foothills. Mucosal leishmaniasis is endemic in the tropical rainforests at lower altitudes. Visceral leishmaniasis (kala azar) does not occur. 
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night. Contrary to what their name suggests, sandflies 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 Quito and surrounding high-altitude areas. Elsewhere, malaria occurs in year-round in rural areas below 1,500 meters (4900 feet)  Significant risk exists in the Amazon region and its tributaries.

• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine (G6-PD test required) is recommended. 


Malaria map


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 (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 remain 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 repellents (20% formulation) are now recommended by the CDC and the World Health Organization as acceptable alternatives 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.


Marine Hazards: 
Portuguese man-of-war, sea wasps, and stingrays are found in the coastal waters of Peru and could be a hazard to swimmers.


Other Diseases/Hazards: 
Anthrax (most often cutaneous; usually transmitted by contact with freshly slaughtered, infected cattle; in January 2008, 7 cases of anthrax were reported, including a fatal case in a farmer.)
• Brucellosis (from ingestion of unpasteurized dairy products, especially goat cheese)
Bartonellosis (Oroyo fever; focally endemic in Andean valleys; reported in September 2006 from Collo Locality, Arahuay District, near Lima)
• Coccidiomycosis (endemic in the Amazonian lowlands)
Cysticercosis (residents of rural, endemic areas of Peru have a disease prevalence of 8%) 
• Cyclosporiasis (This is a gastrointestinal disease caused by the parasite Cyclospora cayetanensis . 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 in contaminated water, and these may persist for a month or more. Cyclospora is treatable with trimethoprim-sulfamethoxazole).
• Diphyllobothriasis (tapeworm infection from raw marine fish)
• Eechinococcosis (major health problem in central Andean areas)
• Fascioliasis (liver fluke disease; acquired by consumption of raw aquatic plants; risk elevated in Amazonian lowlands)
• Gnathostomiasis (caused by a helminth worm, may be acquired by eating raw or undercooked freshwater fish, including ceviche, a popular lime-marinated raw fish salad)
• Hantaviral disease (including hemorrhagic fever with renal syndrome and hantaviral pulmonary syndrome; transmitted by contact with rodent urine, saliva, or feces) 
• Leptospirosis 
• Paragonimiasis (from ingestion of raw freshwater crabs and crayfish) 
• Plague (flea-borne; human plague is reported from Peru nearly every year, chiefly from the departments of Cajamarca, La Libertad, Piura, and Lambayeque in the northern part of the country). More cases reported from La Libertad in 2010. 
• Strongyloidiasis and other helminthic infections
• Tick-borne relapsing fever
• Typhus, scrub typhus and spotted fevers: In 2010, Rickettsial transmission was reported (Am J Trop Med) widespread in the Iquitos region. Rickettsia species should be further explored as potential causes of acute febrile illnesses in the region. The typhus group includes flea- and louse-borne typhus. Scrub typhus is transmitted by mites. Spotted fevers are usually transmitted by ticks.


Plague: 
According to WHO, 17 cases of plague (12 bubonic, 4 pneumonic, and 1 septicemic) have been confirmed from Ascope Province (La Libertad Department). Sporadic cases of bubonic plague, a localized infection transmitted by rat fleas, are known to occur in this region. Pneumonic plague is transmitted through inhalation of infective respiratory droplets from humans with spread of the bacteria to the lungs. Recent information indicates that no new cases of pneumonic plague have been reported since July 11, 2010. The risk to travelers is minimal. You should avoid rat infested accommodations in affected areas.


Rabies: 
There is a higher risk of rabies in Peru than in other South American countries. Cases of human rabies, transmitted mostly by dogs and vampire bats, has increased but the exact incidence of human rabies is not known. The Peruvian Ministry of Health confirmed in 2007 a cluster of human rabies deaths following bites from vampire bats. The deaths occurred in rural areas of Madre de Dios and Puno regions. This follows a previous outbreak in December 2006 which occurred in the Amazonas region in northern Peru. In general, transmission of bat rabies in Peru occurs only in remote, often isolated jungle areas. 
• All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. 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.


Travelers' Diarrhea: 
High risk, especially outside first-class hotels and resorts. 
• 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 dairy products. Do not eat raw or undercooked food, especially meat and fish. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%. 
• A quinolone antibiotic, or azithromycin, 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: 
Tuberculosis is a major public health problem in this country. Tuberculosis is highly endemic 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: 
The risk of typhoid fever is higher in Peru than in most other Latin American countries. (Mexico, Peru, Chile, India, and Pakistan are the highest-risk countries). Typhoid is the most serious of the Salmonella infections. Typhoid vaccine is recommended 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.


Yellow Fever: 
Cases of yellow fever are reported each year from Peru. In the first 6 months of 2008, there were three confirmed cases, including one from the Amazonas Department and one from the San Martin Department, and 14 probable cases. All of the cases were fatal. In January 2009, a confirmed case was reported from the department of San Martin. In Peru, most cases of yellow fever occur among workers in the countryside. In 2007, three cases were reported from the Province of La Convencion, an area in the northernmost part in the department of Cuzco. 
• Yellow fever vaccine is recommended for those who intend to visit the jungle areas of the country below 2300 meters (7,500 ft) elevation. There is no risk of yellow fever in the coastal areas, in Cuzco and Machu Picchu, or the Andean highlands (Puno, Lake Titicaca, Arequipa, Colca Canyon). 
• There is no requirement for yellow fever vaccination to enter this country.

Yellow fever risk areas map.