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Nicaragua



Capital: Managua

Time Zone: -6 hours. No daylight savings time in 2008.
Tel. Country Code: 505
USADirect Tel.: 174
Electrical Standards: Electrical current is 120/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug A.


Travel Advisory - Nicaragua

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 Nicaragua


Resource Links

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

Embassies

U.S. Embassy
Managua

The Embassy is located at Km 5½ Carretera Sur, Managua.

The American Citizen Services Office in the Embassy is accessed

through the consular entrance on the west side of the building.


For emergencies requiring consular assistance during our regular office hours of 7:30 AM to 4:15 PM. Please call (505) 2252-7104.

For emergencies after hours, please call (505) 2252-7171 or (505) 8768-7171 and request to speak with the Embassy Duty Officer.

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from travelers over 1 year of age coming from infected or endemic areas.

Passport Information

Passport/Visa: Nicaragua is a young democracy with a developing economy. The promotion of tourism is a top government priority; however, Nicaragua lacks an extensive tourist infrastructure. Potential tourists may want to obtain information from INTUR, the governmental agency responsible for developing, regulating and promoting tourism in Nicaragua. INTUR•s web site is http://www.intur.gob.ni/ and offers some information in English. The climate is hot and humid, with the summer dry season running mid-November through mid-May and the winter rainy season running from mid-May through mid-November. Terrain ranges from the hilly and volcanic to coastal beaches and tropical jungles.

ENTRY/EXIT REQUIREMENTS: On January 8, 2007, the U.S. Government phased in new passport requirements for U.S. citizens traveling in the Western Hemisphere. All U.S. citizens traveling by air are expected to depart and enter the United States on a valid U.S. passport or other authorized document establishing identity and U.S. citizenship. (The U.S. Customs and Border Protection web site at http://www.cbp.gov has more information on U.S. entry requirements.) Visit the Embassy of Nicaragua web site at http://www.cancilleria.gob.ni/ for the most current visa information and locations for the Embassy and the several consulates in 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 travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes (increased risk in lesser-developed countries); from contact with open skin sores of an another person. Recommended for any traveler requesting protection against hepatitis B virus.

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

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.

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.

Yellow Fever: Yellow fever vaccine is required for all travelers >1 year of age arriving from, or transiting through, any country in the yellow fever endemic zones in Africa or the Americas. Not recommended or required otherwise.

Hospitals / Doctors

Basic medical services are available in Managua and in many of the smaller towns and villages. However, treatment for many serious medical problems is either unavailable or available only in Managua. Emergency ambulance services, as well as certain types of medical equipment, medications and treatments, are not available in Nicaragua. Physicians and hospital personnel frequently do not speak English, and medical reports are written in Spanish. Patients must have good understand and an ability to speak Spanish in order to navigate the local medical resources. Each department of the country has its own public hospital.

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 the United States.

A listing of hospitals and doctors is maintained by the U.S. Embassy

Hospital Metropolitano Vivian Pellas
Masaya Highway

(505) 2255-6900

Telephone: USA: (305) 396-2351


This is the most modern hospital in Nicaragua and is the only one accredited by the Joint Commission Intrernational.

The Hospital Metropolitano offers a 24-hour emergency room, an intensive care unit, and a broad range of specialty services.

Destination Health Info for Travelers

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. 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 much higher.
Nicaragua is proportionally less affected by HIV/AIDS than other countries in Central America, with 0.2% of the adult population living with HIV. (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with 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.
• 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.
Health insurance is essential.


Chagas’ Disease: Reported in Atlantic coastal, western, and central regions under 1,500 meters elevation. The risk of transmission occurs primarily in 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 in-utero transmission.


Cholera: Although this disease is occasionally reported in this country, the threat to tourists is very low. Cholera is an uncommon 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. 


Dengue Fever: During 2007, a total of 446 confirmed and 5,055 suspected cases of classical dengue fever were reported. This includes 43 cases of dengue hemorrhagic fever (DHF) with an additional 202 suspected cases. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in the 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.

A dengue fever map is here:


Hepatitis: All travelers not previously immunized against hepatitis A should receive the vaccine. 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 is probably endemic but levels are unclear. Sporadic cases may occur but go 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 2% or less. 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 0.6% 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.


Leishmaniasis: Cutaneous leishmaniasis is reported, primarily from the northern, central, and eastern regions, especially around forested areas. The most recent outbreak reported occurred in 2005 from Cua County, Jinotega Department in the north. Visceral leishmaniasis also occurs, but levels are unclear. The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.


Leptospirosis: Over 600 cases of leptospirosis have been reported countrywide but primarily in the western departments of Leon, Chinandega, Esteli, and Managua since Sept. 2010. Most cases are from flooded areas caused by tropical storm Matthew. Travelers who anticipate extensive outdoor exposure, e.g., disaster relief workers and adventure travelers, should consider prophylaxis with 200 mg of doxycycline once a week.
• The risk of acquiring the disease is higher in adventure travelers who participate in water sports including swimming or white water rafting. The risk increases following periods of heavy rainfall and flooding, because as water saturates the environment, leptospires in the soil pass directly into surface waters.
• Animal hosts excrete leptospira bacteria in the urine. Transmission to humans occurs when spirochetes penetrate mucous membranes or skin following contact with soil and water contaminated by animal urine.


Malaria: Risk is present countrywide below 1,000 meters elevation, except for the major urban areas such as Managua and Leon. Malaria risk is elevated in Chinandega, Jinotega, Nueva Segovia, Atlantico Norte, Atlantico Sur, and Rio San Juan. The majority of cases occur from June to December.
• P. vivax accounts for 80-90% of cases. Chloroquine prophylaxis is recommended in all rural risk areas.

A malaria map for Nicaragua is located here:

Malaria update here:

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) 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.

• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.


Other Diseases/Hazards:

• Abdominal angiostrongyliasis
• Brucellosis (from unpasteurized dairy products and infected animals)
• Coccidiomycosis
• Filariasis (possible risk near Lake Managua)
• Paragonimiasis (Oriental lung fluke; rare)
• Strongyloidiasis and other helminthic infections
• Tick-borne relapsing fever
• Venezuelan equine encephalitis (mosquito-transmitted)


Rabies: Sporadic cases are reported annually, usually transmitted by dogs. Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.


Travelers' Diarrhea: Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. Outbreaks of diarrheal diseases are more common during the rainy season. We recommend that you boil, filter, or purify all drinking water or drink bottled water, and avoid ice cubes and raw and undercooked food. Seek medical advice if you have a fever or are suffering from diarrhea. A quinolone antibiotic, azithromycin, or rifaximin, 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. (A high incidence of amebiasis is reported in Nicaragua. Infection rates of up to 23% have been reported for giardiasis.) Rates for cryptosporidiosis are unclear but probably low.


Tuberculosis (TB): Tuberculosis is highly endemic in Nicaragua 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 vaccine is recommended by the CDC for all people traveling to or working in this country, 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: No cases are currently reported. Travelers entering the country from an endemic area are required to present a certificate of immunization against yellow fever.