Time Zone: -5 hours GMT.
Tel. Country Code: 507
USADirect Tel.: 109
Electrical Standards: Electrical current is 110/60 (volts/hz). North American Style Adaptor Plug and South Pacific Style Adaptor Plug. Grounding Adaptor Plug A.
Travel Advisory - Panama
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 Panama
Demetrio Basilio Lakas Avenue
• U.S. Citizen Services
Phone: (507) 317-5000 or (507) 317-5030
Monday-Thursday: 10:30am - 12 noon and 3:00 pm - 4:30 pm
Friday: 10:30am – 12:00 noon
Automated Information: 317-5030
Torres de las Americas
Tower A, Piso 11
HIV Test: Not required.
Required Vaccinations: Travelers entering the country from an endemic zone are required to present a certificate of immunization against yellow fever.
ENTRY/EXIT REQUIREMENTS: U.S. citizens traveling by air to and from Panama must present a valid passport when entering or re-entering the United States. Sea travelers must have a valid U.S. passport (or other original proof of U.S. citizenship, such as a certified U.S. birth certificate with a government-issued photo ID). Consulate of Panama in U.S.
Panama has a developing economy. Outside the Panama City area, which has many first-class hotels and restaurants, tourist facilities vary in quality. The U.S. dollar is the paper currency of Panama, and is also referred to as the Panama balboa. Panama mints its own coinage.
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: Vaccination is recommended for all travelers >9 months of age traveling to the provinces of Darien, Kunayala (San Blas) and Panama, excluding the Canal Zone, Panama City and the San Blas Islands.
• A yellow fever vaccination certificate is required from all travelers coming from countries with risk of yellow fever transmission
Hospitals / Doctors
Panama City has some good private hospital and clinics but medical facilities outside the capital are limited.
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 that provides for medical evacuation to the United States in the event of serious illness or injury that requires specialty care not available in this country. Air ambulance evacuation to the US may be needed in the event of serious illness or injury.
Good medical care is widely available in Panama City, but is extremely limited elsewhere. Many travelers go to one of the following hospitals or clinics:
• Clinica Hospital San Fernando
363 Zona 9A
Private hospital; general medical/surgical facility; 24-hour emergency room, trauma unit; ICU; Ob/Gyn; pediatrics ward.
Affiliate connections with Tulane University Medical Center, New Orleans, Baptist Health International Center of Miami, and Miami Children's Hospital.
• Hospital Santa Fe
Avenida Frangipani Y Via Bolivar
Hospital Santa Fe is one the most modern and best equipped hospitals in Panam•. It is nearest to the Panama Canal and is the leading provider of health care services to tourists and crew members of ships transiting through the canal. Most doctors and nurses are fluent in the English language.
Cuba-Calle 38 and Calle 39
24-hour Emergency Room
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. 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.
Panama is proportionally less affected by HIV/AIDS than other countries in Central America, with 0.4% 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.
Avian Influenza A (Bird Flu): Avian influenza A (H5N1) has not been reported in Panama.
Chagas’ Disease: Chagas’ disease occurs at low levels in most rural areas of Panama, including the former Canal Zone. A new endemic area has been identified in 2010 in the eastern region of Panama Province. Risk of transmission occurs primarily in areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take precautions against nighttime bites, which typically occur on the face of the sleeping victim.
• Other methods of transmission are possible, from; consumption of food or juice (especially sugar cane juice and acai palm juice) contaminated with crushed triatome insects; from blood transfusions; from fetal transmission.
Chikungunya Fever: In late 2013, chikungunya fever virus was found for the first time in the Caribbean. Chikungunya virus is transmitted by daytime-biting mosquitoes. It is similar to dengue fever in this respect. Symptoms include fever, headache, joint and muscle pain (which may last for weeks to months) and a rash. There is no vaccine to prevent or medicine to treat chikungunya fever. To prevent this illness, apply a DEET-based insect repellent (such as Ultrathon) during the day to exposed skin and wear clothing treated with permethrin (such as Sawyer Aerosol or Military Soak).
Cholera: This disease is reported active in this country, but the threat to tourists is very low. 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. (Referece: NEJM)
Dengue Fever: Endemic year-round, countrywide, with risk elevated during the rainier months (usually May through December). Most recent outbreak is reported from the Veraguas Nurum region.
Dengue fever is a mosquito-transmitted, flu-like viral illness widespread throughout the tropics and subtropics (See map).. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon) to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.
In August 2014, 2 more cases were confirmed by the Ministry of Health in Los Santos [province]; one n San Jose de Las Tablas and the other in Tonosi. Cases of hantavirus infection continue to pop up in Los Santos province, especially in Tonosi and San Jose de Las Tablas, which appear to be focal areas of infection.
Although the majority cases of the cases come from the Azuero region, there has also been one case in Chepo. The Ministry of Health has carried out fumigation programs to stop the propagation of rodents, but they continue to proliferate especially in areas where there is accumulation of rubbish. Rats are carriers of the hantavirus[es] and contaminate bottles and other items with their urine.
Hantaviruses are rodent-borne agents belonging to the Bunyaviridae family. These viruses, which are found throughout Europe, Asia and the Americas, are maintained by different species of rodents, in which they produce chronic, inapparent infections. Humans become infected through contact with urine, saliva or faeces from infected rodents, mainly via the aerosol route. In humans, clinical disease occurs in the form of two major syndromes: hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). Haemorrhagic fever with renal syndrome mainly occurs in Europe and Asia and HPS has only ever been reported in the Americas. Person-to-person transmission of hantaviruses, although uncommon, was described during an outbreak of HPS in southern Argentina. Most epidemics of HFRS and HPS occur in areas with large populations of rodents that have a relatively high prevalence of infection.
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. Transmission of the hepatitis E virus (HEV) occurs primarily through contaminated drinking water. 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 1% 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: Scattered cases of cutaneous and mucocutaneous leishmaniasis occur countrywide in rural areas, but most cases are reported from the western or west-central areas. Visceral leishmaniasis (kala-azar) is not reported. 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.
Malaria: Focally endemic (see map). There is no risk of malaria in Panama City or the Canal Zone itself.
Malaria exists in some parts of Panama, including in some outlying areas of Panama City. Low-level risk exists year-round in rural areas of eastern (Darien and San Blas) and western (Bocas Del Toro, Chiriqui, and Veraguas) provinces. Areas immediately adjacent to the Panama Canal and all major urban areas are probably risk free.
• Chloroquine-resistant falciparum malaria is confirmed in Darién and San Blas provinces, including San Blas Islands. Travelers to this region should take one of the following antimalarial drugs: Atovaquone/proguanil (Malarone), doxycycline, mefloquine, or primaquine (G6-PD test required). Chloroquine is recommended for prophylaxis in the Bocas Del Toro Province. This province borders on Costa Rica.
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 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: Cysticercosis, hantavirus (hemorrhagic fever with renal syndrome reported in 2004)
• Filariasis (may occur in the extreme northeast)
• Histoplasmosis (from exposure to bat guano), leptospirosis (country-wide; greatest risk during periods of heavy rainfall; outbreaks reported among military personnel performing jungle training exercises)
• Mansonellosis (increased incidence in northwestern Darien)
• Mayaro virus disease (transmitted by mosquitoes in tropical forests)
• Paragonimiasis (Oriental lung fluke; from consumption of raw freshwater crabs or crayfish)
• Tick-borne rickettsioses (spotted fever group)
• Toxoplasmosis (usually transmitted by infective cat feces)
• Venezuelan equine encephalitis, transmitted by mosquitoes, is reported from scattered foci, including the Fort Sherman area, on the Caribbean side of the isthmus, and Eastern equine encephalitis, also transmitted by mosquitoes, is reported from various areas)
Rabies: Rabies in animals (usually dogs and bats) is widespread throughout the area. Occasional humn cases are reported. 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: Variable risk. All water sources outside major hotels should be considered potentially contaminated. A quinolone antibiotic, azithromycin, or rifaximin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic therapy may be due to a parasitic disease such as amebiasis or giardiasis. Cryptosporidiosis may occur.
Tuberculosis (TB): Tuberculosis is highly endemic in Panama 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) 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. 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: This country is in the Yellow Fever Endemic Zone. The CDC recommends yellow fever vaccine for all travelers >9 months of age traveling to the provinces of Darien, Kunayala (San Blas) and Panama, excluding the Canal Zone, Panama City and the San Blas Islands. (See map) Unvaccinated travelers should prevent daytime mosquito bites.
• Panama requires travelers arriving from an endemic zone country to present proof of yellow fever vaccination. Vaccination should be given 10 days arrival in this country.