Press Release

Travel Conditions in Honduras, Nicaragua, and Guatemala After Hurricane Mitch

The Department of State has warned U.S. citizens that dangerous conditions exist in Honduras, Nicaragua, and Guatemala, the countries most affected by Hurricane Mitch. Because of the disruption of land transportation, there may be shortages of food, medicine, and other supplies normally delivered by road. Water supplies have been polluted or interrupted by flooding. Electricity and telephone services have been disrupted in many areas. Medical services are overextended by the needs of victims of the disaster. Despite a massive international relief effort, normal services are being restored slowly. It is impossible to predict when the infrastructure will be capable of normal function.

Under these circumstances, CDC highlights the importance of recommended vaccines for all travelers who must visit Central America. All routine immunizations should be up to date, and vaccinations for hepatitis A and typhoid are essential. Recommendations for preventing malaria have not changed: travelers should take chloroquine to prevent malaria if they visit rural areas (except the highlands of Guatemala, where there is no malaria).

CDC's routinely recommended prevention measures assume even greater importance in the aftermath of a natural disaster. (See Travelers' Health) However, these recommendations may be very difficult to follow when normal services are disrupted. Because of interruption of power supplies, refrigeration may not be reliable, necessitating increased care with food. Drinking water should be boiled or disinfected; bottled water may not be available. To ensure safe drinking water-

• Boiling is the most reliable method to make water safe to drink. Bring water to a vigorous boil for one full minute, then allow it to cool; do not add ice. Adding a pinch of salt or pouring water from one container to another will improve the taste.
• Chemical disinfection can be achieved with either iodine or chlorine, with iodine providing greater disinfection in a wider set of circumstances. For disinfection with iodine use either tincture of iodine or tetraglycine hydroperiodide tablets, such as Globaline*, Potable-Aqua*, and others.

After heavy rainfall, an increase in the mosquito population can be expected. An accompanying increase in dengue and malaria transmission is therefore a possibility. Travelers should protect themselves from insect bites by—

• Using an insect repellent containing DEET, in 30%-35% strength for adults and <30% for children,
• Wearing long-sleeved shirts and long pants from dusk through dawn, and
• using bed nets impregnated with the insecticide permethrin, unless housing is air-conditioned or well-screened.

Another concern after flooding is increased risk for leptospirosis, a disease spread through contact with contaminated water. Heightened awareness by physicians that leptospirosis is a common cause of febrile illness in flood-affected areas should increase the likelihood that patients will be diagnosed and treated appropriately. Prompt administration of penicillin or doxycycline based on clinical suspicion of leptospirosis could be potentially lifesaving in circumstances where rapid laboratory diagnostics are not available. People visiting at-risk areas can reduce the risk of exposure by avoiding contact with potentially contaminated water or by wearing protective boots or other clothing when contact with such water is necessary. Anyone who develops a febrile illness after returning from a flood-affected tropical country should be seen by a physician, and leptospirosis should be considered in the differential diagnoses. For more information about this disease, see Leptospirosis.

For more information about conditions in the areas affected by this natural disaster, you may wish to consult the consular advisories posted by the Department of State at Travel.State.Gov

* The use of trade names is for identification only and does not imply an endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES