Disease and Illness in Costa Rica

Generally, Costa Rica is a very healthy country.  However, being in a tropical location (only ten degrees above the equator), there are risks that face people traveling here.  As with almost all diseases, most are avoidable and curable.

Sadly though, many US based travel agents without offices in Costa Rica, provide misinformation that people blindly follow.  I once met a older (70’s maybe) couple that were told to get typhoid shots before they came.  They did… needlessly.  Another gentlemen told me he was warned about malaria and to bring quinine tablets and get an injection before visiting Costa Rica.  The correct information was to simply bring repellent and do not visit any swamps! Silly.

So here are a few of the the little nasty bugs we have here and a brief bit on each. Click to visit.

Cold, Flu, and the Gripe
Dengue Fever|
Cholera
AIDS, Hepatitis – STD’s
Malaria
Leptospirosis
Chagas Disease
Chikungunya

Colds, Flu and Gripe

Yeah, it’s here too.

The Costa Rican variety is not significantly different from the the flu’s or colds found everywhere else in the world as far as I can tell.  Temperature, nausea, diarrhea, malaise, maybe vomiting.  About the only difference I can see is that here, it is called gripe (pronounced gree-pay), which appears to be a catch-all for that whole cadre of viral type infections.  Some hit your digestive system, others your chest.  Unless you are in a high risk group (very young or very old or with respiratory issues), it is pretty much a non event.

Drink the liquids, go to bed, etc. Flu immunizations are available here.  I was going to suggest getting a flu shot before visiting especially if you are coming here on vacation during flu season.  However, as I think about it, although the symptoms are more or less the same, the strain of the virus is NOT , so getting a flu shot in Canada may be useless in Costa Rica.  Then, as I think more, a flu shot MAY be good as you’ll likely be flying with a someone who has your strain!   Sheesh!  Check with your doctor to see if this might be a good preventative idea.

Dengue Fever Costa Rica

Dengue fever and dengue hemorrhagic fever (DHF) are viral diseases transmitted by Aedes mosquitoes, usually Ae. aegypti. The four dengue viruses (DEN-1 through DEN-4) are immunologically related, but do not provide cross-protective immunity against each other.  What this means is if you get one, you can still get the other three.

Plain Dengue Fever, while certainly an annoyance, is much like catching a nasty flu virus.  The symptoms start about 4-7 days after being bitten, and are characterized by sudden onset of a  high fever, severe headache (frontal), and joint and muscle pain. Many people also experience nausea, vomiting, and rash. The rash appears 3–5 days after onset of fever and sometimes spreads from the body to the arms, legs, and face.  It is nasty, but not normally fatal.  You just feel real crummy.

The big brother to this is the dengue hemorrhagic fever (DHF).  THIS is a nasty little fellow indeed.  This version CAN be fatal, so if you are suffering the symptoms described above, see a doctor ASAP, even if you have returned to your home country.  Do not ignore these symptoms. This form of infection is not common.

No vaccine is available. so there is nothing you can do before you come. However, as of June 2012, a new vaccine is in its phase 3 trial. If all goes well, expect a possible vaccine in 2015. You can, however, reduce the risk of acquiring dengue by remaining in well-screened or air-conditioned areas when possible, wearing clothing that adequately covers the arms and legs (not practical at the beach), and applying insect repellent to both skin and clothing (best) when in ares with greatest infestation of mosquitoes (beaches, rain forest, etc). The most effective repellents are those containing N, N-diethylmetatoluamide (DEET)

Dengue is NOT epidemic here but is currently a very serious problem and you should not ignore this.  Yes, you can get it, but don’t over react to what I have written. Remember this is a daytime biting only mosquito, so while out in areas where there are a lot of mosquitoes, just use a good bug repellent!

The Dengue mosquito, prefers to feed on us during the daytime. There are two peak biting times: in the morning for several hours after daybreak and in the late afternoon for several hours before dark. The mosquito may feed at any time during the day, however, especially indoors, in shady areas, or when it is overcast.

Though possibly a bit more likely in the beach and rain forest areas, the Dengue mosquito is also in San Jose.  The government really pushes prevention here with TV ads and notices on newspapers.  Clearly, there are far more cases reported during the rainy season than in Summer.

Oh… and DO NOT take aspirin.  If this is the hemorrhagic version, it makes matters worse.

Costa Rican minister of Health, stated that about 23,000 dengue cases had been reported in 2011.

Chikungunya (to me, the older nastier big brother of Dengue Fever

The World Health Organization (WHO) reported local transmission of chikungunya in Saint Martin. Local transmission means that mosquitoes in the area have been infected with chikungunya and are spreading it to people. This is the first time that local transmission of chikungunya has been reported in the Americas.

Local transmission of chikungunya is now being reported in other countries in the Caribbean. As of October 21, 2014, the following Caribbean countries have reported cases of chikungunya:

Anguilla
Antigua
Aruba
Bahamas
Barbados
British Virgin Islands
Cayman Islands
Curaçao
Dominica
Dominican Republic
Grenada
Guadeloupe
Haiti
Jamaica
Martinique
Montserrat
Puerto Rico
Saint Barthelemy
Saint Kitts
Saint Lucia
Saint Martin (French)
Saint Vincent and the Grenadines
Sint Maarten (Dutch)
Trinidad and Tobago
Turks and Caicos Islands
US Virgin Islands

Notice? No Costa Rica… yet!

CDC recommends that travelers to the Caribbean protect themselves from mosquito bites. Some travelers may be more likely to get chikungunya, have severe disease, or be at higher risk for other reasons. CDC advises travelers in high-risk groups to discuss their travel plans with their health care provider. These groups include the following:

People who have arthritis

People with serious underlying medical conditions (such as high blood pressure, heart disease, or diabetes)

People older than 65

Women who are late in their pregnancies, because of the risk to babies born at the time their mother is sick

Long-term travelers, including missionaries and humanitarian aid workers and people visiting friends and relatives

People who might have difficulty avoiding mosquito bites, such as those planning to spend a lot of time outdoors or staying in rooms without window screens or air conditioning.

What is chikungunya?

Chikungunya is an illness caused by a virus that spreads through mosquito bites. The most common symptoms of chikungunya are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Chikungunya disease rarely results in death, but the symptoms can be severe and disabling. Most people who get sick feel better within a week. In some people, the joint pain may last for months or years.

Who is at risk?

Travelers who go to these islands in the Caribbean are at risk of getting chikungunya. In addition, travelers to Africa, Asia, and islands in the Indian Ocean and Western Pacific are also at risk, as the virus is present in many of these areas. The mosquito that carries chikungunya virus can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas.

What can travelers do to prevent chikungunya?

There is currently no vaccine or medicine to prevent chikungunya. The only way to prevent chikungunya is to prevent mosquito bites. Preventing bites can be difficult, but it is important as you can get sick after just one bite. Follow these steps to reduce the chances that you will be bitten by mosquitoes during your trip.

Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.

Use an appropriate insect repellent as directed.

Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:

DEETExternal Web Site Icon (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon)

Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US])

Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals)

IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)

Always follow product directions and reapply as directed:

If you are also using sunscreen, apply sunscreen first and insect repellent second.

Follow package directions when applying repellent on childrenExternal Web Site Icon. Avoid applying repellent to their hands, eyes, and mouth.

Use permethrin-treatedExternal Web Site Icon clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:

Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.

If treating items yourself, follow the product instructions carefully.

Do not use permethrin directly on skin.

Stay and sleep in screened or air conditioned rooms.

Use a bed net if the area where you are sleeping is exposed to the outdoors.

If you feel sick and think you may have chikungunya:

Talk to your doctor or nurse if you feel seriously ill, especially if you have a fever.

Tell them about your travel.

Cholera in Costa Rica

Cholera is caused by a bacteria, Vibrio cholerae. It’s transmitted from person to person by direct contact (often via healthy people carrying the disease) or consuming contaminated food and water.

Now saying this, don’t worry about it.  I have never heard of a case of cholera in Costa Rica.

Hepatitis –  also – STD’s – AIDS in Costa Rica

There are five strains of this.

Hepatitis A and E are transmitted by contaminated food and drinking water. This is another non-event in Costa Rica unless you find yourself eating dinner in some really nasty place or drinking sewage water.  The water in Costa Rica is very safe to drink, and you need use bottled water only if you are out in the boonies somewhere or are one of those people who are really sensitive to changes in the water you drink.

Now SAYING that, the Center for Disease Control lists Costa Rica as a high exposure area, so not wanting to ignore our government, please DO be careful where and what you eat and drink.

Symptoms are jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, or fever.  Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoid high fat foods.

Hepatitis E is transmitted in the same way as hepatitis A and can be really serious in pregnant women.

Hepatitis B, C, and D are spread through contact with infected blood, blood products or body fluids.  This means mostly sexual contact, use of un sterilized needles (or shaving stuff), blood transfusions, or contact with infected blood through  small breaks in the skin or gums. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. This is nasty, and should be treated like ant other Sexually Transmitted Disease (STD).  Use protection if you do not know your partner’s mother’s name.  Just kidding, but as Costa Rica is a popular spot for ‘adult tourism’, please be careful.

Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.

There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types.

AID’s and Syphilis

AIDS, while not epidemic, is certainly on the increase here.  Syphilis is also very common with 6% of the sex workers testing positive.  Recent articles indicate AIDS is underreported to the health authorities, so maybe it is best not to believe the published figures.

I doubt I have to explain much about this unless you are visiting from another planet, so I will make it simple.

Get AIDS – You Die.

PLEASE use protection as every year we lose hundreds of thousands (maybe millions now) of good people world wide to a disease that is almost entirely avoidable.

Here are some recent statistics to perhaps bring this into closer focus:

Malaria in Costa Rica

Malaria was really never much of a problem here, but things have changed, at least in one small area of Costa Rica.  The area I am referring to is in and around Matina in the province of Limón.  Geographically, this is an area North of Guapiles and Siquirres.  This is the “banana zone” obviously because of the heavy production of bananas in that area.  Over 2,000 cases have been reported in 2007, mostly affecting those 15 to 30.

Another affected area is along the border of Panama and Costa Rica.

These are both areas that are pretty unlikely to be on the average traveler’s itinerary, but for some reason should you be traveling to (generally not just through) these zones, you should consult your physician prior to arriving.,

Not that malaria is carried by the same mosquito that carries Dengue, so be sure to carry some bug repellent.

Symptoms range from fever, chills and sweating, headache, diarrhea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately.

This area is not on the normal tourist agenda, and in fact it would be a bit odd to be traveling in this area at all.  However, if you should be here in those Pacific Lowland areas, do take precautions by first discussing this with your doctor before you leave home.  Obviously, in addition to any pills prescribed by your doctor, bring a ton of bug repellent.

The rest of Costa Rica is not affected, so enjoy your trip!

Leptospirosis

Two deaths, one each in August and September 2005, have been attributed to Leptospirosis here in Costa Rica.  It is caused by bacteria of the genus Leptospira.  Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, and respiratory distress, however, it is rare that death occurs.

Humans become infected through contact with water, food, or soil containing urine from infected animals.  It is easily treatable with antibiotics.  The illness lasts from a few days to 3 weeks or longer, however without treatment, recovery may take several months.  The disease is not known to be spread from person to person.  To download a complete description of this disease, in .PDF format, click here.

Chagas Disease

Thanks to alert reader and contributor, Julie Becker, I am now made aware of yet another disease in Costa Rica.  It is Chagas Disease and is transmitted indirectly by the cute little thing to your right, the triatome bug.  Well, actually, it is transmitted by the feces (en español, ca-ca or in kid speak, poopee) from this critter.

These blood-sucking bugs themselves get infected by biting an infected animal or person. Once infected, the bugs pass T. cruzi parasites in their feces.

The bugs are found in houses made from materials such as mud, adobe, straw, and palm thatch. During the day, the bugs hide in crevices in the walls and roofs. During the night, when the inhabitants are sleeping, the bugs emerge. Because they tend to feed on people’s faces, triatomine bugs are also known as “kissing bugs.” After they bite and ingest blood, they defecate on the person. Yuck! The person then becomes infected through the bite. People can also become infected by:

• unknowingly touching their eyes, mouth, or open cuts after having come into contact with infective triatome bug feces
• bugs directly depositing infected feces in their eyes
• eating uncooked food contaminated with triatome bug feces
• receiving infection from mother during pregnancy or at birth
• receiving an infected blood transfusion or organ transplant

In addition to Costa Rica, Chagas disease is locally transmitted in Argentina, Belize, Bolivia, Brazil, Colombia, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Venezuela, and rarely, in the United States.

The bad news is that this is a fairly serious disease.

The good news is that anyone reading this web site is pretty unlikely to get this disease unless you will be living in pretty squalid conditions as these bugs live in cracks and holes of substandard housing, specifically, houses constructed from mud, adobe, or thatch.  Well constructed homes, hotels, etc are extremely unlikely to host these fellows.

However those visiting Costa Rica who will be living under these conditions… Peace Corp members perhaps should be especially alert as there is no known way to prevent the disease by inoculation.

More good news!  Should you get infected with Chagas, medication is usually effective when given during the early acute stage of infection.

Symptoms of Chagas

This is complex, so I’ll just re-print here the information from the CDC.

• Acute stage:

Acute symptoms only occur in about 1 percent of cases (one in a hundred). The most recognized symptom of acute Chagas infection is the Romaña’s sign – a person’s eye on one side of the face swells, usually at the bite wound or where feces were deposited or accidentally rubbed into the eye. Other symptoms that are not unique to Chagas disease may include

• • fatigue, fever, enlarged liver or spleen
  • swollen lymph glands

Sometimes a person develops a rash, loss of appetite, diarrhea, and vomiting. In infants and in very young children with acute Chagas disease, the brain may be damaged severely enough to cause death. In general, a person’s symptoms last from 4 to 8 weeks and then they go away, even without treatment.

• Indeterminate stage:

Eight to 10 weeks after infection, the indeterminate stage begins and may last for many years. During this stage, people do not have symptoms.

• Chronic stage:

Ten to 30 or 40 years after infection, 20-30% of infected people may develop the most serious symptoms of Chagas disease, such as

• • cardiac problems, including an enlarged heart; altered heart rate or rhythm; heart failure; or cardiac arrest. And,
  • enlargement of the esophagus or large bowel, which results in problems with swallowing or severe constipation.

Not everyone with Chagas disease will develop the chronic-stage symptoms.

Prevention

• Avoid sleeping in thatch, mud, or adobe houses.
• Use insecticides to kill bugs and reduce the risk of transmission.
• Remember that he blood supply in any country may not always be screened for
• Chagas disease and blood transfusions may thus carry a risk of infection.

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