Read below for travel health advice on Chile from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Chile will need vaccinations for hepatitis A and typhoid fever, as well as medications for travelers' diarrhea. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.
|Hepatitis A||Recommended for all travelers|
|Typhoid||For travelers who may eat or drink outside major restaurants and hotels|
|Measles, mumps, rubella (MMR)||Two doses recommended for all travelers born after 1956, if not previously given|
|Tetanus-diphtheria||Revaccination recommended every 10 years|
Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.
The following are the recommended vaccinations for Chile.
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.
Typhoid vaccine is 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. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. Polio has been eradicated from the Americas, except for a small outbreak of vaccine-related poliomyelitis in the Dominican Republic and Haiti in late 2000.
An outbreak of hantavirus pulmonary syndrome, a life-threatening viral infection, was reported from rural areas in southern and central Chile in late 2001. Sporadic cases have been reported since that time, chiefly in the region from Maule to Aysen. From 2007 through 2011, a total 246 cases of hantavirus pulmonary syndrome were reported nationwide, including 58 in the Bio Bio region and 42 in Los Lagos. Hantavirus infections occur in those who live in close association with rodents and are unlikely to affect most travelers, though campers in forest areas may be at risk. See Emerging Infectious Diseases, ProMED-mail, and the Ministry of Health (in Spanish) for further information.
Four hantavirus cases were reported in January 2011: one each from the Chaquihuan sector of the municipality of Los Muermos; from the Los Maitenes sector of the town of Casablanca; from the Nacimiento community in BioBio; and from the Pinto community in Nube province. Two cases were reported from Coyhaique, two from Corral, and one from Maule in March 2011. One was reported from Los Lagos in April 2011 and another in September 2011. One was reported from Araucania and one from Los Rios in May 2011. Eight cases were reported from Bio-Bio in August 2011. A total of 61 cases were reported nationwide for the year 2010, including at least 14 in Biobio and 9 in Maule. Fifteen of the cases were fatal. One case occurred in an earthquake relief worker who had been assigned to an unspecified area in the southern part of the country. An additional case was reported from the Coyhaique region in December 2010. For the year 2009, a total of 34 cases were confirmed: one in the Metropolitan Region (capital city of the country), three in Region VI, five in Region VII, ten in Region VIII, seven in Region IX, one in Region XIV, four in Region X and three in Region XI. Nine of the cases were fatal.
An outbreak of Vibrio parahemolyticus infections was reported from Chile in December 2008, particularly affecting the southern regions of Maule and Biobio. More than 200 cases were described (see ProMED-mail, December 23, 2008). In January 2005, an outbreak of Vibrio parahemolyticus infections was reported from Puerto Montt, a major city in Region X of Chile, and spread rapidly to other parts of the country, resulting in more than 10,000 cases by the end of March (see Emerging Infectious Diseases). Vibrio parahemolyticus is acquired by eating infected fish or shellfish which has not been fully cooked. The main symptom is acute diarrhea. There is no clear benefit from antibiotics. Travelers to Chile should be careful not not to consume any raw or undercooked fish or shellfish.
Amnesic toxin was detected in shellfish collected in the northern Chilean region of Atacama in December 2008. Until further notice, shellfish from this area should not be consumed, even if thoroughly cooked.
An outbreak of respiratory syncytial virus infections, chiefly affecting infants and children, was reported from Santiago during the southern hemisphere winter of 2001.
Chagas disease is no longer transmitted in Chile, due to an aggressive program of insecticide spraying.
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
Food and water precautions
Tap water is generally safe to drink in major cities, but water quality is variable in rural areas. If in doubt, do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish, including ceviche. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.
All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Air pollution is a significant health problem in Santiago, especially during the winter (May through August). Travelers with respiratory or cardiac conditions and those who are elderly or extremely young are at greatest risk for complications from air pollution, which may include cough, difficulty breathing, wheezing, or chest pain. The risk may be minimized by staying indoors, avoiding outdoor exercise, and drinking plenty of fluids. Further information on air quality levels is available at the National Air Quality Information Service (SINCA) website at www.sinca.conama.cl.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
Ambulance and Emergency Services
For an ambulance in Chile, call SAMU at 131.
There are two modern facilities in Santiago that offer 24-hour walk-in service for urgent problems, as well as specialty care (by appointment) and inpatient services: Clínica Las Condes (Lo Fontecilla 441, Las Condes, phone 210-4000) and Clínica Alemana (Av. Vitacura 5951, Vitacura, phone 212-9700). You can find the names of additional physicians, dentists, and laboratories in Santiago on the U.S. Embassy website (click on “American Citizens” at the top of the home page). The medical care in Santiago and Valparaiso is generally good, but it may be difficult to find assistance in remote areas. Major hospitals accept credit cards, but many doctors and hospitals in Chile expect immediate payment in cash. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.
Traveling with children
Make sure you have the names and contact information for qualified medical personnel before you go abroad.
Food and water precautions, which are recommended for all travelers, must be strictly followed at all times, because diarrhea is especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever are not approved for children less than two years of age.
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
Travel and pregnancy
International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.
Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary. In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.
Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.
Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Americans living in or visiting Chile are encouraged to register at the Consular Section of the U.S. Embassy in Santiago and obtain updated information on travel and security in Chile. The U.S. Embassy is located at Avenida Andres Bello 2800, Santiago; tel. (56-2) 335-6550 or 232-2600; after-hours tel. (56-2) 330-3321. The Consular ACS section is open to the public 8:30am-11:30pm, Monday-Friday, except American and Chilean holidays. The Embassy's mailing address is Casilla 27-D, Santiago; the Consular fax number is 56-2) 330-3005; and the email address is firstname.lastname@example.org . The Embassy home page is http://santiago.usembassy.gov/ , where Americans may also register on line.
For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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