Read below for travel health advice on Colombia from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Colombia will need vaccinations for hepatitis A, typhoid fever, and yellow fever, as well as medications for malaria prophylaxis and travelers' diarrhea. Travelers should be sure they are fully immunized against measles and tetanus-diphtheria. Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Insect repellents are recommended, in conjunction with other measures to prevent mosquito bites. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.
Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all rural areas below 800 m (2624 ft).
|Hepatitis A||Recommended for all travelers|
|Typhoid||Recommended for all travelers|
|Yellow fever||Recommended for Amazonas, Antioquia, Arauca, Atlántico, Bolivar, Boyacá, Caldas, Caquetá, Casanare, Cauca, Cesar, Choco (only the municipalities of Acandí, Juradó, Riosucio, and Unguía), Códoba, Cundinamarca, Guainía, Guaviare, Huila, La Guajira (only the municipalities of Albania, Barrancas, Dibulla, Distracción, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Urumita, and Villanueva), Magdalena, Meta, Norte de Santander, Putumayo, Quindio, Risaralda, San Andrés and Providencia, Santander, Sucre, Tolima, Vaupés, and Vichada. For the departments of Cauca, Nariño, Valle de Cauca, and central and southern Choco, and the cities of Barranquilla, Cali, Cartagena, and Medellín, recommended only for those at risk for a large number of mosquito bites. Not recommended for areas greater than 2300 m in elevation, including the city of Bogotá, and also the municipality of Uribia in the La Guajira department|
|Hepatitis B||Recommended for all travelers|
|Rabies||For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats|
|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.
Malaria in Colombia: prophylaxis is recommended for all areas less than 1700 m (5577 ft), except that there is no malaria risk in Bogotá and Cartagena. Risk is highest in the departments of Amazonas, Choco, Cordoba, Guainia, Guaviare, Putumayo, and Vichada. For a map showing the risk of malaria in different parts of the country, go to the Pan American Health Organization.
Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
Insect protection measures are essential.
For further information about malaria in Colombia, go to the World Health Organization.
Altitude sickness may occur in travelers who ascend rapidly to altitudes greater than 2500 meters, including those flying directly to Bogota. Acetazolamide is the drug of choice to prevent altitude sickness. The usual dosage is 125 or 250 mg twice daily starting 24 hours before ascent and continuing for 48 hours after arrival at altitude. Possible side-effects include increased urinary volume, numbness, tingling, nausea, drowsiness, myopia and temporary impotence. Acetazolamide should not be given to pregnant women or those with a history of sulfa allergy. For those who cannot tolerate acetazolamide, the preferred alternative is dexamethasone 4 mg taken four times daily. Unlike acetazolamide, dexamethasone must be tapered gradually upon arrival at altitude, since there is a risk that altitude sickness will occur as the dosage is reduced.
Travel to high altitudes is generally not recommended for those with a history of heart disease, lung disease, or sickle cell disease.
The following are the recommended vaccinations for Colombia.
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. 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.
Yellow fever vaccine is recommended for all travelers greater than nine months of age traveling to the following departments less than 2300 m in elevation (see map): Amazonas, Antioquia, Arauca, Atlántico, Bolivar, Boyacá, Caldas, Caquetá, Casanare, Cauca, Cesar, Choco (only the municipalities of Acandí, Juradó, Riosucio, and Unguía), Códoba, Cundinamarca, Guainía, Guaviare, Huila, La Guajira (only the municipalities of Albania, Barrancas, Dibulla, Distracción, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Urumita, and Villanueva), Magdalena, Meta, Norte de Santander, Putumayo, Quindio, Risaralda, San Andrés and Providencia, Santander, Sucre, Tolima, Vaupés, and Vichada. The vaccine should be considered only for those at increased risk due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites, for travel to the following areas west of the Andes less than 2300 m in elevation: the departments of Cauca, Nariño, Valle de Cauca, and central and southern Choco, and the cities of Barranquilla, Cali, Cartagena, and Medellín (see map). The vaccine is not recommended for travelers whose itineraries are limited to areas greater than 2300 m in elevation, including the city of Bogotá, and also the municipality of Uribia in the La Guajira department. In January 2004, a yellow fever outbreak was reported from the departments of Guajira, Magdalena, Meta, and Cesar, including Sierra Nevada and Tyrona parks (see "Recent outbreaks" below). In recent years, yellow fever has also been reported from the departments of Antioquia, Boyaca, Caqueta, Casanare, Choco, Cundinamarca, Santander, Norte Santander, and Vichada, and the intendencias of Arauca, Cucuta, Guaviare, and Putumayo. For further details on yellow fever in Colombia, go to the Pan-American Health Organization (PDF).
Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. The vaccine should not in general be given to those who are younger than six months of age, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a malignant neoplasm and those with a history of thymus disease or thymectomy. Caution should be exercised before giving the vaccine to those who are between the ages of 6 and 8 months, age 60 years or older, pregnant, or breastfeeding. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.
Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.
All travelers should be up-to-date on routine immunizations, including
Cholera vaccine is not generally recommended. In the past, cholera has been reported from impoverished areas along the Atlantic and Pacific Coasts and in the areas bordering the two large rivers that cross the country from south to north, the Magdalena and the Cauca. Most cases have been reported from the Atlantic Coast, with the highest incidence among the Wayuu people. In recent years, only a small number of cholera cases have been identified (see "Recent outbreaks" below). Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.
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.
Five human cases of yellow fever were reported from the department of Meta in January 2009. Four were probably acquired in the municipality of La Macarena and one in the municipality of Puerto Concordia. Two of the cases were fatal (see the Pan-American Health Organization). Yellow fever vaccine is recommended for all travelers to Colombia, except that travelers whose itinerary is limited to the cities of Bogota, Cali, and Medellin are at lower risk and may consider foregoing immunization.
A yellow fever outbreak was reported in December 2003 from the departments of Guajira, Magdalena, Meta, and Cesar, including Sierra Nevada de Santa Marta, a popular tourist area along the Caribbean coast, and Tayrona Park, also on the Caribbean coast. A total of 28 cases and 11 deaths were identified, chiefly from the municipalities of Santa Marta, Valledupar, and Dibulla. Most cases occurred among males over the age of 15 who worked in the countryside. An outbreak of yellow fever was also confirmed among monkeys in Los Bestos Ecological Park, in the department of Cesar (see EID Weekly Updates). Previously, a yellow fever outbreak was reported in June 2003 from the northeastern part of Colombia near the Venezuelan border, resulting in a total of 101 cases and 44 deaths. The outbreak began in the department of Norte Santander (counties of Convencion, Cucutilla, El Carmen, El Tarra, Encino, and Teorama y Tibu), which accounted for most of the cases, then spread to the department of Cesar (counties of Agustin Codazzi, Becerril and La Jagua de Ibirico) and the department of Guajira (see EID Weekly Updates).
Outbreaks of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, occur regularly in Colombia. More than 100,000 cases were reported nationwide for the first seven months of 2010, including at least 115 deaths, chiefly from the departments of the Valle del Cauca, Risaralda, Huila, Meta, Tolima, and Santander (see ProMED-mail, February 16, April 20, and July 19, 2010). A dengue outbreak in 2007 caused more than 40,000 cases and 19 deaths by the end of the year. The most affected areas were the cities of Yopal, Medellin, Cucuta, Villavicencio, Valledupar, Santa Marta, and Cartagena. Cases of dengue occur annually in Colombia, with the greatest incidence in Santander, Tolima, Valle, Norte de Santander, Meta, and Huila. Dengue fever is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are essential, as below.
An outbreak of hantavirus pulmonary syndrome was reported in March 2006 from Necocli, a town in the northeastern department of Antioquia. A total of eight people were affected. 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 ProMED-mail for further information.
Two cases of cholera were reported from the Candelillas district in the municipality of Tumaco (Nariño) in July 2004. The water from Quespi creek, which flows into the Mira River and supplies the water to this district and to San Andrés de Tumaco, was found to be contaminated with the bacteria that cause cholera. Control measures have been implemented to prevent additional infections. For further information, go to the the Pan-American Health Organization.
A rabies outbreak caused by large numbers of bat bites was reported in May-June 2004 from Birrinchao, along the Purricha river in the Choco region. A mass vaccination campaign was undertaken in July. In June 2010, two cases of human rabies were reported from the department of Santander, one related to a bat bite and the other to a cat bite. For further information, go to Pro-MED mail.
A total of 38 cases of severe acute respiratory disease were reported from September 25 through November 28, 2003, chiefly from Antioquia, North of Santander, and Bogota. Symptoms included fever, cough, difficulty breathing, headache, and malaise. Chest x-rays showed interstitial and alveolar infiltrates. Thirteen deaths were reported. Known respiratory viruses have been isolated from a number of patients, but the cause of most of the cases has not yet been determined. Further investigation is in progress. For more information, go to EID Weekly Updates.
A diphtheria outbreak was reported from Santiago de Cali, the capital of the Valle del Cauca province in the southwestern part of the country, from August through October 2000. A total of eight cases were identified. See the Epidemiological Bulletin for details. Tetanus-diphtheria vaccine is recommended for all travelers who have not received a booster within the last 10 years, as above.
A measles outbreak which began in neighboring Venzuela was reported to have spread to Colombia by January 2002. As of July 6, 2002, a total of 68 cases, mostly in children, had been confirmed. A measle vaccination campaign is under way. See the Centers for Disease Control and Health Canada for further information.
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
Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. 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.
Insect and Tick Protection
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
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
There is no 911 emergency response system in Bogota.
For an ambulance in Bogota, call Suma Emergencias (tel. 621-0630 or 310-229-9696), Ambulancias Medicas (tel. 214-8304, 620-5107/5105) or Ambulancias Tras Medica (tel. 625-6910, 258-6669) and ask to be taken to the "Servicio de Urgencias Fundacion Santa Fe" (Calle 119 No. 9-10; tel. 571-629-0477). Ambulances may not be staffed by trained paramedics and response times may be slow. Cash payment will be expected.
If you develop a life-threatening medical problem, you’ll probably want to be evacuated to a country with state-of-the-art medical care. For air ambulance service, call Aeromedicas, Ambulancia Aerea (air ambulance service in and from Colombia); El Dorado International Airport, Entrance 2, Int. 1, Of. 105 (tel. (571) 413-91-60, 413-8915; fax (571) 413-9550.)
Adequate medical care is available in major cities, but may be difficult to find in rural areas. Emergency rooms may be overcrowded, even at the better facilities. For many travelers, the hospital of choice is the Fundación Santa Fe de Bogotá (Calle 119 No. 9-33, Bogotá; tel. 571-603-0303; website http://eng.fsfb.org.co/cms/Default.aspx), which offers a 24-hour emergency room as well as a broad range of specialty services. Another well-regarded facility is the Clinica Del Country (Carrera 16 No. 82-57, Bogotá; tel. 571-530-0470, 530-1270; website http://www.clinicadelcountry.com). For a guide to physicians, dentists, pharmacies, and other hospitals in Colombia, go to the U.S. Embassy website at http://bogota.usembassy.gov/wwwfmedl.pdf. Most doctors and hospitals will expect payment in cash before treatment, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.
Several incidents of death and serious medical complications resulting from elective, aesthetic surgery (e.g., liposuction) have been reported to the U.S. Embassy. If you are considering having elective surgery in Colombia, be sure that you thoroughly investigate the surgeon's credentials.
The following pharmacies are listed by the U.S. Embassy in Bogota (all offer delivery service):
Traveling with children
Make sure you have the names and contact information for qualified medical personnel in Colombia before you go abroad (see the U.S. Embassy website).
In general, the recommendations for infants and young children are the same as those for adults, except that certain vaccines and medications should not be administered to this age group. Most importantly, yellow fever vaccine is not approved for use in those under age nine months. Unless there is an extraordinary need to do so, children less than nine months of age should not be brought to areas where yellow fever occurs.
The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's particularly important to keep children in this age group well-covered to protect them from mosquito bites.
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 (see the U.S. Embassy website). 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.
Yellow fever vaccine, which consists of live virus, should not in general be given to pregnant women. Unless absolutely necessary, pregnant women should not travel to areas where yellow fever occurs.
Pregnant women should also avoid areas where malaria is transmitted. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults. Of the currently available drugs for malaria prophylaxis, Mefloquine (Lariam) may be given if necessary in the second and third trimesters, but should be avoided in the first trimester. There are no data regarding the safety of atovaquone/proguanil (Malarone) during pregnancy, so the drug should be avoided pending further information. Doxycycline may interfere with fetal bone development and should not be given during 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.
Travel to altitudes greater than 4000 meters (13,100 feet) should be avoided during pregnancy. During the third trimester and during high-risk pregnancies, travel should be limited to altitudes less than 2500 meters (8200 feet).
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)
U.S. citizens living in or visiting Colombia are encouraged to register with the U.S. Embassy in Bogota through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within Colombia. Americans without Internet access may register directly with the U.S. Embassy in Bogota. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The Consular Section is open for American Citizens Services, including registration, from 8:30 a.m. to 12:00 noon, Monday through Thursday, excluding U.S. and Colombian holidays. The U.S. Embassy is located at Avenida El Dorado and Carrera 50; telephone (011-57-1) 315-0811 during business hours (8:30 a.m. to 5:00 p.m.), or 315-2109/2110 for emergencies during non-business hours; fax (011-57-1) 315-2196/2197; Internet website - http://usembassy.state.gov/bogota. The Consular Agency in Barranquilla, which provides some limited consular services, is located at Calle 77B, No. 57-141, Piso 5, Centro Empresarial Las Americas, Barranquilla, Atlantico, Colombia; telephone (011-57-5) 353-2001; fax (011-57-5) 353-5216; e-mail: email@example.com.
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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The many good reviews received for this Campsite are not wrong. Set halfway up a deep valley on the road to Pal village, it has a backdrop of beautiful pine covered mountainsides, and the constant sound of the nearby stream torrent that runs by the side of the camp.
It has 3 different accommodation zones: A large block with 16 apartments, 8 log cabins and a campsite field for 30 or more caravans, campers and tents.
Running up and down the valley is their 18 hole pitch & putt golf course. You need to have a licence to play.
The owners Mariebelle and her brother and their family are very friendly, she speaks Catalan, Spanish, French and passable English; and is more than willing to help out in any way and are greatly appreciated by visitors.
Visitors to the Park are mainly from Spain and France; but you often encounter other europeans like Brits, Dutch, Swedes and Germans. It is not on the "through road" from France to Spain; so will involve a bit (30mins) detour off the main road if you are passing: it is worth the trip up the North Valley.