Read below for travel health advice on Ecuador from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
Most travelers to Ecuador will need vaccinations for hepatitis A, typhoid fever, and yellow fever, as well as medications for malaria prophylaxis, travelers' diarrhea, and altitude sickness. 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 areas except the cities of Guayaquil and Quito, the central highland tourist areas, the Galapagos Islands, and altitudes greater than 1500 m (4921 ft).
|Hepatitis A||Recommended for all travelers|
|Typhoid||For travelers who may eat or drink outside major restaurants and hotels|
|Yellow fever||Recommended for the following provinces east of the Andes Mountains less than 2300 m in elevation: Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe. For travel to the following provinces west of the Andes and less than 2300 m in elevation - Esmeraldas, Guayas, Los Rios, Manabi, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha, and Tungurahua - recommended only for those at risk for a large number of mosquito bites. Not recommended for travel limited to areas greater than 2300 m in elevation, the cities of Guayaquil and Quito, or the Galápagos Islands Required for travelers arriving from a yellow-fever-infected area in Africa or the Americas.|
|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 Ecuador: prophylaxis is recommended for all areas except the cities of Guayaquil and Quito, the Galapagos Islands, and altitudes greater than 1500 m (4921 ft). Transmission is highest in Esmeraldas, El Oro, and Manabi. 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), doxycycline, or primaquine 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. Primaquine may cause hemolytic anemia in those with G6PD deficiency, so a blood test documenting normal G6PD levels must be obtained before starting primaquine. In those with normal G6PD levels, the main side-effect of primaquine is gastrointestinal disturbance, which can be minimized by taking the medication with food.
Insect protection measures are essential.
Long-term travelers who will be visiting malarious areas and 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.
For further information about malaria in Ecuador, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization
Altitude sickness may occur in travelers flying to Quito, which is almost 3000 meters above sea level. 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 Ecuador.
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.
Yellow fever vaccine is recommended for all travelers greater than nine months of age traveling to the following provinces east of the Andes Mountains less than 2300 m in elevation: Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe (see map). 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 provinces west of the Andes and less than 2300 m in elevation: Esmeraldas, Guayas, Los Rios, Manabi, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha, and Tungurahua (see map). Yellow fever vaccine is not recommended for travelers whose itineraries are limited to areas greater than 2300 m in elevation, the cities of Guayaquil and Quito, or the Galápagos Islands (see map). In recent years, yellow fever has been reported from the provinces of Morona-Santiago, Napo, Pastaza, Sucombios, and Zamora-Chinchipe. In April 2005, the Ecuadoran authorities announced a yellow fever alert in the province of Sucombios, due to a yellow fever outbreak in neighboring areas of Colombia. The vaccine is required for travelers greater than one year of age arriving from a country in Africa or the Americas with risk of yellow fever transmission. Nationals and residents of Ecuador are required to possess certificates of vaccination on their departure to an area with risk of yellow fever transmission.
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. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy. The vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs.
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. In Ecuador, rabies is usually caused by dog bites, and the provinces of Pichincha and Guayas report the largest number of cases. Cases are also report from vampite bat 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.
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.
Cholera vaccine is not generally recommended, even though a small number of cases are still reported each year, because most travelers are at low risk for infection. 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.
A rabies outbreak was reported in November 2011 among children in the Achuar indigenous tribe in Morona-Santiago province, killing ten. The outbreak was related to bites from infected vampire bats. 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 measles outbreak was reported from the province of Tungurahua in October 2011, causing 131 cases by January 2012. All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Ecuador.
An outbreak of Angiostrongylus meningitis caused by consumption of raw snails was reported in December 2008 from the area of La Ercilia, San Eduardo, Zapotal parish, Ventanas canton, in Los Ríos province. Ten cases had been identified by the end of the year. Travelers to Ecuador should not eat raw snails or other raw seafood.
Cases of dengue fever, a flu-like illness which is sometimes complicated by hemorrhage or shock, are reported annually from Ecuador. Almost 9000 cases were reported in the first ten weeks of 2010, more than three times as many as were described for the same period the previous year. The southern coastal province of El Oro was particularly affected. In May 2010, a dengue outbreak was reported from San Cristobal Island in the Galapagos Islands. In March 2009, an increased number of cases was described in Esmeraldas province in far northern Ecuador. In January 2008, an outbreak was reported from El Oro, chiefly affecting Santa Rosa and Machala. For the year 2007, more than 1600 cases were identified nationwide. In July-August 2002, a major dengue outbreak resulted in more than 5000 cases, including the first cases ever reported in the Galapagos Islands (see the World Health Organization). Seven additional cases were reported from the Galapagos in the first three months of 2010.
Dengue fever is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. In Ecuador, dengue fever occurs most often in the coastal provinces. No vaccine is available at this time. Insect protection measures are strongly advised, as below.
An outbreak of probable histoplasmosis was reported among a group of Italian researchers who had visited Ecuador in late July and early August, 2006. Symptoms included fever, shortness of breath, fatigue, and sore throat with oral ulcerations. Several cases developed lung nodules. The only common destination for all those involved was a lodge in the Otonga Rain Forest. For further information, go to ProMED-mail (August 26, 2006). Histoplasmosis is caused by Histoplasma capsulatum, a soil-based fungus transmitted by inhalation. The infection is not transmitted from person to person.
Three fatal cases of the plague were reported from Chimborazo province in May 2004. Previously, an outbreak of pneumonic plague was reported from Chimborazo province in 1998, causing 12 deaths. The plague is usually transmitted by the bite of rodent fleas. Less commonly, the disease is acquired by inhalation of infected droplets, which may be coughed into the air by a person with plague pneumonia, or by direct exposure to infected blood or tissues. Those who may have contact with rodents or their fleas should bring along a bottle of doxycycline, to be taken prophylactically if exposure occurs. Those less than eight years of age or allergic to doxycycline may take trimethoprim-sulfamethoxazole instead. To minimize risk, travelers should avoid areas containing rodent burrows or nests, never handle sick or dead animals, and follow insect protection measures, as described below.
A cholera outbreak affecting a total of 25 persons was reported in December 2003 from Zamora Chinchipie province, Yantzaza canton, Chicantildea parish, San Vicente de Caney district. For further information, go to EID Weekly Updates.
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.
For in-depth public health information, go to the Pan-American Health Organization. For disease statistics and further information, go to the Ministerio de Salud Publica (in Spanish).
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, sea bass, and a large number of tropical reef fish.
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). 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.
To prevent sandfly bites, follow the same precautions as for mosquito bites, except that netting must be finer-mesh (at least 18 holes to the linear inch) since sandflies are smaller.
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 Quito, call ADAMI at 2265-020 or 2269-247, or UTIM at 2553-415 or 2562-608. Another option is to call the Hospital Metropolitano ambulance service at 2265-020, 2269-030, Ext. 2110, 2193, 2119. Ambulances in Ecuador are in short supply and may not be staffed by trained personnel.
Adequate medical care is available in the major cities, but is extremely limited elsewhere. In Quito, many travelers go to the Hospital Metropolitano (Av. Mariana de Jesús; tel. 2261-520, 2269-030; website http://www.hospitalmetropolitano.org/en/descripcion.htm), a modern, private hospital which offers a 24-hour emergency room and a broad range of specialty services. Another option is the Hospital Voz Andes (Villalengua 278; tel. 2252-142, 2241-540). For a guide to physicians, laboratories, and other hospitals in Quito, go to the U.S. Embassy website at http://www.usembassy.org.ec/English/CONSULAR/DmedliEN.htm. Most doctors and hospitals will expect payment in cash, 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.
Medical care in the Galapagos Islands is extremely limited. There are no facilities for acute cardiac or surgical care. Those with serious illnesses must be evacuated to the Ecuadorian mainland or the United States for treatment. A privately owned decompression chamber opened in 2001 on Santa Cruz Island (Puerto Ayora: Protesub (Sub-aquatic), 18 de febrero and R. Lara Street, Puerto Ayora, Santa Cruz Island, tel.(593) 5-526-911, (593)99-855-911, (593)99-283-990, (593)99-283-994). The Ecuadorian Navy operates a second decompression chamber at the San Eduardo Naval Base in Guayaquil (on the mainland).
Pharmacies are generally well-supplied, but the availability of some medications may be sporadic, particularly narcotics and tranquilizers. Many medications which require a prescription in Europe and North America are available over-the-counter in Ecuador. Many travelers go to Fybeca, a chain of about 30 pharmacies located throughout Quito (call 1-800-FYBECA for delivery; branches at Av. Amazonas 5482 and T. de Belanga; tel. 2445-174, 2459-082; and Centro Comercial Iñaquito; tel. 2244-206, 2246-456; and elsewhere; website www.fybeca.com). Other pharmacies include Alemana (branches at Av. 10 de Agosto 1893 and Carrión; tel. 2228-160; and at García Moreno 717 and Bolívar; tel. 2211-706); WAYS (Av. De Los Shyris 152 between Eloy Alfaro and Av. 6 de Diciembre; tel. 2562-312); and Americana (Av. 12 de Octubre 604; tel. 2528-425). The pharmacies in Quito take turns staying open after hours. The pharmacy on-duty is marked by an illuminated "Turno" sign.
Those dispensing medications in pharmacies often have little training and sometimes recommend inappropriate medications. Travelers should not seek or follow their advice. According to the U.S. State Department, "Folk healers and traditional markets offer herbal and folk remedies which should be avoided as formulations are questionable and some components may interact with other prescription medications."
Traveling with children
Make sure you have the names and contact information for qualified medical personnel 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)
Americans living or traveling in Ecuador are encouraged to register with the U.S. Embassy in Quito or the Consulate General in Guayaquil through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within Ecuador. Americans without Internet access may register directly with the U.S. Embassy in Quito or the Consulate General in Guayaquil. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. Travelers or prospective residents in Guayaquil's consular district may register on-line at www.usembassy.state.gov/quito, which also has an e-mail service to the Consulate General.
The Consular Section in Quito is open for citizen services, including registration, from 8:00 a.m. to 12:30 p.m. and 1:30 to 4:00 p.m., Monday through Thursday, excluding U.S. and Ecuadorian holidays. The Consular Section in Guayaquil is open for those services from 8:00 a.m. to 12:00 noon, Tuesday through Friday, excluding U.S. and Ecuadorian holidays. The U.S. Embassy in Quito is located at the corner of Avenida 12 de Octubre and Avenida Patria (across from the Casa de la Cultura); telephone (011-593-2) 256-2890, extension 4510, during business hours (8:00 a.m. to 5:00 p.m.) or 256-1749 for after-hours emergencies; fax (011-593-2) 256-1524; Internet web site - http://www.usembassy.org.ec.
The Consulate General in Guayaquil is located at the corner of 9 de Octubre and Garcia Moreno (near the Hotel Oro Verde); telephone (011-593-4) 232-3570 during business hours (8:00 a.m. to 5:00 p.m.) or 232-1152 for after-hours emergencies; fax (011-593-4) 232-0904. Consular services for U.S. citizens in the Galapagos Islands are provided by the Consulate General in Guayaquil with assistance from a U.S. Consular Agent in Puerto Ayora, Galapagos.
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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Before you apply read about the Medical Professionals Roles on Red Planet TravelYou need to be logged in and have applied to MDth channel to contribute to this page.
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Page Type: Hotel
Tell us your job, knowledge, experience..
My Experience: Doctor
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Check out our page on Ecuador for information on how to get there, accommodation, video and reviews.
Do you have any recent experiences of clinics here? Please search for them, use the drop box at the bottom of their page to send us comments - good and bad.
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Looking for somewhere to stay near Ecuador? Here is our list of options.
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