Puerto Rico Travel Health Information

Read below for travel health advice on Puerto Rico from the MDtravelhealth channel on Red Planet Travel.

Page Sections

1. Summary
2. Medications
3. Immunizations
4. Recent outbreaks of diseases
5. Other Infections
6. Food and Water
7. Tick Precautions
8. Swimming and Bathing
9. Ambulance
10. Medical Facilities
11. Pharmacies
12. Travel with children
13. Travel and pregnancy
14. Page Drop Box

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• Summary You can't Edit

  1

  All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

  Vaccinations:

  Hepatitis A	Recommended for all travelers
  Hepatitis B	For travelers who will have intimate contact with local residents or potentially need blood transfusions or injections, especially if visiting for more than six months
  Rabies	For travelers 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

   

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  <p>All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.</p> <p>Vaccinations:</p> <table class="table table-striped table-hover table-bordered"> <tbody> <tr> <td>Hepatitis A</td> <td>Recommended for all travelers</td> </tr> <tr> <td>Hepatitis B</td> <td>For travelers who will have intimate contact with local residents or potentially need blood transfusions or injections, especially if visiting for more than six months</td> </tr> <tr> <td>Rabies</td> <td>For travelers at high risk for animal bites or involved in any activities that might bring them into direct contact with bats</td> </tr> <tr> <td>Measles, mumps, rubella (MMR)</td> <td>Two doses recommended for all travelers born after 1956, if not previously given</td> </tr> <tr> <td>Tetanus-diphtheria</td> <td>Revaccination recommended every 10 years</td> </tr> </tbody> </table> <p> </p>

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• Medications You can't Edit

  2

  Medications

  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.

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  <p><strong>Medications</strong></p> <p><a href="../resource/travelers_diarrhea">Travelers' diarrhea</a> is the most common travel-related ailment. The cornerstone of prevention is <em>food and water precautions</em>, 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 <a href="http://www.univgraph.com/bayer/inserts/ciprotab.pdf">ciprofloxacin (Cipro)(PDF)</a> 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 <a href="http://www.salix.com/pdf/XifaxanPI.pdf">rifaximin (Xifaxan)</a> 200 mg three times daily or <a href="http://www.pfizer.com/hml/pi's/zithromaxregpi.html">azithromycin (Zithromax)</a> 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.</p> <p>Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. <em>Adequate fluid intake</em> is essential.</p> <p>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.</p> <p>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.</p>

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• Immunizations You can't Edit

  3

  Immunizations
  
  The following are the recommended vaccinations for Puerto Rico.
  
  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.
  
  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 only for those at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers living in areas with a high risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats. 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.
  
  Typhoid vaccine is recommended for those planning an extended stay in rural areas or expecting to consume potentially contaminated food. Typhoid is uncommon in most Caribbean countries. Most travelers do not require typhoid immunization.
  
  All travelers should be up-to-date on routine immunizations, including

  • Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years. Three cases of tetanus, two of them fatal, were reported from Puerto Rico between February and May 2002. See MMWR for details.)
  • Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.)
  • Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or 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.

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  <p>Immunizations<br /><br />The following are the recommended vaccinations for Puerto Rico.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Rabies vaccine is recommended only for those at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers living in areas with a high risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats. 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.<br /><br />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.<br /><br />Typhoid vaccine is recommended for those planning an extended stay in rural areas or expecting to consume potentially contaminated food. Typhoid is uncommon in most Caribbean countries. Most travelers do not require typhoid immunization.<br /><br />All travelers should be up-to-date on routine immunizations, including</p> <ul> <li>Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years. Three cases of tetanus, two of them fatal, were reported from Puerto Rico between February and May 2002. See MMWR for details.)</li> <li>Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.)</li> <li>Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)</li> </ul> <p><br />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.</p>

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• Recent outbreaks of diseases You can't Edit

  4
  Recent outbreaks
  
  Cases of dengue fever, a flu-like illness which may be complicated by hemorrhage or shock, are reported annually from Puerto Rico. A major dengue outbreak was reported in March 2010, causing more than 12,000 cases and 31 deaths before the outbreak ended in December. A particularly large outbreak was reported in 2007, resulting in almost 11,000 cases and eight confirmed deaths by the end of the year. In most years, the incidence peaks from September to November. Transmission reached epidemic levels in 1994 and 1998. 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. The cornerstone of prevention is insect protection measures, as outlined below.
  
  An outbreak of viral meningitis was reported in June 2004 from Puerto Rico, resulting in approximately 400 cases, chiefly in children. The outbreak began in the the southern coastal town of Arroyo, then spread to the eastern coastal town of Cieba and the mountain town of Aibonito. As of mid-October, the outbreak appeared to be waning. Most cases were caused by echovirus 30, which does not in general lead to serious illness. Echoviruses are spread by direct contact with the respiratory secretions or feces of an infected person. No travel precautions are recommended at this time except for careful attention to hand washing and personal hygiene, especially after using the toilet, before eating, and after changing diapers. The chief symptoms of meningitis are fever, severe headache, stiff neck, sensitivity to bright light, drowsiness or confusion, and nausea and vomiting. Anyone who develops these symptoms should immediately seek medical attention. For further information, go to the Centers for Disease Control and the Pan-American Health Organization.
  
  An outbreak of acute hemorrhagic conjunctivitis, an epidemic form of highly contagious conjunctivitis (pink-eye) characterized by sudden onset of painful, swollen, red eyes, with conjunctival bleeding and excessive tearing, was reported from Puerto Rico in August-October 2003. Almost half a million people were involved, chiefly school-aged children and those living in crowded urban areas. A previous outbreak was reported in 1997. Acute hemorrhagic conjunctivitis is caused by Coxsackievirus A24. In most cases, the illness resolves uneventfully, but may cause significant discomfort and temporary incapacity. Acute hemorrhagic conjunctivitis may be prevented by frequent hand washing and avoidance of sharing towels and bedding. For further information, go to MMWR.

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  Recent outbreaks<br /><br />Cases of dengue fever, a flu-like illness which may be complicated by hemorrhage or shock, are reported annually from Puerto Rico. A major dengue outbreak was reported in March 2010, causing more than 12,000 cases and 31 deaths before the outbreak ended in December. A particularly large outbreak was reported in 2007, resulting in almost 11,000 cases and eight confirmed deaths by the end of the year. In most years, the incidence peaks from September to November. Transmission reached epidemic levels in 1994 and 1998. 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. The cornerstone of prevention is insect protection measures, as outlined below.<br /><br />An outbreak of viral meningitis was reported in June 2004 from Puerto Rico, resulting in approximately 400 cases, chiefly in children. The outbreak began in the the southern coastal town of Arroyo, then spread to the eastern coastal town of Cieba and the mountain town of Aibonito. As of mid-October, the outbreak appeared to be waning. Most cases were caused by echovirus 30, which does not in general lead to serious illness. Echoviruses are spread by direct contact with the respiratory secretions or feces of an infected person. No travel precautions are recommended at this time except for careful attention to hand washing and personal hygiene, especially after using the toilet, before eating, and after changing diapers. The chief symptoms of meningitis are fever, severe headache, stiff neck, sensitivity to bright light, drowsiness or confusion, and nausea and vomiting. Anyone who develops these symptoms should immediately seek medical attention. For further information, go to the Centers for Disease Control and the Pan-American Health Organization.<br /><br />An outbreak of acute hemorrhagic conjunctivitis, an epidemic form of highly contagious conjunctivitis (pink-eye) characterized by sudden onset of painful, swollen, red eyes, with conjunctival bleeding and excessive tearing, was reported from Puerto Rico in August-October 2003. Almost half a million people were involved, chiefly school-aged children and those living in crowded urban areas. A previous outbreak was reported in 1997. Acute hemorrhagic conjunctivitis is caused by Coxsackievirus A24. In most cases, the illness resolves uneventfully, but may cause significant discomfort and temporary incapacity. Acute hemorrhagic conjunctivitis may be prevented by frequent hand washing and avoidance of sharing towels and bedding. For further information, go to MMWR.

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• Other Infections You can't Edit

  5
  Other infections
  
  Schistosomiasis is endemic. Swimming and bathing precautions are advised, as below.
  
  Fascioliasis is reported.
  
  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.

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  Other infections<br /><br />Schistosomiasis is endemic. Swimming and bathing precautions are advised, as below.<br /><br />Fascioliasis is reported.<br /><br />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.<br /><br />For in-depth public health information, go to the Pan-American Health Organization.

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• Food and Water You can't Edit

  6
  Food and water precautions
  
  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.
  
  When visiting undeveloped areas, do not drink tap water unless it has been boiled, filtered, or chemically disinfected, and do not drink unbottled beverages or drinks with ice.

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  Food and water precautions<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />When visiting undeveloped areas, do not drink tap water unless it has been boiled, filtered, or chemically disinfected, and do not drink unbottled beverages or drinks with ice.

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• Tick Precautions You can't Edit

  7
  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 accomodation 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.

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  Insect and tick protection<br /><br />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 accomodation 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.

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• Swimming and Bathing You can't Edit

  8
  Swimming and bathing precautions
  
  Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Swimming in the ocean or a chlorinated swimming pool carries no risk of schistosomiasis.

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  Swimming and bathing precautions<br /><br />Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Swimming in the ocean or a chlorinated swimming pool carries no risk of schistosomiasis.

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• Ambulance You can't Edit

  9
  For an ambulance in Puerto Rico, call 911 or 787-343-2222.

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  For an ambulance in Puerto Rico, call 911 or 787-343-2222.

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• Medical Facilities You can't Edit

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  Medical facilities
  
  Excellent medical facilities are available in Puerto Rico, including Ashford Presbyterian Memorial Community Hospital (1451 Av. Ashford, Condado, San Juan, tel. 787-721-2160); General Hospital Dr. Ramón Emeterio Betances (Rte. 2, Km 157, Mayagüez, tel. 787-735-8001; Hospital Damas (2213 Ponce Bypass Rd., Ponce, tel. 787-840-8686); and Hospital Dr. Dominguez (300 Font Martello, Humacao, tel. 787-852-0505). All of these hospitals have 24-hour emergency rooms.
  
  For complicated, out-patient medical problems, you can make an appointment at University of Puerto Rico School of Medicine by calling 787-758-7910. The Faculty Practice Plan at the University offers a broad array of specialists and sophisticated diagnostic facilities. Medical care for travelers is also provided by the Iturregui Medical Group, which includes a U.S.-trained infectious diseases specialist (Yuri E Corrales MD, Ave Iturregui # 820, San Juan, PR. 00924; tel. 787-768-4278).

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  Medical facilities<br /><br />Excellent medical facilities are available in Puerto Rico, including Ashford Presbyterian Memorial Community Hospital (1451 Av. Ashford, Condado, San Juan, tel. 787-721-2160); General Hospital Dr. Ramón Emeterio Betances (Rte. 2, Km 157, Mayagüez, tel. 787-735-8001; Hospital Damas (2213 Ponce Bypass Rd., Ponce, tel. 787-840-8686); and Hospital Dr. Dominguez (300 Font Martello, Humacao, tel. 787-852-0505). All of these hospitals have 24-hour emergency rooms.<br /><br />For complicated, out-patient medical problems, you can make an appointment at University of Puerto Rico School of Medicine by calling 787-758-7910. The Faculty Practice Plan at the University offers a broad array of specialists and sophisticated diagnostic facilities. Medical care for travelers is also provided by the Iturregui Medical Group, which includes a U.S.-trained infectious diseases specialist (Yuri E Corrales MD, Ave Iturregui # 820, San Juan, PR. 00924; tel. 787-768-4278).

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• Pharmacies You can't Edit

  11
  Most pharmacies in San Juan and other major cities are well-supplied. Most prescription medications sold in the United States are also available in Puerto Rico.

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  Most pharmacies in San Juan and other major cities are well-supplied. Most prescription medications sold in the United States are also available in Puerto Rico.

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• Travel with children You can't Edit

  12
  Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.
  
  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).
  
  When traveling with young children, be particularly careful about what you allow them to eat and drink (see "Food and water precautions" above), because diarrhea can be especially dangerous in this age group. Young children should be kept well-hydrated and protected from the sun at all times.
  
  Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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  Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.<br /><br />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).<br /><br />When traveling with young children, be particularly careful about what you allow them to eat and drink (see "Food and water precautions" above), because diarrhea can be especially dangerous in this age group. Young children should be kept well-hydrated and protected from the sun at all times.<br /><br />Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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• Travel and pregnancy You can't Edit

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  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. Adequate fluid intake is essential.

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  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.<br /><br />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.<br /><br />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. Adequate fluid intake is essential.

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