Read below for travel health advice on Spain from the MDtravelhealth channel on Red Planet Travel.
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Summary of recommendations
In general, no special medications or immunizations are necessary for travel to Spain.
|Recommended for extended travel to rural areas where food hygiene is questionable
|Recommended for all travelers
|Measles, mumps, rubella (MMR)
|Two doses recommended for all travelers born after 1956, if not previously given
|Revaccination recommended every 10 years
|Recommended for all travelers from November through April
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for Spain:
Hepatitis A vaccine is recommended for extended travel to rural areas where food hygiene is questionable. 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.
Travelers who require protection against hepatitis A and are less than two years old, are pregnant, or have less than two weeks before departure should receive a single intramuscular dose of gammaglobulin (see hepatitis A for dosage) instead 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.
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.
Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.
An outbreak of Legionnella infections was reported in September 2014 from Sabadell (Barcelona), causing 34 cases, four of them fatal. At around the same time, a Legionella outbreak occurred in Ripollet (Barcelona), causing five cases, three of them fatal. The Ripollet outbreak appeared to be related to a contaminated refrigeration tower from the Tratamientos Termicas Carreras company. As of late September, both outbreaks appeared to be under control.
Legionnaires' disease is a bacterial infection which typically causes pneumonia but may also involve other organ systems. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires' disease is not transmitted from person-to-person. For further information on Legionaires' disease among travelers to Spain, go to the European Working Group on Legionella Infections.
In August 2013, a Legionella outbreak in the Eastern Valles region in Catalonia resulted in 14 cases, none of them fatal. In January 2012, a Legionnella outbreak was reported among travelers who had stayed at the AR Diamante Beach Hotel in Calpe, on the Costa Blanca, Spain. A total of 18 cases were confirmed: 12 British, 4 Spanish, and 2 French. Four of the cases were fatal. The hotel was closed pending environmental improvements (see Eurosurveillance). A Legionnaires' outbreak was reported from Blanes in Catalonia in September 2012, causing 14 cases, including three Dutch tourists.
A Legionella outbreak was reported from Madrid in November 2010, causing 51 cases, five of them fatal. The source of the outbreak has not been determined. In July 2010, a Legionnaires' outbreak was reported from Vallgorguina, causing 43 cases. The source of the outbreak was thought to be irrigation systems located in the center of town. An outbreak of Legionnaires' disease was reported in June 2010 from Alcoy city (province of Alicante), caused by colonization of two self-service car-washing facilities. Outbreaks were also reported from Alcoy in August and October 2009, related to asphalt spreading machines (see ProMED-mail, July 8 and 18 and October 25, 2010). In June 2006, a Legionella outbreak occurred in Pamplona in northern Spain, affecting 149 people as of June 14. Most of the cases occurred close to the city center. The source of the outbreak has not been confirmed, though four cooling towers in the area tested positive for Legionella and have been closed. See NATHNAC, Eurosurveillance, and ProMED-mail (June 5, 2006) for details. A much larger outbreak occurred in Murcia in July 2001, chiefly affecting the the northern neighborhoods of the city. A total of 420 cases were confirmed, including four deaths. The source of the outbreak was never determined. See the World Health Organization, Eurosurveillance, and ProMED-mail (October 17, 2001) for details. An outbreak linked to two contaminated cooling towers was reported from Zaragoza in June and July 2004, affecting at least 30 people. A separate outbreak related to a contaminated cooling tower occurred in the municipalities of Vic and Gurb (Central Region of Catalonia) in October and November 2005, causing 55 cases (see Eurosurveillance).
Outbreaks of mumps have been occurring frequently in Spain in recent years. All travelers born after 1956 should make sure they have had either two doses of MMR or mumps vaccine or a blood test showing mumps immunity. Those born before 1957 are presumed to be immune. Children who are 12 months or older should receive a total of 2 doses of MMR 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 MMR vaccine.
The most recent mumps outbreak was reported from Vigo, the most populated area of Galicia, in January-February 2013, causing almost 200 cases. At around the same time, a mumps outbreak occurred in Madrid. In December 2012, an outbreak was reported from Asturias, causing 150 cases. In December 2011, a mumps outbreak was reported from Girona in northern Spain, causing 148 cases. In August 2006, a mumps outbreak occurred in Navarra in northern Spain following a local festival, causing more than 1300 cases (see Eurosurveillance and ProMED-mail, January 11, 2007).
An outbreak of ciguatera food poisoning was reported from the Canary Islands in May 2012, affecting four family members who had eaten amberjack (see Eurosurveillance). Another outbreak was reported from the Canary Islands in December 2013, affecting ten people. Travelers to the Canary Islands should avoid eating large reef fish, such as amberjack, barracuda, red snapper, grouper, and sea bass.
An outbreak of leishmaniasis was reported from the southern part of Madrid in April 2012, chiefly involving Fuenlabrada. A total of 150 cases were reported by the end of the year. Residents and users of the parks at Polvoranca and Bosqu Sur were particularly affected. Cases were also reported from Leganes, Getafe and Humanes, near the green zones of Bosquesur (ProMED-mail). Leishmaniasis is a chronic parasitic infection transmitted by the bites of sandflies. The cutaneous form is manifested by chronic skin lesions which are typically painless, enlarge slowly, and develop central ulceration, often covered with eschar and surrounded by an erythematous, indurated border. The disease is endemic in Spain. The chief reservoir is dogs. Travelers to affected areas should protect themselves from sandflies by applying insect repellent and keeping themselves covered.
Measles outbreaks are frequently reported from Spain. A major outbreak occurred in Andalusia between January and August 2011, causing 1759 cases (see Eurosurveillance). 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. Children who are 12 months or older should receive a total of 2 doses of MMR vaccine, separated by at least 28 days. Children between the ages of 6 and 11 months should be given a single dose of measles or MMR vaccine before travel to Spain. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.
A measles outbreak was reported from Elche in early 2012, causing 106 cases by March (see Eurosurveillance). An outbreak was reported from Alicante in February 2012, causing 167 cases, and from Madrid in October 2011, causing almost 400 cases. A measles outbreak occurred in Gipuzkoa, a province of the Basque country, in June 2011. In May 2011, an outbreak was reported from the Canary Islands, causing 25 confirmed cases. The outbreak appeared to have been caused by the introduction of the virus by travelers from the United Kingdom and Germany, where many people have failed to receive measles vaccine due to unfounded rumors that the vaccine is associated with autism. Outbreaks were reported in May 2011 from Aragon, causing 20 cases, and from Ceuta (Spanish territory on the north coast of Africa), causing 15 cases. In March 2011, outbreaks were reported from Seville, causing more than 1000 cases by May, and from Rute (Cordoba), causing at least 30 cases. In November 2010, a measles outbreak was reported from Granada in southern Spain, causing 250 cases by April 2011 (see Eurosurveillance and the World Health Organization). In February 2010, a measles outbreak in the municipality of Jumilla (Murcia) caused 65 cases, almost all in citizens of Bulgarian and Romanian origin who had not been fully vaccinated. In February 2008, a measles outbreak was reported from the town of Algeciras in the south of Spain, causing 57 confirmed cases by April (see Eurosurveillance). A measles outbreak was reported from Barcelona in the last quarter of 2006, affecting 213 people by January 31, 2007, and from Madrid in February 2006, resulting in 59 cases as of March 16 (see Eurosurveillance and ProMED-mail; January 11 and 22, 2007).
An outbreak of an uncommon infectious disease, probably tick-related lymphadenopathy, was reported from Spain in August 2008. For details, go to ProMED-mail, August 11, 2008.
An outbreak of tularemia occurred between June and December 2007 in a rural area in the province of Palencia and in the provincial capital city of León in the province of Castilla y Leon, located in the northern part of Spain. A total of 507 cases were laboratory-confirmed. About one-third occurred in farm workers or people whose jobs involved contact with the environment, such as gardeners, rangers, and lake and reservoir maintenance staff. About one-quarter were caused by direct contact with rodents (see Eurosurveillance and ProMED-mail, August 11, 2007). A previous tularemia outbreak was reported from Castilla y Leon in November-December 1997, apparently related to the handling of infected hares (see Eurosurveillance). The 1997 outbreak resulted in 534 cases. Tularemia may be acquired by direct contact with infected animals, by mosquito or tick bites, or by inhalation. Symptoms may include fever, swollen glands, and skin lesions. Severe cases may be complicated by pneumonia or sepsis.
An increase in the number of cases of viral meningitis was reported from the Autonomous Region of Madrid during the first nine months of 2006, chiefly affecting those under 15 years of age (see Eurosurveillance). Two deaths were recorded. Most cases were caused by enteroviruses. An increase was also observed in other regions of Spain. Viral meningitis is a mild illness which is spread by direct contact with the respiratory secretions or feces of an infected person. No travel precautions are recommended 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.
An outbreak of rubella was reported from the autonomous region of Madrid during the first weeks of 2005. Most cases occurred in young adults of foreign origin, chiefly from Latin America (see Eurosurveillance). A rubella outbreak was reported from Alcaniz in April 2012 (see ProMED-mail). All travelers to Spain should make sure they have been vaccinated against rubella, which is one of the routine childhood immunizations.
Five cases of variant Creutzfeldt-Jakob disease (CJD) have been identified in Spain. The disease is acquired by eating beef from cows with a related infection known as bovine spongiform encephalopathy (mad cow disease). At present, the risk of acquiring variant CJD from European beef appears to be extraordinarily low, at most about one in 10 billion servings. The Centers for Disease Control does not advise against eating European beef, but suggests that travelers who wish to reduce their risk may either abstain from beef while in Europe or eat only solid pieces of muscle meat, such as steak, rather than products like sausage or chopped meat that might be contaminated. There is no evidence of any risk from pork, lamb, milk or milk products. For recent updates, go to ProMED-mail.
For further information, see Weekly Epidemiological Record, 1996.
For disease statistics and updates on recent outbreaks, go to the Boletin Epidemiologico Semanal (in Spanish).
Food and water precautions
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. 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. This is particularly important for travelers to the Canary Islands, where large reef fish are more likely to be caught and consumed.
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.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal 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.
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 general emergencies in Spain, call 112. For ambulance services, call the following numbers:
Samur - 092
Uvimovil - 061
Ambulances Cruz Roja - 91 522 2222
Ambulancias Sasu - 91 355 1039
Physicians and hospitals
For an on-line guide to physicians, hospitals, and emergency medical services in Spain, go to the United States Embassy website.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Good medical care is available in both Spain and Andorra. Regulations regarding medications may vary from those in the United States. Spanish regulations do not permit the international shipment of medication, so please do not ship medication from the United States to Spain. U.S. citizens who plan a lengthy trip to Spain should bring their medication or obtain a prescription for that medication from a Spanish physician...
Traveling with children
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).
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, and appropriate antibiotics for common childhood infections, such as middle ear infections.
Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
(reproduced from the U.S. State Dept. Consular Information Sheet)
Americans living in or visiting Spain or Andorra are encouraged to register at the Consular Section of the U.S. Embassy in Madrid or at the U.S. Consulate General in Barcelona, where they may obtain updated information on travel and security within Spain or Andorra.
The U.S. Embassy in Madrid, Spain, is located at Serrano 75; telephone (34)(91) 587-2200, and fax (34)(91) 587-2303. U.S. citizens who register in the Consular Section at the U.S. Embassy, Consulate General, or one of the Consular Agency listed below can obtain updated information on travel and security within Spain or Andorra. Additional information is available through the U.S. Embassy’s Internet homepage at http://madrid.usembassy.gov/.
The U.S. Consulate in Barcelona is located at Paseo Reina Elisenda 23-25; telephone (34)(93) 280-2227 and fax (34)(93) 205-5206. Visitors to Barcelona can access additional information from the Consulate General’s web page at http://barcelona.usconsulate.gov/.
There are six Consular Agencies in Spain, which provide limited services to American Citizens, but are not authorized to issue passports.
Fuengirola near Malaga, at Avenida Juan Gomez Juanito #8, Edificio Lucia 1C, 29640, Fuengirola, telephone (34)(952) 474-891 and fax (34)(952) 465-189, hours 10:00 a.m. to 1:00 p.m.;
La Coruna, at Canton Grande 6, telephone (34)(981) 213-233 and fax (34)(981 22 28 08), hours 10:00 a.m. to 1:00 p.m.;
Las Palmas, at Edificio Arca, Calle Los Martinez de Escobar 3, Oficina 7, telephone (34)(928) 222-552 and fax (34)(928) 225-863, hours 10:00 a.m. to 1:00 p.m.;
Palma de Mallorca, Edificio Reina Constanza, Porto Pi, 8, 9-D, 07015 Palma de Mallorca, Spain. Telephone (34)(971) 40-3707 or 40-3905 and fax (34)(971) 40-3971. Hours 10:30 a.m. to 1:30 p.m.; Seville, at Paseo de Las Delicias 7, telephone (34)(954) 231-885 and fax (34)(954) 232-040, hours 8:30 a.m. to 1:30 p.m.;
Valencia, at Doctor Romagosa #1, 2-J, 46002, Valencia telephone (34)(96)-351-6973 and fax (34)(96) 352-9565, hours 10:00 a.m. to 1:00 p.m.
For Andorra, please contact the U.S. Consulate in Barcelona.
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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