Vaccinations and Other Prophylaxis

Note that many physicians unfamiliar with Panama except for a vague and dated notion that the place is synonymous with “tropical disease” go overboard in prescribing all kinds of unneeded preventative measures. Many a visitor who plans only to visit Panama City and the Panama Canal area comes loaded with expensive antimalaria medications that serve no purpose other than to amuse their fellow travelers and hosts. Some travelers also worry about official warnings they see about disease risk in Bocas del Toro and Kuna Yala. These warnings are generally based on remote areas of the mainland, not the islands that tourists visit.

What kind of precautions to take depends largely on where travelers plan to go and what they plan to do. Those who will spend most of their time in Panama City and the Panama Canal area probably do not need more than minimal protection. Those planning a trek across the Darién may want every defense against disease they can find.

Health conditions and vaccination recommendations can change quickly, so check current requirements and advisories through the CDC (www.cdc.gov/travel) or your doctor.

All visitors should make sure their routine immunizations are up to date, especially against measles-mumps-rubella and tetanus-diphtheria. The incidence of these diseases in Panama is low to nonexistent, but the CDC recommends everyone stay current on their immunizations against them, including nontravelers.

The CDC also recommends that travelers to Central America be vaccinated against hepatitis A and, in some cases, hepatitis B. A rabies vaccination is recommended for those who expect to spend a lot of time outdoors, particularly in rural areas. The CDC suggests typhoid fever vaccinations for those traveling in Central America, though the chance of contracting it in Panama seems remote.

Those planning to travel to rural parts of Panama, especially near the Costa Rican or Colombian border, should probably be vaccinated against yellow fever and may want to consider antimalaria medication.

There is a far greater risk of someone bringing yellow fever to Panama than of catching it there (the last known case in Panama was in 1974). Until recently, Panama required proof of a current yellow-fever vaccinations from travelers entering the country from anyplace where yellow fever is endemic. This regulation comes and goes, so it’s probably a good idea to have the vaccination if coming from an endemic area, just in case. This means tropical South America, including Colombia, and most of sub-Saharan Africa. Check the CDC website for current information and for a list of U.S. clinics that administer the vaccinations.

Beware: Panamanian authorities have been known to vaccinate those arriving from infected countries at the airport if the traveler cannot present a yellow-fever certificate. Better to take care of this before leaving home. Be sure to bring a properly stamped and signed international yellow-fever certificate, which the person administering the vaccine should give you.

There is no vaccine for malaria, but there are several kinds of antimalarial drugs meant to be taken daily or weekly before, during, and after travel to an endemic area.

Visitors to most parts of Panama should not need to take them. However, outside of Panama City and the area around the former Canal Zone there is a slight risk of contracting malaria. The risk is greatest in the Darién and the Comarca de Kuna Yala (San Blas Islands and mainland). The highest-risk areas west of the Panama Canal are the rural parts of Bocas del Toro and Veraguas provinces.

Many travelers even to these areas don’t take antimalarial medication unless they plan to spend a fair amount of time in remote villages or sleep somewhere that doesn’t have screened-in rooms. The true risk is almost impossible to measure, so think about the kind of traveling you want to do and discuss options with your physician.

There is a chloroquine-resistant strain of malaria in the Darién and Kuna Yala. Mefloquine, doxycycline, or atovaquone/proguanil is recommended for those planning to spend a significant amount of time in these regions. Chloroquine is considered effective against any strains found west of the Panama Canal.

These medications go by an assortment of brand names, which can cause confusion. Some antimalarial medications have serious side effects and are not recommended for everyone (pregnant or breast-feeding women should avoid them). They can also make one more susceptible to sunburn. Some of the contraindications are unusual—mefloquine, for instance, is not recommended for those with a history of depression—so do some research and quiz your doctor carefully. To be effective, travelers must continue to take the medications anywhere from a week to a month after returning home.

© William Friar from Moon Panama, 3rd Edition