As colourful as its currency and its national flower – a stunning orchid called a purple country girl – Costa Rica is a magical place to live. From the rugged volcanic rainforest terrain to its stunning protected coastlines and beaches, this truly beautiful country has so much to offer local people and expats alike.Home to around five per cent of the entire planet’s biodiversity, Costa Rica is a tropical paradise teeming with exotic wildlife including spider monkeys and quetzal birds. A walk along a jungle lined beach makes spotting wildlife such as monkeys, sloths, parrots and toucans more likely. However, due to the high rainfall and humid temperatures, some of those animals come with a health warning.
This is why the CDC (the Centers for Disease Control and Prevention) and WHO (World Health Organization) recommend the following vaccinations for anyone travelling to Costa Rica: hepatitis A, hepatitis B, typhoid, yellow fever, rabies, meningitis, polio, measles, mumps and rubella (MMR), Tdap (tetanus, diphtheria and pertussis), chickenpox, shingles, pneumonia and influenza.
However, there is no vaccination for the virus currently impacting Mexico, Central America, South America, the Caribbean, tropical areas of Southeast Asia, Oceania and parts of Africa. The Zika virus (ZIKV) is a mosquito-borne flavivirus that was first identified in Ugandan monkeys in 1947. It was found in humans in 1952 in both Uganda and the United Republic of Tanzania.
Costa Rica has been categorised as having a risk of Zika infection. Reports from 2018 show that there were around 400 cases of Zika in Costa Rica during that year. Most of these were linked to counties in the Limón province and northern area of the country.
In the majority of cases, Zika is asymptomatic. However, those who do experience symptoms complain of conjunctivitis, mild fever, headache, sensitivity to light, muscle and joint pain as well as a skin rash with red spots on the face, neck, trunk and upper arms which can spread to the palms or soles. Some people may also experience a lack of appetite, diarrhoea, abdominal pain, constipation, dizziness, nausea, vomiting and general malaise.
A worldwide risk assessment from 2019 documented that real-time data on Zika outbreaks and transmissions in Costa Rica are often not available as most people who contract the condition do not know they are infected, making it impossible to accurately convey a country’s true up-to-date level of risk.
Zika is primarily transmitted by infected female mosquitoes of the Aedes aegypti and Aedes albopictus breeds, which are typically active from dawn to dusk and are abundant in urban settings. The virus may be misdiagnosed as Dengue fever but can be detected via a blood or urine test. Those bitten by an infected mosquito tend to become ill within three to 12 days and are usually fully recovered within seven days.
In order to help prevent infection, meticulous anti-mosquito bite measures should be taken. Apply sunscreen on exposed skin followed by a 20% Picaridin repellent spray 20 minutes later. Mosquitoes cannot bite through clothing, so cover up. Choose neutral colours such as beiges and light greys in loose, light-weight materials. For added protection, an insect repellent containing 20%-30% DEET can be sprayed onto clothing.
As of May 2019, anti-mosquito advice suggests that scented soaps, shampoos, deodorants, perfumes and after-shaves should be avoided, and shoes should be worn both inside and out. Sleep or rest under an insecticide-treated bed net and ensure that all doors and window screens are closed and tear or hole-free. Cover any food, drinks, compost and rubbish and get rid of any containers or items which hold water either inside or outside of your accommodation.
Even though the main mode of transmission is the bite of an infected mosquito, a few sexual transmission events have been reported and issues associated with this type of transmission and pregnancy have come to light. Zika infection during pregnancy is likely to result in abnormalities in the developing foetus and newborn, such as microcephaly (decreased head size which may lead to developmental delays), miscarriage, stillbirth and premature birth. Zika is also a trigger of Guillain-Barré syndrome (a progressive muscle weakness that can lead to temporary paralysis), neuropathy and myelitis, particularly in adults and older children.
As of the 24th Jun 2019, the CDC recommends that pregnant women (or those trying to become pregnant) do not travel to areas where there is an active or historic outbreak of Zika. When deciding whether to travel, the destination, reasons for travelling, and ability to prevent mosquito bites should be considered. You can download a risk assessment document here.
Pregnant couples in at-risk countries should use condoms from start to finish every time they have sex or abstain from sex for the entire pregnancy. Those interested in becoming pregnant need to protect themselves too and should consider waiting to get pregnant until they are outside an area with the risk of Zika. They should discuss their plans for pregnancy with a healthcare provider to determine their risk and the options available.
Correctly using male condoms and other barriers such as female condoms and dental dams, every time, can reduce (though not eliminate) the risk of sexually transmitted diseases. Such measures can also provide protection against other diseases that may be transmitted through sex.
All residents of and travellers to areas with ongoing or historical transmission should prevent mosquito bites and make informed decisions on whether to abstain from sex, practice safer sex or avoid/delay pregnancy. In areas where transmission has been interrupted and those without ongoing transmission, re-introduction of the virus may occur, but the probability of large outbreaks is likely to be low due to herd immunity. The likelihood of exposure for residents and travellers in such settings is negligible.
Research is ongoing to investigate the long-term effects of the Zika infection on pregnancy outcomes as well as its effects on other neurological disorders in children and adults. WHO is supporting countries that are trying to get control of the Zika virus by taking actions outlined in the ‘Zika Strategic Response Framework’, advancing research in prevention, surveillance and control of Zika and associated complications, thus strengthening the capacity of laboratories to test for Zika worldwide, as well as to develop, strengthen and implement integrated surveillance systems for the Zika virus and associated complications.
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