Costa Rica – Health Risks, Inoculations, Vaccinations, and Health Certificates

What are the main health risks for expats living in Costa Rica?

Costa Rica encompasses an extraordinary variety of landscapes — from mist-draped cloud forests and towering volcanoes to stretches of Pacific and Caribbean coastline. This ecological abundance, however, brings with it a range of health hazards that expats should familiarise themselves with both before arriving and after settling in. Insects including mosquitoes, ticks, and fleas are capable of transmitting several diseases in Costa Rica, many of which cannot be prevented through vaccination or prophylactic medication.

Dengue fever represents the most significant day-to-day health threat from mosquitoes. It is the leading mosquito-borne illness in the country, with over 31,200 cases recorded in 2024 and more than 1,200 cases in the early months of 2025. Transmission occurs year-round but intensifies during the rainy season between May and November. Dengue is by no means confined to isolated rural settings — it appears in urban neighbourhoods, towns, and popular tourist destinations alike. The Aedes mosquito responsible for its spread bites during daylight hours, with peak activity in the early morning and late afternoon. Symptoms closely resemble a severe case of influenza and include high fever, intense headaches, pain behind the eyes, and joint aches. In more serious cases, the illness can progress to internal bleeding.

Malaria poses a lower but nonetheless real risk. In 2024, there were 232 locally acquired malaria cases in Costa Rica, concentrated largely in the provinces of Alajuela and Limón, with the greatest exposure in lowland zones near the Nicaraguan border. Because the malaria parasites found in Costa Rica are resistant to chloroquine, selecting the correct preventive medication is essential — a travel health professional should be consulted before visiting those provinces.

Chikungunya is an additional mosquito-borne illness to be aware of. Roughly 405 infections were recorded in Costa Rica during 2024. The disease causes fever and debilitating joint pain that may persist for months, alongside headaches, muscle soreness, and skin rash.

Gastrointestinal illness is another frequent concern, especially for those newly arrived. Hepatitis A can be contracted through food or water that has been contaminated and is not uncommon in Costa Rica. Traveller’s diarrhoea affects a high proportion of newcomers. The quality of food and water varies considerably across the country — risk levels differ between remote highland trails and urban centres.

Environmental health risks deserve attention as well. Heat stroke can be fatal, and preventing it requires regular food and fluid intake, lightweight loose-fitting clothing, and reduced physical exertion during the hottest parts of the day. Air pollution is also a concern: residents of Costa Rica are exposed to ambient particulate matter (PM2.5) levels averaging 14.1 micrograms per cubic metre, exceeding the OECD average of 11.2 micrograms. The country’s active volcanoes — including Arenal, Poás, and Irazú — pose ongoing risks. While major eruptions are uncommon, periodic volcanic activity can generate ash clouds and degrade air quality across nearby areas.

Chagas disease is a less prominent but real threat. Transmission can occur when the faeces of the triatomine insect are inadvertently rubbed into a bite wound, the eyes, or the mouth. This risk is most relevant for those spending extended periods in rural settings or older buildings.

Are any vaccinations or inoculations required before entering Costa Rica?

Costa Rica imposes one conditional vaccination requirement for entry: proof of yellow fever immunisation is mandatory for travellers arriving from countries classified as transmission risk zones. This is a legal entry requirement, not a discretionary recommendation.

Countries currently considered at risk — and from which arriving travellers must present proof of yellow fever vaccination — include Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Paraguay, Peru, Suriname, Venezuela, and Trinidad and Tobago, with a number of African nations also included on Costa Rica’s official list. Any foreign national who arrives without presenting a valid International Certificate of Vaccination against yellow fever to immigration officials will be refused entry.

It is worth clarifying that this requirement targets travellers coming directly from endemic countries, not all international arrivals. Passing through an at-risk country’s airport, port, or land border on a transit visa does not trigger the vaccination requirement. Medical exemptions also exist: exceptions apply for infants under nine months of age, individuals over the age of 60, those transiting through the country, and in circumstances where the relevant government determines that vaccine supplies are insufficient.

The yellow fever entry rules in Costa Rica have been evolving in recent years. As of March 2026, the Costa Rican Ministry of Health has declared that proof of yellow fever vaccination is required for individuals departing Costa Rica for Brazil, Peru, and designated high-risk African countries, with the requirement for travel to Colombia having taken effect in May 2025. Given that this list continues to be updated, travellers and prospective residents should always confirm the latest requirements directly with the Costa Rica Ministry of Health or their nearest Costa Rican consulate before making travel arrangements.

No other vaccinations are legally required for entry into Costa Rica. As of 2024, COVID-19 vaccination and testing are not required. All remaining vaccines fall into the recommended rather than mandatory category for entry purposes.

Which vaccinations are recommended for expats moving to Costa Rica?

Although only the yellow fever vaccine is formally required for entry (and only for those arriving from endemic regions), health authorities advise a broader set of immunisations for anyone planning to live in Costa Rica over the long term. These can be divided into routine vaccinations that should be current regardless of destination, and vaccines specifically relevant to Costa Rica’s disease landscape.

Routine vaccinations to ensure are up to date:

• MMR (Measles, Mumps, Rubella): Measles continues to circulate in parts of the world and can be introduced through international travel. Anyone without confirmed vaccination or who requires a booster should address this before moving.
• Tdap (Tetanus, Diphtheria, Pertussis): Given the active outdoor lifestyle typical in Costa Rica, cuts, scrapes, and other minor injuries are common — making tetanus protection particularly relevant.
• Polio and Influenza: Both the CDC and WHO recommend keeping polio and influenza vaccination current for travel and residence in Costa Rica.
• Varicella (Chickenpox) and Shingles: Additional vaccines may be recommended depending on personal immunisation history; a healthcare provider can assess what is appropriate.

Destination-specific vaccines recommended for Costa Rica:

• Hepatitis A: Transmitted through contaminated food and water, Hepatitis A is a genuine risk in Costa Rica. A two-dose course provides lasting protection, though a single dose offers adequate coverage for most visits.
• Typhoid: Particularly advisable for those who plan to eat from street stalls or spend time in rural communities. The vaccine is available as an injection or in oral capsule form.
• Hepatitis B: Recommended for anyone who anticipates receiving medical care, having tattoos or piercings, or engaging in activities carrying a risk of physical injury. The standard course involves three doses.
• Rabies: A worthwhile consideration for those planning to spend substantial time outdoors in rural settings. Costa Rica’s wildlife includes bats and other animals known to carry the virus.

For expats planning to live or spend extended periods in Alajuela and Limón provinces — the regions with the highest malaria exposure — a conversation with a doctor about antimalarial medication is advisable. Options such as atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine may be suitable depending on individual circumstances. For all other parts of the country, consistent use of mosquito bite prevention measures is generally regarded as adequate.

No single resource captures every possible health risk. Consulting a travel health specialist or visiting a dedicated travel health clinic — ideally at least six weeks before departure — allows for personalised recommendations tailored to your health history and travel plans. Even if departure is imminent, an appointment is still worth making.

Do you need a health certificate to move to or work in Costa Rica?

A formal medical examination is not a blanket requirement for all Costa Rica residency applications, but health-related documentation does feature in the process — most notably for specific residency categories. The principal health obligation for all legal residents is enrolment in the national healthcare system rather than completion of a pre-arrival medical check. That said, certain application categories do call for additional health paperwork.

Depending on the residency category being pursued, applicants may need to demonstrate enrolment in Costa Rica’s national health insurance scheme, the Caja Costarricense de Seguro Social. Some categories also require a medical certificate issued by a Costa Rican-licensed physician confirming that the applicant is in good health and free from communicable disease. The precise documentation required varies according to whether the application falls under the pensionado (retiree), rentista (income-based), investor, or worker category.

Regardless of category, all legal residents in Costa Rica are required to participate in the public healthcare system. Health coverage is a legal requirement for all residents — citizens and foreign nationals alike — irrespective of their immigration or residency status. The law stipulates that every resident must hold either private health insurance or coverage through the state-administered system.

The residency application process involves the following steps:

1. Identify the most appropriate residency category (pensionado, rentista, investor, worker, etc.) for your situation through the Dirección General de Migración y Extranjería.
2. Compile the required documentation, which may include evidence of income, apostilled criminal background checks, birth or marriage certificates, and — for certain categories — a health certificate from a licensed Costa Rican doctor.
3. Lodge your application and pay the relevant government fees. Filing fees generally fall between $50 and $250 depending on the residency type; these cover administrative processing by immigration authorities (as of 2025).
4. Await a decision from immigration officials. Processing times typically range from four to fifteen months, influenced by the completeness of the application and current workloads.
5. Once approved, register with the Caja Costarricense de Seguro Social (CCSS). Newly approved residents must present proof of residency status and supporting documentation at their nearest government regional office, after which they will be assigned to a local clinic for patient registration.
6. Pay applicable fees and begin contributing to the CCSS. Registration with the Caja is obligatory for all residents and involves monthly payments calculated on the basis of declared income.

For most expats, monthly CAJA contributions fall in the range of $60 to $200, linked to the declared income associated with the relevant residency category (as of 2025). Fee structures are subject to change, so always confirm current amounts directly with immigration authorities or a licensed Costa Rican immigration attorney.

How does healthcare in Costa Rica compare to what expats may be used to?

Costa Rica’s healthcare system consistently ranks among the most developed in Latin America. Around 93% of the population has coverage for a core range of services, and 70% of people expressed satisfaction with the availability of quality healthcare — a figure that surpasses the OECD average of 64%. Expats arriving from countries with universal health systems will find the overall framework broadly familiar; those accustomed to private insurance as the primary mechanism for healthcare access may need to adjust to the mandatory public enrolment model.

The system operates on a dual structure combining public and private provision. On the public side, the Caja Costarricense de Seguro Social (CCSS or La Caja) has underpinned universal coverage and social security in Costa Rica since the 1940s. Permanent residents and citizens enrolled in the CAJA system are entitled to comprehensive coverage encompassing all medical procedures, appointments, hospital stays, and prescription medications. The system is sustained through modest monthly contributions from all residents, scaled according to income.

In practice, many expats draw on both systems simultaneously. When the public pathway involves long wait times — for example, for diagnostic tests — patients often opt to pay privately for faster access, while still relying on the CAJA for other aspects of their care. Private doctors are also able to write prescriptions for medications dispensed through public pharmacies, which can reduce costs considerably.

As with universal healthcare systems in other countries, the public system in Costa Rica is not without its frustrations. Waiting times can be lengthy, administrative processes may feel cumbersome, and access to practitioners who speak languages other than Spanish may be limited — a notable difference from countries where multilingual medical staff are more widely available.

The private healthcare sector offers greater flexibility, with patients able to choose their own general practitioner, specialists, and hospital. English-speaking clinicians are far more accessible in the private sphere, and appointment waiting times are generally shorter. The private hospitals most frequently used by internationally-minded expats are CIMA Hospital in Escazú, Clínica Bíblica in San José, and Clínica Católica in the San José-Guadalupe area. CIMA Hospital holds particular distinction as the only hospital in Central America accredited by the US Department of Veterans Affairs.

When it comes to costs, medical care in Costa Rica is considerably more affordable than in many Western countries — consultations, diagnostic tests, and even complex surgical procedures can cost a quarter to a third of equivalent treatment in the United States. Standards of care are generally high, though ambulance response times in remote locations can vary significantly, and emergency treatment for visitors without coverage is limited to initial stabilisation only.

What are the risks of travel within Costa Rica, and are there regional health differences?

Despite its compact size, Costa Rica has considerable geographic diversity, and health risks shift meaningfully depending on where you are in the country. This is particularly relevant for expats settling outside San José or those who regularly venture into coastal or rural regions.

Dengue and mosquito-borne disease: The highest concentrations of dengue cases tend to occur in the Central Pacific and central regions. That said, the Aedes mosquito is highly adaptable and widely distributed, meaning dengue exposure exists across most lowland areas and is not restricted to any one zone. Notably, the majority of 2024’s dengue cases were recorded around San José in the mountain belt — not along Costa Rica’s beaches as might be assumed.

Malaria: Malaria exposure is concentrated in Alajuela and Limón provinces. Residents and visitors spending significant time in these areas are advised to consider antimalarial medication. In the rest of the country, thorough mosquito bite prevention is generally considered sufficient protection.

Volcanic and environmental hazards: The active volcanoes of Arenal, Poás, and Irazú present continuing hazards. While large-scale eruptions are infrequent, lower-level volcanic activity can produce ash plumes and have a localised impact on air quality. In April 2025, an eruption at Poás forced the closure of the national park and disrupted nearby communities. Expats and visitors should stay abreast of volcanic activity reports and follow any guidance issued by local authorities.

Flooding and landslides: The rainy season running from May to November coincides with the Atlantic hurricane season and brings elevated risks of flooding and landslides. These hazards are most acute for those living in river valleys, coastal lowlands, or areas of steep terrain.

Remote areas: Access to emergency medical services in major cities is relatively straightforward, but distances to hospitals or clinics can be substantial in remote communities. Anyone considering a move to a jungle lodge, an isolated beach settlement, or a highland village should carefully evaluate proximity to healthcare facilities before committing.

For those engaging in outdoor activities, remain alert to shifting weather patterns and exercise caution when conditions deteriorate. Basic essentials such as insect repellent, sunscreen, and a first aid kit should always be on hand. At higher altitudes, temperatures can fall sharply and the physical demands of exertion increase dehydration risk. In coastal lowlands, intense UV radiation and heat are the predominant environmental health concerns.

Where can expats get reliable and up-to-date health advice for Costa Rica?

Health requirements, vaccination guidance, and disease risk assessments in Costa Rica can change at short notice. It is essential to verify current information through official channels both before travel and throughout your time in the country. The following authoritative sources are recommended:

• Costa Rica Ministry of Health (Ministerio de Salud): The primary official body responsible for health regulations, vaccination requirements, and disease surveillance within Costa Rica. The ministry’s website publishes updates on yellow fever requirements and endemic disease monitoring. Visit: www.ministeriodesalud.go.cr
• Costa Rica Immigration Authority (Dirección General de Migración y Extranjería): The definitive source for residency application requirements, including health documentation obligations by residency category. Visit: migracion.go.cr
• US Centers for Disease Control and Prevention (CDC) — Costa Rica traveller page: Offers current vaccine and health recommendations, disease outbreak notifications, and preventive health guidance specific to Costa Rica. Visit: wwwnc.cdc.gov/travel/destinations/traveler/none/costa-rica
• UK Travel Health Pro (NaTHNaC) — Costa Rica: The National Travel Health Network and Centre provides detailed country-specific health advice including vaccination recommendations, regional disease risks, and outbreak updates. Visit: travelhealthpro.org.uk/country/52/costa-rica
• World Health Organization (WHO) — Costa Rica: Offers broad epidemiological data, country health profiles, and disease alert information. Visit: www.who.int/countries/cri
• Caja Costarricense de Seguro Social (CCSS): The public healthcare authority overseeing CAJA enrolment, public hospital and clinic access, and resident health coverage. Visit: www.ccss.sa.cr
• Private travel health clinics: Before relocating, visiting a specialist travel health clinic in your home country enables personalised vaccine scheduling, antimalarial prescriptions, and country-specific health briefings. Once in Costa Rica, facilities such as CIMA Hospital in Escazú and Clínica Bíblica in San José offer ongoing medical care and specialist referrals.

A reminder: specific requirements, fee levels, vaccination lists, and disease risk assessments are all subject to revision. Always consult current official sources before making health-related decisions about your move.

Frequently Asked Questions

Do I need to get new vaccinations if my home-country vaccinations are already up to date?

Standard routine immunisations — such as MMR, tetanus-diphtheria-pertussis, and polio — are generally considered valid and do not need to be repeated if they are current. However, you will most likely require destination-specific vaccines such as Hepatitis A and Typhoid, which are not included in all national vaccination schedules. A travel health clinic can assess your immunisation records and identify any gaps before you travel.

Is health insurance required to apply for residency in Costa Rica?

Health coverage is a legal requirement for all residents of Costa Rica — both citizens and foreign nationals — regardless of immigration or residency status. The law requires every resident to hold either a private health insurance policy or coverage through the state-administered system. Once residency is granted, enrolment in the CCSS (CAJA) public system becomes obligatory.

What happens if I develop a serious illness or need emergency care in Costa Rica?

Healthcare standards in Costa Rica are generally high. Ambulance response times in remote locations may vary, and visitors without insurance coverage are entitled only to initial emergency stabilisation. Legal residents enrolled in the CAJA system have full coverage. It is strongly recommended that all expats maintain comprehensive health insurance — through CAJA, a private Costa Rican insurer, or an international plan — to cover all eventualities, including medical evacuation if required.

How do I find a doctor who speaks a language other than Spanish in Costa Rica?

Multilingual practitioners, including English-speaking doctors, are far more readily available within the private healthcare sector. Major private hospitals such as CIMA Hospital in Escazú, Clínica Bíblica, and Clínica Católica in San José are the facilities most commonly used by expats and typically have internationally trained, multilingual staff. Many foreign embassies also maintain contact lists of recommended local doctors for their nationals.

Can I use my existing foreign prescriptions in Costa Rica?

Prescriptions issued in certain countries — including the UK — cannot be dispensed in Costa Rica. A fresh prescription from a Costa Rican-licensed physician will be required. Additionally, some medications that are legally available elsewhere may be restricted or prohibited in Costa Rica; confirm with the Costa Rican embassy that any medications you intend to bring are permitted, and carry an adequate supply for your journey along with extra in case of delays.

Is dengue fever a risk in San José, or only in rural areas?

Dengue is not confined to the countryside — cases occur in cities, towns, and tourist destinations throughout Costa Rica. The majority of dengue cases recorded in 2024 were detected in the mountainous areas near San José rather than at the country’s beaches. The best preventive measures — wherever you are in Costa Rica — include applying insect repellent, wearing long-sleeved clothing, and removing any standing water around your home.

Do I need to take antimalarial tablets if I’m living in San José?

Malaria risk in Costa Rica is low overall and is concentrated primarily in the provinces of Alajuela and Limón, particularly in lowland zones close to the Nicaraguan border. For those residing in San José or the Central Valley, antimalarial medication is not generally recommended. If you plan to spend extended time in higher-risk provinces, discuss appropriate preventive options with a doctor beforehand.

How long does it take to get enrolled in the CAJA public healthcare system?

Obtaining residency — a prerequisite for CAJA enrolment — typically takes around 18 months. Once residency is approved, registration takes place at your nearest government regional office. During the period before CAJA membership is active, you will need to arrange alternative cover for any medical costs incurred. Most expats address this gap by maintaining private health insurance to avoid exposure to significant unexpected expenses.