The document provides information for travelers preparing to visit Guatemala, including details on vaccinations recommended for the trip such as hepatitis A and B, typhoid, rabies, and malaria prophylaxis. It also offers tips for staying healthy in Guatemala such as avoiding mosquito bites, contaminated food and water, animal bites, and injuries. Contact information is given for local police, embassies, and tourist assistance organizations in case of emergency during the visit.

1. Guatemala Preparing For Your Trip

2. Where is Las Conchas, Guatemala? http://www.geographyiq.com/countries/gt/Guatemala_map_flag_geography.htm Las Conchas

3. Packing Essentials Adequate supply of prescription medications Medication for diarrhea Pepto Bismol, Loperamide, and antibiotics for traveler’s diarrhea Medication for other common illnesses Headache – Acetaminophen, Aspirin Upset stomach – Pepto Bismol Motion sickness - Meclizine, Dimenhydrinate, Promethazine Sunglasses and hat Loose fitting clothing for tropical weather Antibacterial liquid/wipes Sleeping net for bed Protection from mosquitoes Insect repellant DEET for skin Permethrin for clothes, sheets, sleeping nets Sunblock SPF of 15 or greater

4. Before Your Trip Vaccinations The following vaccinations are recommended: Be up-to-date on all vaccines required in U.S. Hepatitis A Hepatitis B Typhoid Rabies Malaria Prophylaxis is strongly recommended.

5. Before Your Trip—Routine Vaccines Influenza You need one dose every fall (or winter) Pneumococcal You need 1 or 2 doses if you smoke cigarettes or have certain chronic medical conditions Varicella (chickenpox) Consider this vaccine if you have never had chicken pox OR if vaccinated and you only received one dose Tetanus, Diphtheria, pertussis (whooping cough) Be sure to get a 1-time dose of “Tdap” (adult whooping cough vaccine) You need a Td booster shot every 10 years Measles, Mumps, Rubella You need at least 1 dose of MMR if you were born in 1957 or later more information available at: http://www.immunize.org/catg.d/p4030.pdf

6. Before Your Trip—Hepatitis A One of the most common vaccine-preventable infections acquired during travel Spread person-to-person, or contaminated water/food HepA is asymptomatic, but flu-like symptoms are not uncommon; lasts 3 to 6 months Vaccinations available HAVRIX—2 doses, 2nd dose 6 to 12 months after initial dose VAQTA—2 doses, 2nd dose 6 to 18 months after initial dose TWINRIX—protects against both HepA and HepB; 4 doses Other preventable measures Boil/cook all foods for at least 1 minute Do not drink tap water or brush teeth with tap water Do not consume raw vegetables, or fruits that cannot be peeled. Avoid food and drinks from street vendors Eat only foods that have been thoroughly cooked or still steaming hot “Boil it, cook it, peel it, or forget it” Treatment None; only symptoms are treatable

7. Before Your Trip—Hepatitis B Transmission Bodily fluids Early signs and symptoms Nausea, vomiting, abdominal pain, jaundice, skin rashes, joint pain, arthritis Incubation period 90 days Two categories Acute: usually goes away after 2 or 3 weeks. Liver function returns to normal in 4 to 6 months Chronic: may lead to cirrhosis and death Vaccinations Recombivax HB Energix-B Both vaccines are inactivated and dosing periods are at 0, 1, and 6 month intervals Treatment Acute: none Chronic: antiviral medications

8. Before Your Trip—Typhoid Transmission Consumption of water or food contaminated with infected human feces Signs and Symptoms Fever that gradually increases daily from low-grade to high, macular rash on trunk, headache, malaise, anorexia, enlargement of liver and spleen Preventative Measures “Boil it, cook it, peel it, or forget it” Vaccinations Vivotif: oral, live attenuated vaccine, must be refrigerated, dosage is 1 capsule every other day - 4 dosages Typhim Vi: Vi capsular polysaccharide vaccine, IM injection every 2 years Both are given 2 weeks prior to exposure Treatment Empiric treatment: Ciprofloxacin for duration of 3 to 5 days Alternative: 3rd generation cephalosporin (Cefixime, Cefdinir)

9. Before Your Trip—Rabies Rabies can be found on all continents except Antarctica In certain areas of the world, including Central and South America, rabies in dogs is still a major problem Preventative measures Best accomplished by avoiding bites from mammals Wound cleansing and disinfection Vaccination Vaccinations HDCV: human diploid cell vaccine; given IM at pre-exposure or post-exposure PCEC: embryo cell vaccine; given IM at pre-exposure or post-exposure Human Rabies Immune Globulin: local infusion at wound site + IM distal site; post-exposure

10. Before Your Trip—Malaria Location Rural areas only at altitudes below 4,921 feet No malaria in Guatemala City, Antigua, or Lake Antitlan Drug Resistance None Malaria Type P. vivax; 97% P. falciparum; 3% Prophylaxis for areas with malaria Atovaquone/proguanil (Malarone) Doxycycline Mefloquine Primaquine Must be tested and documented to have normal glucose-6-phosphate dehydrogenase activity

11. How Do I Stay Healthy? Avoid mosquito bites Avoid outbreaks Be aware of peak exposure times and places Wear appropriate clothing Check for ticks Use Bed nets Spray Insecticides Treat clothes with Permethrin Apply DEET containing insecticide to skin Avoid areas of standing water Reside in well air-conditioned, enclosed areas

12. How Do I Stay Healthy? Prevent animal bites and scratches Travelers to rabies-endemic countries should be warned about the risk of acquiring rabies and educated on avoiding bites (see “rabies” for additional information) Street dogs represent the most frequent risk for bite exposure to travelers, followed by monkeys Children are considered high risk because their small stature makes extensive bites more likely, they are attracted to animals, and there is the remote possibility that they may not report a possible exposure

13. How Do I Stay Healthy? Avoid contaminated food and water Drink only bottled water or use water sanitizing techniques Boil water Do not use ice cubes Avoid undercooked meat and fish All fruits and vegetables should be cleaned and peeled; if not, avoid it Do not consume food from street vendors Do not consume unpasteurized dairy products

14. How Do I Stay Healthy? Other Important Tips Be aware of possible natural disasters Avoid injuries Wear helmets, no drinking and driving, avoid overcrowded transportation, avoid night driving, consider hiring a driver, follow all traffic laws, wear a seatbelt Keep feet clean and dry, and never go barefoot Reduces the risk of fungal and parasitic infections

15. How to Stay Safe Always travel with your group Stay on main roads Be cautious of ANY stranger who approaches you Avoid having devices such as cell phones, laptops, and iPods visible (never use them in public) Never hail taxis – only use reputable tour organizations Taxi Seguro – “safe taxi” Travelling after dark is strongly discouraged If by chance, you are victimized, do not resist Avoid large gatherings of people – protests are common & may become violent Crime and Safety

16. Crime and Safety Kidnapping Keep a close eye on any children in the group Don’t make any unnecessary contact with children people are often accused of stealing children if they are seen talking or taking pictures with children

17. U.S. Embassy Guatemalan American Citizen Services (502) 2326-4501 – normal business hours Normal business hours Monday – Thursday - 7:30 a.m. – 12 p.m. and 1 p.m. – 3 p.m. Friday – 7:30 – 11:30 a.m. (502) 2331-2354 – after normal business hours Guatemalan Police number – equivalent to “911” 120 122 123 The Embassy is located at AvenidaReforma 7-01, Zona 10, Guatemala City, Guatemala. The American Citizen Services Unit in the Embassy is accessed through the door on 7thCalle. ASISTUR – Assistance to Tourists 1500 2421-2810 1500 5578-9836 Fax 1500 2421-2891

18. References We hope you enjoy your stay in Guatemala! If you need additional information, please do not hesitate to use these resources: Centers for Disease Control and Prevention: http://wwwnc.cdc.gov/travel/ World Health Organization: http://www.who.int/en/ US Department of State: http://travel.state.gov/travel/travel_1744.html The Shalom Foundation: http://theshalomfoundation.org

19. http://theshalomfoundation.org