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ED QUEST"ONS #OUT $E LT$

To prepare this page we consulted a panel of Dominican physicians. These included Pan American Health Organization consultant, immunologist Amiro Prez Mera !ritish"trained gastroenterologist Al#erto $antana %rench"trained pediatrician %elipe Perdomo &$"trained pathologist 'azmin (edondo and &$"trained geriatrician !elinda )icioso and documents produced #y the *orld Health Organization and the &$ +o,ernment -enter for Disease -ontrol. These answers are pro,ided as general guidelines. They are in no way a#solute and should not #e construed to apply to all tra,elers. ny recommenda%&on' (or %a)&n* 'un+ $un"related pro#lems are the principal cause of tourist ,isits to resort doctor.s offices in the Dominican (epu#lic. /t is the most common health hazard affecting tra,elers to the -ari##ean. The -ari##ean sun is ,ery strong, and you can #urn e,en on a cloudy day. Don t forget there is reflecti,e light e,en in the shade. The sun is strongest from 01 am to 2 pm. 3ote that lips and scalp can #urn 4ust li5e the s5in on the #ody, therefore an $P% 06 or higher is recommended for e,eryone. Prefer a waterproof sunscreen, as you will #e most pro#a#ly doing a lot of sweating or swimming. Ditto, use sunscreen on the upper part of your foot, which can easily #urn, too. %or more complete sun protection, purchase a product that #loc5s #oth &)! and &)A. The only ingredients that will protect the s5in are7 titanium dio8ide, zinc o8ide, or a,o#enzone. /f you forget to #ring your own, many leading world #rands are a,aila#le locally. (educe pro#lems related to sun e8posure #y using sunglasses, wide"#rimmed hats, and sunscreen or sun #loc5 lotions. -hildren if outside from 01 to 2 pm should wear dar5"colored t"shirts and hats, when possi#le, and sunscreen or sun #loc5 should #e applied se,eral times a day. Apply sunscreen regardless of the child using a t"shirt. !a#ies less than si8 months old should spend ,ery little time in the sun. /f they are out in the sun, they should wear protecti,e clothing, including a hat with a #rim that shades their face. %or #a#ies o,er si8 months and children, remem#er to apply sun screen half an hour #efore they go outside and reapply e,ery two to three hours when they are in the sun or water, e,en if the la#el says the product is waterproof. The #lazing tropical sun should not #e ta5en lightly. $unstro5e or heat stro5e is a serious medical condition. /t #egins with a headache, dizziness and fatigue #ut can 9uic5ly lead to con,ulsions and unconsciousness or e,en to death. , STRO"NTEST"N L D"SORDERS PRE-ENT"N, STOM .$ UPSETS/ 01a% '1ou2d " )now %o a3o&d *e%%&n* %ra3e2er4' d&arr1ea+ !y drin5ing more water than you would at home, e8ercising moderation in alcoholic #e,erages and food, e8ercising moderation in sun ta5ing, and watching what you eat you can reduce the possi#ilities of #eing affected. %urthermore, ,isitors to the D( can reduce the li5elihood of getting sic5 #y #eing aware of the simple matters that will #e e8plained here. One of the ma4or pro#lems is that people ,isit the D( with a pre4udice against the water, so they end up drin5ing less water and this aggra,ates the pro#lem. Most ,isitors find themsel,es in a hotter climate than what they are accustomed to and will dehydrate without e,en 5nowing it, especially if consuming alcoholic #e,erages. -ontrary to myth, you #ecome 9uic5ly de"hydrated e,en when

consuming large amounts of these drin5s the ethyl alcohol pre,ents proper a#sorption of electrolytes to needed cellular #odies. To ma5e things worse, one of the most popular #e,erages among tourists, the pi:a colada, has la8ati,e properties. 'ou should #e infle8i#le a#out consuming at least 01 glasses of water;non"alcoholic #e,erages a day. -ar#onated soft drin5s, soups, #ottled water, &HT mil5 containers or fruit 4uice from reputa#le #rands in containers that you open yourself, or e,en fruit 4uices that you prepare yourself are not su#4ect to any contamination. 'ou can chec5 whether you are getting dehydrated #y noticing if you go more than two to three hours without ha,ing to urinate, and whether your urine is dar5 yellow. Parents should #e especially ,igilant of their children that are li5ely to #e e,en more out in the sun than the adults. 3ote that e,en when swimming in the sea;ocean you are losing #ody heat and can #ecome dehydrated. Thus, #y 5eeping an ade9uate consumption of li9uids, your #ody will #e in #etter condition to resist micro#es to which your #ody is not immune. Ade9uately hydrated persons are less li5ely to get seriously sic5 and will reco,er faster. /n the Dominican (epu#lic, a fre9uent cause of mild stomach upset is o,er"indulgence in food as a result of ta5ing ad,antage of the all"inclusi,e program. %ood poisoning can also occur if there has #een improper handling of food or drin5 #y 5itchen or ser,ing personnel. !y consuming coo5ed meals, food that ha,e #een recently coo5ed, or which has #een handled #y trained personnel, tourists can reduce the possi#ility of contamination. *hen possi#le eat food that is coo5ed right in front of you, or that comes freshly coo5ed from the restaurant.s 5itchen. 3ote also that international tra,ellers are su#4ected to ,arious forms of stress inherent to the actual process of arri,ing and departing from a destination that may reduce their resistance to disease7 crowding, long hours of waiting, disruption of eating ha#its, changes in climate and time zone. These factors may in themsel,es pro,o5e nausea, indigestion, e8treme fatigue, and insomnia. re %1ere med&c&ne' or 3acc&ne' %1a% can be %a)en be(ore1and %o a3o&d be&n* a((ec%ed by d&arr1ea+ 3ote that there is no ,accine against <turista<, some people are 4ust more immune then others. Thus, two people could eat and drin5 the same things and only one get sic5. The *orld Health Organization says that prophyla8is of tra,eller.s diarrhea with #ismuth su#salicylate =Pepto !ismol> is impractical it is difficult to recommend an effecti,e anti#iotic for prophyla8is without 5nowing the type and nature of the li5ely causati,e agents in the areas to #e ,isited. Moreo,er, the *orld Health Organization is against the prophylactic use of anti#iotics. This can lead to the de,elopment of drug resistance in the agents of diseases and these drugs are not without side"effects =including diarrhea>. 01a% 'pec&a2 precau%&on' '1ou2d %1o'e w1o are 'u'pec% o( 1a3&n* 'en'&%&3e '%omac1' %a)e+ Persons most li5ely to get ill are persons who ha,e rarely tra,eled outside their home area and thus ha,e not #een e8posed to different micro#es or e,en un5nown allergens. These persons should ta5e special care to maintain ade9uate le,els of hydration, reduce the amount of sun ta5en and follow all recommendations gi,en on this we# page. 01a% (ood' '1ou2d we a3o&d+ T1e US *o3ernmen% %ra3e2 1ea2%1 on2&ne 'er3&ce recommend' no% ea%&n* da&ry produc%' 'u'pec% o( be&n* unpa'%eur&5ed and %o ea% (ru&% %1a% you can pee2 your'e2(. /f the hotel has ade9uate 5itchen handling techni9ues, there should not #e a pro#lem with eating salads and uncoo5ed ,egeta#les. /f you suspect you ha,e a sensiti,e stomach try a little and test yourself. Most cheese in the D( is imported or manufactured #y large companies, such as (ica, and thus has #een ade9uately pasteurized. Prefer food that is ser,ed hot. *hene,er possi#le, eat fruit you ha,e peeled yourself. " 2&)e my mea% med&um6rare. .an " ea% %1&' mea%+ 01a% abou% raw (&'1 and 'ea(ood+ 'es. The process of coo5ing the outside of the meat should 5ill any contamination which will #e on the outside not the inside of the meat. *hat is not recommended is to eat raw foods such as tartar

stea5. 'ou should a,oid raw meats and seafood =oysters>, with the e8ception of <ce,iche< which is fish that has #een marinated =cured> in lemon;lime 4uice. ?,en if you ha,e a hardy stomach, ta5e the ris5 of eating fish and meat carpaccio only in restaurants with an e8cellent reputation. Spec&a2 recommenda%&on' (or bab&e' and c1&2dren+ "' %1ere pa'%eur&5ed m&2) a3a&2ab2e+ .an " (eed my baby %1e (ru&%+ $ow 'a(e are %1e da&ry produc%' 'er3ed a% re'or%'+ Pasteurized mil5 is a,aila#le in &HT pac5aging in food stores. The leading #rands are Parmalat, 3estl and (ica. -ompanies that ha,e high standards in fruit 4uices are !on and (ica. -rystal, $anta -lara, Atlanta and Agua Or#is are leading #ottled water #rands readily a,aila#le. *hene,er possi#le, prefer #ottled water which retains its minerals. A,oid water su#4ect to the osmosis process. -hildren tend to dehydrate faster than adults #ecause they will spend more time outside and are usually more acti,e. They are also less li5ely to #e aware of the need to inta5e water. Parents should #e especially ,igilant that their children ingest at least 01 glasses of li9uid a day. This can include soft drin5s and 4uices. " 1a3e been recommended %o on2y dr&n) bo%%2ed wa%er7 &ce cube' made by mac1&ne'7 and %o bru'1 my %ee%1 w&%1 bo%%2ed wa%er. 01y doe' %1e wa%er 1a3e an e((ec% on %our&'%' and no% %1e 2oca2'+ "' (ood coo)ed &n 2oca2 wa%er 'a(e %o ea%+ .an " dr&n) co((ee or %ea+ 01a% abou% carbona%ed be3era*e'+ *ith the e8ception of a ,ery few hotels, tap water is not pota#le in the D(. Thus the recommendation to consume #ottled water. 3ote, though, that this same water warning is gi,en #y tour operators nearly e,erywhere, regardless of the destination. The reason, according to doctors and other health e8perts, is that most of the time tra,ellers to ma4or cities and resorts get a reaction to un5nown micro#es in tap water and;or un5nown allergens. $o the #ottled water warning is 4ust a sensi#le precaution. 3ote it is ,ery important to drin5 at least 01 glasses of water a day when ,isiting to not #ecome dehydrated and to not lower your immune capacity against alien micro#es. *hene,er possi#le prefer water that is la#eled as containing minerals, and not purified with an osmosis process. The tap water does not affect the locals or foreign residents #ecause their #odies are immune to the micro#es found in the water. ?,en so, #ecause tap water in the D( is not pota#le, residents are recommended to #oil the water or #uy #ottled water for drin5ing. Most residents #rush their teeth with tap water as they ha,e already #uilt up the needed immunity. %ood coo5ed in local water is safe to eat as #oiling 5ills the #acteria. -offee and tea are fine as they are made with #oiling water. -ar#onated #e,erages also are micro#e free, #ecause the process acts against #acteria. 01a% mea'ure' do Dom&n&can 1o%e2' %a)e %o a3o&d (ood po&'on&n*+ The Ministry of Pu#lic Health and the 3ational Hotel @ (estaurant Association =Asonahores> ha,e wor5ed together to raise food handling le,els at Dominican hotels throughout the country. The Ministry of Tourism, in coordination with Asonahores and the *orld Tourism Organization, sponsors intensi,e courses on safe food handling in the tourism sector, to instruct hotel esta#lishments to incorporate the Hazard Analysis -ritical -ontrol Point $ystem =HA--P>. A recent course was gi,en at the P&-MM &ni,ersity in April 0AAA. Bi5ewise, most hotels wor5ing with the ?nglish mar5et ha,e signed on for the ser,ices of the -ristal Americas food hygiene systems. This has resulted in the #an on recycling of #uffet food that in the past caused food contamination, as well as the implementing of high standards in food hygiene and handling. Dominican hoteliers participate in e8tensi,e programs sponsored #y international companies to maintain high le,els of hygiene among 5itchen and ser,ing personnel. Most ma4or hotels ha,e water filter systems, #ut recommend their guests use #ottled water as an e8tra precaution. $ic5 guests represent losses for the hotel as the le,el of satisfaction declines and hotels get #ad reports from the tour operators that send the guests. $o guests. health is logically a ma4or concern for all. 01a% &' %ra3e2er4' d&arr1ea+ 01a% are %1e 'ymp%om'+ *orld Health Organization stats show that diarrhea affects an estimated C1"61D of all tra,elers, regardless of where they are tra,eling. *hile a mild case of stomach upset will last half a day, others can last two to se,en days. The typical symptoms of the more se,ere tra,eler.s diarrhea are diarrhea, nausea, #loating, urgency and malaise. /t is rarely life threatening.

01en '1ou2d " 'ee a doc%or &( " 'u'pec% %ra3e2er4' d&arr1ea+ Anti#acterial drugs are generally unnecessary in simple gastro"enteritis, e,en when a #acterial cause is suspected, #ecause the complaint will usually resol,e 9uic5ly without such treatment. Most pro#lems are temporary and should pass after a day. /t is #est to let the to8ins flow from your #ody. !ut again, if necessary for sightseeing or tra,el, if suffering from moderately loose or fre9uent stools an antimotility drug can #e used, such as /modium, prefera#ly o,er !ismuth su#salicylate preparations, such as Pepto !ismol. Do not use for more than 2E hours. /f the diarrhea is ,iolent or lasts longer than FG hours, ,isit the on"site doctor. /f diarrhea is accompanied #y high fe,er, a,oid ta5ing anti"motility drugs. Most resorts and out"of"city hotels ha,e on"site doctors that are e8perienced in treating tra,eler.s diarrhea. S1ou2d " br&n* Pep%o #&'mo27 Lomo%&27 "mod&um or any an%&b&o%&c'+ This is unnecessary as they are readily a,aila#le at hotel shops, pharmacies and hotel doctor offices. /f you do #ecome ill with tra,eler.s diarrhea, it is usually self"limited and treatment re9uires only simple replacement of fluids and salts lost in diarrhea stools. 3one of the a#o,e"mentioned preparations should #e ta5en if the tourist has access to a toilet. During an attac5, stop food inta5e only if ,omiting has occurred drin5 plenty of fluids =#ottled water with minerals, soft drin5s, clear soup> a,oid fizzy drin5s, tea or coffee and return to a normal diet as 9uic5ly as possi#le, a,oiding large amounts of mil5 or fats. %resh #ananas are recommended for the lost potassium, e,en if they go through you 9uic5. -onsulted physicians only recommended ta5ing /modium and only if one cannot change scheduling of an e8cursion or tra,el plans. 3ote that Pepto !ismol, Bomotil nor /modium will ha,e an effect on the duration of the diarrhea. 01a% '1ou2d " do &( %1e d&arr1ea per'&'%'7 &' 3&o2en% or %1ere &' b2ood &n my '%oo2'+ /f the diarrhea lasts more than two days or there is #lood in your stools, see a doctor. Do not ta5e penicillin or sulfa drugs on your own, as you may #e at great ris5 for an allergic reaction. $tudies ha,e shown that the use of anti#iotics may shorten the length of illness. %re9uently prescri#ed anti#iotics are do8ycycline, trimethoprim;sulfametho8azole =!actrim, $eptra> or fluro9uinolones =ciprofla8acin and norflo8acin>. ?rythromycin"type anti#iotics are prescri#ed for those under 0G and those allergic to sulfa. All said, it is #etter to ha,e an on"site doctor prescri#e the anti#iotics and not use them #eforehand. /t is difficult to recommend an effecti,e anti#iotic without 5nowing the type and nature of the li5ely causati,e agents in the area to #e ,isited. The on"site physician can also prescri#e these and they can #e purchased in the D( if necessary. The on"site physician will most li5ely ha,e these a,aila#le at the resort dispensary or they will #e sold at the hotel store. Do %1e 'ame med&c&ne recommenda%&on' app2y &( my c1&2d *e%' d&arr1ea+ /modium is not recommended for young children. ?rythromycin"type anti#iotics may #e prescri#ed for those under 0G and those allergic to sulfa. %irst line treatment is treatment of fluid and electrolyte depletion, with an increase in fluids with minerals or a commercial preparation such as Pedialyte.

- .."N T"ONS 01a% 3acc&na%&on' '1ou2d " *e%+ 3o particular immunization is re9uired #y law for tra,eling to the D(. 'ou may decide to get the ,accinations #ased on the tra,eler.s medical history, proposed itinerary, duration of stay and purpose for tra,eling. /f you ha,en t #een immunized since childhood, consider #olstering you tetanus ,accination. 'ou should also #e immunized against =or immune to> measles, mumps, ru#ella and chic5en po8. &$ national health organizations recommend a diptheria;tetanus #ooster =TD #ooster> e,ery ten years as part of routine medical care, regardless of where you li,e or tra,el. ?lderly people are more

at ris5 as they may not ha,e #een immunized with the ,accinations during childhood, may not ha,e completed the full course of immunization nor had #oosters. !oosters are especially recommended if you will #e camping, gardening or ,isiting rural communities. /n case of an acute in4ury or wound of more than 0 cm that may ha,e #een contaminated, the doctor may decide to treat it with TD #ooster or human tetanus immune glo#ulin in the worse case scenario. Other medics may suggest anti#iotic therapy =penicillin, metronidazole or erhythromycin> to eradicate ,egetati,e cells, the source of the to8in. /f the wound is clean, and the patient has recei,ed F or more doses of the ,accine, none of these treatments will #e necessary. /f the child is younger than se,en, DPT may #e administered instead of TD. %or ad,enturous tourists that will stay for more than three wee5s, will #e ta5ing e8cursions off the #eaten trac5, that will #e tra,eling #eyond resort or tourist areas and eating at small cafes or ,isiting rural areas, in addition, loo5 into getting a Twin (i8 ,accine, which will immunize you against #oth Hepatitis A and !. $e,eral persons are already immune, so a test should #e done. -onsulted physicians are contrary to the application of immune glo#ulin #efore tra,el. There is a ris5 of contracting H/), and the ,accine co,erage is only of short term duration. /f you will #e residing in the D( for more than si8 months, you should also consider getting the Twin (i8 ,accine. Dominican children are immunized with the Hepatitis ! ,accine from early childhood. S1ou2d " %a)e ma2ar&a %ab2e%' or '1o%'+ " 1a3e %o2d %1ere can be '&de e((ec%'+ "' %1e *a&n wor%1 %1e r&')+ The *orld Health Organization lists the Dominican (epu#lic as a low malaria ris5"e8clusi,ely in the malignant =P.falciparum> form"e8ists throughout the year especially in rural areas of the western pro,inces that #order with Haiti such as Monte -risti, Da4a#Hn and ?lIas Pi:a. The *HO states that there is no e,idence of P.falciparum resistance to any antimalarial drug, and thus malaria ta#lets;shots are not recommended. 3ote that most Dominican resorts are a GJ hour dri,e from the frontier with Haiti. The gain is not worth the ris5 of ta5ing the medicine. /n the ,ery unli5ely case you fall ill with malaria, the ade9uate dose of -hloro9uine =common trade names7 Aralen, A,loclor, 3i,a9uine, (esochin> will release the sic5ness in C2"KC hours, thus prophyla8is is not recommended. OT$ER "LLNESSES ND $E LT$ $ 8 RDS 01a% &' c&*ua%era and w1a% &' %1e 2&)e2&1ood o( *e%%&n* &%+ "( " ca%c1 &%7 any recommenda%&on'+ $ow (re9uen%2y do %our&'%' ca%c1 &%+ -iguatera affects few tourists at Dominican resorts #ecause since their guests demand lots of fish they purchase these directly from offshore trawlers that fish in deep waters far from reefs. %ish caught offshore in the deep oceans rarely get poisonous, and most resorts #uy their fish from offshore trawlers, as do the supermar5ets. )ery #riefly it is a serious illness caused #y eating coral reef fish that ha,e accumulated a high le,el of natural to8ins through their diet. O,er 611 different types of fish can get poisonous from ingesting certain dinoflagelates on the reefs, such as am#er4ac5, #arracuda, grouper, mac5erel, moray eels, mullet, parrot fish, red snapper, sea #ass and surgeon fish. The most ris5y are larger carni,orous fish that li,e near coral reefs. There is no way to identify such fish from non"poisonous ones, and the poison =tetradoto8in> is not destroyed #y any coo5ing process. To reduce the ris5, prefer the smaller, younger fish, and don.t eat the heads or internal organs, which retain more to8ins. -iguaterra e8ists in the $outh Pacific =Hawaii>, coastal areas of -alifornia, %lorida and the &$ +ulf -oast. $ymptoms include ,omiting, diarrhea, tingling of the e8tremities, and a re,ersal of sensations, cold feels hot @ ,ice ,ersa. -ases can range from ,ery mild to serious. /f you get any of these symptoms after eating fish it is ad,isa#le to contact a doctor immediately. The mortality rate of this illness is #elow 0D, though, with most tragically ending cases going untreated. There is no certain antidote, #ut Mannitol is often in4ected as a first step. 01a% &' den*ue7 %1e 'ymp%om' and &' &% pre3a2en% amon* %our&'%'+ Dengue is not 5nown to affect tourists as the conditions under which it occurs are not those of tourist areas L such as open fresh water #ins. Dengue =deng.ee> fe,er, caused #y a mos9uito"#orne fla,i,irus, is found in tropical and su#tropical regions of the Americas, Africa, Asia and Australia. /n its acute form, dengue is characterized #y flu" li5e symptoms including se,ere pain in the head, eyes, muscles and 4oints. $ome patients,

particularly infants and children, de,elop <dengue hemorrhagic fe,er<, a se,ere and sometimes fatal ,ariation in,ol,ing circulatory failure and shoc5. The incidence of #oth forms of dengue infection has recently #een increasing, as e8panding ur#anization enlarges the regions inha#ited #y the Aedes mos9uito ,ector. Mos9uitoes capa#le of transmitting this disease are also found within the &nited $tates. Dengue fe,er is more pre,alent when it has #een raining constantly. )ictims typically e8perience a sudden high fe,er, headache and intense #ody pain a#out 6"E days after #eing #itten #y an infected mos9uito. A measles"li5e rash near day F of the fe,er can help distinguish dengue from other tropical illnesses. The acute illness usually concludes on its own after a#out a wee5, #ut fatigue and depression can last for wee5s or months in some cases. There is no ,accine against dengue. The #est protection is to use repellents. *hile most mos9uitos #ite #etween dus5 and dawn, Aedes mos9uitos are most acti,e during the day, especially in the early morning and late afternoon. They usually #reed in ur#an areas in man"made containers filled with relati,ely clean water. The Dominican go,ernment carries out ma4or pu#lic health campaigns to ma5e people aware of the dangers of storing unco,ered water. OT$ER $E LT$ QUEST"ONS 01a% &' 'w&mmer4' ear+ $wimmer.s ear =also 5nown as e8ternal otitis> is ,ery common among tourists. /t occurs due to an e8cess in the time spent in the water =sea or pool>. /t is caused when warm water remains deposited in the ear canal and #acteria grows. /t can #e ,ery painful. Pre,enti,e measures are earplugs, ru##ing alcohol =a few drops> into the ears after swimming =or at the end of the day>, or #y using <Agua"$ec< eardrops that are sold o,er the counter. /f you are affected, the doctor will prescri#e eardrops for a few days. /f the infection includes the eardrum and doesn.t su#side in a few days, oral anti#iotics may #e needed. $ow can " a3o&d be&n* '%un* by a 'ea crea%ure+ The most important rule of safe #athing in the sea is <Boo5 #ut don.t touchM< /f you step on a sea urchin, the spines should #e remo,ed with a fine sterile needle. Otherwise, lea,e them alone and they will gradually come out. /f you come in contact with a 4ellyfish, rinse with seawater, and then apply ,inegar. $ome patients may need to ta5e an antihistamine or apply cortisone cream. Although ,ery rare, if a stingray stings you, the dart can #e ,ery painful #ecause of the to8in that is in4ected. /t is important to a,oid contamination with sources of animal feces, clean your foot well, and put it in ,ery hot water for a minimum of F1 minutes. The foot might need sutures, anti#iotics. A,oid stepping on dirt, which might ma5e tetanus prophyla8is necessary. 01a% abou% cora2+ -ontact with li,e coral reefs should #e a,oided since you can get an irritation or allergy on the s5in. /f you scrape yourself, your s5in can easily get infected. An anti#iotic and anti"allergy cream should #e administered. -oral reef scrapes that are 5ept clean do not need to #e treated for tetanus #ecause the organism is not water"#orne. 01a% &( a bee or a wa'p '%&n*' me+ /f you 5now you are sensiti,e =allergic> to insect stings, carry a 5it called ?pi"pen =epinephrine in4ection> to #e applied right after the puncture. Otherwise, if you are stung see5 help if your s5in swells significantly or if you are short of #reath. 3ote that there are no lethal ,enomous animals in the D(. 01y do mo'9u&%o' b&%e 1uman'+ Only female mos9uitoes #ite humans, #ecause they need #lood to de,elop fertile eggs. They re9uire a <#lood meal< for each of their many #atches of eggs, #ut li5e their male counterparts, they rely on nectar as their main food source. The female mos9uito trac5s her human targets #y following the car#on dio8ide we e8hale. *hen the female mos9uito #ites a

human, she in4ects sali,a into our s5in #efore drawing #lood. The sali,a ma5es penetration easier for her, and it also ser,es to pre,ent #lood clots from de,eloping in her food canal. The welts and itch that we e8perience after a #eing #itten #y a mos9uito are actually an allergic reaction to her sali,a. 01a% can " do %o a3o&d mo'9u&%o b&%e'+ Mos9uitos are not a ma4or pro#lem at resort hotels #ecause the hotels fumigate regularly. 3ote, though that some people are more prone to #e #itten then others. 'ou may consider using -oppertone.s $un and !ug Botion, especially if you will #e ta5ing e8cursions off the resort. *hat is important to note is to use a mos9uito repellent that contains D??T. /f you will #e entering an area with many mos9uitos, apply this lotion to your s5in and clothing. ?8ercise caution when using repellents on children. The American Academy of Pediatrics recommends choosing a repellent made for children L containing no more than 01 percent D??T L and applying it to their clothing rather than s5in when possi#le. .an " *e% my pre'cr&p%&on dru*' &n %1e DR+ Most prescriptions can #e filled in the D(. /f the #rand name is not a,aila#le, a su#stitute can #e found. /t is recommended, though to #ring an ade9uate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary so that ,alua#le ,acation time not #e lost shopping for these. 01ere '1ou2d one *o (or %1e be'% med&ca2 %rea%men% &n %1e DR+ Most hotels ha,e doctors on call or on site. Barger hotels ha,e small dispensaries on site. The #est medical care in the D( is a,aila#le in the capital city, $anto Domingo. /f you are in need of ,isiting a hospital emergency room7 $anto Domingo7 -entro Mdico &-?. A,. Pedro HenrI9uez &re:a. Tel. CC0"10K0 -lInica A#reu. -alle !eller 2C, es9. /ndependencia. Tel. GEE"2200. -orazones &nidos. A,. %antino %alco C0, 3aco. Tel. 6GK"22C0 Ba (omana =$outheast>7 -entral (omana medical center. Tel. 6CF"FFFF -entro Medico Dr. -anela. A,. Bi#ertad 22, Ba (omana. Tel. 66G"F0F6 Punta -ana;!N,aro7 -lInica Perozo =HigOey>. -alle Puan QQ/// 3o. 06K. Tel. 662"CEAF 3orth -oast7 -lInica Dr. !ournigal =Puerto Plata city>. -alle Antera Mota. Tel. FC1"1C2G PoliclInica !ahIa PrIncipe =(Io $an Puan"Playa +rande>. Pue#lito !ahIa PrIncipe. Tel. CCG"06A1 re %1ere re2&ab2e a&r or *round ambu2ance 'er3&ce' a3a&2ab2e+ Mo,imed offers am#ulance ser,ices in $anto Domingo and $antiago, the two larger cities. Air am#ulance ser,ices can #e contracted to fly into the principal Dominican airports. Two companies are $O$ at 6F1"2G2G or Mo,imed at 0"C11"1A00. ny web '&%e' (or (ur%1er %ra3e2 1ea2%1 &n(orma%&on+ *orld Health Organization http7;;www.who.int;ith;english;welcome.html &$ +o,ernment -enter for Disease -ontrol http7;;www.cdc.go,;tra,el;cari#ean.htm All contents copyright =-> C110, D(0. All rights reser,ed.