Travel vaccinations for Puerto Rico

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch. Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil. Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Dengue is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travellers. The mosquitoes that spread dengue are more common in towns, cities and surrounding areas. There is a risk of dengue in this country.Information on current outbreaks, where available, will be reported on our outbreak surveillance database. Travellers should avoid mosquito bites, particularly during daytime hours. Vaccination can be considered for individuals aged 4 years of age and older who have had dengue infection in the past and who are: travelling to areas where there is a risk of dengue infection or areas with an ongoing outbreak of dengue, or are exposed to dengue virus through their work, such as laboratory staff working with the virus Exceptionally, vaccination can be considered in those who have not had dengue in the past. In these situations, further expert advice should be considered. Detailed guidance on how to ascertain previous infection is available in the UK Health Security Agency Immunisation against infectious disease the 'Green book'. The final decision on vaccination rests with the health professional and the traveller after a detailed risk assessment has been performed and the potential risks of vaccination explained.

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong. All travellers should take care with personal, food and water hygiene. Vaccination is recommended for those whose activities put them at increased risk. This includes: Those who are staying with or visiting the local population. Frequent and/or long-stay travellers to areas where sanitation and food hygiene are likely to be poor. Adventure travellers visiting rural areas and staying in basic accommodation such as backpackers. Those with existing medical conditions such as liver disease or haemophilia. Men who have sex with men. People who inject drugs. Those who may be exposed to the virus through their work. Those going to areas of hepatitis A outbreaks who have limited access to safe water and medical care.

Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection. Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal. The risk of exposure is increased by certain activities and length of stay (see below). Children are at increased risk as they are less likely to avoid contact with animals and to report a bite, scratch or lick. Rabies is considered to be a risk in this country. Bats may also carry rabies-like viruses. Travellers should avoid contact with all animals. Rabies is preventable with prompt post-exposure treatment. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Post-exposure treatment and advice should be in accordance with national guidelines. A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply world-wide. Pre-exposure vaccinations are recommended for travellers whose activities put them at increased risk including: those at risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health workers who may be caring for infected patients). those travelling to areas where access to post-exposure treatment and medical care is limited. those planning higher risk activities such as running or cycling. long-stay travellers (more than one month).