Vaccines for the Dominican Republic

Malaria in a beach destination

Many trips to the Dominican Republic stay on the resort coast, and that is exactly where the CDC page surprises. Its transmission areas are primarily the provinces of Azua, Elías Piña, La Altagracia, San Juan and Santo Domingo, and CDC writes "including resort areas" in both the transmission line and the medicine line. La Altagracia is the eastern province that holds Punta Cana, Bávaro and Cap Cana. In the Distrito Nacional, the city of Santo Domingo, transmission is mainly in the La Ciénaga and Los Tres Brazos areas. Other provinces have rare transmission, with insect bite precautions and mosquito avoidance in place of medicine; that covers Puerto Plata, Samaná and La Romana, which are not among the five named provinces.

What CDC reports about the parasite shapes the drug list. P. falciparum accounts for 100% of cases and no drug resistance is reported. So for the five provinces CDC lists chloroquine together with atovaquone-proguanil, doxycycline, mefloquine and tafenoquine. Chloroquine and mefloquine are weekly tablets; atovaquone-proguanil and doxycycline daily. The simulator below counts the tablets for the length of the stay.

For a week in La Altagracia, chloroquine comes to 7 tablets (about $46 at the price pharmacies pay), mefloquine to 7, atovaquone-proguanil to 16 (about $23) and doxycycline to 37, because each regimen starts before arrival and continues after departure. The prescriber weighs these against the traveler's health, other medicines and pregnancy. The malaria risk by country page compares this listing with other destinations.

Two hepatitis vaccines, typhoid on request

Hepatitis A is listed for unvaccinated travelers aged 1 year or older, and one dose before departure is enough for the trip, with the second dose later for long lasting protection. Hepatitis B is listed for unvaccinated travelers younger than 60, and those 60 and older may get it. Both hepatitis A doses and the two dose hepatitis B series cost $460 to $810 across the departments that publish them with their fees (median $550).

Typhoid is not on the "most travelers" line. CDC asks travelers to consider it for areas with poor sanitation and unsafe water, rural areas included, for stays of a month or more and for visits to friends or relatives, the situation of Dominican American families visiting relatives. The shot needs 14 days and costs $174 at the median; the oral capsules cost $121. Cholera vaccine is marked not recommended, because CDC reports that active transmission has ended. Rabid dogs are sometimes found and rabies is present in some wildlife; post-bite vaccine may only be available in larger suburban or urban facilities, a point for long rural stays (two pre-exposure doses: $838 at the median).

Yellow fever: only the Brazil connection

CDC does not recommend yellow fever vaccine for the Dominican Republic, and a direct flight from the United States needs no certificate. The country's rule is narrow and very specific. It requires a certificate from travelers 1 year or older arriving from four states of Brazil: Espírito Santo, Minas Gerais, Rio de Janeiro and São Paulo. Airport transits or layovers of more than 12 hours in any of those states count as well. A connection of a few hours in São Paulo does not trigger the rule; an overnight wait there does.

Arrivals from other Brazilian states, or from Colombia, Peru or Africa, are not covered by the rule as CDC reports it. For the few travelers it does concern, the shot has to be given at least 10 days before arriving in Santo Domingo or Punta Cana, at $269 at the median of the US county lists. Change the starting country below to compare routes.