Inoculation regulations can change at short notice. Please take medical advice in the case of doubt.

1
A yellow fever vaccination certificate is required from all travellers aged one year and over arriving within six days from infected areas.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is not a condition of entry to Nicaragua. However, cholera is a risk in this country, especially after outbreaks in 1999 in Jinotega, Managua, Nueva Segovia and RAAN areas. Precautions are essential. Up-to-date advice should be sought before deciding whether these precautions should include vaccination, as medical opinion is divided over its effectiveness; see the Health appendix.

3
Immunisation against typhoid is strongly recommended.

4
Risk of malaria, predominantly in the benign vivax form, exists throughout the year in 119 municipalities, with the highest risk in Chinandega, Jinotega, Nueva Segovía, RAAN, RAAS and San Juan. In the other 26 municipalities, in the departments of Carazo, Madriz and Masaya, transmission risk is low or negligible. Malaria risk is higher during the rainy season. Chloroquine chemoprophylaxis is recommended.

Food & drink
All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk in rural areas may be unpasteurised and should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid dairy products which are likely to have been made from unboiled milk. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks
Amoebic and bacillary dysenteries, diarrhoeal diseases, typhoid fever and hepatitis A are common throughout the country. Cutaneous and visceral leishmaniasis occur. Dengue fever may occur. There are occasional cases of leptospirosis.
Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay. For more information, consult the Health appendix.

Each department of Nicaragua has a public hospital. These do not charge for emergency services, but will charge for supplies and medicines. There is an extensive network of health posts and health centres in rural areas, however, their resources can be limited. There are about 10 private hospitals/clinics in Managua. Many doctors and hospitals will require payment in cash before treatment, although some private hospitals may accept credit cards. International travellers are strongly advised to take out full medical insurance before departure.