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 over one year of age arriving from infected areas. Travellers arriving from non-endemic zones should note that vaccination is strongly recommended for travel outside the urban areas, even if an outbreak of the disease has not been reported and they would normally not require a vaccination certificate to enter the country.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is no longer a condition of entry to Ecuador. However, cholera is a serious risk in this country and 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 for further information.

3
Typhoid poses some risk in rural areas.

4
Malaria risk, predominantly in the benign vivax form, is high throughout the year below 1500m (4920ft) in 148 cantons in 19 provinces. A high proportion of falciparum cases in Esmeraldas Province are reportedly resistant to chloroquine. There is no risk in Guayaquil or Quito.

Notes
A measels vaccination certificate is required by all nationals travelling from Colombia, Germany, Italy and Venezuela and must be shown upon arrival.

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. Bottled water is available. Milk is 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
Endemic onchocerciasis occurs in rural areas. Hepatitis A and B are hyperendemic and inoculation with gamma globulin is highly recommended. Hepatitis D is endemic in the Amazon Basin. Dengue fever, filariasis, leishmaniasis, onchocerciasis and American trypanosomiasis are diseases carried by insects and might occur. Brucellosis may be contracted by eating or drinking contaminated dairy products. Altitude sickness is a risk flying directly into Quito (2800m/9186ft).
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.

Medical facilities outside the major towns are extremely limited. Acute surgical and cardiac services are not available on the Galápagos Islands; therefore, for more serious illnesses, patients may be evacuated to the USA. Health insurance (to include emergency repatriation) is strongly recommended.