Panama: Marine Ecology and Blue Carbon Conservation in the Pacific and Caribbean

TABLE OF CONTENTS

GENERAL INFORMATION ...... 2 PREVENTION OF INSECT-BORNE ILLNESSES ...... 2 PREVENTION OF FOOD- AND WATER-BORNE ILLNESSES ...... 3 OTHER DISEASES ...... 5 IMMUNIZATIONS ...... 6 IMMUNIZATION SCHEDULE ...... 7

GENERAL INFORMATION SIT Study Abroad programs may venture off the To protect your health in , you need certain usual tourist track. Pay careful attention to health pre-departure immunizations followed by reasonable and safety guidelines. health precautions while in the country. The following health guidelines and requirements are PREVENTION OF INSECT- based on years of experience and the current recommendations from the US Centers for Disease BORNE ILLNESSES Control and Prevention. They are designed to inform Insect precautions are recommended for this you of health concerns that may be present in program. There is no risk of in Panama especially as you venture to smaller cities and the scheduled destinations of the program. off the usual tourist track, or spend time in small While there is a low risk of malaria in portions of villages and rural areas for extended periods. Comarca Guna Yala- it is mostly on the eastern Although no information sheet can address every side, a significant distance from your program conceivable contingency, the following health excursion to the farthest western tip of Guna Yala. guidelines and requirements are an attempt to Insect precautions only against mosquito bites are provide you with a standard, which if followed, usually sufficient for this program. should optimize good health during your stay abroad. Personal Protective Measures You may find that local customs and practice, as The following insect precautions should be followed, well as varying US physicians’ approaches, at times to prevent mosquito bites: conflict with these guidelines. It is essential that you • Wear long-sleeved shirts and long pants. review these health guidelines and requirements • Use insect repellents on skin and clothing. with your physician, to discuss individual issues DEET-containing products (e.g. Off, Off Deep such as pre-existing medical problems and allergies Woods, Jungle Juice, and Muskol) may be used to particular drugs. Any further questions or on skin in concentrations up to 30–40% and on concerns should be directed to the US Centers for clothing in higher concentrations. Permethrin Disease Control and Prevention (CDC) in Atlanta (Permanone) may also be used on clothing. (www.cdc.gov/travel) or to your own physician. SIT Study Abroad suggests that if you have further questions, you should not hesitate to contact the

Malarial Division of the CDC at 888-232-3228 for recorded information or to visit the CDC website http://www.cdc.gov/malaria/travelers/index.html

2 Panama 2020

Dengue protective measures) and by getting the vaccination This is a viral disease and is transmitted by shots that are available at any yellow fever mosquitoes which bite primarily in the daytime. It vaccination center (consult your physician for the occurs in urban as well as rural areas. There is no nearest center). licensed vaccine against it, but personal protective Please note: yellow fever is not a concern for the measures against mosquito bites are effective in scheduled program destinations. However, if you prevention (see under Personal Protective plan to travel to a yellow fever risk area after the measures). The disease causes considerable program, we recommend the yellow fever discomfort (fever, body aching, but is self-limited in vaccination. adults.

Zika Zika is a viral that is also transmitted by the bite of the Aedes mosquitoes. Symptoms include mild fever, rash, conjunctivitis (red eyes), joint or muscle pain and headache. The disease causes considerable discomfort, but is mild and self-limited, lasting for several days to a week.

There are no vaccines or medications available to prevent or treat Zika therefore students should be vigilant in using insect precautions and personal protection measures against day-biting mosquitoes (see insect precautions section above). PREVENTION OF FOOD- AND CDC recommends that pregnant women consider WATER-BORNE ILLNESSES postponing travel to countries where the Zika virus Tap water is generally safe to drink and cook with in is prevalent. Panama City and other major cities and it is usually safe as well to eat fresh fruits, vegetables, and salads and to put ice in your drinks. Food and water Chikungunya is an arboviral infection that is safety however, cannot be guaranteed from street transmitted by day-biting Aedes mosquitoes. It is food purchases and the water quality is variable in prevalent in tropical Africa and Asia, parts of Central rural areas. and South America, and the Caribbean. Low risk If you are unsure of the food and water quality in the exists throughout the country including Panama area you are visiting, check with a reliable source City. Symptoms are typically fever and joint pain. before using. If in any doubt, take all the There is no licensed vaccine against it, but insect recommended precautions and respect certain do’s precautions and personal protective measures and don’ts: (especially during peak times (early morning and late afternoon) are the main prevention strategy. DO WASH your hands scrupulously with non- contaminated water and soap before eating and Yellow fever snacking. This is a viral disease transmitted by mosquitoes that occurs only in parts of Africa and South DO DRINK America. It is a concern for all mainland areas east • Bottled or canned beverages (water, soda, soft of the Canal Zone (including Comarca Guna Yala – drinks) from a trusted source (ensure caps are an excursion destination). Yellow fever is sealed). • characterized by severe hepatitis with fever. It may Hot beverages (coffee, tea). be prevented by avoiding mosquito bites (personal 3 Panama 2020

• Water that reached a rolling boil for at least one minute at sea level (longer at higher altitudes). • Carbonated mineral water.

DON’T DRINK • Tap water, even in ice; don’t risk using it for brushing your teeth either. • Tap water in larger cities is often safe, but the water in rural areas is probably not, so be sure to check with a reliable source before using, and if in any doubt, take all the recommended precautions. Diarrhea-Producing Infections In Panama, there is a mild to moderate incidence of DO USE diarrhea among travelers. Most common is • Commercial iodide or tinctured liquid iodine to “traveler’s diarrhea”, a self-limited diarrhea lasting treat water, ONLY if bottled water (from a trusted from a few to several days, characterized by watery, source) is not available and boiling water is not non-bloody bowel movements. Traveler’s diarrhea possible. Chlorine in various forms is less usually requires no treatment other than fluid reliable than iodine. These provide substantial replacement including ORS (World Health protection when added to tap water. Organization’s oral rehydration solution, which comes in package form). Antidiarrheals such as DO EAT Imodium or Lomotil may be used short-term in some • Cooked vegetables, fruits with thick covering circumstances. Pepto Bismol in large amounts and (citrus, bananas, and melons); and well-washed certain antibiotics (doxycycline, sulfa-TMP, raw fruits and vegetables. ciprofloxacin) can prevent or attenuate the infection. • Meat or fish that is thoroughly cooked (pork and Antibiotics are indicated for more severe cases of lamb should be very well done). traveler’s diarrhea. • Pasteurized dairy products from large

commercial dairies. Hepatitis A DON’T EAT Hepatitis A is a highly contagious virus that causes • Unwashed or unpeeled raw fruits and liver inflammation. It is most commonly spread vegetables. through contaminated food and water. Most • Fruits that do not have a thick, disposable Americans have not previously been exposed to the outside covering. hepatitis A virus and are at risk of contracting the • Rare or raw meat or fish or shellfish. disease during travel to areas where the disease is • Dairy products from small, independent vendors more prevalent. A very effective vaccine is available without pasteurizing facilities, including food of and should be administered 2–3 weeks prior to any kind that has been left out in the sun, travel. especially custards, creams, and mayonnaise. • Raw (unpasteurized) milk or milk products. Typhoid Fever Tuberculosis and brucellosis, both serious Typhoid is an infection caused by a particular diseases are transmitted in this way, so the species of the salmonella bacterium. It is spread by consumption of unpasteurized milk and milk contaminated food and water. Symptoms include products should be strictly avoided. fever, severe toxicity, rash, and in about half the

cases, bloody diarrhea. Untreated, there is a 30% There may be times when refusing an offer of food mortality rate. Vaccines are 60–70% effective in or beverage, even a drink with ice or avoiding a prevention. One vaccine involves a single injection, salad will be considered rude. You must decide for with immunity lasting 2 years. A second one is yourself, but polite refusals, thought out in advance, administered orally every other day for 4 doses, and are often handy. Discuss these alternatives with lasts 5 years. Antibiotic resistance has been your Academic Director(s). 4 Panama 2020

developing, but treatment of the disease with certain Hepatitis B well-known antibiotics is usually effective. As with all Hepatitis B is a serious and often chronic viral diarrheal illnesses, careful dietary discretion infection of the liver. Since this type of hepatitis is continues to be the main line of defense. most often acquired from contact with infected blood, sexual contact (as with HIV), or skin-to-skin A note on swimming: Avoid swimming or wading contact of mutual open cuts and sores, appropriate in fresh water. Many parasites and bacteria live in precautions to avoid these types of exposure are water and can cause serious illness. Properly necessary. This includes avoiding getting tattoos, or chlorinated pools and salt water are generally safe ear/body piercings and avoiding cuddling children from infectious diseases. with sores or draining insect bites. A series of three immunizing injections is recommended. This series should be initiated as early as possible so that at OTHER DISEASES least two doses are taken prior to departure. This Prevention of animal bites and infections: will provide partial protection. The third shot should Rabies risk occurs primarily via direct contact with be taken five months after the second dose, and bats; wildlife and domestic animals. Dog rabies is may be given after returning home to achieve full, not a concern. Nevertheless, strict adherence to the long-lasting immunity. An accelerated schedule can following is important for a safe and rabies-free also be used as an alternative. experience: • Avoid bites from all animals and especially avoid HIV/AIDS and Blood Supplies handling or feeding puppies, kittens, monkeys, HIV/AIDS is a concern worldwide. The HIV virus is or other animals. They can have rabies before it transmitted by way of bodily fluids from an infected is obvious. person. HIV is spread mainly by having anal or • If you have been bitten or have had direct vaginal sex or sharing drug injection equipment with contact with the saliva of a suspected rabid a person who has HIV. AIDS is an acquired immune animal, immediately wash the affected area with deficiency that can result in life- threatening a soap solution and running water thoroughly to infections and is the most advanced stage of the neutralize and to rinse out the virus. Then HIV infection. It is the student's responsibility to proceed immediately for post-exposure protect him /herself from acquiring the disease treatment, the sooner the better; depending on through sexual transmission. Students anticipating the location of the bite, you may have little time. even the possibility of sexual activity are strongly • If at all possible, the animal should be captured and kept under cautious surveillance until the urged to bring their own condom supply. Other diagnosis and therapy are completed. If capture potential routes of infected blood transmission such is not possible, a clear description of the animal as tattooing, body piercing, and needle sharing must and the circumstance of contact should be be strictly avoided. carefully recorded. With regard to blood transfusions, our Academic Directors have identified hospitals, through Tuberculosis consultation with the local US embassy, where safe Tuberculosis (TB) is a bacterial disease spread by blood is available. In a life-threatening situation, the airborne droplets from a person with untreated risks versus benefits of an emergency blood pulmonary TB or by ingestion of TB-contaminated transfusion must be examined carefully and a unpasteurized milk products. Transmission is more decision made based on the best information at likely in conditions of crowding and poverty. A TB hand. skin test can indicate prior exposure to tuberculosis and is recommended prior to travel (unless already Coronavirus COVID-19 known to be positive). A repeat test is also COVID-19 is a newly identified respiratory virus that recommended after returning to the US even if the was discovered in China. Cases of the virus have pre-departure test was negative. spread rapidly in China and have also been reported in over 100 other countries, including the 5 Panama 2020

United States. The World Health Organization • Wear a facemask if you are sick, especially (WHO) has declared this disease a global pandemic when you are around other people (e.g., sharing for the worldwide spread of a new disease for which a room or vehicle) and before you enter a most people do not have immunity. COVID-19 is healthcare provider’s office. usually spread through direct contact with an • Most importantly, stay connected: infected person as well as through respiratory Communicate daily with your SIT Academic droplets produced when an infected person coughs Director. SIT continues to update its contingency and evacuation plans to ensure that we are or sneezes. It is unknown if the virus can spread prepared to take appropriate action in the event from contact with contaminated surfaces or objects. of a change in circumstances. Symptoms of COVID-19 are fever, cough, and shortness of breath, and may appear 2-14 days after exposure. The illness can also cause body aches, sore throat, vomiting and diarrhea. Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases. There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus and protect yourself! • Clean your hands often-wash your hands carefully and frequently with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing IMMUNIZATIONS FOR PANAMA your nose, coughing, or sneezing. If soap and Immunizations fall under two categories: 1) those water are not readily available, use a hand that are required for SIT Study Abroad admission sanitizer that contains at least 60% alcohol. and 2) those that are recommended to protect your Cover all surfaces of your hands and rub them health and well-being by building up your immune together until they feel dry. Avoid touching your defenses against specific prevalent diseases. In eyes, nose, and mouth with unwashed hands. addition, certain basic immunizations are required • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of by US law. your elbow. Throw used tissues in the trash. • Clean AND disinfect frequently touched Plan ahead at least 8 weeks, as laid out in the surfaces daily. This includes tables, doorknobs, sample schedule at the end of these instructions light switches, countertops, handles, desks, since some immunizations require more than one phones, keyboards, toilets, faucets, and sinks. dose for effectiveness. The physician administering • Avoid close contact with people who are sick. the inoculations should record all immunizations on Put distance between yourself and the International Certificate of Vaccination or other people if possible. Prophylaxis (ICVP, also known as the WHO card). • Inform your Academic Director immediately if The WHO card is to be with you at all times while in you have a pulmonary disease or any respiratory the host country. If for some reason you are illness; have a fever or feeling sick; if you have unable to obtain a WHO card or your WHO card been in close contact with a person known to have COVID-19; and/or have recently traveled is lost it will be sufficient to carry a copy of your from an area with widespread or ongoing immunization record with you. community spread of COVID-19. • Seek medical care, contact ISOS and a REQUIRED (for participation in program): doctor, if you develop symptoms; • MMR (measles, mumps, rubella): You will • Avoid travel if you are sick or have a fever. need to be immunized if you have not had two Your Academic Director will make appropriate doses of live measles vaccine. accommodations for students who are ill. 6 Panama 2020

• Tetanus, diphtheria, pertussis: The primary child series is required. Boosters (Td or Tdap) Before the start of are effective for 10 years. If you are uncertain program Immunizations when you had your last injection, we Tetanus(Td,Tdap) booster recommend that you get another booster. 8 weeks Yellow fever

RECOMMENDED (as a health precaution- 7 weeks Influenza consult your physician): 5 weeks • Typhoid: This vaccine is strongly urged as a Typhoid (injection or oral) viable protective measure. The vaccine is given 3 weeks either orally or by injection. Discuss the relative Hepatitis A vaccine merits of each with your doctor

With reasonable attention to health and hygiene • Influenza: Influenza vaccine should be considered for any individual wishing to rules, your stay in Panama should be a healthy one. decrease risk of influenza or non-specific Aside from minor ailments due to adjustments to the respiratory illness-especially those who are at new food, water and climate, this is the experience high risk for complications from influenza of the large majority of SIT Study Abroad students. including those with asthma, COPD, diabetes, We do, however, recommend you see your chronic cardiovascular disease and physician on returning to the US in order to test for immunocompromised conditions. any possible lingering infection contracted overseas.

• Hepatitis A: Hepatitis A vaccine, which provides long-term immunity, is recommended. Take good care of yourself!

• Hepatitis B: A series of 3 immunization injections is recommended. See section on Hepatitis B.

SAMPLE IMMUNIZATION SCHEDULE FOR PANAMA To assist your planning, we suggest the following schedule for required and recommended immunizations. For your own comfort and protection, do not leave shots to the last minute!

7 Panama 2020