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Thailand Travel Requirements & Vaccinations

Thailand is a country located in Southeast Asia on the Indochinese peninsula. Officially known as the Kingdom of Thailand, it was formerly known as Siam. Thai is the official language of Thailand with English being spoken in most of the larger cities and tourist destinations. Thailand is home to some of the most popular and luxurious resorts in Asia.

The terrain of Thailand varies greatly and ranges from mountainous regions in the north, to plateaus in the east and river valleys in much of the interior. Despite the geographical variations, most of Thailand experiences a tropical wet and dry (savanna) climate which is comprised of three distinct seasons:

• Summer or pre-monsoon season lasts from mid-February to mid-May and is characterized by warm, dry temperatures.
• Rainy or southwest monsoon season lasts from mid-May to mid-October and is defined by an abundance of rain.
• Winter or northeast monsoon season is mid-October through mid-February and comes with dry, mild weather conditions.

Thailand has a vast array of attractions and activities to offer visitors, including:

• Bangkok and the many historical, natural and cultural sights it has to offer
• Trekking and adventure travel in the forested mountain regions
• Archaeological sites, Buddhist temples and museums
• Clear blue/green shallow waters on sandy beaches along the coast
• A diverse wildlife system

Recommended Vaccinations for Thailand Travel

• Hepatitis A
• Japanese encephalitis

*Rabies vaccination is typically only recommended for very high risk travelers given that it is completely preventable if medical attention is received within 7 – 10 days of an animal bite.

Travelers may also be advised to ensure they have received the routine vaccinations listed below. Some adults may need to receive a booster for some of these diseases:

• Measles, mumps and rubella (MMR)
• Tdap (tetanus, diphtheria and pertussis)

Older adults or those with certain medical conditions may also want to ask about being vaccinated for shingles and/or pneumonia.

This information is not intended to replace the advice of a travel medicine professional. Not all of the vaccines listed here will be necessary for every individual.

Talk to the experts at UH Roe Green Center for Travel Medicine & Global Health to determine how each member of your family can obtain maximum protection against illness, disease and injury while traveling, based on age, health, medical history and travel itinerary.

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Travel Vaccines and Advice for Thailand

Thailand is a popular destination with its tropical climate, food, culture and beaches.

Thai is the official language of Thailand. But, other smaller languages spoken in rural areas. The primary religion of Thailand is Buddhism and is prevalent in many aspects of culture throughout Thailand. Islam is also practiced in Southern provinces.

Bangkok, Thailand’s capital city, is also the largest city in the country. Bangkok is highly populated with congested streets, modern buildings and temples. It is most known for its nightlife.

Thailand’s other major cities include Ayutthaya, Chiang Mai, and Chiang Rai.

On This Page: Do I Need Vaccines for Thailand? Other Ways to Stay Healthy in Thailand Do I Need a Visa or Passport for Thailand? What Is the Climate Like in Thailand? How Safe Is Thailand? Temples in Thailand What Should I Take to Thailand? U.S. Embassy in Thailand

Do I Need Vaccines for Thailand?

Yes, some vaccines are recommended or required for Thailand. The CDC and WHO recommend the following vaccinations for Thailand: typhoid , cholera , hepatitis A , polio , yellow fever , Japanese encephalitis , chikungunya , rabies , hepatitis B , influenza , COVID-19 , pneumonia , meningitis , chickenpox , shingles , Tdap (tetanus, diphtheria and pertussis) and measles, mumps and rubella (MMR) .

See the bullets below to learn more about some of these key immunizations:

• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Cholera – Food & Water – Cholera is rare, but present in Thailand. Vaccination is recommended for travelers at increased risk or visiting areas with active transmission.
• Hepatitis A – Food & Water – Recommended for most travelers.
• Polio – Food & Water – Due to an increase in cases globally, an additional adult booster is recommended for most travelers to any destination.
• Yellow Fever – Mosquito – Required if traveling from a country with risk of yellow fever transmission.
• Japanese Encephalitis – Mosquito – Recommended depending on itinerary and activities. Recommended for extended travel, recurrent travelers and travel to rural areas. Present throughout country, especially northern regions. Most cases from May to October.
• Chikungunya – Mosquito – Thailand is a higher risk region. Vaccination is recommended.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Hepatitis B – Blood & Body Fluids – Recommended for travelers to most regions.
• Influenza – Airborne – Vaccine components change annually.
• COVID-19 – Airborne – Recommended for travel to all regions, both foreign and domestic.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Meningitis – Direct Contact & Airborne – Given to anyone unvaccinated or at an increased risk, especially students.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.

See the table below for more information:

Specific Vaccine Information

• Typhoid – Typhoid, caused by Salmonella Typhi, spreads via contaminated food and water, especially in areas with poor sanitation. Protect yourself by practicing good hygiene and safe food habits. Vaccination can significantly reduce the risk of typhoid infection, especially when traveling to endemic areas.
• Hepatitis A – Be sure to protect yourself from hepatitis A, a contagious liver infection caused by HAV, through vaccination. The virus spreads through contaminated food, water, and close contact. Along with vaccination, maintaining proper hygiene and avoiding undercooked shellfish are essential for prevention.
• Japanese Encephalitis – Japanese encephalitis is a mosquito-spread viral disease that affects the central nervous system. Prevention is achieved through protective attire and vaccination.
• Chikungunya – Chikungunya, a mosquito-borne virus, can be prevented by avoiding mosquito bites and reducing breeding sites. The chikungunya vaccine provides the best protection.
• Rabies – Rabies is a deadly viral illness transmitted mainly through animal bites. Vaccination is pivotal, with pre-exposure and post-exposure options available to protect against this potentially fatal disease.
• Hepatitis B – The hepatitis B virus leads to liver infection through contact with infected fluids. The most effective safeguard is the hepatitis B vaccine, administered in a series of shots that stimulate the body to produce antibodies, providing long-term immunity. It is crucial for infants and those at an increased risk of exposure.
• Measles, Mumps, Rubella (MMR) – Measles, mumps, and rubella are viral infections that can spread through close contact and respiratory droplets. Vaccination is the most effective way to halt their transmission. The MMR vaccine, given in two doses, strengthens immunity, reducing the chances of contracting and spreading these diseases.

Malaria in Thailand

Malaria in Thailand is primarily found in border provinces near Myanmar, Cambodia, Laos and Malaysia. Rare cases occur in other regions. Chloroquine resistance is present in the country. Atovaquone, doxycycline, mefloquine and tafenoquine are suggested as antimalarials if traveling to the region. Consult with a travel health specialist on which antimalarial will best fit your needs.

Japanese encephalitis vaccines are mandatory for those living in rural areas, hiking or camping. Those that plan to stay longer than a month should consider getting vaccinated.

Various mosquito-borne diseases are present in Thailand. Malaria poses a threat to travelers to some regions of the country. Make sure you are protected with antimalarials.

Medical treatment is adequate and common in urban areas. Healthcare is also available in rural areas, though the health care providers may not speak English.

To find out more about these vaccines, see our vaccinations page . Ready to travel safely? Book your appointment either call or start booking online now .

Other Ways to Stay Healthy in Thailand

Prevent bug bites in thailand.

Safeguard against bug bites by dressing appropriately and using EPA-registered repellents with DEET, picaridin, or OLE. If bitten, cleanse the area, refrain from scratching, and mitigate discomfort with OTC treatments. Seek medical aid for serious reactions.

Food and Water Safety in Thailand

When traveling, ensure food safety by adhering to CDC recommendations, which include eating fully cooked foods, avoiding raw seafood, and selecting reputable dining places. Safely drink bottled beverages, avoiding ice in uncertain water sources, and consume alcohol in moderation. Prevent travelers’ diarrhea through hand hygiene and avoiding street food in unsanitary areas.

Altitude Sickness in Thailand

Altitude sickness, characterized by symptoms like headache and nausea stemming from oxygen deprivation at high elevations, can be prevented through gradual ascent, hydration, and medication like acetazolamide. Should AMS symptoms arise, immediate descent to lower altitudes, rest and seek medical attention.

Infections To Be Aware of in Thailand

• Avian/Bird Flu – Avian flu, also known as bird flu, is a contagious virus that affects birds and can spread to humans. Preventing it involves vaccination of poultry, strict biosecurity on farms, safe handling and cooking of poultry, surveillance for outbreaks, and raising public awareness.
• Dengue – Dengue fever is a mosquito-borne illness with symptoms ranging from mild to severe, including high fever and pain. The CDC emphasizes prevention through avoiding mosquito bites by using repellents and removing standing water. Treatment focuses on symptom relief and hydration, avoiding certain pain relievers that can worsen bleeding risks.
• Leishmaniasis – Leishmaniasis is transmitted by sand flies’ bites. To prevent its spread, individuals should use insect repellents, wear long-sleeved clothing and limit outdoor activities during sand fly activity periods. Eliminating breeding sites and early diagnosis are crucial for effective prevention.
• Zika – Zika, a mosquito-borne virus, can cause mild to severe symptoms and poses significant risks during pregnancy. Prevention strategies include using insect repellent, safe sex practices, and avoiding travel to affected areas.

Do I Need a Visa or Passport for Thailand?

U.S. citizens staying in Thailand for 30 days or less do not need a visa. But, their passport must be valid for at least six months from the date of entry.

Sources: Embassy of Thailand and U.S. State Department

Always carry your passport and visa with you to avoid arrest in Thailand.

What Is the Climate Like in Thailand?

Thailand is a country with a tropical climate that is hot and humid throughout the year. The temperature ranges from 25 to 35 degrees Celsius during the day. The weather can be different depending on where you are in Thailand. Here are some popular tourist destinations:

• Bangkok : Bangkok is hot and humid all year round. It rains a lot, especially between May and October.
• Phuket : Phuket is a tropical place. It can rain a lot from May to October. The temperature is usually between 75 and 90 degrees.
• Chiang Mai : Chiang Mai has a tropical climate with three different seasons: cool, hot, and rainy. The cool season runs from November to February, the hot season from March to May, and the rainy season from June to October.
• Pattaya : Pattaya is hot and humid all year round. It rains a lot, especially between May and October.
• Koh Samui : Koh Samui is an island that has two different seasons: dry and rainy. The dry season runs from December to April, and the rainy season from May to November.

Remember that weather can change, so always check the forecast before you travel.

How Safe Is Thailand?

In the past few years, there have been periodic terrorist attacks at popular tourist attractions in Thailand,. This remains a high-concern today. There is an ongoing risk of terrorist attacks in Thailand.

The National Council for Peace and Order (NCPO) has placed strict restrictions on media and have banned political gatherings. Tourists may be detained by the military for openly criticizing the NCPO.

Pick-pocketing is common in Thailand as is sexual violence in bars and isolated areas.

Do not use your passport as collateral. Many rental places are scams.

In Southern Thailand (Yala, Pattani, Narathiwat, and Songkhla), martial law is still prevalent. Tourists are cautioned against traveling to these areas.

Temples in Thailand

Avoid mosquitoes and other bugs, insect-borne disease are a threat throughout the world., keep the bugs away with passport health’s repellent options .

There are over 40,000 temples in Thailand, making them popular tourist attractions. These temples range in age and architecture and many are still in use today.

Wat Pho, located in Bangkok, is one of the most popular due to its size and attractions within. It is one of the largest complexes in the country, holding many buildings. Wat Pho houses the largest reclining Buddha and largest collection of Buddha images.

The site is also headquarters for the teaching and preservation of Thai medicine. There, tourists can find two massage schools and pavilions.

You must take off your shoes to enter and you purchase coins to put into bowls for good luck. All the money goes towards renovating and up-keeping the site.

What Should I Take to Thailand?

Thailand is a hot and humid country, it’s important to pack lightweight and comfortable clothing. You should bring comfortable shoes for walking, sun protection like sunscreen, hats, and sunglasses to avoid the strong sun rays. Mosquitoes are common in Thailand, so it’s important to bring insect repellent to avoid bites.

Thailand uses different types of electrical outlets, so it’s recommended to bring a universal adapter. It’s also recommended to pack any prescription medication and over-the-counter medications such as pain relievers, anti-diarrhea medication, and motion sickness medication.

Thailand is a cash-based society, so it’s important to bring cash and credit cards. If you plan to visit the beaches or go swimming, don’t forget to pack swimwear and a beach towel. When visiting temples or other religious sites, make sure to dress respectfully, covering your shoulders and knees, and avoid wearing revealing clothing in public places.

Don’t forget to bring your passport, visa (if required), travel insurance, and any other important travel documents.

U.S. Embassy in Thailand

All Americans visiting Tunisia should register online with the U.S. Department of State before departure. This will inform the office of your travel plans within the country and will allow them to reach out in the case of an emergency or evacuation.

Once in Thailand, the information for the U.S. Embassy is:

U.S. Embassy Bangkok 95 Wireless Road Bangkok 10330 Thailand Telephone: + (66) (2) 205-4049, 02-205-4049 (within Thailand) Emergency After-Hours Telephone: +(66) (2) 205-4000, 02-205-4000 (within Thailand) Fax: +(66) (2) 205-4103, 02-205-4103 (within Thailand) Email: [email protected]

If you have any questions about traveling to Thailand or are wondering what shots you may need for your trip, schedule an appointment with your local Passport Health travel medicine clinic. Call us at or book online now! and protect yourself today.

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Update to Covid-19 vaccine guide for travellers to Thailand

The tourism authority of thailand (tat) on monday provided an update to guide to covid-19 vaccines for international travellers to thailand effective from december 16, 2021..

International travellers, including returning Thais and foreign residents, who are above 18 years of age should get fully vaccinated for Covid-19 with a vaccine approved by Thailand’s Ministry of Public Health (MoPH) or the World Health Organisation (WHO) no less than 14 days before their travel date.

Travellers 12-17 years of age, travelling with parents under the Test & Go entry scheme and Sandbox Programme, are not required to be vaccinated but must have a negative RT-PCR test result within 72 hours before travelling. Those unaccompanied must get vaccinated with at least one dose of an approved vaccine and must have a negative RT-PCR test result.

Travellers 6-11 years of age, travelling with parents under the Test & Go entry scheme and Sandbox Programme, must have a negative RT-PCR test result within 72 hours before travelling.

Travellers under 6 years of age, travelling with parents with a negative RT-PCR test result within 72 hours before travelling, are not required to have a pre-arrival negative RT-PCR test result and can have saliva test when entering the Kingdom.

Travellers previously infected within 3 months before travelling must have a medical certificate of recovery or get vaccinated with at least one dose of an approved vaccine for an unspecified period of time before travelling.

List of approved Covid-19 vaccines

Currently, the MoPH has approved the following manufacturers and vaccines:

• CoronaVac by Sinovac Biotech Ltd – 2 doses needed / 2-4-week interval;
• AstraZeneca or Covishield by AstraZeneca and the University of Oxford, SK Bioscience (South Korea), Siam Bioscience, and Serum Institute of India (Covishield) – 2 doses needed / 4-12-week interval;
• Pfizer–BioNTech or Comirnaty by Pfizer Inc. and BioNTech 2 doses needed / 3-week interval;
• Janssen or Janssen/Ad26.COV2.S by Johnson & Johnson Services, Inc. – 1 dose needed;
• Moderna by Moderna Inc. – 2 doses needed / 4-week interval);
• Sinopharm or COVILO by Sinopharm Co., Ltd. – 2 doses needed / 3-4-week interval);
• Sputnik V by the Gamaleya Research Institute of Epidemiology and Microbiology – 2 doses needed – 3-week interval).

Meanwhile, the WHO’s guidance on the Covid-19 vaccines is available  here .

Have you been fully vaccinated?

According to the MoPH, travellers are considered fully vaccinated if:

• They get their second dose of a 2-dose vaccine; such as, the AstraZeneca or Pfizer vaccines, no less than 14 days before their travel date to Thailand.
• They get a single-dose vaccine; such as, Janssen vaccine, no less than 14 days before their travel date to Thailand.
• In case of mix-and-match vaccines, travellers should get their second dose of a different vaccine within the recommended interval of the first vaccine no less than 14 days before their travel date to Thailand. For example, if the first vaccine is CoronaVac from Sinovac Biotech and the second vaccine is AstraZeneca, the time between the two doses is 2-4 weeks.

Travellers who do not meet these criteria may be denied entry into Thailand.

Requirements for the ‘Certificate of Covid-19 Vaccination’

The travellers’ Certificate of Covid-19 Vaccination should contain the following details:

• Given name and last name;
• Date of Birth;  
• Nationality;
• Passport or Identification No.;
• Name of the Covid-19 vaccine;
• Vaccination dates;
• Vaccine manufacturer and lot/batch number;
• Authorised organisation in the country of origin.

In addition to being fully vaccinated, international travellers should have all of their advance arrangements in good order for arrival and entry. For more information on Thailand’s reopening programmes, see:  https://www.tatnews.org/thailand-reopening/ .

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Before you travel check that:

• your destination can provide the healthcare you may need
• you have appropriate travel insurance for local treatment or unexpected medical evacuation

This is particularly important if you have a health condition or are pregnant.

Emergency medical number

Dial 1669 and ask for an ambulance.

Contact your insurance or medical assistance company promptly if you’re referred to a medical facility for treatment.

Vaccinations and health risks

At least 8 weeks before your trip check:

• the latest information on vaccinations and health risks in TravelHealthPro’s Thailand guide
• where to get vaccines and whether you have to pay on the NHS travel vaccinations page

Health risks in Thailand include:

• dengue fever

See the ‘Other risks’ section of the TravelHealthPro Thailand guide for more on health risks .

To avoid mosquito-borne viruses, such as dengue fever and Zika virus, take steps to avoid being bitten by mosquitoes.

Air quality

There can be high levels of air pollution in large cities. This includes Bangkok and Chiang Mai, which are also affected by seasonal regional smoke haze from the burning of trees. The high pollution and particulate count sometimes reach dangerous levels. This may worsen bronchial, sinus or asthma conditions.

Check air quality levels for many cities on the World Air Quality Index website .

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries.

Hospitals and pharmacies across Thailand will usually accept UK prescriptions. Brand name medication can often be more expensive than locally produced medication.

Medication sold on the street may not be genuine or may have been stolen. Taking medication without medical advice or a prescription can have serious health consequences.

Read best practice when travelling with medicines on TravelHealthPro . The NHS has information on whether you can take your medicine abroad .

Healthcare facilities in Thailand

FCDO has a list of English-speaking doctors in Thailand . All hospitals require guarantee of payment before treating patients. Make sure you have adequate health insurance.

Private hospitals in Thailand are of a high standard but can be expensive. Public hospitals and clinics do not always meet UK standards, particularly outside Bangkok.

COVID-19 healthcare in Thailand

Check the latest information on risk from COVID-19 risk for Thailand on TravelHealthPro .If you have severe symptoms, or any questions related to COVID-19, while in Thailand, call the Thai COVID-19 Hotline on 1422. There is more information on the PR Thai Government Facebook page .

Travel and mental health

Read FCDO guidance on travel and mental health . There is also mental health guidance on TravelHealthPro .

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Vaccinations for thailand.

For most standard tourists the usual recommended vaccinations for Thailand include cover against the childhood diseases (Tetanus and Diphtheria, Measles, Mumps and Rubella) as well as cover against the food borne diseases of Typhoid and Hepatitis A. For those trekking in the Thai countryside or staying for longer periods then cover against Hepatitis B and Rabies should be considered.

All Travellers

Tetanus is contracted through contaminated cuts, bites and breaks in the skin. The vaccination provides cover for approximately 10 years in the majority of patients. It is frequently combined with cover against other diseases such as Poliomyelitis , Diphtheria and/or Pertussis .

Find out more about Tetanus

Hepatitis A is a common disease in many of the hotter regions of the world and usually contracted through contaminated food and water. Cover against Hepatitis A can be given alone or combined with protection against Hepatitis B. Once completed, the Hepatitis A vaccination ( given on two occasions 6 to 12 months apart ) provides cover for approximately 25 years in the majority of patients.

Find out more about Hepatitis A

Typhoid is a bacterial disease contracted through contaminated food and water. Once completed, the Typhoid vaccination given on one occasion provides cover for between 2 to 3 years in the majority of patients

Find out more about Typhoid

Hepatitis B is a viral disease which is usually transmitted in a very similar fashion to HIV/AIDS through contact with infected body fluids (eg blood exposure and sexually). This vaccine can be combined with cover against Hepatitis A. The standard schedule for Hepatitis B is to administer the vaccine on days 0, 28 and 180. A more rapid schedule can be used in cases where cover is needed more urgently and this is administered on days 0, 7, 21 to 28 and also 365. Following either course (and not before completion) a blood test can be taken to confirm sufficient antibody protection. Where the correct level of antibodies are showing (>10iu) the vaccination is recognised to provide  cover for life .

Find out more about Hepatitis B

Rabies is a viral disease which is usually transmitted through the bite, the lick or the scratch of any infected warm blooded animal. As per the current WHO guidance, the vaccine is usually administered on days 0 and between 7 and 28 . Once a course is completed, the vaccination provides life long ‘immune memory’ in the majority of patients BUT after any possible exposure the individual always needs further vaccination to boost antibody production

Find out more about Rabies

Meningococcal Meningitis is a bacterial disease which is usually transmitted through the respiratory route. The vaccine is given on one occasion and provides cover against four of the main forms of this disease. Once a course is completed the vaccination provides for over 10 years in the majority of patients.

Find out more about Meningococcal Meningitis

Cholera / E coli are both food / water borne diseases. This oral vaccine is given on two occasions between 1 to 6 weeks apart before travel. The second dose (frequently given one week after the initial one) should be administered 7 days before potential exposure . Once completed the cover against Cholera is expected to be for about 2 years . The cover against E coli is shorter and thought to be effective for between 3 to 4 months . In travellers who have completed an initial primary course within the past 2 years a single further dose is sufficient to maintain this cover.

Find out more about Cholera

Japanese Encephalitis is a viral disease transmitted through the bite of an infected mosquito. The Ixiaro vaccine is given on two occasions one month apart with a third dose at 12 months . Once completed the vaccine is thought to provide cover for between 2 to 3 years but possibly longer.

Find out more about Japanese Encephalitis

When travelling from Ireland to Thailand there are no compulsory vaccines required for entry into the country. Nevertheless if your passport shows that you have travelled via a yellow fever endemic country then the immigration authorities in Thailand will usually check to see that you have received adequate vaccination cover against that disease.

Most travellers should start their vaccines about 4 to 6 weeks before they leave Ireland. However those planning a longer visit, or where their planned trip is likely to bring them to more rural parts of Thailand, should attend earlier to ensure that they have sufficient time to complete the vaccine courses.

Malaria prophylaxis may need to be considered depending on the expected itinerary.

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The culture, the people, the rich heritage, and the mind-wobbling scenic beauty of Thailand move every person who goes to visit this beautiful land. Thailand is a country with a large attraction of tourists and travelers from all across the globe. Thailand houses the largest number of Buddhists and monks and is equipped with more than forty-thousand Buddhist temples in the country. The country is also famous for its amazing shops and street food. Traveling to this country is no less than bliss!

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• Section 2 - Vaccination & Immunoprophylaxis— General Principles
• Section 2 - Yellow Fever Vaccine & Malaria Prevention Information, by Country

Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

• Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

• Fluvoxamine
• Metoclopromide
• Tetracycline
• Calcineurin inhibitors
• Ciprofloxacin
• CYP2D6 enzyme substrates 1
• CYP3A4 enzyme inhibitors 2
• Methotrexate
• QT- prolonging agents 3
• Bismuth subsalicylate
• Barbiturates
• Carbamazepine
• Iron- containing preparations
• mTOR inhibitors
• Antiarrhythmic agents
• Beta blockers
• Calcium channel receptor antagonists
• CYP3A4 enzyme inducers 4
• H1 receptor antagonists
• Lumefantrine
• Phenothiazines
• Protease inhibitors
• Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

• HIV medications
• Antacids containing magnesium or aluminum hydroxide
• Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

• Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

• Acetaminophen
• Anticholinergics
• Aspirin, high dose
• Dextroamphetamine
• Diclofenac sodium
• Mecamylamine
• Anticholinesterases
• Digitalis preparations
• Hypoglycemic agents
• Macrolide antibiotics
• Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

Bibliography

Frenck RW Jr., Gurtman A, Rubino J, Smith W, van Cleeff M, Jayawardene D, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19(8):1296–303.

Jabeen E, Qureshi R, Shah A. Interaction of antihypertensive acetazolamide with nonsteroidal anti-inflammatory drugs. J Photochem Photobiol B. 2013;125:155–63.

Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine. J Infect Dis. 1997;175(4):871–5.

Nascimento Silva JR, Camacho LA, Siqueira MM, Freire Mde S, Castro YP, Maia Mde L, et al. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella. Vaccine. 2011;29(37):6327–34.

Nielsen US, Jensen-Fangel S, Pedersen G, Lohse N, Pedersen C, Kronborg G, et al. Travelling with HIV: a cross sectional analysis of Danish HIV-infected patients. Travel Med Infect Dis. 2014;12(1):72–8.

Ridtitid W, Wongnawa M, Mahatthanatrakul W, Raungsri N, Sunbhanich M. Ketoconazole increases plasma concentrations of antimalarial mefloquine in healthy human volunteers. J Clin Pharm Ther. 2005;30(3):285–90.

Sbaih N, Buss B, Goyal D, Rao SR, Benefield R, Walker AT, et al. Potentially serious drug interactions resulting from the pre-travel health encounter. Open Forum Infect Dis. 2018;5(11):ofy266.

Stienlauf S, Meltzer E, Kurnik D, Leshem E, Kopel E, Streltsin B, et al. Potential drug interactions in travelers with chronic illnesses: a large retrospective cohort study. Travel Med Infect Dis. 2014;12(5):499–504.

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Dominican Republic

Travel Advisory June 6, 2023

Dominican republic - level 2: exercise increased caution.

Reissued with updates to health information.

Exercise increased caution in the Dominican Republic due to crime.

Country Summary:  Violent crime, including armed robbery, homicide and sexual assault is a concern throughout the Dominican Republic. The development of a professional tourist police corps, institution of a 911 system in many parts of the country, and a concentration of resources in resort areas means these tend to be better policed than urban areas like Santo Domingo. The wide availability of weapons, the use and trade of illicit drugs, and a weak criminal justice system contribute to the high level of criminality on the broader scale.

Read the country information page for additional information on travel to the Dominican Republic.

If you decide to travel to the Dominican Republic:

• Be aware of your surroundings.
• Do not physically resist any robbery attempt.
• Do not display signs of wealth, such as wearing expensive watches or jewelry.
• Follow the advice of resort and tour operators regarding local safety and security concerns.
• Enroll in the Smart Traveler Enrollment Program (STEP) to receive Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on Facebook and Twitter .
• Review the Country Security Report for the Dominican Republic.
• Prepare a contingency plan for emergency situations.  Review the Traveler’s Checklist .
• Visit the CDC page for the latest Travel Health Information related to your travel.

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Passports must be valid for the period of stay in the Dominican Republic.

1 page required for entry stamp

Not required for visits shorter than 30 days

None required if arriving from the United States

$10,000 and over or its equivalent must be declared

Embassies and Consulates

U.s. embassy santo domingo.

Av. República de Colombia #57 Santo Domingo, Dominican Republic Telephone: +(809) 567-7775 Emergency After-Hours Telephone: +(809) 567-7775, dial zero (0) ask for Duty Officer Email:   [email protected] Hours: Monday through Friday from 7:00 AM to 4:00 PM except U.S. and Dominican holidays 

Consular Agencies

U.S. Consular Agent - Puerto Plata Plaza el Doral, carretera Luperón KM 3 1/2 Puerto Plata, Dominican Republic Telephone:  +(809) 586-4204, +(809) 586-8023 Emergency After-Hours Telephone:  (809) 567-7775, dial zero (0) ask for Duty Officer Email:  [email protected] Hours:  Monday through Friday from 8:00 AM to 5:00 PM except U.S. and Dominican holidays

U.S. Consular Agent - Bavaro/Punta Cana Palma Real Shopping Center Business Center 2nd Floor Bavaro, La Altagracia, Dominican Republic Telephone:  (809) 552-8990 Emergency After-Hours Telephone:  +(809) 567-7775, dial zero (0) ask for Duty Officer Email:  [email protected] Hours:  Monday through Friday from 8:00 AM to 5:00 PM except U.S. and Dominican holidays

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

Visas are not required for visits shorter than 30 days. Visit the  Embassy of the Dominican Republic  website for current visa information.

All visitors to the Dominican Republic are charged a $10 tourist card fee that is incorporated into airline charges. Cruise passengers must obtain a tourist card if they are disembarking for longer than 24 hours. Once used, the card allows for stays up to 30 days but can be extended at the General Directorate of Migration in Santo Domingo.

Contact the  Migration Department  in Santo Domingo for visa extension requests. Failure to request an extension will result in a fine at the airport upon departure. The fines range from approximately $55 USD for one month to as high as $1,555 USD for overstays of 10 years or more.

All passengers are required to fill out an  E-Ticket  or paper form when entering or exiting the Dominican Republic. If using E-Ticket, a new form is required for each entry and exit and the code generated upon form completion can be presented at the airport on a digital device.

Visitors must have a ticket entering and leaving the country, the financial means to pay for their stay, and an address in the Dominican Republic where they will be staying.

Exit Requirements for Children:  Minors (children under 18) who are citizens (including dual citizens) or legal residents of the Dominican Republic, if not accompanied by both parents or legal guardian(s), are required to present official proof of parental consent to travel. Please see the Dominican  Migration Department's  website for detailed instructions on the required documents.

HIV/AIDS Restrictions:  Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of the Dominican Republic. The Dominican Republic has restrictions on granting residency to people with HIV/AIDS. Please verify information with the Dominican Republic’s  Migration Department  before you travel.

Yellow Fever Vaccine:  Proof of vaccination against yellow fever is required for travelers entering the Dominican Republic from Brazil. Similar requirements may apply to those traveling from other  countries with yellow fever risk .

Find information on  dual nationality ,  prevention of international child abduction ,  and  customs regulations  on our websites.

Safety and Security

Crime:  Crime is a threat throughout the Dominican Republic. Tourist destinations are generally more policed than metropolitan areas.

• If robbed, hand over your personal belongings without resisting.
• Do not carry or wear valuable items that will attract attention.
• Be wary of strangers.
• Travel with a partner or group if possible.

International Financial Scams:  See the  Department of State  and the  FBI   pages for information.

Dating App Robberies:  Several U.S. citizen travelers in the Dominican Republic have reported that they were robbed by people they met through popular online dating applications. If meeting with strangers, you should strongly consider meeting only in public places and avoiding isolated locations where crimes are most likely to occur.

Demonstrations:  Avoid areas of demonstrations and exercise caution if you are in the vicinity of large gatherings or protests.

Victims of Crime:  Report crimes to the local tourist police (POLITUR) at 809-222-2026 or  911  and contact the U.S. Embassy at 809-567-7775. 911 is operational throughout the country apart from some areas located near the Haitian border. Remember that local authorities are responsible for investigating and prosecuting crime.

See our webpage on  help for U.S. victims of crime overseas .

• Help you find appropriate medical care.
• Assist you in reporting a crime to the police.
• Contact relatives or friends with your written consent.
• Provide general information regarding the victim’s role during the local investigation and following its conclusion.
• Provide a list of local attorneys.
• Provide our information on  victim’s compensation programs in the U.S.
• Provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution.
• Replace a stolen or lost passport.

Domestic Violence:  U.S. citizen victims of domestic violence are encouraged to contact POLITUR (809-222-2026), the  National Police ( 809-682-2151), and the U.S. Embassy for assistance.

Sexual Assault:  Rape and sexual assault has been reported throughout the Dominican Republic, including at major resorts and hotels.

Notes for your safety:

• U.S. citizens have been targeted with date rape drugs.
• Sexual assault victims in the Dominican Republic should not expect the totality of assistance offered in the United States. Rape kits are often not available until the following morning and must be administered by Dominican authorities.
• Victims often have to request medication to avoid transmission of STDs and reduce the chances of pregnancy.
• Prosecution of a rape case moves forward very slowly. Dominican law may require the victim to return to the Dominican Republic at some stages of the judicial process.
• Security outside of the resort area, including beach areas, is unpredictable, especially at night.

Best Practices:

• Contact the police/hotel management if resort staff demonstrate unwanted attention.
• Victims of sexual/other assault should contact the police and the Embassy. Insist that hotel management take immediate action by contacting the police.
• In a resort, avoid secluded places. Always be accompanied by someone you know, even going to the restroom.
• Do not consume alcoholic beverages alone or with new acquaintances. Do not leave drinks unattended.  Know your limits and help your friends/travelling companions to remain safe.
• Shout for help immediately if threatened or made uncomfortable.
• Report suspicious activity, including excessive friendliness by hotel employees, to hotel management, the U.S. Embassy, and local police.
• Do not swim alone due to life-threatening undertows.

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities may not commonly occur in all parts of the country. Hazardous areas and activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in or near major cities or major tourist zones. First responders may be unable to access areas outside of major cities or major tourist zones. The ability to provide urgent medical treatment may be limited. U.S. citizens are encouraged to purchase medical evacuation insurance. See our webpage for more  information on insurance providers for overseas coverage . 

Local Laws & Special Circumstances

Criminal Penalties: You are subject to local laws. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned. Individuals establishing a business or practicing a profession that requires additional permits or licensing should seek information from the competent local authorities, prior to practicing or operating a business. 

Furthermore, some laws are also prosecutable in the United States, regardless of local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website. Penalties for possessing, using, or trafficking illegal drugs in the Dominican Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. Arrest Notification:  If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See our webpage and  general information on legal assistance  for further information.

Counterfeit and Pirated Goods: Although counterfeit and pirated goods are prevalent in many countries, their possession they may still be illegal according to local laws. You may also pay fines or have to give them up if you bring them back to the United States. See the U.S. Department of Justice website for more information.

Faith-Based Travelers:  See the following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report – see country reports
• Human Rights Report – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTI Travelers:  There are no legal restrictions on same-sex sexual relations or the organization of LGBTI events in the Dominican Republic.

See our LGBTI Travel Information page and section 6 of our Human Rights report for further details.

Travelers with Disabilities:  The law in the Dominican Republic prohibits discrimination against persons with physical, sensory, intellectual or mental disabilities, but the law is not enforced consistently. Social acceptance of persons with disabilities in public is not as prevalent as in the United States. Accessible facilities, information, communication/access to services and ease of movement is limited in most parts of the country. Large resorts and Santo Domingo may have some generally accessible infrastructure, but travelers should not expect the level available in the United States.

Students:  See our  Students Abroad  page and  FBI travel tips .

Women Travelers:  See our travel tips for  Women Travelers .

Disaster Preparedness:  Register with the Embassy on or before your arrival through our  travel registration website . In the event of a natural disaster or emergency, this will keep you informed. Additional information on  natural disasters and disaster preparedness  can be found on our website. Real Estate:  Property rights are irregularly enforced, and investors often encounter problems in receiving clear title to land. Consult a reputable attorney before signing documents or closing on any real estate transactions. Real estate investments by U.S. citizens have been subject to legal and physical takeover attempts. Absentee landlords and absentee owners of undeveloped land are particularly vulnerable. Consider purchasing title insurance. Scams:  Scammers often target elderly people by pretending to be a law enforcement official, an attorney, or a U.S. Embassy official, claiming that a loved one has been arrested overseas. The caller instructs the victim to wire money. Scammers sometimes impersonate family members, such as a scared grandchild. Contact the U.S. Embassy before wiring money to the Dominican Republic. When in doubt, try to contact your loved one directly.

For emergency services in the Dominican Republic, dial 911 or 809-202-2026 .

Ambulance services:

• The training and availability of emergency responders may be below U.S. standards.
• Ambulances are not present or reliable in most areas of the country. They are more reliable and available in Santo Domingo, Santiago, Punta Cana, and Puerto Plata.

We do not pay medical bills.  Be aware that U.S. Medicare/Medicaid does not apply overseas.  Most hospitals and doctors overseas do not accept U.S. health insurance.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See  our webpage  for more information on insurance providers for overseas coverage. Visit the  U.S. Centers for Disease Control and Prevention  for more information on type of insurance you should consider before you travel overseas.

We strongly recommend supplemental insurance to cover medical evacuation.

Always carry your prescription medication in original packaging, along with your doctor’s prescription. Check with the  Ministry for Public Health  to ensure the medication is legal in the Dominican Republic.

Vaccinations:  Be up-to-date on all  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention.

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention  (CDC)

Air Quality:  Visit  AirNow Department of State  for information on air quality at U.S. Embassies and Consulates.

The U.S. Embassy maintains a  list of doctors and hospitals . We do not endorse or recommend any specific medical provider or clinic.

Health facilities in general:

• Public medical clinics lack basic resources and supplies.
• Hospitals and doctors require payment “up front” prior to service or admission.
• Private hospitals usually require advance payment or proof of adequate insurance before admitting a patient.
• Be aware that some hotels, resorts, etc. have exclusive agreements with medical providers, which have costs associated and may limit your choices in seeking emergency medical attention.
• Medical staff may speak little or no English.
• Generally, in public hospitals only minimal staff is available overnight in non-emergency wards. Consider hiring a private nurse or having family spend the night with the patient, especially a minor child.
• Patients bear all costs for transfer to or between hospitals.
• Psychological and psychiatric services are limited, even in the larger cities, with hospital-based care only available through government institutions

Medical Tourism and Elective Surgery

U.S. citizens have suffered serious complications or died during or after having cosmetic or other elective surgery. 

If you are considering travel to the Dominican Republic for cosmetic surgery, be mindful of the following:

• Have a medical evaluation from a U.S. doctor to determine if you are a good candidate for surgery.
• Before travel, carefully research the doctor (e.g. qualifications, experience performing the surgery, complication rate) and credentials of the recovery facility you plan to use.
• Share all health information (e.g. medical conditions, medications, allergies) with your doctor before your surgery.
• Obtain international travel insurance that covers medical evacuation back to the United States and repatriation of remains. For more information, see:  https://wwwnc.cdc.gov/travel/page/insurance . 
• See a travel medicine professional in the United States at least 4–6 weeks before your trip to discuss healthy travel and to learn about specific risks related to your surgery and travel. For more information on the risks of medical tourism, see:  https://wwwnc.cdc.gov/travel/page/medical-tourism .
• Your legal options in case of malpractice are very limited in the Dominican Republic. 

Tap Water:  Tap water is unsafe to drink. Bottled water and beverages are considered safe. Please note that many restaurants use tap water for ice.

Adventure Travel

• Visit the U.S. Centers for Disease Control and Prevention website for more information about  Adventure Travel .

General Health

The following diseases are prevalent:

• Tuberculosis
• Chikungunya

Visit the U.S. Centers for Disease Control and Prevention website for more information about  Resources for Travelers  regarding specific issues in the  Dominican Republic .

Travel and Transportation

Road Conditions and Safety:  Driving conditions vary across the country. Drive defensively and with extreme caution.

Consider hiring a professional driver instead of driving yourself. You can hire licensed drivers who are familiar with local roads through local car rental agencies. In case of accidents, normally only the driver will be taken into custody. In 2019 six people died per day due to traffic accidents in the Dominican Republic.

Frequent hazards include:

• other drivers not using headlights and/or taillights after dark
• animals in the road
• missing manhole covers and large potholes
• uneven road surfaces
• scooters and motorcycles driving erratically and splitting lanes
• driving on sidewalks or against traffic
• intersections without stop signs
• unregulated and congested traffic patterns
• speeding or the running of stoplights
• heavy urban traffic

Traffic Laws:  Traffic laws are not enforced consistently. After an accident causing serious injury or death, authorities will often take the driver into custody, even if the driver is insured and appears to have not been at fault. Detentions frequently last until a judicial decision has been reached or until a waiver has been signed by the injured party.

Seat belts, and helmets for motorcyclists, are required by law. Violators may be fined. There are no child car seat laws. Police stop drivers using cell phones without a hands-free device.

Public Transportation:  Public transportation includes a metro and public bus system as well as shared bus or van taxis known as “guaguas” (converted vans or microbuses, often without doors). Guaguas run regular routes within urban areas and between towns in the countryside. Public buses and guaguas operating in the capital do not meet U.S. safety standards. Avoid unregulated taxis, which also often lack basic safety features. Use a reputable taxi service, either one recommended by your hotel or a well-known, vetted company. Rideshare services such as Uber are available in many parts of the country. Private bus lines travel between large cities and to popular tourist destinations. 

See our Road Safety page for more information. Visit the website of the Dominican Republic’s Ministry of Tourism and INTRANT (Instituto Nacional de Transito y Transporte Terrestre) the national authority responsible for road safety.

Aviation Safety Oversight:  The U.S. Federal Aviation Administration (FAA) has assessed the government’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Dominican Republic’s air carrier operations. Further information may be found on the  FAA’s website.   FAA’s safety assessment page .

Maritime Travel:  The U.S. Coast Guard has concerns about the security practices in the ports of the Dominican Republic. Until those concerns can be addressed, the Coast Guard advises that Mariners and passengers on commercial vessels traveling through the ports of the Dominican Republic should exercise caution.

Mariners planning travel to the Dominican Republic should also check for  U.S. maritime advisories and alerts . Information may also be posted to the  U.S. Coast Guard homeport website , and the  NGA broadcast warnings .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in  Dominican Republic . For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

Travel Advisory Levels

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