The information on these pages should be used to research health risks and to inform the pre-travel consultation. For advice regarding safety and security please check the UK Foreign and Commonwealth Office (FCO) website.

Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel. However, even if time is short, an appointment is still worthwhile. This appointment provides an opportunity to assess health risks taking into account a number of factors including destination, medical history, and planned activities. For those with pre-existing health problems, an earlier appointment is recommended.

While most travellers have a healthy and safe trip, there are some risks that are relevant to travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, sexually transmitted infections, or health issues related to the heat or cold.

All travellers should ensure they have adequate travel health insurance.

A list of useful resources including advice on how to reduce the risk of certain health problems is available below.

Resources

• Food and water hygiene
• Insect and tick bite avoidance
• Personal safety
• Sexually transmitted infections
• Sun protection

Details of vaccination recommendations and requirements are provided below.

All Travellers

Travellers should be up to date with routine vaccination courses and boosters as recommended in the UK. These vaccinations include for example measles-mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine. Country specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided.

Those who may be at increased risk of an infectious disease due to their work, lifestyle choice, or certain underlying health problems should be up to date with additional recommended vaccines. See the individual chapters of the ‘Green Book’ Immunisation against infectious disease for further details.

Certificate Requirements

Please read the information below carefully, as certificate requirements may be relevant to certain travellers only.  For travellers further details, if required, should be sought from their healthcare professional.

• There are no certificate requirements under International Health Regulations currently listed in WHO International Travel and Health.
• There is no risk of yellow fever in Nicaragua, however, in January 2017, the Ministry of Health, Nicaragua [translation tool required] declared that an yellow fever vaccination certificate is now required from all travellers arriving from countries where WHO has determined that there is a risk of yellow fever transmission. Nicaragua notes the priority countries are Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Panama, Venezuela, Paraguay and Peru. The measure also includes all African countries except the Democratic Republic of Congo, Tanzania, Sao Tome and Principe, and Somalia. This information should be followed until further notice. See also information on the certificate requirement from US embassy in Nicaragua. 
• View the WHO list of countries with risk of yellow fever transmission.
• Due to an outbreak of yellow fever in Brazil 2017, country certificate requirements may be updated at short notice. Please check Pan American Health Organisation for updated or additional requirements for the international certificate of vaccination or prophylaxis. 
• According to World Health Organization (WHO), from 11 July 2016 (for all countries), the yellow fever certificate will be valid for the duration of the life of the person vaccinated. As a consequence, a valid certificate, presented by arriving travellers, cannot be rejected on the grounds that more than ten years have passed since the date vaccination became effective as stated on the certificate; and that boosters or revaccination cannot be required. See WHO Q&A.

Most Travellers

The vaccines in this section are recommended for most travellers visiting this country. Information on these vaccines can be found by clicking on the blue arrow. Vaccines are listed alphabetically.

Some Travellers

The vaccines in this section are recommended for some travellers visiting this country. Information on when these vaccines should be considered can be found by clicking on the arrow. Vaccines are listed alphabetically.

Malaria is a serious illness caused by infection of red blood cells with a parasite called Plasmodium. The disease is transmitted by mosquitoes which predominantly feed between dusk and dawn.

Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more. Other symptoms may include feeling cold and shivery, headache, nausea, vomiting and aching muscles. Symptoms may appear between eight days and one year after the infected mosquito bite.

Prompt diagnosis and treatment is required as people with malaria can deteriorate quickly. Those at higher risk of malaria, or of severe complications from malaria, include pregnant women, infants and young children, the elderly, travellers who do not have a functioning spleen and those visiting friends and relatives.

Prevention

Travellers should follow an ABCD guide to preventing malaria:

Awareness of the risk – Risk depends on the specific location, season of travel, length of stay, activities and type of accommodation.

Bite prevention – Travellers should take mosquito bite avoidance measures.

Chemoprophylaxis – Travellers should take antimalarials (malaria prevention tablets) if appropriate for the area (see below). No antimalarials are 100% effective but taking them in combination with mosquito bite avoidance measures will give substantial protection against malaria.

Diagnosis – Travellers who develop a fever of 38°C [100°F] or higher more than one week after being in a malaria risk area, or who develop any symptoms suggestive of malaria within a year of return should seek immediate medical care. Emergency standby treatment may be considered for those going to remote areas with limited access to medical attention.

Risk Areas

• There is a low risk of malaria in Nicaragua: awareness of risk and bite avoidance recommended.
• There is a very low risk of malaria in Managua: awareness of risk and bite avoidance recommended.

Special risk groups

In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [over 70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).

Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.
In these circumstances, you may wish to seek specialist advice, although chloroquine would be an option.

The final decision whether or not to advise antimalarials rests with the travel health advisor and the traveller after individual risk assessment.

Resources

• Malaria in brief
• Malaria factsheet
• Insect and tick bite avoidance
• Children’s antimalarial dose table
• Guidelines for malaria prevention in travellers from the United Kingdom

There are some risks that are relevant to all travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, sexually transmitted infections, or health issues related to the heat or cold. Some additional risks (which may be present in all or part of this country) are mentioned below and are presented alphabetically.

Dengue

Dengue is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk.  It causes a flu-like illness, which can occasionally develop into a more serious life-threatening form of the disease. Severe dengue is rare in travellers.

The mosquitoes that transmit dengue are most abundant in towns, cities and surrounding areas. All travellers to dengue areas are at risk. 

Dengue in Nicaragua

There is a risk of dengue in this country.

Prevention

• All travellers should avoid mosquito bites particularly between dawn and dusk.
• There is currently no medication or vaccination available for travellers to prevent dengue.

Dengue in brief

Zika Virus

Zika virus (ZIKV) is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk. A small number of cases of sexual transmission of ZIKV have also been reported. Most people infected with ZIKV have no symptoms. When symptoms do occur they are usually mild and short-lived. Serious complications and deaths are not common. However, there is now scientific consensus that Zika virus is a cause of congenital Zika syndrome (microcephaly and other congenital anomalies) and Guillain-Barré syndrome.

Zika virus in Nicaragua

This country is considered to have a moderate risk of Zika virus transmission. Pregnant women should consider postponing non-essential travel until after the pregnancy.  Details of specific affected areas within this country are not available but the mosquitoes that transmit ZIKV are unlikely to be found above 2,000m altitude.

The map below shows areas which are above 2,000m and can be used by travellers and health professionals as a general guide to indicate potentially lower risk areas for mosquito-acquired ZIKV infection. Travellers whose itineraries are limited to areas above 2,000m are at a lower risk of acquiring ZIKV from a mosquito; however there may still be a risk of sexual transmission.

Map provided by the Travelers’ Health Branch, Centers for Disease Control and Prevention

The categories shown on this map are intended as a general guideline and should not be considered to indicate absolute risk. Elevation may vary within an area to a larger extent than this map can depict. The presence of mosquitoes may change seasonally, with increasing temperatures or rainfall, and may change over time. Travellers to destinations that cross or are near an elevation border may wish to consider the destination as an area of lower elevation. Travellers to high elevations are still at risk of getting Zika from sex.

Prevention

• All travellers should avoid mosquito bites particularly between dawn and dusk.
• There is no vaccination or medication to prevent ZIKV infection.

•         It is recommended that pregnant women planning to travel to areas with a moderate risk of ZIKV transmission should consider postponing non-essential travel until after pregnancy.

• Women should avoid becoming pregnant while travelling in, and for 8 weeks after leaving an area with active ZIKV transmission or 8 weeks after last possible ZIKV exposure.
• Couples should follow guidance on prevention of sexual transmission of Zika and avoid conception while travelling and for up to 6 months on return.
• If a woman develops symptoms compatible with ZIKV infection, it is recommended she avoids becoming pregnant for a further 8 weeks following recovery.
• Pregnant women who visited this country while pregnant, or who become pregnant within 8 weeks of leaving this country or within 8 weeks after last possible ZIKV exposure, should contact their GP, obstetrician or midwife for further advice, even if they have not been unwell. Further information about when to perform fetal ultrasound scanning, and, if necessary, referral to the local fetal medicine service is available.

Preventing sexual transmission

• Most cases of ZIKV are acquired via mosquito bites but cases of sexual transmission of ZIKV are occasionally reported.
• See further information for pregnant women, their partners and couples planning pregnancy.

See detailed guidance on factors to consider when assessing the risk of ZIKV.

Zika virus in brief