Chapter 4Select Destinations

Clive M. Brown

DESTINATION OVERVIEW

The Caribbean is an arc-shaped group of islands that separate the Gulf of Mexico and the Caribbean Sea from the Atlantic Ocean. Historically, politically, culturally, and geographically, the Caribbean region can be divided as follows:

• Greater Antilles: Cuba, Jamaica, Cayman Islands, Hispaniola (Haiti and Dominican Republic), and Puerto Rico
• Lesser Antilles: Virgin Islands, Anguilla, Saint Kitts and Nevis, Dominica, Barbuda, Montserrat, Guadeloupe, Martinique, Saint Lucia, Saint Vincent and the Grenadines, Barbados, and Grenada
• Atlantic Ocean islands: Bermuda, The Bahamas, and the Turks and Caicos Islands
• South American shelf islands: Trinidad and Tobago, Aruba, Curacao, and Bonaire

In addition, coastal areas of the mainland countries of Belize in Central America and Guyana, Suriname, and French Guiana in South America are often considered part of the Caribbean.

The islands and mainland countries vary in geography, from sandy and dry islands with fantastic beaches to volcanic, lush rainforests. Ah, the beaches! For many tourists, this is the Caribbean’s raison d’être, and with over a thousand islands to choose from, choices are almost limitless. The dazzling beaches on the islands and mainland coasts of the Caribbean Sea, the Gulf of Mexico, and the Atlantic Ocean provide a vacation experience that broadens the mind and provides a travel destination with luxury, excitement, tranquility, and relaxation.

Coral reefs are among the most diverse and beautiful of all marine habitats, and the Caribbean has about 7% of the world’s coral reefs. With reefs surrounding virtually the entire border of the Cuban marine shelf, the Belize barrier reef complex is the largest continuous reef system in the western Atlantic. Jamaican reefs are among the most species-rich in the Caribbean, and The Bahamas offers over 1,000 dives, including specialty dives such as shark close-ups and diving with dolphins. The Caribbean is one of the world’s top diving destinations: travelers can dive year round, and water temperatures average 74°F–81°F (23°C–27°C).

The Caribbean climate is tropical, with daytime temperatures in most of the region in the low- to mid-80s°F (26°C–30°C) during North America’s winter months and in the upper 80s to low 90s°F (lower 30s°C) in the summer months. Nighttime temperatures are around 10°F (5°C) cooler. Bermuda has similar summertime temperatures, but in the cooler months the nighttime low is in the upper 50s°F (12°C–15°C). Temperatures fluctuate depending on altitude, especially in the mountainous countries of Cuba (Pico Real del Turquino: 6,476 ft; 1,974 m), Jamaica (Blue Mountain Peak: 7,402 ft; 2,256 m), Haiti (Morne de la Selle: 8,959 ft; 2,731 m), and the Dominican Republic (Pico Duarte: 10,164 ft; 3,098 m). The sunny climate and recreational resources make the Caribbean a major winter vacation destination. The Caribbean is considered “a tropical paradise,” and tourism is an extremely important economic activity for the region. Tourist arrivals were recorded by the Caribbean Tourism Organization as slightly over 22 million in 2009 for their 33 member countries. In 2007, the United States accounted for almost 12 million tourist arrivals.

HEALTH ISSUES

Immunizations

Everyone should be up to date with routine vaccinations, whether or not they travel. In addition, hepatitis A and B vaccination is recommended for all unvaccinated travelers. Typhoid vaccine is recommended for some travelers to the Caribbean, especially if they are staying long-term, staying with friends or relatives, or visiting smaller cities, villages, or rural areas where exposure might occur through food or water. Preexposure rabies vaccination may be recommended for some travelers in rare instances.

Malaria

Malaria caused by chloroquine-sensitive Plasmodium falciparum is endemic in Haiti. Travelers to Haiti should take appropriate chemoprophylactic and preventive measures to minimize the risk of acquiring malaria. Forty-five years after it had been eradicated, autochthonous malaria transmission has been reported in Jamaica (rare local cases in Kingston) and The Bahamas (Great Exuma). There have not been ongoing reports of malaria in travelers to Great Exuma, suggesting no sustained transmission; therefore, there are no specific recommendations for travel to The Bahamas, although measures to avoid mosquitoes are recommended to prevent dengue. Mosquito avoidance measures are recommended for travel to Jamaica, particularly Kingston. In addition, malaria occurs in the Dominican Republic (see Chapter 3, Yellow Fever and Malaria Information, by Country). Endemic malaria occurs in the 3 mainland countries of Guyana, Suriname, and Belize, and appropriate prophylaxis is recommended when visiting these countries.

Other Vectorborne Diseases

Dengue

The Caribbean is among the most common regions from which US travelers acquire dengue. Dengue is endemic in most Caribbean countries because the vector, the Aedes mosquito, is ubiquitous. Outbreaks are being reported more frequently, and the numbers of cases of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) reported in these countries are increasing. All 4 dengue serotypes have been isolated in the Caribbean. Although the overall transmission of dengue fever was not reported to be unusually high across the region, reports of dengue fever, DHF, and DSS increased during 2009 and 2010, with larger increases reported in 2010 than in 2009 by some islands (notably Jamaica, Trinidad and Tobago, and the French islands Martinique and Guadeloupe). During 2009, the predominant dengue serotypes identified were types 2 and 3, although predominantly types 1 and 2 were identified during 2010. Suriname reported serotype 4 both years and type 1 in 2010, and Saint Lucia also reported serotypes 1 and 2. Residents of the United States traveling to the Caribbean should take appropriate prevention measures to protect themselves from dengue.

Yellow Fever

Trinidad and Tobago and the mainland countries of French Guiana, Guyana, and Suriname are areas with risk of yellow fever virus transmission, but it is not holoendemic in Trinidad and Tobago. Vaccine is recommended for travelers aged ≥9 months to the 3 mainland countries and the island of Trinidad (except the urban areas of Port of Spain), but not the island of Tobago.

Other Diseases

Travelers’ Diarrhea and Foodborne Diseases

Caribbean cuisine is a fusion of spices and cooking styles from African, Amerindian, British, Spanish, French, Dutch, Indian, and Chinese cultures. Whether jerked chicken or ackee and salt fish in Jamaica, cracked (deep fried) conch or conch fritters in The Bahamas, or roti with curried meat or vegetables in Trinidad and Tobago, travelers will want to experience the culinary excitement of Caribbean cuisine. However, travelers should stick to legitimate eating establishments and avoid itinerant vendors. Travelers’ diarrhea is one of the most common travel-related illnesses, and some countries in the Caribbean fall into the intermediate-risk group, with attack rates of 8%–20%. Central America falls into the high-risk group, with attack rates of 20%–50%. Jamaica is unique among tourist destinations for having a hotel-based surveillance system of illness and injuries in travelers and for doing occasional exit surveys among travelers at its airport to estimate the risk of travelers’ diarrhea. Since interventions to prevent and control diarrhea in visitors were implemented, Jamaica reported a 72% reduction in diarrhea in the visitor population from 1996 to 2002. Outbreaks of ciguatera poisoning, which results from eating toxin-containing reef fish, have also occurred on many islands (see Chapter 2, Food Poisoning from Marine Toxins).

Histoplasmosis

Outbreaks of histoplasmosis have occurred in travelers to some Caribbean islands and to mainland French Guiana. For ecotourism enthusiasts, spelunking and trekking are possible activities that may put travelers at higher risk for exposure.

Physical Concerns for the Traveler

Crime and Drugs

The crime rate is high in some countries of the Caribbean; however, the Department of State reports often note that even in the most troubled countries, violent crime rarely affects tourists. A 2007 report from the World Bank estimated that the overall murder rate in the Caribbean was 30 per 100,000 inhabitants, 4 times that in North America. Jamaica has one of the highest rates of violent crime in the world but a relatively low rate of property crime. Visitors are rarely the victims of violent crime, but are most often victims of property crimes and may be targeted in locations frequented by tourists. Statistics suggest lower crime rates in the Caribbean countries of Montserrat, the Cayman Islands, Saint-Barthélemy, the British Virgin Islands, Bonaire, and Dominica. Travelers from the United States who are visiting friends and relatives in the Caribbean will most likely enter communities that the average tourist will not. These travelers should be reminded that they are not immune to crime and injury in these communities.

Travelers are reminded that while illegal drug use is prevalent in some tourist areas, possession or use of marijuana or other illicit drugs is illegal, including in Jamaica. In addition to the health risks associated with illicit drug use, each year, many American citizens are arrested and incarcerated for drug-related crimes in Jamaica.

Traffic

Road traffic accidents are the leading cause of injury death among US citizens in foreign countries. Tourists will encounter road conditions that differ significantly from those in the United States. In some countries, roads may vary from 2-lane paved roads to dirt tracks, and some may lack markings or reflectors. Although many Caribbean countries have areas with well paved roads and even highways, many countries and many areas within countries have long, curvy roads with steep stretches where some parts of the road are in disrepair. This is especially true in rural and mountainous areas. In a few of the smaller Caribbean islands, such as Bermuda, motor vehicle rentals may be limited to motorbikes, since cars are not often available. Unlike in the United States, drivers drive on the left in the English-speaking Caribbean countries.

Natural Disasters

The Atlantic hurricane season runs from June through November and peaks between August and October, when the waters of the Caribbean are warmest. Many of the Caribbean islands are in the path of Atlantic hurricanes through the Atlantic Ocean, the Caribbean Sea, and the Gulf of Mexico. The southernmost islands (Aruba, Barbados, Curaçao, Bonaire, Grenada, and Trinidad and Tobago) are rarely hit by hurricanes.

The Caribbean is also an area of major earthquake activity (magnitude ≥7.0) with the potential for generating tsunamis. On January 12, 2010, Haiti was hit by a magnitude 7.0 earthquake, resulting in more than 200,000 estimated deaths.

Beaches, Rafting, Diving, and Snorkeling

Even in the cooler months of the year, travelers are at risk for sunburn, which can be more severe with alcohol use. Travelers should use adequate sun protection and keep hydrated. Drowning is the third leading cause of injury death among US citizens in foreign countries, so travelers should ensure that they are fit and healthy to undertake water-related activities and always have company when doing them. Dives should not be done within 24 hours before a flight or before mountain hikes to avoid the risk of decompression sickness. Jamaica has a decompression facility in Discovery Bay on its north coast near many of the diving areas.

Cutaneous larva migrans is a risk for travelers on some beaches in the Caribbean. Leptospirosis is common in many areas, most notably some regions in Jamaica, and poses a risk to travelers engaged in recreational freshwater activities. Such activities may include whitewater rafting, kayaking, adventure racing, or hiking. Travelers can reduce their risk for leptospirosis by avoiding activities that expose them to contaminated fresh surface water.

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