* Malaria risk exists throughout the year, especially in the western provinces and in La Altagracia province. Risk in other areas is low to negligible.

All water should be regarded as being potentially contaminated and sterilisation should be considered essential. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is pasteurised. Only eat well-cooked meat and fish. Vegetables should be cooked and fruit peeled.

Vaccinations for tuberculosis and hepatitis B are sometimes recommended. Bilharzia (schistosomiasis) is endemic; avoid swimming and paddling in fresh water. Outbreaks of dengue fever occur in the area. Rabies may be present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay.

Health insurance (to include emergency repatriation) is strongly recommended. Medical care is limited and variable in quality. An emergency service is available in Santo Domingo.