Health conditions are adequate in Managua, but in the outer areas of the country extreme caution is recommended. Remember that the chances of contracting an illness increase drastically once off the normal tourist routes, when in rural areas, and when in close contact with poor children. Also, the longer the stay, the greater the chances of becoming ill. A safe visit would be about 3 weeks.

Vaccinations: Before leaving for Nicaragua, doctors recommend the following vaccinations:
Typhoid: recommended for all
Tetanus: recommended for all
Polio: recommended for all
Hepatitis A: Strongly recommended for all
Cholera: recommended for extended rural visits
Rabies: recommended for rural visits
Yellow fever: required for visitors from infected areas

Prescription Medicine:
Emergency supplies of any prescription medication should be carried. However, one might be able to find it in a local pharmacy as well and prescription drugs are sold over-the-counter without a letter from a doctor. However, you should carry a translated copy of your prescription with you so that it will be easier to find what you need.

Medical Facilities:
For serious conditions, the hospitals are inadequate. However, even though local hospitals fall below international standards, the physicians are perfectly able to deal with common local situations such as parasites, minor broken bones, and minor dental problems. There are good quality optometrists who can replace contact lenses or glasses for a reasonable price as well. There are several moderate clinics and hospitals inside Managua, but very few in the rest of the country.

Insurance:
Many times, a foreign insurance policy will not cover conditions abroad. Before leaving for Nicaragua, you should check with your agent to make sure exactly what the terms of your contract are. Also, it is helpful to have a provision for an emergency evacuation.

Common Illnesses:
Contracted from food and water:
Parasitic worms: common
Hepatitis: occurs
Cholera: occurs
Brucellosis: occurs
Leptospirosis: occurs

Contracted from insects:
Malaria: common
Dengue fever: common
Venezuelan equine: occurs
Leishmaniasis: occurs
Chagas’ disease: occurs

Other: yellow fever, influenza, measles, diphtheria, rabies (common in dogs and bats)

Precautions:
Beverages: Drink only bottled beverages (including water) or beverages made with boiled water. Even innocent ice cubes could cause you to become the victim of Montezuma’s revenge.

Food:
Eat well-cooked foods while they are still hot and fruits that can be eaten without being touched by your hands and fruits that have to be peeled. Also avoid dairy products, raw seafood, and especially street vendors! And never, ever ask your friendly guide to take you to eat at a "real" Nicaraguan restaurant. Food and water-born diseases are the primary cause of illnesses in visitors to Nicaragua, so use caution.

Other:
Don’t forget to use plenty of sunscreen and insect repellent which contain DEET. If you are going to be sleeping somewhere that is not closed in, consider purchasing a mosquito net. Wear clothing that will offer the least amount of exposed skin while traveling in the rural areas. Remember, mosquitoes and mosquitoes are not your only fear, by a long shot. Fleas, ticks, and lice can crawl anywhere, and they do.

Description of Diseases
Malaria: This disease is transmitted only by mosquitoes and is common in the rural areas of Nicaragua. However, mosquitoes breed by water, so any cities close to a large body of water are at risk. Typical symptoms of malaria include: fever, chills, general achiness, and malaise. Early stages of malaria may resemble the onset of the flu but it can continue without treatment until it causes anemia, kidney failure, coma, and death. Malaria can be prevented by taking chloroquine a week before going to an exposed area, while there, and for about a month after leaving.

Dengue Fever: This viral infection is transmitted by mosquitoes in residential areas and causes symptoms similar to the flu: high fever, severe headaches, joint and muscle pain, and rash. Sometimes the face and neck will become very flushed along with chills in the beginning. The fever sets on very rapidly, but the rash will appear about three days after the fever. There is no vaccine, but it does not cause death, except in very rare cases. It can be treated by bed rest and fever-reducing medecines like acetaminophen, but not aspirin. The mosquitoes that carry this disease are predominant in urban areas during the day, though they rarely live above 4000 feet.

Yellow Fever: This is a viral disease which is transmitted to humans by mosquitoes, but it is exceptionally rare. Symptoms include: fever, chills, headache, vomiting, jaundice, internal bleeding, kidney failure, and death in about 5% of those affected. There is no drug to treat it, but there is a vaccine. If you feel that you should receive the vaccine, contact your doctor to make sure that you are physically eligible to receive the vaccine.

Parasites: These invisible creatures are usually transmitted through food and water, but some can also penetrate bare skin and mosquitoes can transmit others. Parasites usually cause persisting discomfort in general, but specific symptoms include: fever, swollen lymph nodes, rashes or itchy skin, digestive problems such as abdominal pain or diarrhea, eye problems, and anemia. Travelers should take care to eat well cooked meals, not eat beverages made with non-purified water, wear shoes, and avoid insect bites.

Cholera: This diarrhea illness is caused by the infection of the intestine and is usually mild or without symptoms. It is transmitted by eating or drinking food which has not been prepared properly. Drinking tap water in rural areas and eating whole tomatoes which have not been washed in pure water would be examples of risking behavior. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these cases, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. . Those who follow the eating precautions on this site are to virtually no risk and therefore a vaccine would be redundant.

Hepatitis A: This viral infection of the liver is transmitted by the fecal oral route, by directly touching an infected person, by eating contaminated food or beverages, and from uncooked fruits and vegetables which have been contaminated by handling. Symptoms include: fatigue, fever, loss of appetite, nausea, jaundice, aches and pains, vomiting, dark urine and light stools. No specific cure is available, so prevention by vaccination is the only alternative. Extensive visits to rural areas, close contact with local people, and eating under poor sanitary conditions present the greatest risk, however the disease occurs in those using moderate precautions as well. As a first line of precaution, receive one of the two vaccines which are available to prevent Hepatitis A. Secondly heat foods to higher than 85 degrees Celsius for more than one minute, in order to kill the virus.