Diseases That Expats Should Avoid In Panama

Moving to Panama’s tropical climate holds the promise of an endless summer. But, there are diseases that expats should avoid in Panama. This article explores the most common diseases that occur, as well as a few rare ones.

In 1888, Friedrich Nietzsche wrote his truism, “Was mich nicht umbringt, macht mich starker.” Today, we all know the expression as “what doesn’t kill me, makes me stronger.”

It is part of everyday banter, and the young-at-heart, explorer types use it often. Nevertheless, there are a few nasty diseases around. Although the chance of attracting one of these nasties is slim, it is good to be informed.

Forewarned is forearmed.

Panama’s geography

Before we discuss the common diseases that expats should avoid, let us have a look at Panama’s geography, for easy reference.

There will be mentions of the Darién Gap. It is a large swath of undeveloped swampland and forest, about 100km long, within Panama’s Darién Province and the northern portion of Colombia’s Chocó Department.

The Pan-American Highway does not run through the Darien Gap. In fact, it is the only place to find a break in the 30,000km long road network.

Darien gap
Map of Panama, the red circle shows the approximate extent of the Darién Gap.

Another remote and undeveloped area is Panama’s “Mosquito Coast”. It lies along the north coast, roughly between Boca de Rio on the west, and Coclé de Norte on the east. It stretches inland for about five kilometres.

Mosquito coast
Panama’s so-called “Mosquito Coast”


As part of the tropical region that exists in a broad band around the equator, Panama is no stranger to malaria.

The canal connection

The thousands of deaths during the construction of the Panama Canal brought malaria into sharp focus. In 1884, three years after the French started construction of the canal, the death rate was more than 200 per month, the largest percentage of that due to malaria.

When the US took control of the canal in 1904, the theory around mosquito’s spreading malaria was still unproven. However, William Gorgas, who later became Surgeon General of the US Army, implemented large-scale sanitation and mosquito eradication measures, which paid off. By 1906, malaria was under control.

A 1941 report issued by the Canal Commission stated that during the past 20 years, there were only seven deaths from malaria among employees.

Today, Panama City is virtually malaria free.

Web HostingAbout malaria

Malaria (Spanish: Malaria  ) is a serious tropical disease, caused by parasites that enter the bloodstream. According to American Family Physician, five main species of parasites are responsible for the transmission of malaria in humans, some more dangerous than others.

The bite of an infective female Anopheles mosquito can transmit these parasites to humans. To produce eggs, the mosquito usually consumes a blood meal, thus needing humans and animals as hosts.

Panama diseases: Anopheles mosquito
The Anopheles mosquito, called a “night-time biter” because it is most active from dusk to dawn. About 460 species are recognised; while over 100 can transmit human malaria, only 30–40 commonly transmit parasites of the genus Plasmodium, which cause malaria in humans in endemic areas.

The development of the parasites takes seven to 21 days, depending on the species of the parasite. After the parasites enter the host’s liver, the replication stage begins.

The initial flu-like symptoms, after the incubation period of seven to 21 days, include any or a combination of the following:

  • High temperature
  • Headache
  • Nausea
  • Diarrhoea
  • Muscle pains

Malaria is neither contagious nor infectious.

Risk areas and prevention

The Darien Gap and the aptly named Mosquito Coast are the high-risk areas in Panama. Whereas Bocas del Toro is a medium risk area, there is a much lesser risk in the areas to the south of the Mosquito Coast.

Panama City and the former Canal Zone are low-risk areas. However, given a warm climate and high rainfall, the entire country can potentially be home to an infected mosquito.

The best way to prevent malaria is to prevent the mosquito bite in the first place. Use appropriate clothing, screens on windows and doors, appropriate bedding (mosquito nets) and use insect repellent.

I do not promote the use of prophylaxis for the prevention of malaria. Nevertheless, if you are uncertain, you should consult your physician or a travel clinic.

What is the treatment?

The use of the correct drugs can cure malaria, and clear the body of all the malaria parasites. However, the disease will continue if not treated, or treated with the wrong drug. Some drugs are not effective because the parasite is resistant to them.


Chikungunya fever (Spanish: Fiebre chikungunya  ) is caused by a homonymous virus, which is transmitted to humans by the bite of the Aedes aegypti and Aedes albopictus mosquitoes.

Aedes aegypti, called a “daytime biter”, since it is active from dawn to dusk. The mosquito is identified by The white markings on its legs and a marking in the form of a lyre on the upper surface of its midsection, identify this pest. (Credit: US Dept of Agricultur)

According to Mayo Clinic, it causes the sudden onset of fever and severe joint pain. Other signs and symptoms may include fatigue, muscle pain, headache and rash. Signs and symptoms of chikungunya usually appear within two to seven days after the bite of an infected mosquito.

Risk areas and prevention

You should consider the entire country as a risk area, with the exception of elevations higher than 2,000m (6,500ft) where the risk is minimal.

The best way to prevent chikungunya is to prevent the mosquito bite in the first place. Use appropriate clothing, screens on windows and doors, appropriate bedding (mosquito nets) and use insect repellent.

What is the treatment?

No vaccine exists to prevent chikungunya fever, and there is no effective antiviral treatment. However, the disease runs a limited course and rarely causes serious complications. Treatment is aimed at relieving symptoms.


Zika (Spanish: Zika  ) is one of the diseases that expats should avoid in Panama. Although the number of reported cases have declined dramatically after the 2015-2016 outbreak, it remains a risk.

Zika Virus infection is caused by the Zika Virus (ZIKV) belonging to the Flaviviridae family. The virus is transmitted by infected female Aedes aegypti and Aedes albopictus mosquitoes. A pregnant woman can transmit the virus to her fetus.

IAMAT, a non-profit organization that aims to keep travellers healthy, states that there is strong scientific consensus that Zika Virus causes neurological complications, including microcephaly in infants born to pregnant women infected with the virus.

In the majority of cases, Zika Virus infection is asymptomatic – people do not exhibit symptoms. Those with symptoms usually get ill three to 10 days after being bitten by an infected mosquito. Symptoms include mild fever, headache, muscle and joint pain, nausea, vomiting, and general malaise.

Risk areas and prevention

You should consider the entire country as a risk area, with the exception of elevations higher than 2,000m (6,500ft) where the risk is minimal.

The best way to prevent zika is to prevent the mosquito bite in the first place. Use appropriate clothing, screens on windows and doors, appropriate bedding (mosquito nets) and use insect repellent. There is no vaccine against Zika Virus.

What is the treatment?

Most people fully recover from the illness within 7 days. The treatment represents supportive care of symptoms only as there is no antiviral treatment available.

Dengue Fever

It seems we just cannot get away from the influence of the Aedes aegypti mosquito. Thus far, she has featured in the transmission of both chikungunya and Zika! Now she is linked to another disease that expats should avoid in Panama, namely Dengue fever.

Dengue (Spanish: Dengue  ) is a viral infection, transmitted through the bite of infected Aedes aegypti and Aedes albopictus female mosquitoes, that feed both indoors and outdoors during the daytime. These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tires. Lack of reliable sanitation and regular garbage collection also contribute to the spread of the mosquitoes.

Dengue is mostly asymptomatic. If symptoms do show, it will generally occur between four and seven days after the mosquito bite.

The symptoms include fever that flares up in waves, pain behind the eyes, muscle and joint pains, and very tellingly, a skin rash with red spots.

There is no antiviral treatment for dengue.

The real danger of Dengue lies in the chance of it progressing to Dengue Hemorrhagic Fever (DHF). Symptoms include severe abdominal pain, vomiting, diarrhea, convulsions, bruising, and uncontrolled bleeding. Complications can lead to circulatory system failure and shock and can be fatal.

Risk areas and prevention

The government had great success with its mosquito eradication programs. However, similar to chikungunya and Zika, you should consider the entire country as a risk area, with the exception of elevations higher than 2,000m (6,500ft) where the risk is minimal.

The best way to prevent Dengue fever is to prevent the mosquito bite in the first place. Use appropriate clothing, screens on windows and doors, appropriate bedding (mosquito nets) and use insect repellent.

What is the treatment?

Physicians strongly discourage self-medication. Generally, treatment is aimed at relieving the symptoms.

Yellow Fever

This is the fifth disease in this article, which is transmitted by mosquitoes and the fourth by the infamous Aedes aegypti.

In terms of tropical diseases, Panama and the Canal are generally associated with malaria. However, yellow fever (Spanish: fiebre amarilla  ) killed almost as many workers as malaria did, during the early construction period of the Panama Canal.

Infection by this virus usually leads to a flu-like condition, which is not serious. However, in about 10% of cases patients can develop serious complications, and about 50% of these are potentially deadly.

Gorga’s crusade to eradicate disease-carrying mosquitoes completely wiped out yellow fever on the isthmus.

Risk areas and prevention

According to the World Health Organisation, “Yellow fever is endemic in ten South and Central American countries and in several Caribbean islands. Bolivia, Brazil, Colombia, Ecuador, and Peru and Venezuela are considered at greatest risk.”

This implies that the Darien Gap remains a risk area for attracting yellow fever.

Because mosquitoes transmit yellow fever, prevention would be the same as for the previously discussed diseases.

Yellow fever vaccination

There seems to be some confusion amongst travellers and expats about yellow fever vaccinations. It is straightforward, allow me to explain.

Firstly, the regulation is that any person, who travels from or has visited an area where yellow fever is endemic, must be able to produce proof of his or her yellow fever vaccination. Clinics issue an aptly coloured yellow card containing detail of the vaccination. This is because infected humans can pass the virus to mosquitoes, referred to as the urban cycle.

Yellow fever vaccination certificate
Yellow fever vaccination certificate

Secondly, for anybody travelling to an area where yellow fever is endemic, it makes sense to vaccinate for protection against the disease.

Pro tip: A yellow fever vaccination might be costly, but just get it. Carry it together with your passport and you will never have any hassles entering any country. Moreover, the vaccination will protect you against yellow fever!


Leishmaniasis (Spanish: Leishmaniosis  ) is a parasitic infection, transmitted through the bite of infected female sand flies belonging to the Phlebotomus, Lutzomyia and Psychodopygus species.

Female Lutzomyia having a blood meal. (Credit: Ray Wilson)

These nocturnal insects bite from dusk to dawn. They are very tiny silent flyers – they do not hum – and their bite might go unnoticed.

There are three major categories of leishmaniasis:

  • Cutaneous: causes a skin lesion around the bite, which usually self-heals between one and 12 months.
Leishmaniasis lesion
An active cutaneous leishmaniasis lesion. (Credit: Medscape)
  • Mucocutaneous: starts like cutaneous, and then spreads to the soft palate, mouth and nose, potentially causing severe disfigurement.
  • Visceral: a very severe disease that causes spleen megalophaly. It can be deadly if not treated.
Risk areas and prevention

Infrequent cases of cutaneous and mucocutaneous leishmaniasis occur in rural areas in the entire country. Western and west-central Panama (Bocas del Toro, Chiriqui, Ngäbe-Buglé, northern Veraguas, Cocle and western Colon) have the most cases of leishmaniasis.

Panama Provinces

There is no vaccine or prophylactic medication available. The only way to prevent leishmaniosis is to avoid the bite of a sand fly.

Wear appropriate clothing, use insect repellent on exposed skin, use screens on windows and doors, and make use of insecticide inside the home.

An interesting fact is that sandflies are poor flyers, so if you sleep on the higher floors of a building, you can avoid some (or most) of them!

What is the treatment?

Most cutaneous lesions will self-heal, but the best advice is to consult your family doctor as soon as you suspect having the disease. Your doctor could prescribe anti-parasitic drugs or may recommend other treatments based on the type of leishmaniasis you have.

Whooping Cough

In February 2019, the news outlet PanamáToday, reported an outbreak of whooping cough (Spanish: Tos ferina  ) in the Ngäbe-Buglé region. Regrettably, several children have subsequently died from the disease.

Whooping cough, also called pertussis, is a highly contagious bacterial infection of the lungs and airways. The droplets of the coughs or sneezes of an infected person can spread the disease.

Symptoms usually begin appearing as cold symptoms such as a cough, runny nose, sore throat and usually little or no fever. After several days, the cough may become more severe; it may come in spasms or as a series of coughs without a chance to breathe between coughs.

Early diagnosis (within three weeks) and a course of antibiotics can stop the spread of the disease, although it will not reduce the symptoms. If diagnosed later than three weeks, you will normally not need any specific treatment, as you will no longer be contagious. The coughing should self-heal over a few months.


Rabies (Spanish: Rabia  ) is a viral infection caused by viruses belonging to the Lyssavirus genus. It is a zoonosis – an animal disease that can spread to humans – transmitted by saliva through bites and scratches of infected mammals.

We strongly recommend rabies vaccination for expats and their children who plan to spend a lot of time outdoors (which is generally the case in Panama). In Panama, bats are mostly responsible for the transmission of Rabies.


Avoid contact with feral animals or wildlife. If a mammal bit or scratched you, wash the wound repeatedly and thoroughly with copious amounts of soap and water, and irrigate with an antiseptic. More importantly, seek medical attention immediately.

Other diseases to know about

We recommend vaccinations for other diseases that expats should avoid in Panama.

Travellers and expats should consult a travel clinic or their family physician about vaccinations against Hepatitis A, Hepatitis B and DTP. (DTP is an abbreviation of Diphtheria, Tetanus and Polio. A single vaccine protects against all three of these diseases.)

Top 10 causes of death

After all the doom and gloom about tropical diseases and things that bite, here are good news. Your chance of attracting one of the tropical diseases is relatively small, provided you apply preventative measures. Your chances to succumb to one is in fact very small.

Also, keep in mind that Panama’s healthcare system is adequate to deal with any of the diseases that we discussed.

The Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington, USA, has released a report about the top 10 causes of death in Panama.

Top 10 causes of death Panama
Top 10 causes of death in 2017 and percent change, 2007-2017

From this informative graphic, it seems that a healthy diet, and dodging taxis in Panama City, are just as important to remain in good health!

“If a mosquito has a soul, it is mostly evil. So I don’t have too many qualms about putting a mosquito out of its misery. I’m a little more respectful of ants” – Douglas Hofstadter

I would love to have your thoughts on diseases that expats should avoid in Panama. Have you been a victim of an infected mosquito or sand fly?

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Diseases that expats should avoid in Panama

Sold everything, became minimalist. Retired early, in Hispanic America. Helping others do the same. This free guide will help you plan your relocation. Do you have a question?


  1. Hey Chris, thanks for the info. Being aware of these critters will help me be prepared. My family I and will be moving to Panama as soon as I can sell my farm here in South Africa……can’t wait.

  2. Great information. I’ll be in Panama soon and though I’ve traveled there often have never given any thought to any of these. I’ll make sure to be prepared next time around.

    • Thanks for popping in Nailil. Some of the diseases (malaria, yellow fever and zika) are really low risk, but all that is needed is one infected mosquito to cause a lot of discomfort! And one can be prepared without being paranoid! Enjoy your trip.

    • My pleasure Sandy! Good luck with the trip, I hope it will be enjoyable. In the mean time, you are welcome to send us any questions.


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