Guatemala and Belize

Destination overview

Guatemala

Bordered by Mexico to the north, Belize and Honduras to the east, and El Salvador to the southeast, Guatemala is the most populous country in Central America with over 18 million inhabitants. It is the third largest by area covering more than 108,000 km² (over 42,000 mi²), after Nicaragua and Honduras. Often referred to as the "Land of Eternal Spring" due to its pleasant year-round temperatures, Guatemala attracts tourists to explore its Mayan ruins, picturesque colonial towns, and stunning landscapes featuring volcanoes and lakes. The country is also a popular destination for learning Spanish, with numerous language schools catering to international students. While Spanish is the official language, Guatemala is linguistically diverse with 25 indigenous languages spoken, including various Mayan languages, Garifuna, and Xinca. Annually, the country welcomes between 2 and 2.5 million international visitors.

Guatemala City, the capital, is a highly urbanized hub offering luxury hotels, diverse culinary options, and accessible medical services. In contrast, conditions outside the capital can differ significantly, with limited availability of consumer products, challenging travel conditions, and often inadequate medical facilities. Guatemala's 22 departments feature a wide ecological diversity, including highland cloud forests, dense jungles, semi-arid deserts, and extensive agricultural regions. While rural areas present significant charm and numerous unique destinations, travelers should be prepared for various health risks.

Belize

Approximately the same size as New Jersey, Belize has an area of 23,000 km² (8,867 mi²). It shares its western and southern borders with Guatemala and its northern border with Mexico's Quintana Roo state; the Caribbean Sea forms the eastern boundary of the country (Map 11.2.5.1). Northern Belize is characterized by coastal plains with pockets of dense forest, while the west and south are predominantly coastal plains or savannas and low mountains, respectively. Belize's Caribbean coastline features sandy white beaches, numerous islands, and one of the longest barrier reefs in the world.

Travelers visiting Belize's inland can participate in a variety of adventure activities, including canoeing, cave tubing, climbing Mayan ruins, hiking, and zip-lining through jungle canopies. Most visitors come to experience the beaches and the coastal barrier reefs, which boast some of the best scuba diving in the region. The official language of Belize is English, although Belizean Creole, Spanish, Mayan languages, and Plautdietsch (a variety of German spoken by Mennonite settlers) are also spoken.

Map 11.2.5.1: Guatemala and Belize

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SOURCE:

Centers for Disease Control and Prevention

Destination map of Guatemala and Belize. Both countries are highlighted in orange. Guatemala is bordered by Mexico to the north and west, Belize to the northeast, the Caribbean Sea to the east, Honduras and El Salvador to the southeast, and the Pacific Ocean to the southwest. Key locations in Guatemala include Guatemala City, other major cities, and various national parks and volcanoes such as Volcán de Fuego, Volcán de Pacaya, and Volcán de Santa Maria. Belize is bordered by Mexico to the north, the Caribbean Sea to the east, and Guatemala to the west and south. Key locations in Belize include Belmopan, Belize City, and natural reserves such as the Great Blue Hole, Ambergis Caye, and Hol Chan Marine Reserve. A small inset map shows the location of Guatemala and Belize within Central America.

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Infectious disease risks

Ensure travelers are up to date on their routine immunizations. Routine childhood immunization rates in both Guatemala and Belize declined during the COVID-19 pandemic, potentially increasing the risk for vaccine-preventable infections such as measles and pertussis. This decline not only raises the risk for local populations but also for visitors who may be exposed to these diseases. Hepatitis A and typhoid vaccines are recommended for visitors to both countries.

Enteric infections and diseases

Giardiasis

Giardia is endemic throughout the world. In addition to drinking water precautions, remind travelers to avoid swallowing water from streams, ponds, and lakes.

Taeniasis and cysticercosis

Guatemala and Belize are considered endemic for multiple parasitic infections, including taeniasis and cysticercosis, which are caused by different life stages of the Taenia solium parasite. Cases occur in all departments of Guatemala; the majority have been reported from Chiquimula, Huehuetenango, Petén, Quetzaltenango, and Zacapa. Taeniasis can present as a mild or asymptomatic intestinal infection following the ingestion of undercooked pork products.

Cysticercosis, a more serious infection of muscle, brain, or other tissues, is caused by ingestion of T. solium eggs shed in the stool of human carriers. Over months to decades, the infection can progress to neurocysticercosis, a rare but potentially disabling or fatal infection. Consuming food, including raw or undercooked vegetables, contaminated with T. solium eggs can cause cysticercosis.

Travelers' diarrhea

Travelers' diarrhea commonly affects visitors to Guatemala and Belize. Advise travelers to follow instructions on safe food and water precautions (see Food and Water Precautions for Travelers). Tap water is not potable in Guatemala or Belize, even in the capital cities. There are many options for treating water, including boiling, filtration (e.g., using ceramic water filters), chlorination, and disinfection using ultraviolet light. Bottled water is widely available.

Counsel travelers to avoid consuming unpasteurized dairy products (particularly soft or fresh cheeses) and raw or undercooked meat or fish. Avoid leafy green or raw vegetables unless they are thoroughly washed and disinfected or cooked before consumption. For further information about travelers' diarrhea, see Travelers' Diarrhea chapter.

Typhoid fever

Typhoid fever, caused by infection with Salmonella typhi, occurs in both Guatemala and Belize and can be life-threatening, although appropriate and timely management usually prevents serious disease (see Typhoid and Paratyphoid Fever chapter). Infection with typhoid fever in the United States is associated with international travel, in particular southern Asia, but also among travelers returning from Central America. Offer typhoid vaccine to all travelers, especially to those visiting smaller cities or rural areas. Vaccinated travelers should still follow food and water precautions.

Respiratory infections and diseases

Coronavirus disease 2019

All travelers going to Guatemala and Belize should be up to date with their COVID-19 vaccines. Expect COVID-19 vaccine availability to be limited or non-existent in Guatemala and Belize.

Influenza

Seasonal influenza strains in Central America may circulate in a pattern similar to the United States although with noted variability in tropical regions (see Influenza chapter). Advise travelers to receive the influenza vaccine ≥2 weeks before departure. Low reported rates of influenza at destinations may reflect limited surveillance rather than an absence of transmission.

Tuberculosis

Guatemala and Belize are considered moderate incidence countries for tuberculosis (TB). Help travelers determine their potential for exposure to Mycobacterium tuberculosis. Risk for infection is greatest among travelers who will be working around individuals with untreated TB (e.g., drug rehabilitation centers, health care settings, prisons, shelters); those staying for an extended time with friends and relatives; and those who eat unpasteurized dairy products, a risk factor for bovine TB (see Tuberculosis chapter).

Sexually transmitted infections and HIV

HIV prevalence in Guatemala is low in the general population (0.2% among adults aged 15–49 years). Most cases occur among people at increased risk, including commercial sex workers, those who use injection drugs, men who have sex with men, and the sexual partners of these individuals. HIV prevalence is greater in Belize (1.1% among adults aged 15–49 years). Counsel travelers to reduce their risk of HIV and other sexually transmitted infections, including chlamydia, gonorrhea, herpes, and syphilis, by avoiding injection drug use and unprotected sex. High-quality condoms are available for purchase at pharmacies in both countries.

Soil- and water-borne infections

Cutaneous larva migrans

Cutaneous larva migrans, a creeping skin eruption commonly associated with animal hookworm infection, has been reported in Guatemala and Belize (see Post-Travel Dermatologic Conditions chapter). Cases are associated with walking on beaches or warm soil; advise travelers to use footwear and avoid direct skin contact with soil and sand.

Leptospirosis

Leptospirosis, a zoonotic bacterial disease transmitted to humans primarily through exposure to water contaminated with animal urine, is present in Guatemala, with most cases reported following flooding related to hurricanes and linked to recreational activities such as white-water rafting and tubing (see Leptospirosis chapter). Cases have been documented in most departments of Guatemala. In Belize, leptospirosis is also present although information on the frequency and geographic distribution of infection is limited. Advise travelers to avoid swimming or wading in potentially contaminated water (particularly flood waters) and to use protective footwear or clothing if they are likely to be exposed during work or recreation. Encourage febrile travelers to seek health care if their activities put them at risk, although a confirmed diagnosis may be challenging in Guatemala or Belize.

Vector-Borne diseases

Arboviruses: Chikungunya, dengue, and Zika

Chikungunya, dengue, and Zika viruses are all transmitted in both Guatemala and Belize. Annual rates of arbovirus infections vary significantly. Travelers staying primarily in highland areas will have more limited exposure to disease-carrying mosquitoes; those visiting coastal or low-lying areas and beaches are at increased risk.

Dengue remains a significant arboviral threat, with risk present year-round in some areas (see Dengue chapter). Large outbreaks occur periodically in both countries, with Guatemala reporting record high cases of dengue in 2024. While warmer, lower altitude departments such as Baja Verapaz, Escuintla, Petén, Santa Rosa, and Zacapa report cases annually, an increasing number of dengue cases have been reported in Sacatepéquez (where Antigua Guatemala is located) and Guatemala City.

Cases of chikungunya and Zika have been reported in Guatemala in recent years and, to a lesser extent, Belize (see Chikungunya and Zika chapters). Because of the risk for birth defects in infants born to mothers infected with Zika virus during pregnancy, instruct people who are pregnant or trying to become pregnant and their sex partners about the most recent CDC recommendations and promote the use of mosquito-avoidance behaviors.

Encourage travelers to take steps to prevent mosquito bites by using an effective insect repellent, wearing long-sleeved shirts and long pants, and staying in accommodations with window screens or air conditioning where available (see Mosquitoes, Ticks, and Other Arthropods chapter).

Leishmaniasis

Guatemala and Belize are classified as endemic for cutaneous leishmaniasis (see Leishmaniasis chapter). Risk for infection is greater among people with outdoor exposure (e.g., ecology workers, ecotourists, travelers staying in rustic settings). Travelers can reduce their risk for sand fly bites by avoiding outdoor activities at night, wearing protective clothing, applying insect repellent, and sleeping in air-conditioned or well-screened areas. In Guatemala, most cases are reported from the departments of Alta Verapaz, Huehuetenango, and Petén. Detailed data on leishmaniasis in Belize are not routinely published.

Malaria

Malaria cases have been declining in Guatemala in recent years, but risk is still a concern in some areas. Alta Verapaz, Baja Verapaz, Escuintla, Izabal, and Petén account for most cases, and prophylaxis against Plasmodium vivax malaria is recommended only for travelers visiting these departments. Antigua, Guatemala City, and Lake Atitlán are not considered risk areas for malaria (see Yellow Fever Vaccine and Malaria Prevention Information, by Country chapter).

Belize was certified malaria-free by WHO in 2023. Except for travel to the aforementioned departments in Guatemala, mosquito avoidance and insect bite precautions, but not chemoprophylaxis, is recommended for travelers to either country.

Rickettsial diseases

Rickettsial diseases are emerging pathogen in Central America, often associated with febrile illnesses that might be mistaken for other conditions like dengue or malaria. Although there are reports of rickettsial infections throughout Central America, the true extent of these diseases is not well-documented and is almost certainly under-reported. In Guatemala, infections have included Rickettsia prowazekii, Rickettsia rickettsia, Rickettsia typhi, and Rickettsia felis (see Rickettsial Diseases chapter). In Belize, Rickettsia-infected ticks have been found in several districts, suggesting infection risk to humans. Provide travelers to both countries with information about how to avoid flea and tick bites, both indoors and outdoors (see Mosquitoes, Ticks, and Other Arthropods chapter).

Trypanosomiasis

Chagas disease, transmitted by triatomine insects infected with Trypanosoma cruzi, is endemic to some areas of Guatemala. Most cases have been reported from the departments of Chiquimula and Jutiapa, with a smaller number from other, primarily lowland, departments.

In 2022, healthcare professionals and public health officials published a report of the first known case of acute Chagas disease diagnosed in Belize. Risk for infection among travelers is believed to be low but is presumably increased for people staying in poor quality housing in endemic regions.

Yellow fever

Yellow fever is not a risk in either Guatemala or Belize. The Government of Guatemala, however, requires proof of vaccination against yellow fever from travelers arriving from countries where there is risk of yellow fever virus transmission or who have >12-hour airport layovers or transits through countries with risk of yellow fever transmission. For more details, see Yellow Fever Vaccine and Malaria Prevention Information, by Country and Yellow Fever chapters. Belize currently has no yellow fever vaccine requirements for entering travelers.

Environmental hazards and risks

Air pollution

In Guatemala City, with a metropolitan population of over three million, air pollution can be a concern especially for those with asthma and aggravating conditions. Belize's urban areas are much less dense, but urban and rural air quality in both countries may be negatively impacted by vehicle emissions, burning of waste, and limited regulatory control of industrial emissions. In Guatemala, periods of intense volcanic activity can cause increased particulate matter in areas within range of a volcano's fallout (see Air Quality and Ionizing Radiation During Travel chapter). Visitors can access real-time air quality data and health advisories from several sources such as IQAir and WAQI to stay informed about air quality conditions in these countries.

Altitude illness

At 1,533 m (5,029 ft) above sea level, Guatemala City is at a moderately high elevation. The highest point in Guatemala is just over 3,900 m (13,000 ft). Belize has a more moderate topography (average elevation of 130 m), with its highest point at 1,124 m (3,668 ft). Advise travelers coming from lower elevations, particularly those with heart and lung conditions and those planning to climb high-elevation volcanoes, to consider an acclimatization period (see High Altitude Travel and Altitude Illness chapter).

Animal bites

Rabies

Guatemala and Belize are among the few countries in the Americas that still report rabies in dogs. Rabid dogs are reported every year, and all dog bites must be considered as possible exposures to rabies (see Rabies chapter). Rabies can also be transmitted by other Central American animals, including bats, coatis, coyotes, foxes, and skunks. Educate travelers about recommended post-exposure prophylaxis following an animal bite or scratch. Although rabies immune globulin for post-exposure prophylaxis may be available in some areas of Guatemala, supplies can be uncertain; immune globulin for postexposure prophylaxis is not routinely available in Belize.

Recommend pre-exposure rabies prophylaxis to travelers who will be involved in outdoor activities (e.g., bicycling, camping, or hiking), especially in rural areas; people planning activities that place them at increased risk for exposure to dogs or wildlife (e.g., those who will have occupational exposure to animals); or those who will be visiting less developed, remote areas where access to medical care is limited. Children can be at particular risk due to exposure to dogs. Advise long-term travelers (e.g., humanitarian aid workers, faith-based workers) and their children to receive pre-exposure rabies prophylaxis (see Long-Term Travelers and Expatriates chapter).

Scorpions, snakes, and other venomous wildlife

A wide variety of scorpion, snake, and spider species, including venomous varieties, can be found in both Guatemala and Belize (see Poisonings, Envenomations, and Toxic Exposures During Travel chapter).

The striped bark scorpion (Centruroides spp.), pale-yellow in color with 2 dark stripes on its carapace, is highly venomous and commonly found in both Guatemala and Belize. In Guatemala, scorpions are more prevalent in the eastern jungles and in sites around Lake Atitlán. Guatemala and Belize have 18 species of venomous snakes (e.g., coral snakes, various pit vipers, and the neotropical rattlesnake), with some bites posing a risk for serious injury, including death. The Chilean recluse spider (Loxosceles laeta) and black widow spider (Latrodectus spp.) are venomous spiders found in Guatemala and Belize. Antidotes and antivenoms are available at some locations in Guatemala and Belize; anyone experiencing a bite should quickly seek medical attention.

Beach and ocean exposures

Many of the Pacific Ocean black sand beaches in Guatemala are known for dangerous undertow, large waves, and steep drop-offs; multiple drownings happen each year. Even strong swimmers can be at risk, and children should be supervised anywhere near the water's edge.

Belize is known for its beaches and diving opportunities, but divers should be advised to seek a reputable diving company with a strong safety record (see Scuba Diving: Decompression Illness and Other Dive-Related Injuries chapter). Beginner divers should ensure that their diving plans are commensurate with their level of experience. Sharks are known to be present in the waters off Belize, and swimmers and divers should seek local guidance.

The invasive lionfish is found in waters off Belize; the spines of the lionfish are venomous and can cause intense pain and discomfort for humans who are pricked. Treatment involves hot water, analgesics, and antihistamines, and may require medical attention. Divers should review safety instructions before engaging in lionfish spearing. Lionfish can be eaten safely. There is little information regarding lionfish off the small Caribbean coast of Guatemala.

Ciguatera poisoning

Ciguatera poisoning occurs when consuming reef fish that have high concentrations of ciguatoxin in their flesh (see Food Poisoning from Marine Toxins chapter). Ciguatera poisoning has been rarely reported in Belize, with the few reported cases related to consumption of barracuda but not lionfish. There have been investigations of fish with ciguatoxin bioaccumulation on the Caribbean coast of Guatemala but little documentation of human cases. Travelers should be aware of nausea, vomiting, and neurologic symptoms such as tingling fingers, tingling toes, or a sensation of hot-cold temperature reversal. Instruct travelers to seek medical attention if any of these symptoms develop.

Harmful algal blooms

Guatemala periodically experiences harmful algal blooms on the Pacific coast (see Food Poisoning from Marine Toxins chapter). Paralytic shellfish poisoning is a potentially serious risk for people consuming bivalve mollusks (e.g., clams, oysters, mussels, scallops) harvested during these periods. When conditions warrant, Guatemala's Ministry of Agriculture can impose bans on harvesting and eating shellfish; advise travelers to follow local instructions. Alerts may be published by the Ministry of Health and other government entities and disseminated via local news sources. Recommend travelers to avoid swimming during harmful algal blooms; exposure can cause eye and skin irritation.

Climate and sun exposure

The climate in Guatemala and Belize varies significantly by region. Remind travelers of the risk of sun exposure during outdoor activities, even in predominately temperate high-elevation areas (see Sun Exposure in Travelers chapter). In many of the urban or tourist areas, broad-spectrum sunscreen may be available for purchase. Advise travelers going to more rural areas to purchase sunscreen prior to departure and to take it with them in their travel health kit (see Travel Health Kits chapter).

Natural disasters

Earthquakes and volcanoes

Guatemala is one of the most seismically and volcanically active countries in the world. Past earthquakes define the landscape of colonial ruins in Antigua, Guatemala, but frequent high intensity earthquakes have brought significant destruction in areas throughout the country as recently as 2012. Smaller earthquakes occur frequently and occasionally cause fatalities due to landslides and infrastructure damage. Alert travelers to the importance of understanding and adhering to evacuation instructions and to be aware of designated meeting areas near large buildings.

Guatemala has 3 currently active volcanoes (Pacaya [2,552 m; 8,373 ft], Santa María/Santiaguito [3,772 m; 12,375 ft], Volcán de Fuego [3,768 m; 12,362 ft]) and multiple other dormant and extinct volcanoes. In 2018, eruptions from Volcán de Fuego resulted in landslides that killed over 200 people and destroyed many homes. As with earthquakes, counsel travelers to be aware of local news related to volcanic activity; advise them to work only with reputable guides and to practice caution when mountaineering around active volcanoes.

Seasonal flooding, hurricanes, and tropical storms

Guatemala and Belize are affected by Atlantic hurricanes, and Pacific storms can also affect Guatemala, with the season lasting from mid-May to November. Remind travelers to follow weather reports of hurricanes, tropical storms, or heavy rainstorms, which can provoke catastrophic flooding and landslides, even significantly inland. Make sure travelers know to never enter a flooded roadway and to be mindful of the potential for increased incidence of diarrheal illnesses and mosquito-borne diseases after certain weather events.

Safety and security

Crime and security

Crime can be an important consideration in both Guatemala and Belize. Encourage travelers to consult the U.S. Department of State website for critical safety and security alerts pertaining to their intended destinations within Guatemala, including areas considered as "do not travel" due to elevated risk due to crime. Educate travelers about the U.S. Department of State's Smart Traveler Enrollment Program (STEP), which sends electronic updates to enrolled travelers about safety conditions at their destination.

Advise visitors going to Guatemala or Belize to travel in groups and stay on main roads. Theft and robbery are the most common forms of crime in Guatemala, although narcotics-related violence exists in some areas (see Safety and Security Overseas chapter).

Although Belize generally poses a lower risk for crime, the U.S. State Department notes travelers should exercise increased caution, particularly in parts of Belize City. Travelers can find specific up-to-date information for this location and others on the U.S. Department of State website.

Political unrest

Protests occur with some regularity in Guatemala, both in urban areas and through nationwide blockades of roadways. These typically well-publicized blockades can complicate transit and cause localized skirmishes. Land disputes in some areas of Guatemala have a history of violence, so encourage travelers to consult reputable local guides before traveling in rural areas. While less common, political demonstrations can also occur occasionally in Belize, and travelers should follow local media reports and avoid large gatherings.

Traffic-related injuries

Remind travelers going to Guatemala or Belize to use a seat belt (and age-appropriate car seat or booster seats for families with children) when riding in a car and to wear a helmet when riding a bicycle or motorbike (see Injury and Death During Travel chapter). Travelers with children (see Traveling Safely with Infants and Children chapter) should be advised to carry car seats with them as they may be difficult to locate in-country. Injuries pose a significant threat to travelers in Guatemala, with road-related mortality steadily rising according to the World Bank. Guatemala's roadway system is often in poor repair, with steep drop-offs in mountainous areas and washouts in low-lying areas.

Roadway and boating accidents are likewise a concern in Belize. Trauma services outside of (and even within) larger cities are limited. Driving at night through the countryside can be dangerous and should be avoided.

Availability and quality of medical care

Good quality health care is available in Guatemala City through larger private hospitals. Some private hospitals with 24-hour service are also available in Belize City (Belize Medical Associates, Healthcare Partners Limited, Universal Health Services). The public hospital systems, even in larger cities, face significant resource limitations in both countries. Medical services in rural areas may be extremely limited. Payment (cash or, in some cases, credit card) is likely to be required before care is given. U.S. health insurance is not accepted. Discuss with patients the importance of purchasing travel health insurance and medical evacuation insurance, as well as packing a first aid kit (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance and Travel Health Kits chapters).

Medical tourism

Medical tourism is a growing industry in Guatemala, with many internationally trained physicians providing care. Nonetheless, concerns include the inability to manage unforeseen emergencies, infection with antimicrobial-resistant strains of bacteria, and a general lack of oversight. Potential medical tourists should be aware of the additional inherent risks associated with surgery, medical procedures, and traveling while being treated for a medical condition or during recovery (see Medical Tourism chapter).