Mexico

Destination overview

Mexico, the second most populous country in Latin America (population >120 million), is the country most often visited by U.S. tourists. Many U.S. residents, particularly in the border region, travel to Mexico to visit friends and relatives, contributing to the nearly 200 million U.S.-Mexico land border crossings annually. The capital, Mexico City, is one of the world's largest cities (population >20 million) and is a popular destination for business and mass gathering events.

Mexico's diverse geography throughout its 32 states attracts travelers for nature, recreation, and sport. The country's rich history, diverse cuisine, and proud culture reflect its pre-Columbian and Hispanic past. In the past decade, Mexico has emerged as a popular destination for medical tourism (see Medical Tourism chapter). Table 11.2.3.1 provides popular tourist activities in Mexico and health risks by region.

Map 11.2.3.1

View LargerDownload

SOURCE:

Centers for Disease Control and Prevention

A map of Mexico displaying its states, major cities, and significant geographical landmarks. The map highlights the country's borders with the United States above and Guatemala and Belize below. The Gulf of America is located to the right, the Pacific Ocean and the Sea of Cortez are located to the left. Notable locations include Mexico City, Monterrey, Guadalajara, Cancún, and Tijuana. Important landmarks like Chichén Itzá, Palenque, Copper Canyon, and Popocatépetl volcano (5,426m) are marked. A small map in the bottom right shows a detailed view of the Mexico City region, including Teotihuacán and Pico de Orizaba (5,636m). Another small map in the top right corner shows Mexico’s position in North America.

Show Text Description

Table 11.2.3.1: Regional tourism highlights and health risks in Mexico

Infectious disease risks

All travelers should be up to date on their routine immunizations. Measles and mumps outbreaks in Mexico have coincided with worldwide and regional outbreaks. Hepatitis A is endemic to Mexico; visitors should receive ≥1 dose of the vaccine series before travel.

Enteric infections and diseases

Enteric infections commonly affect visitors to Mexico. Travelers should be advised to follow safe food and water precautions (see Food and Water Precautions for Travelers chapter). Tap water in Mexico is not safe to consume. Travelers, especially those going to remote areas, should avoid consuming the following: unpasteurized dairy products, particularly soft or fresh cheeses; raw or undercooked meat or fish; leafy greens; and raw fruit or vegetables. Remind travelers to avoid swallowing water when swimming or wading in recreational waters, including pools and lakes.

Cholera

Risk for cholera infection is low, with sporadic cases reported, the last occurring in 2018. Cholera vaccination is not recommended for travelers to Mexico.

Taeniasis and cysticercosis

Taenia solium and Taenia saginata are endemic to Mexico. Taeniasis, a tapeworm infection, is caused by ingestion of infected undercooked pork or beef. Eating undercooked vegetables contaminated with human feces containing T. solium larvae may lead to neurocysticercosis, a potentially disabling neurologic infection.

Travelers' diarrhea

Travelers' diarrhea frequently affects visitors to Mexico and typically develops after ingesting contaminated food or water. Gastrointestinal symptoms not responding to typical antibiotics for travelers' diarrhea may be caused by Giardia spp., other protozoa, or viruses.

Typhoid fever

Typhoid fever is endemic in Mexico and vaccination is recommended, especially for those visiting or staying in smaller cities or rural areas with poor sanitation conditions and limited access to clean water. Good hygiene practices will also minimize risk (see Typhoid and Paratyphoid Fever chapter).

Respiratory infections and diseases

Coronavirus disease 2019 and influenza

All travelers going to Mexico should be up to date with their COVID-19 vaccines. Influenza circulates seasonally in Mexico, usually October–May. All travelers should be up to date with the current season's influenza vaccine.

Endemic fungi

Coccidioides, which causes coccidioidomycosis or valley fever, is endemic to the soil of northwestern Mexico. Mitigation techniques include avoiding dust storms, keeping car windows closed when driving, and using an N95 respirator for activities around dusty air. Histoplasma, which causes histoplasmosis, is found mainly in Mexico's central and southeast regions. Avoiding areas with bird or bat droppings will minimize risk. For additional prevention measures, see the National Institute for Occupational Safety and Health valley fever and histoplasmosis websites.

Legionnaires' disease

Caution travelers that water systems, including air conditioners, spas, hot tubs, and saunas, pose a risk for pulmonary infection in susceptible populations. Legionellosis outbreaks have been reported at resorts in Mexico. Legionellosis should be included in the differential diagnosis of travelers who develop pneumonia within 14 days of travel, especially older and immunocompromised people (see Post-Travel Respiratory Infections chapter).

Tuberculosis

Mexico is considered a moderate-incidence country for tuberculosis. Travelers at risk for exposure should be assessed prior to travel. Risk is greatest among those staying in Mexico for prolonged periods of time, particularly if working around people with untreated tuberculosis (e.g., drug rehabilitation centers, healthcare settings, prisons, shelters; see Tuberculosis chapter).

Sexually transmitted infections and HIV

HIV prevalence in Mexico is low, except among high-risk populations (e.g., sex workers, injection drug users, men who have sex with men). Other sexually transmitted infections, including chlamydia, gonorrhea, and syphilis, are also more prevalent in these populations (see Sex and Travel chapter). Travelers should avoid condomless sex with unfamiliar partners (condoms are easily available for purchase in Mexico) and injection drug use. Hepatitis B vaccine is recommended for people expecting to stay in Mexico ≥6 months, medical tourists, or anyone who might be exposed to blood or body fluids, including through sexual contact.

Soil and waterborne infections

Cutaneous larva migrans

Cutaneous larva migrans, a creeping skin eruption commonly associated with dog hookworm infection, is a risk at less-visited beaches with stray dog and cat populations (see Post-Travel Dermatologic Conditions chapter). Resort areas have reduced their risk through stray animal removal programs. Caution travelers to wear shoes and avoid direct skin contact with soil and sand.

Vector-borne diseases

Mosquitoes, ticks, fleas, sandflies, and other arthropods which transmit pathogens are present across Mexico. Counsel travelers to take steps to prevent bites by avoiding outdoor activities at dusk and night, using insect repellent, wearing long-sleeved shirts and pants, and staying in accommodations with air conditioning or screens (see Mosquitoes, Ticks, and Other Arthropods chapter). Due to elevation, Mexico City remains a low-risk destination for most mosquito-borne illnesses.

Arboviruses: Chikungunya, dengue, and Zika

Dengue is endemic throughout central and southern Mexico, and sporadic periodic outbreaks occur in the northern states bordering the United States. Risk is minimal in Mexico City due to high elevation. Transmission is a risk year-round, with peak incidence reported May–November (see Dengue chapter).

Chikungunya virus (see Chikungunya chapter) has been present in Mexico, with the last major outbreak in 2015. Zika (see Zika chapter) has also been a risk, with the last major outbreak occurring in 2016. Zika may cause birth defects in infants born to mothers infected during pregnancy. Women who are pregnant or trying to become pregnant, as well as their sexual partners, should be aware of the most recent CDC recommendations.

Advise travelers to minimize exposure to mosquito bites.

Malaria

Malaria incidence has decreased dramatically in Mexico; Plasmodium vivax is the only endemic species (see Yellow Fever Vaccine and Malaria Prevention Information, by Country and Malaria chapters; and Map 1.5.31). Prophylaxis is recommended in Campeche, Chiapas, and southern Chihuahua (Map 11.2.3.1). Occasional cases are reported in Oaxaca, Sinaloa, Sonora, and Tabasco. Although one case of locally acquired P. vivax was reported in Texas near the Mexican border in 2023, there is usually no malaria transmission along the U.S.-Mexico border.

Map 1.5.31

SOURCE:

Centers for Disease Control and Prevention

A map of Mexico highlights malaria prevention recommendations. Areas shaded in orange signify places where both malaria prevention medication (chemoprophylaxis) and mosquito avoidance are recommended. This includes the states of Chiapas, Campeche, and an area in the southern part of Chihuahua. The states in brown indicate mosquito avoidance only. This includes the states of Sonora, Sinaloa, Oaxaca, and Tabasco. The rest of the country is shaded in beige, representing areas with no known malaria transmission, including major cities like Mexico City, Guadalajara, and Monterrey.

Show Text Description

Leishmaniasis

Sand flies that transmit cutaneous leishmaniasis are present in Mexico, with infections concentrated in Quintana Roo, the southern region, and Nayarit (see Leishmaniasis chapter). Risk is greatest in areas with moist, organic matter (e.g., jungle floor). Caution travelers to seek medical attention for bites/ulcers that fail to heal, particularly on the ear (Chiclero's ulcer).

Rickettsial diseases

Spotted fever group

Rocky Mountain spotted fever (RMSF; caused by Rickettsia rickettsii) and Rickettsia parkeri are transmitted by ticks present in Mexico. Cases are concentrated in northern border states but occasionally are reported in Sinaloa, Yucatán, and Veracruz. In 2023, numerous fatalities resulted from an RMSF outbreak in Baja, California. Advise travelers to avoid ticks and conduct tick checks. Risk for tick exposure increases in grassy, brushy, or wooded areas and during close contact with dogs or other mammals on which ticks feed. Advise travelers to seek prompt medical attention for fever, headache, or rash (see Mosquitoes, Ticks, and Other Arthropods chapter).

Typhus group

Flea-borne murine typhus (Rickettsia typhi) circulates in Mexico and may be underreported because symptoms are similar to dengue fever. Risk is low among tourists, but travelers should avoid fleas and their hosts, particularly domestic animals.

Trypanosomiasis

Chagas disease, caused by Trypanosoma cruzi and transmitted by triatomine insects, is endemic throughout Mexico. Most cases occur along the southern and central regions. Tourists are generally at low risk due to higher-quality lodging. Caution travelers to consider using bed nets in poor-quality housing (mud or adobe walls, thatched roofs, and screenless windows). Advise travelers to seek medical attention for unilateral swelling of the eyelid (Romaña's sign). As of 2012, blood donations in Mexico are screened for Chagas disease.

Environmental hazards and risks

Air pollution

Air pollution in Mexico City has decreased in recent years. It can still be severe during the dry winter months, exacerbating asthma and aggravating chronic lung and heart conditions. Advise travelers to check air quality prior to outdoor activities in Mexico City (see Air Quality and Ionizing Radiation During Travel chapter).

Altitude illness

Mexico City is over a mile high (2,250 m; 7,382 ft). Healthy travelers from lower elevations and people with heart and lung conditions might require an acclimatization period (see High-Altitude Travel and Altitude Illness chapter).

Animal bites

Rabies

Mexico is free of dog-maintained rabies virus (see Rabies chapter). Other mammals, including coatis, foxes, skunks, and bats, are reported carriers of rabies virus. Pre-exposure rabies prophylaxis is recommended for ecotourists, biology or field researchers, those at increased risk for wildlife exposure, or those traveling in areas with limited access to medical care. Rabies immune globulin for post-exposure prophylaxis is available in Mexico.

Scorpions, snakes, and other venomous wildlife

Many harmful arthropods are endemic to Mexico, including widow (Latrodectus spp.) and recluse (Loxosceles spp.) spiders, fire ants, wasps, and bees (see Poisonings, Envenomations, and Toxic Exposures During Travel chapter). Caution travelers with known allergies to take appropriate precautions (see Severely Allergic Travelers chapter).

Mexico is home to the highest scorpion biodiversity in the world, including the potentially lethal Centruroides genus (bark) scorpion. Scorpions are most active at night during warmer months in the central-Pacific region. Advise travelers to shake out shoes, clothing, and bedding. Pit vipers (Agkistrodon, Bothrops, and Crotalus spp.) and coral snakes (Micruroides spp.) are also present. High-risk travelers (ecotourists, field biologists) should take precautionary measures and inquire about antivenom availability at local facilities.

Beach and ocean exposures

Marine envenomation

Stingrays, jellyfish, and sea urchins are abundant along Mexico's coasts, particularly during spring and summer when coastal waters are warmer (see Poisonings, Envenomations, and Toxic Exposures During Travel chapter). Caution travelers to shuffle feet when entering warm, shallow waters, and watch for sea urchins in shallow waters or near rocky shorelines.

Sargassum seaweed

Sargassum (brown seaweed) season occurs April–August along Mexico's Caribbean coastline. Exposure to decomposing seaweed can result in difficulty breathing, headaches, nausea, and skin eruptions called "swimmers' dermatitis." Advise travelers to avoid direct skin exposure to Sargassum seaweed, rinse with copious amounts of freshwater if exposed, and seek medical attention if they experience respiratory trouble.

Climate and sun exposure

Mexico's climate varies by region, season, and elevation. Ultraviolet rays intensify at southern latitudes. Travelers engaging in outdoor activities should use broad-spectrum sunscreen (readily available for purchase in Mexico) and limit prolonged or repetitive sun and heat exposure to avoid sunburn and heatstroke (see Sun Exposure in Travelers and Heat and Cold Illness in Travelers chapters).

Natural disasters

Earthquakes and volcanoes

Sitting atop 3 large tectonic plates, Mexico is one of the most seismically active countries in the world. Most earthquakes occur in the south and along the Pacific coast. Travelers should follow audible earthquake early warning systems and evacuation instructions, typically posted in large buildings.

Mexico is home to several active volcanoes. Eruptions may disrupt travel or pose health risks to those with asthma or other lung conditions. Masks are recommended in the event of volcanic ash.

Hurricanes

Hurricane season extends from May through November. Travelers, especially to coastal regions, should be alert to weather reports. After heavy rainstorms, travelers should be mindful of the potential increased incidence of diarrheal and mosquito-borne diseases. In 2023, category 5 Hurricane Otis and, in 2024, category 4-5 Hurricane Milton resulted in significant damage to infrastructure in and around Acapulco. Advise travelers to be aware of recent storm damage and current weather reports because storms may intensify quickly and unexpectedly.

Toxic exposures

Carbon monoxide and gas exposures

Advise tourists to confirm the presence of a functional carbon monoxide monitor at their lodging (see Air Quality and Ionizing Radiation During Travel, and Poisonings, Envenomations, and Toxic Exposures During Travel chapters). Tourists have been reported to have fallen ill or died due to carbon monoxide or gas leaks.

Lead

Lead may be present in traditional Mexican pottery. The U.S. Food and Drug Administration (FDA) strongly advises against using pottery with leachable lead for cooking, serving, or storing food and drink. Lead-testing kits can help assess safety.

Mercury

Occasional reports of severe mercury poisoning associated with use of Mexican skin-lightening creams as recently as 2019 should serve as a warning against the purchase of any cosmetics that claim to treat acne, lighten the skin, or fade freckles or age spots.

Safety and security

Crime

Although travel to Mexico is generally considered safe, thefts and robberies do occur, and drug-related violence exists. Advise travelers to be aware of their surroundings and personal belongings, particularly in crowded tourist venues. Advise U.S. citizen travelers to enroll with the Department of State's Smart Traveler Enrollment Program (STEP); STEP will provide travelers with information and alerts from local U.S. embassies or consulates about disasters, safety, and security issues at their destination.

Political unrest

Frequent protests occur in the big cities. Demonstrations are usually peaceful but can be large and worsen already congested traffic. When possible, travelers should avoid protests and the surrounding areas.

Traffic-related injuries

Injuries pose the greatest life threat to healthy travelers in Mexico (see Injury and Death During Travel chapter). Mexico's roads are mostly modern, well-maintained, and safe. Toll highways are often of higher quality. Nevertheless, driving in city traffic and at night through the countryside can be dangerous. Remind travelers to use seat belts when riding in cars and helmets when riding a bicycle or motorbike. The Angeles Verdes mobile app provides emergency mechanical assistance, toll services, and tourist information to drivers on toll highways. Travelers in Mexico may dial 078 for roadside assistance.

Availability and quality of medical care

Good health care is available in most cities in Mexico, and tourist hotels and resorts usually have physicians available. Payment (cash or credit card) might be required before any care is given. Most providers do not accept U.S. health insurance or Medicare/Medicaid plans.

Medical tourism

Many U.S. residents visit Mexico to receive health services, primarily cosmetic surgery, dental care, and eye care services from healthcare professionals in northern border cities and in growing markets in Cancun, Guadalajara, Merida, Mexico City, and Monterrey (see Medical Tourism chapter). Advise medical tourists of the inherent risks associated with medical procedures and traveling during treatment for, or recovery from, medical conditions, as well as the potentially different medical practices and standards between the United States and Mexico. People considering travel to Mexico for medical procedures are advised to consult with a U.S. healthcare professional ≥1 month before departure and to verify healthcare professional qualifications and facility credentials in Mexico.

In recent years, there have been concerning epidemiologic events associated with medical tourism in Mexico, including an outbreak of fungal meningitis caused by Fusarium solani associated with epidural anesthesia in cosmetic procedures, Legionella infection associated with dental procedures, nontuberculous skin infections associated with stem cell injections, and carbapenem-resistant Pseudomonas aeruginosa acquired during bariatric surgery.

Many people travel to Mexico to purchase more affordable prescription drugs. The FDA recommends only purchasing medications from legal sources in the United States to ensure safety and effectiveness. In 2023, the State Department issued warnings regarding counterfeit pills tainted with lethal doses of fentanyl and methamphetamine at English-speaking non-chain pharmacies located in tourist areas.

Acknowledgements

The following authors contributed to the previous version of this chapter: Kathleen Moser and Alba Phippard.