Guidance

Costa Rica: migrant health guide

Advice and guidance on the health needs of migrant patients from Costa Rica for healthcare practitioners.

Main messages

If the patient is new to the UK:

  • explain to them how the NHS works
  • discuss how this compares to the healthcare system they’ve been used to

Ensure that all patients are up-to-date with the UK immunisation schedule.

Ascertain any risk factors for hepatitis B infection that may indicate the need for screening, because Costa Rica has a low prevalence.

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin, and see National Travel Health Network and Centre (NaTHNaC), or the Health Protection Scotland websites (TRAVAX and fitfortravel), for travel advice.

There is a risk of malaria in some areas of Costa Rica.

There is a risk of typhoid infection in Costa Rica.

Be alert for possible cases of Chagas disease, and refer as appropriate, because there is a risk of chronic Chagas disease in migrants from Costa Rica.

Infectious diseases

Immunisation

Ensure that all patients, especially children, are up-to-date with the UK immunisation schedule. See Immunisation collection with complete schedules.

Tuberculosis

There is a low incidence of TB in Costa Rica (<40 cases/100,000), so:

  • routine screening for TB is not required
  • consider testing in patients (including children) who show signs and symptoms
  • be aware that TB is a notifiable disease

Sexually transmitted infections and HIV

Take a sexual history, and:

  • screen for STIs and HIV according to risk as specified in the UK national standards and guidelines
  • test all sexually active patients under the age of 25 for chlamydia

Costa Rica has a low rate of HIV (≤1%), so:

  • offer and recommend an HIV test if the patient:
    • falls into a high risk group
    • is newly registering in a high prevalence area
  • be advised that national guidelines do not recommend routine consideration of HIV testing of infants and children who have recently arrived in the UK

Hepatitis B

Costa Rica has a low prevalence of hepatitis B, so:

  • offer screening for hepatitis B to all pregnant women during each pregnancy
  • immunise appropriately babies born to mothers who are hepatitis B positive, and follow-up accordingly
  • be aware that the UK has a selective immunisation programme for hepatitis B

Hepatitis C

Costa Rica has the same or lower prevalence of hepatitis C than the UK, so ascertain any risk factors for HCV infection that may indicate the need for screening.

Travel plans and advice

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin, and see National Travel Health Network and Centre (NaTHNaC), or the Health Protection Scotland websites (TRAVAX and fitfortravel), for travel advice.

Malaria

There is a risk of malaria in Costa Rica, so:

Typhoid

There is a risk of typhoid infection in Costa Rica, so:

  • ensure that travellers to Costa Rica are offered typhoid immunisation and advice on prevention of enteric fever
  • remember enteric fever in the differential diagnosis of illness in patients with a recent history of travel to-or-from Costa Rica

Helminths

There is a risk of helminth infections in Costa Rica, including soil transmitted helminthiasis.

Chagas

There is a risk of chronic Chagas disease in migrants from Costa Rica, so:

  • be alert for possible cases
  • refer as appropriate

Women’s health

Reproductive health indicators

Reproductive health indicator UK Costa Rica
Number of children per woman¹ 2 2

¹lifetime average

No data are available on:

  • contraceptive use
  • mammography screening rates
  • cervical cancer screening rates

Nutritional and metabolic concerns

Anaemia

There is a low risk of anaemia in adults (estimated prevalence is 5 to 20%) and a moderate risk in pre-school children (estimated prevalence is 20 to 40%), so:

  • be alert to this possibility in recently arrived migrants, particularly for women and pre-school children
  • test as clinically indicated

Vitamin D

Consider the possibility of vitamin D deficiency in people who may be at risk due to:

  • covering their body for cultural or religious reasons (lack of sunlight)
  • skin colour
  • diet (vegan or vegetarian)

Vitamin A

There may be a risk of vitamin A deficiency in Costa Rica.

Iodine

People from Costa Rica may be at risk of iodine induced hyperthyroidism due to excessive intake

Country profile

Health indicators and health care

WHO Global Health Observatory provides a summary of health indicators and health care in Costa Rica.

Culture, politics and history

BBC News and The World Factbook have background information on the culture, politics and history of Costa Rica.

Languages

The main languages used in Costa Rica are:

  • Spanish (official)
  • English

Source: The World Factbook.

Religions

Religion Population (%)
Roman Catholic 76.3
Evangelical 13.7
Other 4.8
None 3.2
Jehovah’s Witness 1.3
Other Protestant 0.7

Source: The World Factbook.

Migration to the UK

There were over 600 people from Costa Rica living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics.

Published 31 July 2014