Guidance

Costa Rica: migrant health guide

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

• From: Public Health England
• Published: 31 July 2014
• Last updated: 26 August 2021 — See all updates

Main messages

If the patient is new to the UK:

• explain to them how the NHS works and their entitlements healthcare
• discuss how this compares to the healthcare system they’ve been used to
• follow guidance on how to comprehensively assess new migrant patients
• ensure that they are up-to-date with the UK immunisation schedule
• ask about any travel plans the patient may have to visit friends and relatives in their country of origin

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

There is a risk of typhoid infection in Costa Rica.

Consider nutritional and metabolic concerns.

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

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 universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups

Hepatitis C

Costa Rica has a higher prevalence of hepatitis C than the UK, so consider screening for hepatitis C if other risk factors apply.

Malaria

There is a low risk of malaria in Costa Rica, mainly due to P. vivax , so:

• test any unwell patient who has travelled to or from affected areas of Costa Rica in the last year
• remember that malaria can be rapidly fatal

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

Chagas

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

• be alert for possible cases
• refer as appropriate

Travel plans and advice

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin. People who travel to visit friends and relatives (VFR travellers) should visit the Foreign and Commonwealth Office for overseas travel advice and National Travel Health Network and Centre (NaTHNaC) for country specific travel advice prior to leaving the UK.

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:

• darker skin
• those who are not often outdoors
• those who cover up most of their skin when outdoors

Vitamin A

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

Iodine

People from Costa Rica may be at risk of adverse health consequences due to excessive intake of iodine.

Women’s health

Reproductive health indicators

Reproductive health indicator	UK	Costa Rica
Number of children per woman¹	1.7	1.7
Use of contraception²	71.7%	70.9%

¹lifetime average; ²by woman of reproductive age or partner

No data are available on:

• mammography screening rates
• cervical cancer screening rates

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	71.8
Evangelical and Pentecostal	12.3
Other Protestant	2.6
Jehovah’s Witness	0.5
Other	2.4
None	10.4

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
Last updated 26 August 2021 + show all updates

1. 26 August 2021

   Updated country guidance on prevalence of communicable diseases and other health topics.

2. 31 July 2014

   First published.