Extremely severe diarrhea, sometimes accompanied by vomiting, is a symptom of cholera. This food and waterborne disease, which in acute cases can kill in hours, comes in epidemics. Outbreaks have been known to occur in Dominican Republic, so to be forewarned is to be forearmed. A cholera vaccine is available, but is only about 50% effective. The best way, therefore, to prevent cholera is to be careful about what you eat and drink (also see Diarrhea).
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Bilharzia or schistosomiasis is a disease caused by parasites found in the fresh water parts of the Dominican Republic. These parasites penetrate human skin, and worms grow inside the blood vessels of the body producing eggs which can, in severe and rare cases, damage the liver, intestines, lungs and bladder. Initial symptoms might include a rash or itchy skin; fevers, chills and muscle aches can follow one or two months later. Preventing bilharzia is simple enough: avoid swimming and bathing in rivers, lakes and ponds and, obviously, drinking the water. If you do bathe in danger areas, try not to spend longer than 10 minutes in the water and dry thoroughly with a towel. Covering yourself with DEET insect repellent will also provide you with some protection.