* Malaria risk exists throughout the year below 1,500m (4,920ft), with moderate to high transmission risk in El Oro, Esmeraldas, Guayas, Los Rios, Manabi, Morona Santiago, Napo, Orellana, Pastaza, Pichincha and Sucumbios. There is no risk in Guayaquil or Quito.

** A yellow fever vaccination certificate is required from travellers over one year of age coming from infected areas. Vaccination against yellow fever is recommended if travelling to the east of the Andes. There is no risk in Quito, Guayaquil or the Galapagos Islands.

It is advisable to drink only bottled or sterilised water in Ecuador. Avoid unpasteurised dairy products. Only eat well-cooked meat and fish. Vegetables should be cooked and fruit peeled.

Vaccinations for tuberculosis and hepatitis B are sometimes recommended. Altitude sickness is a risk, particularly if flying directly into Quito (2,800m/9,186ft).

There are plenty of pharmacies in urban areas. Good medical care is available in Quito, Guayaquil, and most of the big cities. Medical facilities outside the major towns are limited. Acute surgical and cardiac services are not available on the Galápagos Islands; therefore, for more serious illnesses, patients may be evacuated to the USA. Health insurance (to include emergency repatriation) is strongly recommended.