Paraguay Travel Health Guide: Malaria-Free Since 2018, the Americas' Third-Highest Dengue Burden, and the Chagas Risk Most Guides Skip

Paraguay was certified malaria-free by the World Health Organization in 2018, the first country in the Americas to reach that milestone since Cuba in 1973. Dengue is the real story now: Paraguay logged 257,667 suspected cases in 2024, ranking third in the entire Americas region behind only Brazil and Argentina, according to WHO, and a newly detected DENV-3 serotype has kept transmission active into 2026. Chagas disease, spread by triatomine kissing bugs, remains endemic enough that Paraguay is one of the hardest-hit countries in the hemisphere, though vector transmission has been officially interrupted in its eastern regions. The country has no altitude risk and carries a Level 1 US travel advisory. In our clinical experience, dengue prevention, not malaria pills, is what most US travelers to Paraguay get wrong. Start your visit on Wandr before you fly.

By The Wandr Health Team Last updated: September 24, 2026

Quick Facts: Paraguay Health at a Glance

• Region: South America, landlocked, bordered by Argentina, Brazil, and Bolivia. Major draws: the capital Asuncion, the Itaipu Dam and Parana River on the Brazilian border, the Chaco wilderness, and the Jesuit mission ruins near Encarnacion.
• CDC/WHO Malaria Risk: None. The World Health Organization certified Paraguay malaria-free in 2018 after eliminating locally transmitted malaria nationwide.
• Key Health Risks: Dengue, the country's most active mosquito-borne threat with a newly circulating DENV-3 serotype; endemic Chagas disease from triatomine bugs; a CDC chikungunya watch notice; and standard traveler's diarrhea from food and water.
• Recommended Vaccines: Hepatitis A for essentially all travelers, typhoid, a routine tetanus booster if more than 10 years since the last dose, hepatitis B for longer stays, and yellow fever for travelers arriving from or transiting a yellow-fever-endemic country.
• Recommended Medications: A prescription antibiotic for traveler's diarrhea, something for general nausea, and acetaminophen (not ibuprofen) on hand in case of a dengue-like fever.
• US State Department Advisory: Level 1, Exercise Normal Precautions, updated September 17, 2026, with five northeastern border departments rated Level 2, Exercise Increased Caution, for cross-border crime.
• Travel Insurance Recommended: Yes. Care in Asuncion is reasonably strong, but a dengue admission, a Chagas evaluation, or any serious illness outside the capital benefits from evacuation coverage.

Overview: A Malaria Success Story With a Mosquito Problem That Isn't Going Away

Paraguay does not get the tourism attention its neighbors Argentina and Brazil do, but it draws a steady stream of US travelers heading to Asuncion, the Itaipu Dam (the world's second-largest hydroelectric plant, shared with Brazil), the Jesuit mission ruins near Encarnacion, and the vast, sparsely populated Chaco region. The country's own health story is genuinely two-sided. On one hand, Paraguay pulled off one of the more complete public health wins in the hemisphere: zero locally transmitted malaria, certified by WHO in 2018. On the other hand, it has spent the last several years near the top of the Americas' dengue case counts, a mosquito-borne disease with no Wandr-catalog cure and a real need for prevention-first thinking.

Most generic Paraguay guides either skip the health section entirely or default to a short paragraph about malaria that no longer applies. That leaves out the disease that actually matters for a 2026 trip: dengue, which has surged across South America's Southern Cone in the last two years and shows no sign of slowing in Paraguay specifically. This guide walks through what is actually relevant, what is not, and how to prepare for a country that is far safer on the disease front than it looks at first glance, provided you take the mosquito risk seriously.

Malaria: Eliminated, and Certified by WHO in 2018

You do not need antimalarial medication for any standard Paraguay itinerary. The World Health Organization certified Paraguay malaria-free in June 2018, making it the first country in the Americas to reach that status since Cuba in 1973. The scale of the turnaround is worth stating plainly: Paraguay reported more than 80,000 malaria cases in the 1940s, then worked the number down to zero, with the last confirmed Plasmodium falciparum case recorded in 1995 and the last P. vivax case in 2011. WHO Director-General Dr. Tedros Adhanom Ghebreyesus called it proof of concept for the region, noting that "if malaria can be eliminated in one country, it can be eliminated in all countries." Paraguay's own health ministry has since focused on maintaining that status through active surveillance rather than resting on the certification.

If your itinerary continues on to a malaria-endemic country, elsewhere in the Amazon basin or in Africa, for example, our clinical team can prescribe Malarone (atovaquone-proguanil) as part of your pre-trip visit. Paraguay itself does not require it.

Dengue: The Real Mosquito-Borne Risk, and the Americas' Third-Highest Burden

This is the section a generic Paraguay guide skips, and it is the one that actually matters. According to the World Health Organization's own 2024 disease outbreak assessment, Paraguay logged 257,667 suspected dengue cases as of late April 2024, placing it third among all countries in the Americas by total case count, behind only Brazil (6.3 million suspected cases) and Argentina (roughly 421,000), and ahead of Peru. For a country of about 6.8 million people, that is an extraordinary share of the regional burden, and it reflects a broader Southern Cone surge: the Americas region overall saw more than 7.5 million suspected dengue cases and over 3,500 deaths in that same reporting period, nearly triple the case count from the same point in 2023.

The outbreak has not resolved since. Paraguay's Ministry of Public Health has continued to report active transmission across multiple departments, including Asuncion, Central, San Pedro, Cordillera, and Paraguari, and in 2025 authorities confirmed a newly circulating DENV-3 serotype in the city of Aregua, a detection significant enough that a 2026 peer-reviewed genomic investigation was published documenting DENV-3's re-emergence in Paraguay after roughly two decades of absence. That matters clinically: a second dengue infection with a different serotype than a person's first tends to produce more severe illness than the initial infection, which is part of why health authorities responded to the Aregua detection by neutralizing more than 1,200 mosquito breeding sites in the area. Paraguay also launched its first-ever dengue vaccination campaign in November 2025, targeting children ages six to eight, a sign of how seriously the country is now treating the disease, though that pediatric program has no bearing on adult US travelers.

"In our experience, travelers spend a lot of pre-trip energy worrying about a malaria pill they don't actually need in Paraguay, and almost none on the mosquito bite prevention that would meaningfully lower their real risk," says Alec Freling, MD, emergency medicine physician and co-founder of Wandr Health. "Dengue looks like a bad flu at first: sudden high fever, severe headache, pain behind the eyes, joint and muscle pain. There's no antiviral cure, so prevention with repellent and covering exposed skin is genuinely the best tool a traveler has. And if you do develop that fever pattern during or after a Paraguay trip, avoid ibuprofen and other NSAIDs until dengue has been ruled out, because they can worsen the bleeding risk dengue is already associated with. Acetaminophen is the safer choice for fever and pain in that scenario."

Practically, that means daytime mosquito bite prevention matters as much here as anywhere in this guide's series: use an EPA-registered repellent (DEET, picaridin, or IR3535), wear long sleeves and pants where practical, and use screens or air conditioning over open windows, since Aedes aegypti, the mosquito that spreads dengue, bites primarily during the day. For general travel-related nausea or fever discomfort while that picture sorts itself out, our clinical team can discuss ondansetron as part of your kit, alongside the acetaminophen-over-ibuprofen guidance above.

Chikungunya: A Lower-Profile Watch Notice Worth Knowing

Alongside dengue, the CDC currently maintains a Level 1 "Watch" travel health notice for chikungunya in Paraguay, meaning the agency advises practicing usual precautions rather than reconsidering travel, but flags that the mosquito-borne virus is circulating in the country. Chikungunya shares its main mosquito vector with dengue and causes a similar fever-and-joint-pain illness, though joint pain from chikungunya can linger for weeks or months in some patients. The prevention overlap with dengue is complete: the same repellent, clothing, and screening precautions cover both diseases. Read more in our dedicated chikungunya guide for the vaccine conversation, which is worth having with our clinical team if you fall into a higher-risk category or plan extended time outdoors.

Chagas Disease: Endemic, and Widely Misunderstood

This is the risk almost no Paraguay travel guide mentions, and it deserves a clear-eyed explanation rather than alarm. Chagas disease, caused by the parasite Trypanosoma cruzi, spreads primarily through the feces of triatomine bugs, commonly called "kissing bugs" because they tend to bite around the mouth and eyes at night, when an infected bug's feces can be rubbed into the bite wound or mucous membranes. According to the Pan American Health Organization, Chagas is endemic across 21 countries in the Americas, and Paraguay is among the hardest-hit nations in the hemisphere. Regionally, PAHO estimates roughly 6 million people are currently infected, another 70 million are at risk, and the disease causes about 30,000 new infections and 12,000 deaths every year across the Americas.

The genuinely encouraging news is specific to Paraguay: the country has achieved formal interruption of vector-borne (triatomine-to-human) transmission in its eastern region, certified in 2008, and in the Alto Paraguay department, certified in 2013. That means the highest-risk exposure route, contact with infected bugs inside poorly constructed rural housing, has been substantially reduced in large parts of the country through vector control and housing improvement programs.

"Chagas almost never affects a typical Asuncion hotel stay or a short Itaipu Dam day trip," says Mark Karam, PA-C, physician associate and co-founder of Wandr Health. "The exposure risk is concentrated in rural, adobe or thatch-roofed housing, particularly in the Chaco and other rural interior regions, where the bugs live in wall cracks and roof thatch and come out at night. If your itinerary includes extended rural homestays or camping in those areas, sleeping under a permethrin-treated bed net and avoiding contact with the bugs themselves is the real prevention step, since there's no vaccine for Chagas." Acute infection can cause fever, rash, and swelling near the bite site, though many people have no noticeable acute symptoms at all; left undiagnosed, roughly 30% of chronically infected people eventually develop cardiac complications over years to decades. Any traveler with a known triatomine bite or unexplained fever after extended rural travel in Paraguay should seek prompt medical evaluation, since early treatment is more effective than treatment started after the disease has become chronic.

Yellow Fever: Not Required for Most Itineraries, But Worth a Conversation

Paraguay does not currently report yellow fever transmission, and the country has not experienced a recent outbreak. Yellow fever vaccination is required under international health regulations if you are arriving from, or have recently transited through, a country with risk of yellow fever transmission, and it is generally recommended for travelers over 9 months of age given that several of Paraguay's neighbors, including parts of Brazil, do carry yellow fever risk. If your trip combines Paraguay with travel elsewhere in the Amazon basin or another yellow-fever-endemic country, confirm current requirements before you book, since entry rules can change with only a few months' notice. Schedule your vaccine appointment through Wandr to get this and your other pre-trip vaccines settled well before departure.

No Altitude Risk: The One Thing This Guide Doesn't Need to Cover

Unlike several of the destinations in this series, Paraguay poses essentially no altitude risk. The country is one of the flattest in South America, with its highest point, Cerro Pero, reaching only about 842 meters (2,762 feet), and virtually every tourist itinerary, Asuncion, Itaipu, Encarnacion, the eastern Chaco, sits at a low elevation with no acclimatization concerns. If your broader itinerary continues on to the Andes in Bolivia, Peru, or elsewhere, that is a separate conversation for that leg of the trip, not for Paraguay itself.

Food and Water Safety

Tap water in Paraguay, including in Asuncion, is not reliably safe for visitors to drink untreated. Stick to bottled or properly filtered water, avoid ice unless you know it was made from purified water, and be cautious with unpasteurized dairy, raw or undercooked meat, and food sitting out at room temperature, particularly from street vendors. As in most of the destinations in this series, ordinary traveler's diarrhea from food and water, not a single dramatic disease, remains the most common reason a Paraguay visitor ends up needing a prescription mid-trip.

What to Pack: Practical Medications

• Traveler's diarrhea: Azithromycin is our first-line prescription antibiotic; ciprofloxacin is a reasonable alternative when azithromycin is not appropriate. An antispasmodic (dicyclomine) can help with cramping.
• General nausea and fever discomfort: Ondansetron is useful for nausea from illness or travel; given the dengue picture above, our clinical team can also talk through acetaminophen-over-ibuprofen guidance for fever and body aches during your trip.
• Sleep and anxiety: Hydroxyzine can help with travel anxiety or disrupted sleep on the long connecting flights most US travelers need to reach Asuncion.
• Skin irritation: Clotrimazole-betamethasone cream is worth packing for Paraguay's hot, humid climate, which can aggravate fungal or heat-related skin irritation on longer trips.

Our providers review your health profile and itinerary before prescribing, so you get a kit that fits your actual trip rather than a generic list.

Vaccines: What to Get Before You Go

• Hepatitis A: Recommended for essentially all previously unvaccinated travelers, given the food and water safety picture described above.
• Typhoid: Recommended, particularly for travelers spending time outside major hotels and tourist restaurants, or visiting smaller towns and rural areas.
• Hepatitis B: Recommended for travelers at increased risk, including longer stays or higher-risk activity.
• Yellow fever: Required if arriving from a yellow-fever-endemic country; generally recommended for travelers over 9 months old given regional risk in neighboring countries.
• Routine tetanus-diphtheria booster: Confirm your status is current if it has been more than 10 years.

Vaccines on Wandr work differently from prescriptions: you pick a partner pharmacy location and time, we book the appointment, and the pharmacist administers your travel vaccines on-site. Schedule your vaccine appointments through Wandr before you fly.

Travel Advisory and Practical Safety

The US State Department rates Paraguay Level 1, Exercise Normal Precautions, its lowest and safest advisory tier, in an update last revised September 17, 2026. The advisory describes Paraguay as "generally a safe destination for travelers," with crime as the primary risk indicator, rated 3.5 out of 10 in severity, and petty theft flagged as the most common issue in tourist areas. Five northeastern departments, Alto Parana, Amambay, Canindeyu, Concepcion, and San Pedro, carry a higher Level 2, Exercise Increased Caution, rating specifically because of drug and weapons trafficking activity along the Brazilian border. This advisory is separate from, and has nothing to do with, the dengue, Chagas, or yellow fever information in this guide; each is tracked and updated independently. Most standard Asuncion, Itaipu, and Encarnacion tourist itineraries fall outside the higher-risk border departments, but review the current advisory before finalizing plans that include northeastern border travel.

Health and Safety Tips

• Use an EPA-registered mosquito repellent throughout the day, not just at dawn and dusk, since the Aedes aegypti mosquito that spreads dengue and chikungunya bites primarily during daylight hours.
• Avoid ibuprofen and other NSAIDs if you develop a fever during or after your trip until dengue has been ruled out; use acetaminophen instead and seek prompt medical evaluation.
• Avoid sleeping in poorly constructed rural housing without a permethrin-treated bed net if your itinerary includes extended rural stays, given the Chagas disease risk described above.
• Stick to bottled or filtered water throughout your trip, including in Asuncion, and avoid ice and unpasteurized dairy.
• Confirm current yellow fever entry requirements if your broader itinerary includes another South American country.
• Exercise extra caution and keep valuables secured in the five northeastern border departments flagged in the current US travel advisory.
• Carry a copy of your prescriptions and keep medications in their original, labeled packaging.

FAQ

Do I need malaria pills for Paraguay? No. The World Health Organization certified Paraguay malaria-free in 2018, the first country in the Americas to reach that status since Cuba in 1973, after eliminating locally transmitted malaria nationwide. If your itinerary continues to a malaria-endemic country afterward, our clinical team can prescribe Malarone for that leg of the trip.

Is Paraguay safe to visit in 2026? The US State Department rates Paraguay Level 1, Exercise Normal Precautions, its lowest advisory tier, in an update last revised September 17, 2026, describing it as generally safe with crime as the main risk factor. Five northeastern departments bordering Brazil carry a higher Level 2 rating due to trafficking activity, so most standard tourist itineraries in Asuncion and the interior fall outside the elevated-risk zones.

How big of a risk is dengue in Paraguay? Significant. Paraguay logged 257,667 suspected dengue cases in 2024, the third-highest total in the entire Americas region according to the World Health Organization, and a newly circulating DENV-3 serotype detected in 2025 has kept transmission active. Daytime mosquito bite prevention is the most effective tool available, since there is no antiviral treatment for dengue.

What should I do if I develop a fever after visiting Paraguay? Seek medical evaluation and avoid ibuprofen or other NSAIDs until dengue has been ruled out, since they can worsen the bleeding risk associated with dengue infection. Acetaminophen is the safer choice for fever and pain in the meantime, and our clinical team can help you think through symptoms during a Wandr visit.

Is Chagas disease a real risk for tourists in Paraguay? For a standard Asuncion or Itaipu Dam itinerary, the risk is low. Chagas disease, spread by triatomine "kissing bugs," is concentrated in rural, poorly constructed housing, and Paraguay has officially interrupted vector-borne transmission in its eastern region (2008) and Alto Paraguay department (2013). Extended rural homestays or camping carry more exposure risk, and a permethrin-treated bed net is a practical precaution.

Do I need a yellow fever vaccine for Paraguay? Not for a standalone Paraguay trip, unless you are arriving from a yellow-fever-endemic country, in which case it is required. It is generally recommended for travelers over 9 months old given yellow fever risk in some neighboring countries, particularly if your itinerary continues elsewhere in South America.

Is tap water safe to drink in Paraguay? No. Stick to bottled or properly filtered water throughout your trip, including in Asuncion, and be cautious with ice, unpasteurized dairy, and food from street vendors.

Do I need travel insurance for Paraguay? We recommend it. Medical care in Asuncion is reasonably strong, but a dengue-related hospitalization, a Chagas evaluation, or any serious illness while traveling outside the capital is meaningfully less stressful with evacuation and medical coverage in place.

The Bottom Line

Paraguay earned a genuine public health win with its 2018 WHO malaria-free certification, and its Level 1 US travel advisory reflects a country that is broadly safe for visitors. But dengue is a real and current threat, one that put Paraguay third in the entire Americas region for case counts in 2024 and has kept transmitting through a new DENV-3 serotype since. Chagas disease remains endemic in rural areas despite real elimination progress, and yellow fever is worth a conversation if your trip extends beyond Paraguay's borders. None of that calls for an elaborate medical kit, but it does call for serious daytime mosquito bite prevention, a clear acetaminophen-over-ibuprofen plan if a fever develops, and the right vaccines before you go. Our providers can build the right prevention plan for your specific trip. Start your visit on Wandr, or explore our full travel medication lineup and vaccine booking before you fly.

Planning a wider South American trip? Read our guides to Argentina, Brazil, Bolivia, and Uruguay.

This article is for general educational purposes and is not a substitute for personalized medical advice. Medication and vaccine recommendations depend on your individual health history, itinerary, and length of stay. This guide does not provide visa or immigration determinations; confirm current entry and yellow fever certificate requirements with the Embassy of Paraguay or the US Department of State before you travel. Get travel insurance with medical evacuation coverage before departure.

Sources

1. World Health Organization. WHO certifies Paraguay malaria-free (2018). https://www.who.int/news/item/11-06-2018-who-certifies-paraguay-malaria-free
2. World Health Organization. Disease Outbreak News: Dengue - global situation (2024 Americas case data, including Paraguay). https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON518
3. Pan American Health Organization (PAHO/WHO). Chagas disease topic page: regional burden and Paraguay elimination milestones. https://www.paho.org/en/topics/chagas-disease
4. Asuncion Times. A Dengue Fever Prevention Guide for Paraguay Residents and Visitors (DENV-3 detection in Aregua, vaccination campaign). https://asunciontimes.com/paraguay-news/health-news/dengue-fever-prevention-guide-for-paraguay-residents-and-visitors/
5. Re-emergence of DENV-3 in Paraguay after two decades: a genomic and epidemiological investigation. Emerging Microbes & Infections (2026). https://www.tandfonline.com/doi/full/10.1080/22221751.2026.2623695
6. Passport Health. Travel Vaccines and Advice for Paraguay (yellow fever, typhoid, hepatitis A/B guidance). https://www.passporthealthusa.com/destination-advice/paraguay/
7. CDC Travelers' Health. Chikungunya in Paraguay - Watch, Level 1 travel health notice. https://wwwnc.cdc.gov/travel/notices/watch/chikungunya-paraguay
8. Travel Advisory (aggregator of US State Department data). Paraguay travel advisory, Level 1. https://www.traveladvisory.io/advisory/paraguay
9. US Department of State. Paraguay Travel Advisory, Level 1, last updated September 17, 2026. https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories/paraguay-travel-advisory.html