Caribbean Middle America This section includes general information about health hazards as reported by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The region includes Antigua and Barbuda, Aruba, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Cuba, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Montserrat, Netherlands Antilles, Puerto Rico, St. Christopher and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Turks and Caicos Islands, and the Virgin Islands. The islands, a number of them mountainous with peaks 1,000 to 2,500 meters high, have a tropical climate with heavy rain storms and high winds at certain times of the year. Of the arthropod-borne diseases, malaria occurs in endemic form only in Haiti and in parts of the Dominican Republic. Diffuse cutaneous leishmaniasis was recently discovered in the Dominican Republic. Bancroftian filariasis occurs in Haiti and some other islands and other filariases may occasionally be found. Human fascioliasis due to Fasciola hepatica is endemic in Cuba. Outbreaks of dengue fever occur in the area, and dengue hemorrhagic fever has also occurred. Tularemia has been reported from Haiti. Of the foodborne and waterborne diseases, bacillary and amebic dysenteries are common and hepatitis A is reported, particularly in the northern islands. Schistosomiasis (bilharziasis) is endemic in the Dominican Republic, Guadeloupe, Martinique, Puerto Rico, and Saint Lucia, in each of which control operations are in progress, and it may also occur sporadically in other islands. Other hazards may occur from spiny sea urchins and coelenterates (coral and jellyfish) and snakes. Animal rabies, particularly in the mongoose, is reported from several islands.