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Millions of American tourists flock to the Dominican Republic every year, chasing 1,000 miles of palm-studded coastline, shimmering turquoise waters, and a relaxing, sun-dappled retreat.

But fears are mounting over the safety of the Caribbean nation in the wake of the mysterious deaths of at least nine American tourists over the past 12 months, several of whom reported falling ill before their bodies were discovered in their hotels.

The shooting of legendary Red Sox slugger David Ortiz in the capital of Santo Domingo on June 9 has done little to quell tourist unease.

Now, some travelers are reconsidering their vacation plans, while Dominican officials scramble to contain a public relations nightmare in a country that relies heavily on American tourist dollars.

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“I’d have a degree of caution until we have some answers from the Dominican Republic about why these people are getting ill in these resort areas,” said Steve Jermanok, cofounder of Active Travels, a boutique travel agency based in Newton. “People are concerned, and it’s going to affect them if they don’t get to the bottom of this situation very quickly.”

More than 6.5 million visitors traveled to the Dominican Republic last year, including more than 2.7 million Americans, according to Dominican government data. The vast majority of those Americans passed through the country without incident: In 2018, 13 US citizens died of non-natural causes, per US State Department figures.

The country’s minister of tourism, Francisco Javier García, has assured visitors that the Dominican Republic is safe, calling the recent deaths “isolated and regrettable” in a statement this month. Dominican officials working with US authorities, including the FBI, have not determined whether the deaths are connected.

In April, before reports surfaced of the string of baffling tourist deaths, the State Department issued a “Level 2” travel advisory for the Dominican Republic, urging visitors to “exercise increased caution” due to violent crime, citing the “wide availability of weapons, the use and trade of illicit drugs, and a weak criminal justice system.” The State Department has not updated its guidance.

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Still, reports of these puzzling fatalities have given a few travelers and their families pause. Three Americans — a couple from Maryland and a woman from Pennsylvania — died within a few days of each other last month at nearby hotels in the same resort. Prior to their deaths, at least two Americans reported falling ill after drinking a beverage from their hotel minibar. Numerous others, including reality TV personality Melissa Rycroft and a group of Oklahoma high school graduates, said they got violently ill after vacationing there earlier this month.

“It’s too many things now. Too many people are sick and people are dying . . . it’s crazy,” said Yvette Gonzalez, coordinator of the Dominican Festival of Boston.

Boston is home to about 42,000 Dominicans, according to the most recent Census Bureau data. Originally from the Dominican Republic, Gonzalez, who now lives in Jamaica Plain, will travel there for a few days in August. She said she’s cautioned her daughter, who will leave for the island on Friday to visit family and possibly spend time in the resort-heavy city of Punta Cana, “to be careful and check everything,” and to pay close attention to her son, Gonzalez’s grandchild.

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“It’s certainly alarming and I keep wondering, what could this be? What’s going on there?” said Kate Mitchell, a doctoral candidate at Boston University’s School of Public Health, who returned from the Dominican Republic in May. She’ll make several more trips to the country over the next 18 months while she completes her research dissertation on maternal health at public hospitals there.

“It’s a part of the world I’m clearly quite invested in and plan to be spending more time in, so it’s on my mind,” she said.

On a Needham-based TripAdvisor forum for travelers to the Dominican Republic, a June 10 post by Ilovepuntacana19 titled “Anyone thinking of canceling?” has drawn more than 300 replies.

“I had just booked a November vacation the day before reports on these incidents started coming out. I am not canceling,” Darlene66 of Baltimore wrote. “Statistically speaking we should be fine.”

“Yes, we have cancelled and our friends also,” traveler Patty of Texas wrote.

Girlieduke of Vancouver wrote: “Not going! Life is too short to die on vacation . . . Everyone thinks it won’t happen to them but I can bet on it, the people who died thought the same thing.”

It’s still unclear how this flurry of bad press will affect the Dominican Republic’s vital tourism sector, which accounted for more than 17 percent of the country’s total GDP in 2017, according to the World Travel and Tourism Council.

The Dominican Republic clocked more than 2.4 million nonresident visitors arriving by international air in the first four months of 2019, an increase of 4.8 percent over the same period last year.

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But Dominican officials are clearly concerned. The Dominican government has reportedly hired crisis management specialists to help deal with media fallout. On Twitter, government spokesman Roberto Rodríguez Marchena has been promoting the hashtag #BeFairWithDR alongside stories touting the Dominican Republic as a safe and desirable tourist destination.

Early signs, meanwhile, point to trouble: New data from the travel search engine Kayak show searches for flights from the United States to the Dominican Republic dropped 19 percent during the first two weeks in June compared with the same time last year.

Spokeswoman Mary Maguire said most of AAA Northeast’s customers traveling to the Dominican Republic haven’t changed their plans, but “some have rerouted to other destinations and a few have canceled.”

The American Society of Travel Advisors, a trade group for travel agents, has advised its members against giving their clients definitive advice on whether to proceed with their trips to the Dominican Republic.

“Ultimately, it is the traveler who must make that decision,” ASTA said in a message to its members, “ideally doing so in an informed manner and in light of his or her own individual risk tolerance.” An ASTA spokeswoman declined to comment further.

Jermanok, of the Newton travel agency, said he hasn’t fielded any calls from vacationers hoping to visit the Dominican Republic soon, but that’s not unusual.

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His clients prefer to embark on their tropical getaways during New England’s bitter winters and don’t start planning until the fall.

But he wouldn’t be surprised if his clients opted for other sun-swept destinations, such as the Bahamas, Jamaica, Aruba, Saint Lucia, or Hawaii, which are all available to Bostonians by direct flight.

“I can’t blame them,” he said of tourists who may be rethinking their travel plans. “We’ve been there as a family, both Puerto Plata and Punta Cana, and loved it . . . so I hate to see this, but again, we need answers. Why are people getting sick?”


Deanna Pan can be reached at deanna.pan@globe.com. Follow her on Twitter @DDpan.