Time Zone: -2 hours GMT (Rio and Sao Paulo are -3 hours April to October). Brazil spans 4 time zones.
Tel. Country Code: 55
USADirect Tel.: 0
Electrical Standards: Electrical current 110/60 or 220/60 (volts/hz). North American Style Adaptor Plug and European Style Adaptor Plub. Grounding Adaptor Plugs A, D.
Travel Advisory - Brazil
Travelers to Central and South America and the Caribbean need to protect themselves against mosquito-transmitted viruses, such as dengue and Zika, as well as nighttime biting mosquitoes in countries where there is the threat of malaria. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.
Dr. Rose Recommends for Travel to Brazil
• U.S. Embassy
Avenida das Nacoes, Lote 3
The American Citizen Services (ACS) unit at the U.S. Embassy in Brasilia, at the U.S. consulates in Rio de Janeiro, São Paulo and Recife and the Consular Agencies in Brazil provides a wide range of services to U.S. Citizens resident or traveling in Brazil.
SES - Av. das Nações, Quadra 803, Lote 16
70410-900 Brasília DF – Brazil
Telephone: (55 61) 3424-5400
HIV Test: Not required
Required Vaccinations: Brazil currently does not require yellow fever vaccination for entrance into the country. However, travelers are strongly urged to get the yellow fever vaccine before traveling to an area of Brazil with risk of yellow fever transmission (see below).
Passport/Visa: A passport and visa are required for U.S. citizens traveling to Brazil for any purpose. Brazilian visas must be obtained in advance from the Brazilian Embassy or consulate nearest to the traveler's place of residence. There are no "airport visas" and immigration authorities will refuse entry to Brazil to anyone not possessing a valid visa. All Brazilian visas, regardless of the length of validity, must initially be used within 90 days of the issuance date or will no longer be valid. Americans reentering Brazil must be able to show an entry stamp in their passport proving that the visa was issued within 90 days.
For current entry and customs requirements for Brazil, travelers may also contact the Brazilian Consulate in Washington, DC.
Additionally, travelers who have recently visited certain countries, including most other Latin American countries (check Brazilian Consuate website link above), may be required to present an inoculation card indicating they had a yellow fever inoculation or they may not be allowed to board the plane or enter the country.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers.
Hepatitis B: Recommended for all non-immune travelers who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from unscreened blood transfusions. Recommended for any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites, especially bites from vampire bats and dogs. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for treatment with the vaccine.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: Yellow fever vaccine is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas.
• Yellow fever vaccine is RECOMMENDED for all those >9 months of age traveling to areas in Brazil where yellow fever occurs, which includes all areas in the states of Acre, Amapa, Amazones, Goias, Maranhao, Mato Grosso, Mato Grosso do Sol, Minas Gerais, Para, Rondonia, Roraima, and Tocantins, and parts of the states of Bahia, Parana, Piaui, Rio Grande do Sul, and Sao Paulo (see the CDC map for details). Yellow fever vaccine is recommended for Iguacu Falls, but is not necessary for the coastal cities, including Rio de Janeiro, Sao Paulo, Salvador, Recife, and Fortaleza.
Hospitals / Doctors
&itemmenuMedical care is generally good, but it varies in quality, particularly in remote areas, and it may not meet U.S. standards outside the major cities. All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea (moderate to high risk) or other infections (e.g., a urinary tract infection); they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; may be counterfeit, or be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. In the event of a serious illness or injury that can't be treated adequately in this country, you should be flown by air ambulance to the U.S.
The U.S. Embassy maintains a list of hospitals and doctors.
Medical facilities include:
• de Base de Hospital Brasilia
Most specialty services including trauma; 24-hour emergency room.
• Albert Einstein Hospital
Av. Albert Einstein, 627/701
Excellent facility, regularly used by expatriates. Offers broad range of state-of-the-art specialty services.
Accredited by the Joint Commission International and the Consortium for Brazilian Accreditation.
• Hospital Samaritano
Rio de Janierio
Many expatriates go to Hospital Samaritano which specializes in cardiac care but offers other specialty services.
Rio de Janiero
Complete Cardiaac Care
Emergência (21) 2527 6060
Advanced facility with CT, MRI, ultrasound, but nursing care may not be adequate.
• Travel Health ASSIST
The Clínica de Medicina do Viajanten is the first clinic of Travel Medicine in Curitiba and it is the only one in Parana State that is operated by members of International Society of Travel Medicine (ISTM). It also offers services of diagnostic evaluation of disease related to any journey, emission of certificates, evaluation of expatriates, evaluation of tourists in transit and others.
• SAT Emergencia Medicas (Emergency Services)
24-hour medical care.
Destination Health Info for Travelers
AIDS/HIV: Brazil (by far the region’s most populous country) accounts for around 40% of people living with HIV in Latin America. Causative factors are heterosexual promiscuity, commercial sex, bisexuality, homosexuality (men having sex with men), and IV drug use. In some Brazilian cities, more than 60% of drug users are HIV positive.
The HIV prevalence rate in the adult population of Brazil is estimated at 0.5 percent. (Source: www.Avert.org)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Health insurance is essential.
SAFETY AND SECURITY
Violence and threatened violence is a common occurrence in Rio de Janeiro. You should be particularly vigilant before and during the festive and Carnival periods, as there is often a seasonal upsurge in robberies against foreigners around this time.
Slums or “favelas” exist in all major Brazilian cities; they are characterised by poverty and extremely high levels of violent crime. Do not venture into a favela, unless this is safely organised by a respected tour guide. Consult your tour representative or hotel for further advice.
Animal/Marine Hazards: Venomous Snakes: A wide variety of well-camouflaged, aggressive, and harmless-looking species, including neotropical rattlesnakes, lancehead vipers, Colubrid snakes, coral snakes, bushmaster snake, and hog-nosed pitvipers are present countrywide; many have potentially lethal venom. If bitten, seek urgent medical attention!
Forest Animals: Pumas, jaguars, and wild livestock will attack humans; large lizards can deliver painful bites; handling poisonous toads and dart frogs can result in death.
Prevention – Do not approach or disturb; use caution around watering holes, river/lake shorelines, and forested areas adjacent to human settlements.
• Centipedes, Millipedes, Bees/Wasps/Ants: Large specimens, common even in urban areas, are capable of inflicting painful bites, stings, or secreting fluids that can blister skin; Africanized honeybees are common and will sting in great numbers.
Prevention – Shake out boots/bedding/clothing prior to use; never walk barefoot; avoid sleeping on the ground; do not approach or disturb wasp/bee nests; seek medical attention if bitten/stung.
• Leeches: Common in marshes, ponds, streams, and rain forests; widespread on plant foliage during rainy season
Prevention – Wear DEET on exposed skin; as tactical situation permits, avoid wading in fresh or brackish water.
Hazardous Plants – Abundant and widespread toxic plants can cause skin/lung irritation if touched/burned and poisoning if chewed/eaten.
• Marine Animals: Venomous stingrays, cone shells, jellyfish, sea nettles, sea urchins, sharp corals, and man-eating sharks are present along ocean beaches.
Chagas’ Disease: Risk is present in most rural areas of eastern and southern Brazil in Bahias and Tocantins states. This disease is transmitted primarily in well-populated rural-agricultural areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take measures to prevent nighttime bites, especially bites to the face. Chagas disease can also be transmitted by beverages contaminated with triatomid bugs.
• In 2010, multiple outbreaks of Chagas disease have been reported from the northern states of Para, Amazonas, and Amapa, related to consumption of fruit juices, mainly those made from the berries of the acai and bacaba palms. The most recent were reported in January 2010 from the municipality of Santa Isabel do Rio Negro in Amazonas and in November 2009 from a district of Belem, Para state. In 2005, Brazilian health officials reported a widespread outbreak in which Chagas’ disease was transmitted through the consumption of contaminated sugar cane juice. Another outbreak was reported in July 2006 from Santarem township in western Pará state, apparently caused by contaminated bacaba wine.
This mode of transmission (consumption of food or juice or other beverages contaminated by triatomid bugs) may be particularly frequent among the settlers of Amazonian areas. Sugar cane juice (garapa) served at roadside stands should be avoided.
Cholera: This disease is reported sporadically in this country, but the threat to tourists is low. Cholera vaccine is usually recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (Ref: NEJM)
Dengue Fever: Dengue fever is widespread in this country. In fact, the historical incidence of dengue has been exceeded in all states in 2009, especially in Mato Grosso and Minas Gerais. The traditional peak season for dengue in Brazil is January through March. As of March 2008, the state of Rio de Janeiro has reported over 32,000 cases of dengue fever, including 245 cases of dengue hemorrhagic fever (DHF). The greatest number of cases have been reported from the states of Mato Grosso do Sul (along the border with Bolivia and Paraguay, countries which also suffered dengue epidemics this year), Sao Paulo, Rio de Janeiro, Parana and Maranhao. Risk is present year-round in Rio de Janeiro State and Sao Paulo and Ceara States. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in the South America. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.
A map showing the worldwide distribution of dengue fever is here.
Update November 2009: Certain countries in Central and South America, including Argentina, Brazil, Bolivia, Colombia, Paraguay, and Mexico, have experienced unusually high numbers of cases of dengue and dengue hemorrhagic fever during 2009. The peak of case reports occurred during January through May. Currently reported cases of dengue are on a decline in this region; however, there is still an ongoing risk of dengue in these areas.
Filariasis: Focally endemic in northeastern urban coastal areas, including Belem, Maceio, and Recife. Travelers to these regions should take measures to prevent insect (mosquito) bites.
Hepatitis: There is a moderate to high risk of hepatitis A in this country. All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but levels are unclear. A report in 1997 found a 6% seroprevalence rate in the Brazilian Amazon. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate is between 3% and 8%, but may approach 20% in some areas of the Amazon Basin. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at with a prevalence of 2.6% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Insect-Transmitted Viral Diseases: Oropouche fever (vectored by biting midges; explosive outbreaks occur), Mayaro virus disease (dengue-like illness, mosquito-vectored; attack rates up to 20% in the Amazon Basin, including Paro State), eastern equine encephalitis, St. Louis encephalitis, Western equine encephalitis, and Venezuelan equine encephalitis are reported. At least 30 other insect-borne viral illnesses are associated with illness in humans.
• All travelers should take measures to prevent mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Leishmaniasis: Ninety percent of cases of leishmaniasis are reported from the north (mouth of the Amazon) and eastern regions. The disease is endemic to Alagoas, Bahia, Ceara, Espirito Santo, Goias, Maranhao, Mato Grosso do Sul, Minas Gerais, Para, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Roraima and Sergipe. Urban transmission was 1st reported in 1981, from Teresina (Piaui State). A large focus extends from Roraima into Venezuela and Guyana.
In the last 3 months, visceral leishmaniasis (kala-azar), the most aggressive form of the disease, has caused 17 confirmed cases with 6 deaths in the city of Rondonopolis in Mato Grosso state. This is half the cases registered there in the whole of 2007. Cutaneous leishmaniasis and mucocutaneous leishmaniasis occur nearly countrywide in rural and periurban areas with risk elevated in the more humid areas of northern, north-central, and central states; most visceral leishmaniasis occurs in the semi-arid northeastern states (with sharp increases in Maranhao, Piaui, and Rio Grande do Norte States), but has also been reported as far west and south as extreme western Mato Grosso do Sul State and Rio de Janiero State, respectively.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night and are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.
Lyme Disease: The incidence of Lyme disease is unclear, but it appears to be very low. Five cases with “Lyme disease” were reported from Brazil in 1991.
Malaria: Malaria in Brazil is restricted primarily to what is known as the legal Amazon. At least 80% of malaria cases are reported from Mato Grosso, Para, and Rondonia States. Countrywide, P. falciparum accounts for 40% of officially-reported malaria cases. Nearly all other cases are caused by P. vivax. Multidrug-resistant falciparum malaria occurs.
• Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine is recommended in all risk areas, including Amazon River cruises.
The malaria map will show you the endemic areas. Another map is here.
• Malaria is transmitted via the bite of an infected Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon) to exposed skin, applying permethrin spray or solution (e.g., Sawyer 10-Garment Permethrin Soak or Aersol Spray) to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents (such as Ultrathon) are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
NOTE: An increased number of malaria cases caused by Plasmodium vivax were reported from Sao Paulo, Brazil, in the first few months of 2007. Because the overall risk of malaria remains quite low in this region malaria prophylaxis is not recommended. Travelers to Sao Paulo, however, should observe the precautions outlined above to prevent mosquito bites.
Mayaro Virus Disease: In January 2010, a French tourist developed high-grade fever and severe joint manifestations following a 15-day trip in the Amazon basin with Mayaro virus infection. This case is the first reported in a traveller returning from an endemic South American country to Europe.
• Mayaro virus (MAYV) disease is a mosquito-borne zoonosis endemic in humid forests of tropical South America. MAYV is closely related to other alphaviruses that produce a dengue-like illness accompanied by long-lasting arthralgia.
• The transmission cycle of MAYV in the wild is believed to involve wild primates (monkeys) as the reservoir and the tree-canopy-dwelling Haemagogus mosquito as the vector. Thus, human infections are strongly associated with recent exposure to humid tropical forest environments. MAYV disease is an acute, self-limited dengue-like illness of three to five days’ duration. Moreover, MAYV is closely related to chikungunya virus and produces a nearly indistinguishable, highly debilitating arthralgic disease. There is no vaccine to prevent this illness.
• You can prevent MAYV by adhering to insect-bite prevention measures.
Meningitis: According to the Brazilian Ministry of Health, 106 cases of meningococcal meningitis (predominantly serogroup C) were reported during 2009 in the city of Salvador, Bahia State. Outbreaks of meningococcal meningitis in Brazil
in the past have been both B and C (see ProMEDBrazil 19960125.0182). During 2009, Bahia recorded 770 cases of meningitis, 60 percent more than the number identified during 2008.
• Brazilian public health authorities do NOT recommend meningococcal vaccine for travel to any part of Brazil at this time. Note: the quadrivalent meningitis vaccine is not protective against hepatitis B.
Onchocerciasis: Risk is present near swift-flowing streams in densely forested highlands in northern Amazonas and Poraima States; reported among the indigenous Yanomami population living along the Venezuelan border, as well as in nearby tribes and non-Indians visiting the area.
• Travelers to these areas should take measures to prevent insect (blackfly) bites.
Other Diseases/Hazards: Angiostrongyliasis (human angiostrongyliasis, caused by Angiostrongylus cantonensis, is a rat lungworm that has been reported globally. The definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Human infections are acquired by ingestion of raw or undercooked snails or slugs, prawns, or contaminated vegetables that contain the infective larvae of the worm; in Brazil there is an endemic area in the Southern States of Paraná, Santa Catarina and Rio Grande do Sul)
• Brazilian spotted fever (tick-borne; similar to Rocky Mountain spotted fever; found chiefly in the states of Sao Paulo and Minas Gerais; also reported from Rio, Espirito Santo, and the southern state of Santa Catarina; cases reported recently from Itaipava, a popular mountain resort next to Rio)
• Brucellosis (from contaminated dairy products)
• Cutaneous larva migrans
• Cysticercosis (an important health problem in northeastern Brazil, and probably elsewhere)
• Echinococcosis (especially in the southernmost part of the country)
• Human monocytic ehrlichiosis
• Hepatic capillariasis (from ingestion of embryonated eggs in food or dirt)
• Leprosy (highly endemic in Recife area)
• Leptospirosis (spread by water contaminated with rodent urine; a problem frequently occurring in rat-infested urban slums)
• Mayaro virus disease (Amazon region)
• Meningitis (cases reported from Sao Paulo and elsewhere; most cases due to serogroup B meningococci, which is not prevented by the current meningitis vaccines. According to the Brazilian Ministry of Health, 106 cases of meningococcal meningitis (predominantly serogroup C) were reported during 2009 in the city of Salvador, Bahia State, a modest increase over the usual incidence. Brazilian public health authorities do not recommend meningococcal vaccine for travel to any part of Brazil at this time.)
• Respiratory syncytial virus (the most common cause of bronchiolitis in children)
• Rocky Mountain spotted fever (Brazilian spotted fever)
• Relapsing fever
• Toxocariasis (helminth infection of humans caused by the dog or cat roundworm; two forms of disease: visceral larva migrans, which encompasses diseases associated with major organs, and ocular larva migrans (OLM), which affects the eye and optic nerve)
• Tuberculosis (a serious public health problem; 25% of children in some areas may be infected)
• Strongyloidiasis, and other helminthic infections
Plague: Most cases are reported from the drier northern and eastern states from Bahia and Ceara south to Minas Gerais. Thirty-five to 150 cases are reported annually. Travelers to these regions should avoid close contact with rodents (which may be carrying infective fleas). Prophylaxis with doxycycline is protective.
Rabies: There is a higher risk of rabies in Brazil relative to other South American countries. Forty to 120 human cases are reported annually, usually transmitted by stray dogs, but since 2004, vampire bats have recently been implicated in several outbreaks, mostly in the northeastern states of Maranhão and Pará. In Pará State most of the affected persons were living in the rural area around the Acuti Pereira River. Other bat rabies cases have been reported from Viseu municipality, also in Pará State. Rabies cases are also reported countrywide from both urban and rural areas.
• Rabies vaccine should be considered by those traveling to remote areas in the northeastern and northern regions of the country, where most cases now occur, and by travelers in remote urban/rural areas countrywide where there is exposure to the stray dog population and where there is limited access to rabies post-exposure vaccination.
Rabies vaccine is also recommended for persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals and for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.
Schistosomiasis: Intestinal schistosomiasis is a major public health problem. Risk is elevated in the northeast. Risk is present in northern and eastern states from Maranhao south to Parana, including both urban and rural areas. Most cases are reported from Minas Gerais, Bahia States, and Espirito Santo. There is no apparent risk in the Amazon Basin.
• Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: High risk outside of resorts and first-class hotels. Travelers should follow all food and drink precautions. A quinolone antibiotic, azithromycin, or rifaximin (Xifaxin), combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
Tuberculosis: Tuberculosis is a significant public health problem in this country. Tuberculosis is highly endemic in Brazil with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (except short-stay visitors and cruise ship passengers) traveling to or working in South America, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.
Yellow Fever: Yellow fever cases have occurred throughout many parts of Brazil (see map below). Yellow fever is transmitted through the bite of infected daytime-biting mosquitoes. Symptoms can include sudden onset of fever, chills, headache, backache, nausea, and vomiting. Unvaccinated travelers going to endemic areas should take measures to prevent insect bites by applying insect repellents (such as Ultrathon) to exposed skin.
From December 2008 through April 2009, the state of Rio Grande do Sul, on the southern tip of Brazil, reported 20 confirmed human cases of yellow fever infection. Nine of these people died. This is the first time since 1966 that human yellow fever cases have been reported in Rio Grande do Sul. In response to the situation, the Brazilian Ministry of Health has added a number of municipalities to the yellow fever risk area, which now includes the state’s capital city of Porto Alegre.
From February through April 2009, the state of São Paolo in Southern Brazil reported 28 confirmed human cases of yellow fever, including 11 deaths. These cases occurred in municipalities that lie outside the reported yellow fever risk area. In response, the Brazilian Ministry of Health has added a number of municipalities to the yellow fever risk area for São Paolo.
• Yellow Fever Risk Areas in Brazil
Currently, Brazil recommends yellow fever vaccination for travelers to the following states:
All areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, and Tocantins.
Other designated areas of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. (Refer to the Updated CDC Yellow Fever Map for Brazil to see areas of these states with risk for yellow fever transmission.) Vaccination is also recommended for travelers visiting Iguassu Falls.
Vaccination is NOT recommended for travel to the following coastal cities: Rio de Janeiro, São Paulo, Salvador, Recife, and Fortaleza.
Updated yellow fever map of risk areas from the Ministry of Health in Brazil is here:
• The CDC recommends yellow fever vaccination for all travelers >9 months of age going to the endemic zones indicated above. Yellow fever vaccination is NOT required to enter this country.