Brazil

Country fact file

General information

The information on these pages should be used to research health risks and to inform the pre-travel consultation. Travellers should check the Foreign, Commonwealth & Development Office (FCDO) country-specific travel advice page (where available) which provides information on travel entry requirements in addition to safety and security advice. Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel. However, even if time is short, an appointment is still worthwhile. This appointment provides an opportunity to assess health risks taking into account a number of factors including destination, medical history, and planned activities. For those with pre-existing health problems, an earlier appointment is recommended. All travellers should ensure they have adequate travel health insurance. A list of useful resources including advice on how to reduce the risk of certain health problems is available below.

Resources

• Food and water hygiene

• Insect and tick bite avoidance

• Personal safety

• Sun protection

What vaccinations do I need for Brazil?

Details of vaccination recommendations and requirements are provided below.

All travellers

Travellers should be up to date with routine vaccination courses and boosters as recommended in the UK. These vaccinations include for example measles-mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine. Country-specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided. Those who may be at increased risk of an infectious disease due to their work, lifestyle choice, or certain underlying health problems should be up to date with additional recommended vaccines. See details on the selective immunisation programmes and additional vaccines for individuals with underlying medical conditions at the bottom of the 'Complete routine immunisation schedule' document and the individual chapters of the 'Green Book' Immunisation against infectious disease for further details.

Certificate requirements

There are no certificate requirements under International Health Regulations. There is a risk of yellow fever transmission in parts of Brazil (see ‘Some Travellers’ section below).

Most travellers

The vaccines in this section are recommended for most travellers visiting this country. Vaccines are listed alphabetically.

Hepatitis A

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong.

Prevention
All travellers should take care with personal, food and water hygiene.

Hepatitis A vaccination
As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.

Hepatitis A in brief

Tetanus

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.

Prevention
Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil.

Tetanus vaccination
Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Tetanus in brief

Typhoid

Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection.

Prevention
All travellers should take care with personal, food and water hygiene.

Typhoid vaccination
Oral and injectable typhoid vaccinations are available.

Typhoid in brief

Some travellers

The vaccines in this section are recommended for some travellers visiting this country. Vaccines are listed alphabetically.

Chikungunya

Chikungunya is a viral infection spread by mosquitoes which bite mainly during daytime hours. It causes a flu-like illness and can cause severe joint and muscle pains which usually improve in 1–2 weeks but may persist for months or years. It is rarely fatal. There is a risk of chikungunya in this country.

Prevention
Travellers should avoid mosquito bites, particularly during daytime hours.

Chikungunya vaccination
Vaccination may be considered for individuals aged 12 years of age and over who are:

• travelling to regions with a current chikungunya outbreak

• long-term or frequent travellers to regions with an increased risk of chikungunya

• exposed to the chikungunya virus through their work, such as laboratory staff working with the virus.

Chikungunya in brief

Dengue

Dengue is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travellers. The mosquitoes that spread dengue are more common in towns, cities and surrounding areas. There is a risk of dengue in this country.

Prevention
Travellers should avoid mosquito bites, particularly during daytime hours.

Dengue vaccination
Vaccination can be considered for individuals aged 4 years of age and older who have had dengue infection in the past and who are:

• travelling to areas where there is a risk of dengue infection or areas with an ongoing outbreak of dengue,

• exposed to dengue virus through their work, such as laboratory staff working with the virus.

Dengue in brief

Hepatitis B

Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. This country is considered to have an intermediate or high prevalence of hepatitis B.

Prevention
Travellers should avoid contact with blood or body fluids. This includes:

• Avoiding unprotected sexual intercourse.

• Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used).

• Not sharing needles or other injection equipment.

• Following universal precautions if working in a healthcare or other higher risk setting.

Hepatitis B vaccination
Vaccination could be considered for all travellers and is recommended for those whose activities or medical history put them at increased risk.

Hepatitis B in brief

Rabies

Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection. Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal.

Prevention
Travellers should avoid contact with all animals. Rabies is preventable with prompt post-exposure treatment. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial.

Rabies vaccination
A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply world-wide.

Rabies in brief

Tuberculosis

TB is a bacterial infection most commonly affecting the lungs but can affect any part of the body. When a person with TB in their lungs or throat coughs or sneezes they could pass TB on to other people. TB is curable but can be serious if not treated. The BCG vaccination helps to protect some people, particularly babies and young children who are at increased risk from TB. This country has reported an annual TB incidence of greater than or equal to 40 cases per 100,000 population at least once in the last five years.

Prevention
Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) or laryngeal (throat) TB.

Tuberculosis (BCG) vaccination
BCG vaccine is recommended for those at increased risk of developing severe disease and/or of exposure to TB infection.

Tuberculosis in brief

Yellow fever

Yellow fever is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk, but may also bite at night, especially in the jungle environment. Symptoms may be absent or mild, but in severe cases, it can cause internal bleeding, organ failure and death. There is a risk of yellow fever transmission in parts of this country.

Prevention
Travellers should avoid mosquito bites at all times.

Yellow fever vaccination
Vaccination is recommended for travellers aged 9 months and older travelling to specific states and areas in Brazil.

Yellow fever in brief

What about malaria in Brazil?

Malaria is a serious illness caused by infection of red blood cells with a parasite called Plasmodium. The disease is transmitted by mosquitoes which predominantly feed between dusk and dawn. Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more. Other symptoms may include feeling cold and shivery, headache, nausea, vomiting and aching muscles. Symptoms may appear between eight days and one year after the infected mosquito bite.

Prompt diagnosis and treatment is required as people with malaria can deteriorate quickly. Those at higher risk of malaria, or of severe complications from malaria, include pregnant women, infants and young children, the elderly, travellers who do not have a functioning spleen and those visiting friends and relatives.

Prevention

Travellers should follow an ABCD guide to preventing malaria:

• Awareness of the risk – Risk depends on the specific location, season of travel, length of stay, activities and type of accommodation.

• Bite prevention – Travellers should take mosquito bite avoidance measures.

• Chemoprophylaxis – Travellers should take antimalarials (malaria prevention tablets) if appropriate for the area (see below). No antimalarials are 100% effective but taking them in combination with mosquito bite avoidance measures will give substantial protection against malaria.

• Diagnosis – Travellers who develop a fever of 38°C [100°F] or higher more than one week after being in a malaria risk area, or who develop any symptoms suggestive of malaria within a year of return should seek immediate medical care. Emergency standby treatment may be considered for those going to remote areas with limited access to medical attention.

Risk areas

There is a low risk of malaria in the Amazon basin of Brazil, including in the city of Manaus: awareness of risk and bite avoidance recommended. There is a very low risk of malaria in the rest of Brazil: awareness of risk and bite avoidance recommended. There is no risk of malaria in Iguaçu Falls: bite avoidance recommended.

Special risk groups in low risk areas may consider antimalarials in exceptional circumstances.

Resources

• Malaria in brief

• Malaria factsheet

• Insect and tick bite avoidance

• Children's antimalarial dose table

• Malaria prevention guidelines for travellers from the UK

What other risks are there in Brazil?

There are some risks that are relevant to all travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, or health issues related to the heat or cold. Some additional risks (which may be present in all or part of this country) are mentioned below and are presented alphabetically.

Altitude

There is a risk of altitude illness when travelling to destinations of 2,500 metres (8,200 feet) or higher. Important risk factors are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.

Altitude illness in Brazil
There is a point of elevation in this country higher than 2,500 metres.

Prevention
Travellers should spend a few days at an altitude below 3,000m. Where possible travellers should avoid travel from altitudes less than 1,200m to altitudes greater than 3,500m in a single day. Ascent above 3,000m should be gradual.

Altitude illness in brief

Biting insects or ticks

Insect or tick bites can cause irritation and infections of the skin at the site of a bite. They can also spread certain diseases. There is a risk of insect or tick-borne diseases in some areas of South America.

Prevention
All travellers should avoid insect and tick bites day and night. There are no vaccinations (or medications) to prevent these diseases.

Influenza

Seasonal influenza is a viral infection of the respiratory tract and spreads easily from person to person via respiratory droplets when coughing and sneezing. Symptoms appear rapidly and include fever, muscle aches, headache, malaise (feeling unwell), cough, sore throat and a runny nose. In healthy individuals, symptoms improve without treatment within two to seven days. Severe illness is more common in those aged 65 years or over, those under 2 years of age, or those who have underlying medical conditions that increase their risk for complications of influenza.

Prevention
All travellers should:

• Avoid close contact with symptomatic individuals

• Avoid crowded conditions where possible

• Wash their hands frequently

• Practise ‘cough hygiene’: sneezing or coughing into a tissue and promptly discarding it safely, and washing their hands

• Avoid travel if unwell with influenza-like symptoms

Influenza in brief

Outdoor air quality

Poor air quality is a significant public health problem in many parts of the world. Exposure to high levels of air pollution over short time periods (e.g. minutes/hours/days) and longer time periods (e.g. years) is linked to many different acute and chronic health problems.

Prevention
Travellers with health problems that might make them more vulnerable to the effects of air pollution who are travelling to areas of high pollution should:

• discuss their travel plans with their doctor, and carry adequate supplies of their regular medication.

• take sensible precautions to minimise their exposure to high levels of air pollution.

Outdoor air quality in brief

Schistosomiasis

Schistosomiasis is a parasitic infection. Schistosoma larvae are released from infected freshwater snails and can penetrate intact human skin following contact with contaminated freshwater. There is a risk of schistosomiasis in this country.

Prevention
There is no vaccine or tablets to prevent schistosomiasis. All travellers should avoid wading, swimming, or bathing in fresh water.

Schistosomiasis in brief

Sexually transmitted infections

Sexually transmitted infections (STIs) are a group of viral, bacterial and parasitic infections spread during sexual intercourse or by intimate contact. Anyone who is sexually active is at risk of getting an STI wherever they are in the world.

Prevention
Using condoms consistently and correctly with new or casual partners is the most effective way to reduce risk of STIs.

Sexually transmitted infections in brief

Zika virus

Zika virus (ZIKV) is a viral infection spread by mosquitoes which predominantly feed during daytime hours. Most people infected with ZIKV have no symptoms. When symptoms do occur, they are usually mild and short-lived.

Prevention
All travellers should avoid mosquito bites, particularly during daytime hours. There is no vaccination or medication to prevent Zika virus infection.

Zika virus in brief

Source and disclaimer

This travel health information is based on data supplied by NaTHNaC (the National Travel Health Network and Centre). All intellectual property rights in the data are owned by NaTHNaC. It must not be copied, reproduced, distributed, amended or offered for sale without NaTHNaC’s prior written consent.
Patient.info ensures that this information is reviewed and updated on at least a weekly basis. However, NaTHNaC’s data is accurate only as at the date it was prepared, and Patient.info is solely responsible for maintaining its accuracy and completeness after that date. NaTHNaC accepts no liability for the use of this data by Patient.info or its users.