TRAVEL HEALTH ADVICE (click for general advice)

BRAZIL

• Confirm primary courses and boosters are up to date as recommended in the vaccination schedule - including vaccines given to special groups because of risk exposure or complications (e.g. hepatitis B for health care workers, influenza and pneumococcal vaccines for the elderly).
• Courses or boosters usually advised: diphtheria; tetanus; hepatitis A; yellow fever (mainly for Western and Amazonian areas and Iguacu Falls).
• Vaccines sometimes advised: typhoid; hepatitis B; rabies; tuberculosis.
• Yellow fever certificate is required if over 9 months old and entering from an area with risk of yellow fever transmission, unless they are in possession of a waiver stating that immunisation is contraindicated on medical grounds.

Notes on the diseases mentioned above

• Tetanus is contracted through dirty cuts and scratches. This is a serious infection of the nervous system.
• Typhoid and hepatitis A are spread through contaminated food and water. Typhoid causes septicaemia and hepatitis A causes liver inflammation and jaundice. In risk areas you should be immunised if good hygiene is impossible.
• Tuberculosis is most commonly transmitted via droplet infection. BCG vaccination is recommended for travellers under 16 years of age who will be living or working with local people for a prolonged period of time (three months or more). Following individual risk assessment, vaccination may also be considered for travellers under the age of 35 years who may be at high risk through their occupation abroad eg healthcare workers.
• Diphtheria is also spread by droplet infection through close personal contact. Vaccination is advised if close contact with locals in risk areas is likely.
• Yellow fever is spread by mosquito bites. It is a serious often fatal illness. Vaccination is recommended for those who travel into risk areas.
• Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse, It affects the liver, causes jaundice and occasionally liver failure. Vaccination is recommended for those at occupational risk (e.g. health care workers), for long stays or frequent travel to medium and high risk areas, for those more likely to be exposed such as children (from cuts and scratches) and those who may need surgical procedures.
• Rabies is spread through bites or licks on broken skin from an infected animal. It is always fatal. Vaccination is advised for those going to risk areas that will be remote from a reliable source of vaccine. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite.

Malaria - See Map

• A risk of serious Malaria - See Map is present throughout the year in forested areas below 900m within the nine states of Amazonia (Acre, Amapa, Amazonas, Maranhhao (west), Mato Grosso (north), Para (except Belem City on the coast), Rondonia, Roraima and Tocantins). Transmission is high in rain forest areas and occurs less commonly in urban areas in Amazonia such as Porto Velho, Boa Vista, Macapa, Manaus, Maraba, Rio Branco and Santarem.
• There is usually only minimal risk in the tourist resort of Iguaçu Falls but those exploring outside the resort itself into rural or jungle areas, especially into Paraguay, should consider antiMalaria tablets.
• There is a risk for those going on cruises up the Amazon, especially as boats enter populated parts of the rain forest where infected mosquitoes may be taken on board. Most cruises up the Amazon river end up/or start at the city of Manaus where there is a risk of Malaria - See Map .
• Risk is minimal in all states outside Amazonia including the populated eastern coast from Fortazela south to Rio de Janeiro and Sao Paulobrazil.
• Malaria -precautions are essential. Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
• Check with your doctor or nurse about suitable antiMalaria tablets.
• Atovaquone/proguanil OR doxycycline OR mefloquine is usually recommended for those visiting risk areas.
• If you have been travelling in a malarious area and develop a fever seek medical attention promptly. Remember Malaria can develop even up to one year after exposure.
• If travelling to high risk malarious areas, remote from medical facilities, carrying emergency Malaria standby treatment may be considered.

Advice for travellers

• Outbreaks of dengue fever are common in South America and often occur after the rainy seasons where mosquitoes breed more actively. It causes a feverish illness with headache and muscle pains like a bad, prolonged, attack of influenza. There may also be a rash. Mosquito bites should be avoided whenever possible.