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Diseases Spread By
Insect Bites: Dengue Fever    Yellow Fever    Malaria   
Food and Water: Typhoid      Travelers' Diarrhea      Schistosomiasis      Hepatitis A      Cholera     
Animal Bites: Rabies     
Sex & Blood: Unsafe Sex, Dirty Needles, & Contaminated Blood Supplies
Other Diseases: Diphtheria  
Other Diseases: Onchocerciasis   Leishmaniasis   Filariasis   Chagas Disease  

Diseases Spread by Insect Bites
Dengue Fever

Dengue or "break-bone" fever is a viral disease of the tropics and sub-tropics. It is transmitted by the Aedes aegypti mosquito that bites during the daytime and is found in and around human habitation. Symptoms include high fever, severe headaches, joint and muscle pain and cough. A rash often follows. The acute illness can last up to ten days, but complete recovery can take two to four weeks.

Occasionally, a potentially fatal form of dengue called dengue hemorrhagic fever (DHF) occurs. DHF is mostly seen in persons who have been previously infected with dengue - the fatality rate is about 5%.

There is no vaccine against dengue fever. Wear long sleeves and long pants, and use insect repellents to prevent mosquito bites.

IN BRAZIL
Dengue is found in the coastal areas, primarily in Rio de Janeiro.

Yellow Fever

Yellow fever is a viral disease transmitted by mosquitoes that only occurs in parts of Africa and South America. The symptoms range from a mild influenza-like syndrome to a severe hemorrhagic fever with liver failure.

Because it is very contagious, many countries require proof of an up-to-date yellow fever vaccination before entry is allowed if any of the following applies:

  • You have recently visited an infected country.
  • You are visiting a country where the vaccination is required.
  • You are visiting an infected region of an infected country.

In these cases, a signed and stamped WHO Yellow Fever Vaccination Booklet is required.

If visiting a country with yellow fever:

IN BRAZIL

Yellow fever is known to be present in rural areas in the states of Acre, Amapá, Amazonas, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará, Rondonia, Roraima and Tocantins as well as certain areas of Minas Gerais, Paraná and São Paulo.

Malaria

Malaria is a serious disease caused by one of four species of Plasmodium (a parasite) transmitted by mosquitoes that bite at night (from dusk to dawn). Symptoms can develop as early as six days after initial exposure and as late as several months after exposure has ceased. Symptoms can be episodic and may include fever, chills, headache, muscle aches, fatigue, vomiting, diarrhea and jaundice.

If not promptly treated, the malaria caused by Plasmodium falciparum can also cause anemia, seizures, mental confusion, kidney failure, coma and death.

Avoid malaria by preventing mosquito bites and taking anti-malarial drugs. In spite of these protective measures, travelers may still contract malaria.

In countries with chloroquine-sensitive malaria, chloroquine is still effective in preventing malaria. Many countries have chloroquine-resistant malaria, and other drugs (or combinations of drugs) must be taken.

Areas of Brazil have chloroquine-resistant P. falciparum malaria.

Present in a large area
There is malaria in:

  • Most forested areas below 900m within the nine states of the "Legal Amazonia" region: Acre, Amapá, Amazonas, Maranhão (western part), Mato Grosso (northern part), Pará (except Belém City), Rondônia, Roraima and Tocantins
  • Urban areas in the Amazonia region, including in large cities such as Pôrto Velho, Boa Vista, Macapá, Manaus, Santarém and Maraba.
There is no malaria in:
  • Main cities: Rio de Janeiro, Brasília and São Paulo
  • The Iguassu Falls
  • The coastal states from the horn to the border with Uruguay

PREVENTING MALARIA

If visiting a malarial area:

  • Focus on preventing mosquito bites
  • Use a medication to prevent chloroquine-resistant P. falciparum malaria (as these are not 100 percent effective, preventing mosquito bites is still very important)

Appropriate antimalarial medications include:

  • Atovaquone plus proguanil (Malarone®)
  • Doxycycline (many brands and generics)
  • Mefloquine (Lariam® and generics)

Summary of how to prevent insect bites:

  • Wear light-colored clothing that covers most of the body (long sleeves and long pants).
  • Use an insect repellent that contains DEET. Both adults and children can use preparations with up to 35% DEET - the higher the percentage, the longer it lasts.
  • Use insect spray, mosquito coils or electric pads if there are mosquitoes in your room.
  • Unless you are staying in air-conditioned, screened accommodations, consider using a bed net impregnated with permethrin.

Diseases Spread by Food and Water
Typhoid

Typhoid fever is a serious infection caused by a species of salmonella bacteria spread by contaminated food or water. Choosing safe food and water will greatly reduce the risk of developing the disease.

The symptoms usually begin seven to 21 days after exposure. The typical feature of the disease is persistent high fevers. While typhoid fever is often called a diarrheal disease, not all patients have diarrhea. Early symptoms are flu-like: body aches and pains, weakness, loss of appetite and a continuous dull headache. A rash with pink spots may appear on the chest and abdomen of some patients. In severe cases, perforation of the bowel can cause severe bleeding or infection in the abdomen, which can be fatal. Paratyphoid is a similar but less severe disease.

Typhoid and paratyphoid can be cured with antibiotic treatment. Safe vaccinations are available only against typhoid.

IN BRAZIL
There is some typhoid in rural Brazil. However, it is usually of little significance to travelers.

Travelers' Diarrhea

The Disease
Travelers' diarrhea is the most common travel-related illness. It usually occurs within the first week away from home and affects between 20 and 50 percent of all those who go abroad. Travelers are especially likely to become ill at high-risk destinations such as developing nations in Latin America, Africa, Asia and the Middle East.

Travelers' diarrhea is mainly caused by the bacterium E coli, which is spread through contaminated food and water. Other bacteria, especially salmonella, shigella and campylobacter, account for an additional 5-30 percent of all cases. Viruses, such as rotavirus and clacivirus, and parasites are other common causes. Cyclospora particularly impacts travelers to Nepal.

Choosing safe food and water will reduce the risk of developing the disease.

Management of Travelers' Diarrhea
It is important to treat travelers' diarrhea by replacing lost fluids. Continuously sip clear fluids such as water, soft drinks or weak tea. Avoid dairy products, alcohol and coffee. Most cases of travelers' diarrhea will resolve in one or two days.

Occasionally, intravenous re-hydration is required, especially if there has been significant vomiting or extreme diarrhea. Children are very susceptible to dehydration. Seek medical advice and attention early if children are affected.

Medications
Two main types of medications are used to treat travelers' diarrhea:

  • Drugs to slow the diarrhea (e.g. loperamide: Immodium®, Diamode® and many generics) Use according to directions and seek medical attention if there is no improvement within 24-36 hours. Do not use these products if you have a high fever or blood in the stool. Do not give to children.
  • Antibiotics Many travelers choose to carry antibiotics with them, since these drugs are relatively safe to use and usually shorten the illness. Three main classes of drugs are recommended: 
    • Ciprofloxacin (Cipro® and many generics or other quinolone antibiotics) Taken for one to three days. Cannot be given to children.
    • Azithromycin: single dose. Safe for children. Adults take 1 gram (1000mg) once; children take 20mg per kilogram once.
    • Rifaximin (Xifaxan) Taken three times a day for three days. Should not be used if the patient has a fever or blood in the stool. Can be given to children over 12 years old.

Obtain medical advice:

  • If there is no improvement after 24-36 hours, especially in children.
  • If patient develops fever, bloody stools or become lightheaded or dizzy.

IN BRAZIL
Travelers staying outside of first class hotels and tourist resorts are at high risk for travelers' diarrhea and other intestinal illnesses.

Schistosomiasis

Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms that live in freshwater lakes, rivers and rice paddies. The cercariae can penetrate the skin of persons who are wading, swimming, bathing or washing in contaminated water.

There is no vaccine. To prevent infection:

  • Avoid swimming or wading in fresh water in countries where schistosomiasis occurs.
  • The use of soap during bathing reduces the risk of infection, as does a vigorous rubdown with a towel straight after exposure to contaminated water. Do NOT rely on these methods to prevent schistosomiasis.
  • Bath water should be heated for five minutes at 50°C (122°F).
  • Water held in a storage tank for at least 48 hours should be safe.

IN BRAZIL

Schistosomiasis is present in the Northern and Eastern states from Maranhao to Parana. Although not present in São Paulo, many cases have been reported from Bahia and Minas Gerais states, just to the north.

Hepatitis A

Hepatitis A is a viral disease affecting the liver. It is transmitted person-to-person and by contaminated food and water, especially in areas with poor sanitation and overcrowding.

Symptoms begin 15-50 days after infection and can include fever, chills, weakness, loss of appetite, nausea and/or abdominal discomfort followed by jaundice (yellowing of the skin and eyes). The urine may become dark and the stools pale.

Many people infected with hepatitis A, particularly children, suffer only a mild flu-like illness with no specific symptoms. In other cases the jaundice is severe. Occasionally hepatitis A causes life-threatening liver failure; this is more common in the very young, those with underlying health problems and those over the age of fifty. Past infection with hepatitis A virus gives life-long immunity and vaccination is not required.

All non-immune travelers should consider hepatitis A vaccination.

Vaccination
Hepatitis A vaccination should be considered for all non-immune travelers.

As hepatitis A is more severe in persons suffering chronic hepatitis, both hepatitis A and B vaccination is advised for all infected with hepatitis C. Hepatitis A vaccination is also recommended for all infected with hepatitis B.

Cholera The Disease
Cholera is an intestinal infection. The bacterium, Vibrio cholerae, is transmitted through food and water that have been contaminated by the feces of an infected person. One to five days after being infected, the patient develops severe, painless, watery diarrhea, often called "rice-water" stools. Vomiting occurs in most patients. Usually, the symptoms are relatively mild and respond to oral rehydratation.

In severe cases (10-20%), the diarrhea can cause life-threatening dehydration. Treatment involves oral and/or intravenous fluid replacement and antibiotics, which reduce the volume and duration of diarrhea.

Risk for Travelers
Cholera tends to occur in large epidemics, especially in areas where sanitary conditions have deteriorated, such as refugee camps. With the exception of health and relief workers, cholera is rare in travelers, who usually avoid unsanitary conditions.

Vaccine
An injected cholera vaccine is available in many countries but is rarely recommended; immunity is unreliable and may only last a few months. This vaccine is no longer available in the United States.

Two more effective oral vaccines are available in an increasing number of countries, including Canada and a number of European nations. One is an oral live vaccine used specifically against cholera.

The other, the oral B-subunit vaccine Dukoral, gives good protection against cholera and halves the risk of developing traveler's diarrhea caused by ETEC (enterotoxigenic E.coli). ETEC is one of the more common causes of traveler's diarrhea. However, travelers who use this vaccine should also carry self-treatment remedies in the event that they develop diarrhea that is not caused by ETEC.

Preventive Measures
If visiting an area infected with cholera, drink only boiled or bottled water, water that has had chlorine or iodine added to it or carbonated beverages. Avoid ice, as it may have been made with unsafe water.

Choose food that has been thoroughly cooked while fresh and is served hot. Avoid street vendors, pre-peeled fruit or salad, fish and shellfish. Fruit that you wash and peel yourself is safe.

IN BRAZIL
Cholera is present, but the risk to travelers is low.

Diseases Spread by Animal Bites
Rabies

Rabies is a viral disease contracted when bitten or scratched by an infected (rabid) animal, often a dog. The virus travels along nerves from the area of the bite to infect the brain, causing death.

In countries with rabies, ALL animal bites and scratches must be treated seriously. Rabies vaccination is very effective in preventing rabies, even after a bite/scratch by a rabid animal.

Rabies vaccination
In rabies-affected countries, pre-exposure vaccination is often recommended for expatriates and long-term visitors if quality medical care may not be available after being bitten or scratched by an animal. It is especially important for children who may not tell their parents that they have been bitten/scratched.

If bitten or scratched by an animal:

  • Immediately cleanse the wound with soap and water and a povidone-iodine solution if available.
  • Let the wound bleed freely.
  • Seek medical advice from a qualified source or your assistance company, and notify local health authorities immediately to assess the need for rabies post-exposure vaccination, even if you have had pre-exposure vaccination. (THIS CAN BE LIFE SAVING).

IN BRAZIL
Up to 120 cases of human rabies are reported each year and occur nationwide in both rural and urban areas, particularly in the Northeastern states. Although stray dogs are the primary cause of rabies in Brazil, vampire bats have also been known to transmit the disease, especially in the Amazonas region.

Diseases Spread by Unsafe Sex, Dirty Needles & Contaminated Blood Supplies
  • HIV/AIDS, hepatitis B, and hepatitis C are spread by contact with bodily fluids (especially blood and semen). Transmission most commonly occurs during:
    • unprotected sex,
    • needle sharing during IV drug abuse, or
    • by unsafe blood or surgical supplies.
  • Genital herpes (HSV), genital warts (HPV), gonorrhea, chlamydia, syphilis and most other sexually transmitted diseases are spread by genital contact.
  • Prevention:

    • Always use new condoms (preferably brought from your home country),
    • IV drug users should not share needles,
    • In hospitals, make sure that needles and syringes are new,
    • Call International SOS or your corporate medical department if you are hospitalized or before having a blood transfusion.
    Other Diseases
    Diphtheria

    Diphtheria is a serious bacterial infection that causes a grayish membrane to develop across the throat. In severe cases, the neck may become very swollen, and, in tropical climates, skin ulcers may occur. After two to six weeks, a bacterial poison can affect the strength of the head and neck muscles and may weaken the heart. Diphtheria can be fatal.

    Most cases of diphtheria occur in non-immunized or inadequately-immunized persons.

    In most countries, vaccination against diphtheria, tetanus and whooping cough is given in a series of three to four injections during childhood ("triple antigen"). Anyone more than seven years of age who has not received a primary series against diphtheria should receive three doses of tetanus and diphtheria vaccine (Td).

    If you have had the primary vaccination, booster shots are recommended every ten years. Normally, this is combined with the tetanus booster (Td).

    In most countries, vaccination against diphtheria, tetanus and whooping cough is given in a series of three to four injections during childhood ("triple antigen"). Anyone more than seven years of age who has not received a primary series against diphtheria should receive three doses of tetanus and diphtheria vaccine (Td).

    If you have had the primary vaccination, booster shots are recommended every ten years. Normally, this is comb

    Other Diseases
    Onchocerciasis

    Also known as "River Blindness", onchocerciasis is mainly present in parts of tropical Africa however it also occurs in several non-African countries. The parasitic worms are transmitted by black flies that bite by day and are found near rapidly flowing rivers and streams. The worms enter the blood and grow into adults in nodules under the skin. Later, large numbers of microscopic larvae (called microfilariae) are released. These migrate through the tissues under the skin.

    Dark-skinned Africans can suffer patchy loss of skin pigment (called "leopard skin"). Severe itching can also occur. The skin can sag, causing the look of premature aging.

    The most significant complication is blindness--the microfilariae can invade and damage the eye. Symptoms of the disease may occur months to years after departure from endemic areas.

    Those traveling for short periods in endemic regions appear to be at low risk for acquiring the disease. Infections tend to occur in expatriate groups such as missionaries, field scientists and volunteers.

    No vaccine is available. Avoid black fly bites. Wear long-sleeved shirts and long pants. Use an insect repellent containing DEET.

    Leishmaniasis Leishmaniasis is a disease caused by protozoa that can infect humans, dogs, rodents and other small animals. It is transmitted by sandflies that bite mainly between dusk and dawn and can occur in both rural/jungle and urban environments. Sandflies breed quickly in unsanitary conditions, and the spread of the disease is exacerbated by civil war, chronic food shortages and mass population movement.

    Cutaneous leishmaniasis
    Leishmaniasis can cause a skin disease called cutaneous leishmaniasis. This can affect the mucous membranes with a wide range of appearances, the most common being ulcers. It can also cause skin lesions that resemble those of other diseases, including cutaneous tuberculosis, syphilis, leprosy, skin cancer (basal cell carcinoma) and fungal infections.

    A traveler with skin sores that do not heal within a week or two after leaving an area with leishmaniasis should be checked by a tropical disease specialist.

    Viceral Leishmaniasis (Kala-azar)
    Leishmania can also cause systemic disease (visceral leishmaniasis) that can be fatal. The parasites migrate to the bone marrow, spleen and lymph nodes, weakening the immune system. The first manifestations of visceral leishmaniasis develop months, but sometimes years, after infection. In adults, fever for two weeks to two months is accompanied by nonspecific symptoms, such as fatigue, weakness and loss of appetite. Children usually develop vomiting, diarrhea, fever and cough. Weakness increases as the disease progresses. Common infections the immune system can no longer handle, such as pneumonia, diarrhea and tuberculosis, are often the final cause of death. Untreated, the death rate is 15-25%.

    Although the malnourished are more susceptible, adventure travelers, volunteers, missionaries, soldiers and other persons who may be outdoors at night in an infected area are at risk for developing leishmaniasis. Even persons with short stays in infected areas can become infected.

    Prevention
    There is no vaccine or drug(s) to prevent leishmaniasis.

    Avoid sandfly bites by:

    • Minimizing outdoor activities from dusk to dawn--this is when sand flies are most active. Note that sandfly bites are painful, so you will know if you are being bitten.
    • Using protective clothing and insect repellent.
    • Consider using a bed net with fine mesh if there are sandflies in your living quarters. The standard bed nets used to prevent malaria are of no use, as sandflies are about one-third the size of mosquitoes. At least 18 holes to the linear inch are required. Impregnating bed nets and window screens with permethrin aerosol provides some protection, as does spraying dwellings with insecticides.

    CDC Leishmaniasis information

    Filariasis

    Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms and spread by mosquitoes. Infective larvae are injected through the skin by mosquitoes and travel to the lymph nodes, where the adult worms develop. The offspring of these adult worms (microfilaria) then migrate farther in the tissues and circulate in the blood causing a variety of symptoms. Initial symptoms consist of redness of the skin and swelling of the lymph nodes of the arms and legs, headache, weakness, muscles pain, coughing, wheezing and fever.

    Progression of the disease, usually only seen in the indigenous population of the endemic area, can cause grotesque swelling of the legs, arms, breasts and/or scrotum known as elephantiasis. Tropical pulmonary eosinophilia, a serious progressive lung disease, can also occur.

    To contract lymphatic filariasis, one would have to endure thousands of mosquito bites over several months or years. Thus, short-term travelers are at low risk, but all travelers should prevent insect bites.

    No vaccine is available. If visiting an infected area for a long period of time, certain drugs which prevent the disease are available. Seek advice. Use insect repellents, and sleep under bed nets.

    Chagas Disease

    Also known as American Trypanosomiasis, Chagas disease is transmitted by a blood-sucking bug, the triatomine (also known as the "kissing bug"). An infected bug deposits feces on the victim's skin, often at night. Infection occurs when the feces is then accidentally rubbed into a bite, an open cut, eyes or the mouth. Chagas disease can also be transmitted through unscreened blood transfusions.

    Local swelling may appear at the site of inoculation. The initial stages of the infection may go unnoticed, or they may be accompanied by signs of brain and/or heart involvement.

    No vaccine is available.

    Avoid sub-standard accommodations. Other preventive measures include spraying infected houses with insecticides and the use of bed nets.

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