Brazil

This vast rapidly developing country has been under the international spotlight, having recently hosted the soccer World
Cup and in preparation for the 2016 Olympics. Typical itineraries tend to include the immense Iguassu falls on the border
of Argentina, Carnivale festivities in the cities, as well as the beaches, the Amazon jungle and the wetlands of the
Pantanal. Each itinerary carries its own health risks.
The following information provides some broad and general guidelines about health risks and recommendations for
these destinations. This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues

Traveller's Diarrhoea
This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes
vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella, and sometimes by other bugs
such as giardia. Careful food and drink choices (no tap water), as well as hand hygiene help in prevention. It is treated
with rehydration if mild but if inconvenient, with a bowel stopper such as loperamide (Gastrostop or Imodium) and if
more severe or persistent with an antibiotic or giardia treatment. These are best obtained prior to travel. We stock kits
containing all of these medications but they contain prescription items and an appointment with one of our doctors is
required to obtain one.

Security Issues
It is well known that in the cities and on beaches tourists are the target of criminal activity, including theft, muggings and
carjacking. Most cities have adjacent shanty towns (favelas). The following precautions should be taken:

Dress down and avoid carrying expensive watches/ jewellery/cash

Avoid isolated beach locations especially in the evening

Keep away from favelas

Do not fight back if attacked

Use only official taxis

See also the Australian Government's DFAT website for further advice on security issues in Brazil.

Dengue
This mosquito born virus causes a nasty illness with high fever, body aches, headaches and sometimes a rash.
Occasionally serious complications occur. Peak transmission is in the rainy season. It occurs mainly in urban areas. Huge

outbreaks occur in Rio and other coastal cities every summer. The mosquitoes are daytime biters. Mosquito avoidance is
the only prevention. There is no specific treatment but full recovery usually occurs.

Yellow Fever Vaccination Requirements and Recommendations

This is a very serious but rare mosquito borne disease and occurs in Brazil. Most travellers to Brazil require or are
recommended the vaccination either for disease protection, prevention of international spread or for bureaucratic
reasons. Australia and many South American countries require proof of Yellow fever vaccination if you've been in any
part of Brazil within the previous 6 days. An official certificate of vaccination is provided. Some people should not have
the vaccine because of medical contraindications, such as the elderly, pregnant women, those with immune suppression
from illness or medication and those allergic to eggs. In these cases a medical exemption may be issued by a registered
yellow fever clinic, or the advice may be not to travel. This vaccine has common mild side effects and very rarely more
serious reactions. This is a complex topic; make an appointment with one of our travel health doctors to discuss.

Malaria
This mosquito born parasite occurs almost exclusively deep in the Amazon rainforest. Most travellers to Brazil are at low
risk, and there is some controversy (even among doctors who specialise in travel health) as to whether preventative
medication should be taken for a few days in the Amazon basin. The mosquitoes usually bite between dusk and dawn.
Preventive medication should be discussed with a doctor with experience in travel health. Mosquito bites should be
avoided by covering up exposed skin and with DEET containing repellents. Sleeping accommodation should be mosquito
proof e.g. by sleeping under impregnated mosquito netting. Even if all precautions are taken, any fever even up to a
month or two after visiting a malaria affected area should be presumed to be malaria until proven otherwise, which
usually means a prompt visit to a reputable medical clinic.

Other Diseases Flys/Bugs

Cutaneous Leishmaniasis is a rare disease in travellers from sandfly bites in the Amazon - it causes disfiguring facial
ulcers. Chagas is a chronic disease caused by a parasite transmitted by a bug that drops down from the roofing of mud
huts or palm thatch houses, also very rare in travellers.

Animal Bites
Immediate and thorough irrigation and cleaning of animal wounds, followed by a course of shots for rabies is essential. A
tetanus booster may also be necessary. Animal bites are prone to becoming infected and early treatment with antibiotics
may be necessary. See more below under Rabies.

Medical Facilities and Travel Insurance

Private facilities in the major cites provide quality care, however cash payment is often expected and fees are high. Travel
insurance is essential.

Vaccinations
Required Vaccination (for some)
Yellow Fever this is a complex topic - see comments under yellow fever above

Routine Vaccinations for all travellers

All international travellers should be up to date or immune to the following as these are transmissible diseases which may
have serious complications:

Measles

Chickenpox

Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in Brazil in the event of a tetanus prone wound

Recommended Vaccinations for most travellers to Brazil

Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated

Other vaccinations to consider

Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic
animals; in particular dogs, cats, monkeys and bats. For travel to Peru, vaccination against rabies is often recommended
for those at particularly high risk, for example working with animals and those travelling for longer periods.
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Mortality is in the
order of 1 in 10 in some settings. Resistance to common antibiotics is also widespread so treatment has become more
difficult.
Cholera is rare except in humanitarian crises e.g. refugee camps, however, because the vaccine provides some cross
protection against common E Coli diarrhoea, vaccination may be recommended.