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Brazil travel vaccinations and health information

Current news:

Chikungunya: In mid-2014, health authorities reported the first locally acquired infections. Most infections came from the states of Bahia (O) and Amapá (N). This year, there were about 137,800 cases of suspected infection registered and 30.315 were confirmed. 17 people have died. Use mosquito repellent.
Dengue: There is a high risk of dengue throughout the country. The most affected are currently the states of Minas Gerais, Goias and Sao Paulo. Approximately 1.354.290 infections and 318 deaths had already been recorded in the first 23 weeks. Since the end of February the number of weekly new cases is gradually decreasing. Last year, about 1.649 million illnesses were registered and at least 863 people have died. Use protection against predominantly diurnal mosquitoes.
Entry vaccination requirements: Entry vaccinations requirements are temporarily stricter, from July this year, due to the ongoing yellow fever-outbreaks in Angola and the Democratic Republic of Congo. A yellow fever vaccination certificate is required for entry and also at stopover or switch (transit traffic) in one of the two countries. In some parts of Brazil there is also a risk of infection. Vaccination is therefore recommended for travelers in the respective areas.
Influenza: The flu wave started relatively early this year. Since then, about 6,570 serious cases were reported nationwide. We also assumed that there have been a high number of cases of unregistered diseases. 1.233 people died from an infection with the so-called Influenza A (H1N1). Most cases of swine flu were reported in São Paulo. We suggest flu-vaccination.
Zika virus: Infections with the Zika virus were registered for the first time in the state of Bahia (O), in the end of April 2015. It was also the first on the South American mainland. So far, about 165,930 suspected cases were reported nationwide, 66.180 of which were confirmed. The health authorities confirmed the first death in the end of November 2015. Since then the number of deaths has risen to 4. The number of weekly new cases is gradually decreasing since the end of February. The government measures taken for vector control and people awareness have massively increased due to the Olympic Games in early August. Studies have now shown that the virus was introduced in South America between May and the end of December 2013.
Since last year, there has been an increase of children born brain malformations (so-called microcephaly), particularly in the northeast of the country. Until early June, about 7.500 suspected cases were reported nationwide, 1.551 were confirmed.  147 malformations were diagnosed in 2014. Health authorities suspect that the infections with Zika virus can cause these malformations during pregnancy. On February 1, the World Health Organization launched an international health emergency. Travelers should stay alert and use proper mosquito protection. Pregnant women should currently refrain from unnecessary trips to the affected areas.
  

Entry vaccination 

Currently there is no compulsory vaccination requirement for entering Brazil. In addition to the recommended vaccinations in your country, however, further injections could be appropriate for your trip.
The yellow fever vaccination is frequently monitored, contrary to official regulations when entering the country from infected areas. It concerns, in particular, but not only, land borders. There have been increased checks on international airports (for example, Sao Paulo) since 2015.
        
The formal validity of yellow fever vaccination (WHO announcement 2016th): not specified until further notice. Validity of 10 years should be expected.
  

Recommended vaccinations

General check to recommended vaccination, supplement or refresh if necessary.
Take also consideration depending on travel style and residence in the country:
  

Vaccination

Travel Condition 1

Travel Condition 2

Travel Condition 3

Hepatitis A

X

X

X

Yellow Fever (b)

X

X

X

Hepatitis B (c)

X

X

 

Rabies (d)

X

X

 

Cholera (e)

X

X

 

Typhus

X

   

Meningococcal serotypes A, C, W135, Y (g)

X

   

  
(b) In endemic areas. This includes the following states with its entire territory: Acre, Amapá, Amazonas, Goias, Maranhao, Mato Grosso, Mato Grosso do Sul, Para, Rondonia, Roraima, Tocantins, Minas Gerais, Distrito Federal; States with certain parts of their territory: Piaui, Bahia, Sao Paulo (not city of Sao Paulo), Paraná (the Iguazú NP), Santa Catarina, Rio Grande do Sul.
(c) During long missions or closer contact with the local population
(d) Under foreseeable handling animals
(e) Protection against travel diarrhea (ETEC).
(g) In closer contact with the local population.
Travel Condition 1:
Travel through the inland under simple conditions (Backpack / Trekking / Individual Travel) with simple lodgings / hotels; Camping trips, long stays, practical activities in health or welfare, close contact with the local population probably
Travel Condition 2:
Stay in cities or tourist centers (organized) excursions into the inland (Package Travel, accommodation and meals in hotels or restaurants mid- to upper-standards)
Travel Condition 3:
Stay only in big cities or tourist centers (accommodation and meals in hotels or restaurants of higher European standards)

Important Notes

Which vaccinations that ultimately should be carried out, depends on the current risk of infection, on location, on the type and duration of the planned trip, the health condition, as well as the fact that a vaccination for travelers still exists.
Since many diverse aspects must be considered, in each individual case, it is always advisable to take a personal travel health consultation (about 4 to 6 weeks before the trip starts) with an experienced medicine doctor or pharmacist, specialized in travel.

Malaria

Risk: all year
Malaria in Brazil is largely restricted to the nine states of the Amazon region. The risk of transmission varies by region, the highest it is in the local river valleys, in the rain forest as well as in the mining wood chopping industry and newer settlement areas below 900 m during and after the rainy season. Specifically, there is a graded risk in the following states:
* High risk (annual incidence average of> 50 out of 1000) in Rondonia, Roraima, Amazonas, Amapá and Acre;
* Medium risk (annual incidence average of 10 – 49 out of 1000) in Pará (especially in the south) and Mato Grosso (especially in the north);
* Low (herd-like) (annual average incidence <10 out of 1000) in Tocantins and Maranhao, especially in the western parts of both states;
* In the outskirts of the cities of the Amazon region (eg Boa Vista, Cruzeiro do Sul, Macapá, Manaus, Maraba, Porto Velho, Rio Branco, Santarem) you can expect a risk corresponding to each state, but in the actual city areas the risk is low;
* Outside the Amazon region the risk is very low in the adjacent rural areas and it diminishes going eastward;
* The states on the East Coast and the Federal District, with Brasilia as capital, are malaria-free.
  
Prevention:
A consistent mosquito repellent in the evenings and at night reduces the risk of malaria infection significantly (exposure prophylaxis).
The main measures are:
* At dusk and at night stay in mosquito proof rooms (rooms with air condition, mosquitoes do not fly from warm to cold)
* When spending time outdoors in areas where malaria is present, during the evening and at night, use body-covering clothing (long sleeves, long pants).
* Use insect repellents on uncovered skin (calf, wrist, neck). Duration 2-4 hours.
* Use insect-killing agents in the form of aerosols, vaporizers, candles, incense coils in the living area
* Sleeping under mosquito net (especially in high-risk areas)
It is also recommended to take anti-malarial medications (chemoprophylaxis). Ask your doctor or pharmacist, or consult a qualified travel medical advice center for type and duration of chemoprophylaxis. Anti-malarial medications are available with prescription.
Source: German Centre for Travel Medicine