World Country Guide

1
A yellow fever vaccination certificate is required from all travellers over nine months old arriving within from infected regions. Vaccination is strongly recommended for those intending to visit rural areas in the states of Acre, Amapá, Amazonas, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará, Rondônia, Roraima, Tocantins, and certain areas of Minas Gerais, and specific areas of Espirito Santo, Piani, Bahia, São Paulo, Paraná, Santa Catarin and Rio Grande do Sul. If in any doubt, please contact the Brazilian Consulate General (see Contact Addresses section).

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is no longer a condition of entry to Brazil. However, cases of cholera are still reported, especially in the northeast, and precautions are essential. Up-to-date advice should be sought before deciding whether these precautions should include vaccination as medical opinion is divided over its effectiveness; see the Health appendix for more information.

3
Immunisation against typhoid is recommended.

4
Malaria risk exists throughout the year (78 per cent vivax form and 22 per cent falciparum form) below 900m (2953ft) in Acre, Amapá, Amazonas, Maranhão (western part), Mato Grosso (northern part), Pará (except Belém City), Rondônia, Roraima and Tocantins states, as well as some larger cities, such as on the periphery of Pôrto Velho, Boa Vista, Macapá, Manaus, Santerém, Rio Branco and Maraba. The malignant falciparum form of the disease is reportedly highly resistant to both chloroquine and sulfadoxine-pyrimethamine. Mefloquine, doxycycline or atovaquone/proguanil is the recommended prophylaxis.

Food & drink
All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Even filtered water in more remote areas should be avoided and bottled mineral water should be drunk instead. Pasteurised milk and cheese is available in towns and is generally considered safe to consume. Milk outside of urban areas is unpasteurised and should be boiled; powdered or tinned milk is available and is advised in rural areas, but make sure that it is reconstituted with pure water. Avoid dairy products which are likely to have been made from unboiled milk. Only eat well-cooked meat and fish, preferably freshly prepared and served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks
Bilharzia (schistosomiasis) is present. Snakes and leeches may be a hazard. Avoid swimming and paddling in fresh water; swimming pools that are well-chlorinated and maintained are safe. Other infectious diseases prevalent in Brazil include trypanosomiasis (Chagas disease) and mucocutaneous leishmaniasis (on the increase). The former is widespread in rural and poor areas of Brazil and is spread by either insect bites or ingestion of byproducts in contaminated foods/drinks of the vector insect. Dengue fever is on the increase, especially after rain in densely populated areas. Visceral leishmaniasis is endemic (especially in the northeast). Onchocerciasis (especially northern Brazil) and Bancroftian filariasis are also present. Hepatitis A, B and D, Brazilian purpuric fever, amoebiasis, shigella infection, leptospirosis icterohaemorrhagica and brucellosis all occur. There are epidemics of meningococcal meningitis in and around the Rio area. Air pollution, especially in São Paulo City, may aggravate chest complaints.
Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay. For more information, consult the Health appendix.

Health care
There is no reciprocal health agreement with the UK or USA. Full insurance is strongly recommended as medical costs are high. English-speaking medical staff are found mainly in São Paulo and Rio de Janeiro. The main hospital in São Paulo is the Hospital das Clinicas.