Brazil travel vaccinations and health information

Chikungunya: Cases are regularly reported nationwide. In 2019, there were 123,407 cases, most of them in Rio de Janeiro. Since 2017, overall cases have doubled, so various prevention tools such as mosquito nets, anti-mosquito sprays, biocide vaporizers, etc. are recommended. Consider mosquito protection for predominantly diurnal mosquitoes that also transmit dengue and Zika. There is no vaccination, nor specific therapy. Self-protection by avoiding mosquito bites during the day is the best protection.
Dengue: There is a risk of dengue throughout the country and the number of cases is increasing. In 2019, there were approximately 1.5 million cases and 683 deaths. To date, Brazil has registered a total of 1,329,488 cases between January and August 2022. The states most affected are Minas Gerais, Goias, and Sao Paulo. Consider protection against predominantly diurnal mosquitoes. There is no vaccination, nor specific therapy. Self-protection by avoiding mosquito bites during the day is the best protection. Normally dengue spreads especially during the rainy season. However, cases of infection continue to increase even in regions that have not had rain for many days. One type of dengue vaccine is available in the United States. The Dengvaxia vaccine is available starting in 2022 for use in children from 9 to 16 years old with laboratory-confirmed evidence of a previous dengue virus infection and living in areas where dengue is common (occurs frequently or continuously). Dengue is common in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and freely associated states, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. Dengvaxia Vaccine providers give three doses administered subcutaneously and each dose given 6 months apart (at 0, 6, and 12 months) for full protection.
Zika virus: At the end of April 2015, infections with the Zika virus were confirmed for the first time in the state of Bahia (O); they were also the first on the South American mainland. Since the peak year of 2015, cases have been declining sharply. In 2019, there were only 10,400 cases, most of them in Rio de Janeiro. By mid-September 2022, 10,500 ZIKA cases had been reported. Investigations have since shown that the virus was introduced to South America as early as between May and the end of December 2013. Particularly in the northeast of the country, an increasing number of children with malformations of the brain (so-called microcephaly) have been born since 2015. Studies have shown that the viral infection can cause these malformations in newborns of infected mothers. Travelers should be careful to protect themselves from mosquitoes that are predominantly diurnal. Pregnant women should refrain from nonessential travel to affected areas at this time.
Yellow fever: Since 2016, the number of cases has been increasing. According to the Robert Koch Institute, 3 Germans fell ill in February and March after their stay on the island of Ilha Grande, which is popular with tourists, and one of them died. Other international tourists (including those from the Netherlands, Chile, Argentina, France, Great Britain, Romania, Switzerland, and the Czech Republic) also fell ill; none of them had been vaccinated. Authorities have urged the population to be vaccinated. Previously, numerous monkeys had died from the infection in the region. Between December 2016 and August 2017, the largest yellow fever outbreak in the last 30 years was recorded. The southeast of the country was the most affected. However, vaccination is currently recommended for all travelers. Currently, cases are reported in the states of Sao Paulo, Parana and Santa Catarina. By mid-2019, 82 people had become ill and 14 had died. In 2021, there were 8 cases in Brazil.
Rabies: In addition to dogs, cats and bats, monkeys (marmosets), which are often kept as pets, are also carriers of the infection in Brazil. Consultation with a physician experienced in travel medicine should be made well in advance of travel. Only 1 case has been reported in 2019.
Measles: Since the uncontrolled immigration of Venezuelan refugees, cases of measles, already thought to be eradicated, have been reported with increasing frequency throughout Brazil. In 2019, there were nearly 4,500 cases and 4 deaths. The majority in Sao Paulo in each case, with 8,500 cases in 2021, 90 percent more than in 2019. Vaccination protection is recommended.

For the entry with direct flight from the US there is currently no vaccination obligation. However, in addition to the vaccinations recommended in the vaccination calendar in the US, such as tetanus, diphtheria, polio, measles, rubella, and mumps, further vaccinations may be useful for your trip.

When entering the country from areas of infection, the yellow fever vaccination is often checked. This concerns mainly, but not only, land borders. Since 2015, increased controls of international airports (e.g. Sao Paulo) are also reported. The International Association for Medical Assistance for Travellers page lists countries where there are currently yellow fever infection areas. If you have had a previous stopover (within 6 days prior to entry) in Angola or the Democratic Republic of Congo (yellow fever endemic areas), a valid yellow fever vaccination certificate is required upon entry (except for children under 9 months of age).

According to the amended WHO International Health Regulations (effective July 11, 2016), the yellow fever vaccination certificate is valid for life after a single vaccination. In Brazil, 2 yellow fever vaccinations are required at least 10 years apart to be certified for lifelong protection.

Check generally recommended vaccination protection, supplement or refresh if necessary. This includes the vaccinations recommended in the Vaccination calendar in the US such as tetanus, diphtheria, polio, measles, rubella and mumps.

Further vaccinations such as hepatitis A and B, typhoid, rabies. and influenza or a malaria prophylaxis may be useful for your trip. A yellow fever vaccination at least 10 days before entering Brazil is also recommended. There is no country requirement at entry but the WHO recommends a yellow fever vaccination. Recommended for all travelers aged 9 months or over traveling to the states of Acre, Amapá, Amazonas, Distrito Federal (including the capital Brasília), Espirito Santo, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraná, Piauí, Rio de Janeiro, Rio Grande do Sul, Rondônia, Roraima, Santa Catarina, Sao Paulo, Tocantins, as well as to designated areas of Bahia State. Yellow fever vaccination is also recommended for travelers visiting Iguaçu Falls. Not recommended for travellers whose itineraries are limited to areas not listed above, including the cities of Fortaleza and Recife.

Depending on your travel style and conditions of stay in the country, it is therefore important to consider which vaccinations are useful in each individual case:

  
(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 interior of the country under simple conditions (backpacking/traveling/individual travel) with simple accommodations/hotels; camping trips, long-term stays, practical work in health or social services, close contact with the local population likely.

Travel condition 2:
Stay in cities or tourist centers with (organized) excursions into the interior of the country (package tour, accommodation and meals in hotels or restaurants of medium to high standard)

Travel condition 3:
Stay exclusively in major cities or tourist centers (accommodation and meals in hotels or restaurants of upscale or European standards).

Which vaccinations are ultimately to be carried out depends on the current risk of infection on site, the type and duration of the planned trip, the state of health, as well as the possibly still existing vaccination protection of the traveler. Since a wide variety of aspects have to be taken into account in individual cases, it is always advisable to seek personal travel health advice from a physician or pharmacist with experience in travel medicine in good time (about 4 to 6 weeks) before the trip.

Risk: year-round
Malaria in Brazil is largely confined to the nine states of the Amazon region. The risk of transmission varies regionally, being highest in the river valleys there, in the rainforest, and in mining, logging, and recent settlement areas below 900 meters during and after the rainy season. Specifically, a graded risk can be expected in the following states:
* high risk (annual incidences average > 50 per 1000) in Rondonia, Roraima, Amazonas, Amapá, and Acre;
* medium risk (annual incidences average 10 - 49 per 1000) in Pará (especially in the S) and Mato Grosso (especially in the N);
* low (focal)(annual incidences average < 10 per 1000) in Tocantins and Maranhao, especially in the western parts of both states;
* In the cities of the Amazon region (e.g., Boa Vista, Cruzeiro do Sul, Macapá, Manaus, Maraba, Porto Velho, Rio Branco, Santarem), a risk corresponding to the state is to be expected in the outskirts; in the urban areas proper, the risk is low;
* Outside the Amazon region, there is a very low risk only in the adjacent rural areas, which tapers off to the east;
* States on the east coast and the Distrito Federal with the capital Brasilia are considered malaria-free.
Prevention:
Consistent mosquito protection in the evening and nighttime hours significantly reduces the risk of malaria (exposure prophylaxis).
The most important measures are:
* At dusk and at night, stay in mosquito-protected rooms (rooms with air condition, mosquitoes do not fly from warm to cold).
* When staying outdoors in malaria areas in the evening and at night, wear clothing that covers the body as much as possible (long sleeves, long pants).
* Application of insect repellents on uncovered skin (calf, wrists, neck). Duration of effect approx. 2-4 hrs.
* In the living area application of insect repellents in the form of aerosols, vaporizers, candles, incense spirals.
* Sleeping under mosquito net (especially in high risk areas).
In addition, the use of anti-malarial drugs (chemoprophylaxis) is recommended. For information on the type and duration of chemoprophylaxis, ask your doctor or pharmacist, or consult a qualified travel medicine center. Antimalarial drugs are available only on prescription.
Source: Centers for Disease Control and Prevention