10 facts about yellow fever in Brazil

January 21, 2008 | By More

In the face of continuing misinformation on the current yellow fever situation in Brazil, I’ve dedicated some time to gather together a few facts about the crisis. The following text has been written by me and it is based on reliable Brazilian sources (listed at the end of the entry). Hope it clarifies all the doubts you might have.

  1. There hasn’t been a new outbreak of yellow fever in Brazil insofar as yellow fever is endemic in the country.
  2. There have been no cases of yellow fever in areas of Brazil where the disease wasn’t present before.
  3. Yellow fever is only present in rural areas. Since 1942 there are no cases of yellow fever in the towns and cities of Brazil.
  4. Only those visiting risk areas need to get vaccinated against yellow fever.
  5. Tourists visiting risk-free areas do not need to take the vaccine. The vaccine has a series of well-documented side effects.
  6. For the vaccine to be effective, it needs to be taken at least 10 days prior to travel.
  7. NEW: Brazilian authorities are not asking at the moment for an International Certificate of Vaccination Against Yellow Fever regardless of where the passenger comes from.
  8. Yellow fever is transmitted through a mosquito bite.
  9. The main symptoms of yellow fever are: fever, muscle pain, headache, shivers, nausea or vomiting. Symptoms appear between three and six days after becoming infected.
  10. Treatment of yellow fever is supportive only. There is no specific medication to treat yellow fever. Victims of yellow fever need to be treated in hospital.

1. There has not been a new outbreak of yellow fever in Brazil insofar as yellow fever is endemic in the country. Cases are recorded every single year.

– in 2000: 85 cases, resulting in 40 deaths;
– in 2001: 41 cases, resulting in 22 deaths;
– in 2002: 15 cases, resulting in 6 deaths;
– in 2003: 64 cases, resulting in 23 deaths;
– in 2004: 5 cases, resulting in 3 deaths;
– in 2005: 3 cases, resulting in 3 deaths;
– in 2006, 2 cases, resulting in 2 deaths;
– in 2007, 6 cases, resulting in 5 deaths.

In recent years the number of cases of yellow fever had decreased considerably. The number of cases recorded in the first three weeks of 2008 outnumbers the figures for the last four years together. Yellow fever seems to be back in force in 2008.

2. There have been no cases of yellow fever in areas of Brazil where the disease wasn’t present before. The cases registered in 2008 were of people who were not vaccinated and got infected in risk areas.

3. Yellow fever is only present in rural areas. Since 1942 there are no cases of yellow fever in the towns and cities of Brazil. The measures taken by Brazilian authorities aim at preventing the reappearence of urban yellow fever. For that to happen, someone would have to be bitten my a mosquito in a rural area. That person would then travel to an urban area, and would be bitten again by another mosquito that would, from then on, carry the yellow fever virus.

4. Only those visiting risk areas need to get vaccinated against yellow fever.
The Brazilian authorities have recently changed their advice. Previously, they divided the country in four different areas (risk areas, potential risk areas, transition areas and risk-free areas). Now the split is much more simple, just the two areas: risk areas and risk-free areas. ONLY those travelling to risk areas should be vaccinated.

  • risk areas. Those where yellow fever is endemic and the virus is at large in rural areas. The states included in this group are Acre, Amazonas, Amapá, Distrito Federal (Brasilia), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima and Tocantins. In December 2008 there were new additions to the list: the western part of the states of Paraná (including the area of the Iguassu Falls), Piaui, Santa Catarina and São Paulo. The western part of the state of Rio Grande do Sul as well as Porto Alegre and part of its metropolitan area are included too.
  • risk-free areas. Areas where there have been no cases recorded and the likelihood of them happening is null. This area includes the entire Brazilian coast from Rio Grande do Sul up to Piaui (both states included). The state of Espírito Santo and the south of the state of Bahia are now declared risk-free.

5. Tourists visiting risk-free areas do not need to take the vaccine. The vaccine has a series of well-documented side effects.
Suddenly, everyone wants to get vaccinated against yellow fever, regardless of whether they are planning to visit risk zones or not. All vaccines have side effects, and the vaccine against yellow fever is no exception. Getting vaccinated for the sake of it is being discouraged.

6. For the vaccine to be effective, it needs to be taken at least 10 days prior to travel.
In Brazil at least, people embarking on trips to risk areas are taking the vaccine as they are about to begin their journey. You need to take the vaccine at least 10 days before you begin your journey to risk areas. The vaccine is valid for ten years. You should *not* get a booster before the end of that 10-year period.

7. Brazilian authorities are NOT asking at the moment for an International Certificate of Vaccination Against Yellow Fever regardless of where the passenger comes from.
Not long ago the certificate was being asked to passengers coming from a series of countries. That is no longer the case, at least for the time being. The official document from the Brazilian authorities stating a certificate is not needed is here: Certificado Internacional de Vacinação (see paragraph 3, unfortunately in Portuguese only). Basically, the certificate was only asked to passengers coming from countries where there was yellow fever, countries that were a potential threat to other countries. Anvisa (the Brazilian state agency responsible for disease control) states in the document that right now there are no countries posing a threat of spreading yellow fever. Anvisa also states in the document that if the risk should reappear, an alert would be issued.

8. Yellow fever is transmitted through a mosquito bite.
You can’t catch yellow fever from a fellow human being. In the rural areas, the Haemagogus mosquito is the carrier of the yellow fever virus. In urban areas, it is the notorious Aedes aegypti mosquito, responsible as well for transmitting dengue fever to humans.

9. The main symptoms of yellow fever are: fever, muscle pain, headache, shivers, nausea or vomiting. Symptoms appear between three and six days after becoming infected.
In 15% of the cases symptoms can include also jaundice, bleeding and a series of complications. Yellow fever symptoms are very similar to those of dengue fever. For that reason, the diagnosis can only be confirmed after a series of lab tests.

10. Treatment of yellow fever is supportive only. There is no specific medication to treat yellow fever. Victims of yellow fever need to be treated in hospital.

VERY IMPORTANT: the medical information contained on this entry has been put together with responsible care. However, I am no health professional, and medical advice must be sought from doctors and other health professionals.

SOURCES:
On the Portal da Saúde from the Brazilian Ministry of Health up-to-date information on the yellow fever crisis can be found (in Portuguese only). There is a page in English, hidden under a subdomain at the same site, with basic information on yellow fever – but no specific mention to the current crisis (Febre amarela).

In Tourist Support Recommendations: Vaccines from the Brazilian Tourism portal there are general recommendations from the Brazilian authorities to tourists travelling to the country.

The US’s CDC is essential reading too: Yellow Fever in Brazil.

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  1. Global Voices Online » Brazil: Ten facts about yellow fever in Brazil | January 21, 2008
  1. Leo Martins says:

    Thanks for the unbiased info (despite some claims that the Ministry of Health lags behind its responsability as authoritative source). It is also worth mentioning that the vaccine should not be taken at intervals much inferior than 10 years – as some people misleadingly did.

  2. Tony says:

    Thanks for your comments, Leo, I’ve added the bit you mentioned about not getting a booster before the 10-year period – we know well what’s happened in Brazil to people overeager to take the vaccine again.

    Sorry if I was misinterpreted. For once, I think Brazilian authorities were really straightforward, the message was clear and precise. The media made a meal out of it.

    My specific criticism to the government is that there is no up-to-date information on the crisis in languages other that Portuguese. As I sense there is a keen interest not to scare away the tourists, it might have been sensible to reassure them on their own language (English and Spanish at least).

  3. Julie says:

    Thank you very much for the update Tony, I must admit I have been getting more than a little anxious about my impending visit to Brazil and have been frantically searching the web daily for updates in English.

    If there are any further updates in the next week, please post them on here, as I am sure I am not the only person who has been desperate to seek information.

  4. Tony says:

    You’re welcome, Julie. If you tell me where you plan to go I might be able to give you some reassurances.

    While not wanting to downplay the importance of yellow fever – it is a serious disease, the fact remains that the recent cases (call it outbreak if you like) have been so far confined to places where yellow fever is endemic.

  5. Julie says:

    We are going to Rio for the Carnaval. We are not really planning to travel too far afield, but would be grateful of any advice on how far we could go without the vaccine.

  6. Tony says:

    Hi Julie, no problems whatsoever in Rio regarding yellow fever. Neither in the city nor in the entire state of Rio (should you want to spend some time at a nearby beach). The closer you would be to a risk area is the state of Minas Gerais, quite far away. Stick to the coastal area of Rio (plenty of interesting places to see: Arraial do Cabo, Búzios, Ilha Grande, Paraty) and you’ll be safe.

    Have a great trip!

  7. Brian Ford says:

    Will tourist who have visited endemic countries (French Guiana) be allowed visa and entry with a Physician’s “Waiver” of the “International Certificate of Vaccination Against Yellow Fever”?

    My doctor recommends that I do not take the Yellow Fever vaccination, so I am worried that I could be denied Visa/entry.

    The World Health Organization states this is acceptable at http://www.who.int/ith/countries/bra/en/, but I can’t find any verification from a Brazilian source.

  8. Tony says:

    Brian, I’m afraid I can’t answer your question. It is very much up to the individual at the border control. Brazilian authorities state an International Certificate is mandatory if you are coming from their series of listed countries, but I have never seen anybody being asked such certificate. My guess is that the document you have should be enough, in the event someone asked you for proof. But it is just a guess. Do print out the text from the WHO and bring it along.

  9. Brian Ford says:

    Thanks for the quick response Tony!
    Very kind of you to take the time.
    I’m very nervous about this. I’m going to push my doctor to give me the shot so I can stop worrying about it! I don’t believe the “exemption” will necessarily be accepted. I heard from a woman on another blog that said she was denied the visa because of lack of Yellow Fever immunization, which was a surpise to her.
    If anyone else has any thoughts on this, I am very interested.

  10. Tony says:

    Hi Brian, you’re welcome. I wish I could give you more reliable information, but then, this is Brazil. It doesn’t matter what I tell you here if the customs officer you face when you arrive interprets the law his own way.

    Might be good to talk to another doctor before you take the shot. If you’re travelling to a region where yellow fever is endemic, not getting the shot might be as risky, if not more, than taking it. But only a health professional should be able to help you on that regard.

  11. Karen says:

    My family and I are traveling to Belo Horizonte with side trips to Ouro Preto and Tiradentes in April. The shots will cost us about $1000 for the four of us, which is gonna hurt more than the shot. How necessary is the vaccine for the areas we are visiting?

  12. Tony says:

    Hi Karen, I don’t give out medical advice but I can tell you that, so far this year, there have been no cases recorded of yellow fever on the area you will be visiting. However, the Brazilian Health Authorities treat the entire region as a potential risk area, given that there have been cases in the neighbouring states (a few hundred miles away). Hope with this information you can make a more informed decision.

    It’s a shame the shots are so costly. Here in Brazil they are free.

  13. Bonnie says:

    Hi Tony,

    Thank you to Karen for asking the exact question that I have as well. I am traveling from Canada to Belo Horizonte and Ouro Preto in April and would strongly prefer NOT to have to take the Yellow Fever shot. My hosts assure me that the area is safe, but can you confirm that this has also been your understanding?

    I will confirm with a travel doctor as well, but wanted the opinion of a “man on the ground” as it were so that I can make the most informed decision.

    With thanks for all of your efforts!

    Bonnie

  14. Tony says:

    Hi Bonnie, the situation hasn’t changed much since I wrote my reply to Karen. The entire Minas Gerais state is considered to be a risk area. So far there have been no cases recorded, but the risk is there. Ouro Preto and Belo Horizonte are really far from the neighbouring states where yellow fever cases have been recorded. The crisis hasn’t spiraled out of control, as the amount of cases recorded at the beginning of the year made some people fear.

    It’s a difficult one. Of course, I won’t even attempt to tell you do this or do that. I’m not 100% sure what I would do in your case. But the info you have been given is accurate.

    Have a great time! You will be visiting a really nice region where not many tourists venture.

  15. Arty says:

    Hi Tony,

    Thanks for putting all of this great information together. We will be traveling to Florianopolis and Rio at the beginning of April. It looks like both of those areas are pretty clear of yellow fever, correct? Any other suggestions for vaccines or health/safety?

  16. Tony says:

    Hi Arty, you’re welcome! No news on the yellow fever front, so far Florianópolis and Rio remain perfectly safe.

    However, there is a serious outbreak of dengue fever in the city of Rio. So far this year there have been 20.000 cases recorded with 29 deaths.

    I wrote a lengthy text on dengue fever on this blog 10 facts about dengue fever in Brazil.

    In a nutshell, there is no vaccine against dengue fever and the only prevention is to avoid being bitten by the mosquito that carries the disease.

  17. Michael says:

    I am traveling to Sao Paulo on business. Should I get vaccinated?

    Thanks.

  18. Tony says:

    Michael, if you mean the city of São Paulo (as opposed to the state of São Paulo) you don’t need to get vaccinated. No cases of yellow fever reported here for a quite a number of years.

    Have a nice trip!

  19. Sylvie says:

    My son is in Brazil now and we got very confusing information here. He is on immuno suppressants and therefor cannot be given the yellow fever vaccine. He is meant to travel to IGUACU and to the PANTANAL. SAFE OR NOT? any comments would be welcome

  20. Tony says:

    Sylvie, I can’t hand out medical advice as I’m no health professional. There have been no recent reports of yellow fever on the areas you mention (there were cases at the beginning of the year), but that doesn’t mean the risk isn’t there. The health authorities are urging ecotourists to get the vaccine. If that is not a possibility, perhaps it would be better to opt for a different destination. The call is yours.

  21. Cristina says:

    Hi Tony,
    I see it has been some time since this topic has been discussed. I am going to Sao Paulo on 12/2 until 12/19 and have been told by the NYC Brazilian Consulate that I do NOT need a yellow fever vaccine. I am having trouble finding a doctor to give me the shot and I leave in less than 10 days, I just can’t help but be a bit scared that a mosquito is going to find me in the city and infect me….

  22. Tony says:

    Hi Cristina, yellow fever was never an issue in São Paulo city. You definitely do NOT need a vaccine. Don’t worry, mosquitos here do not carry the yellow fever virus. Have a nice trip!

  23. Jonathan says:

    Hi Tony:

    Thanks for all this information. I’ll be traveling to Belo Horizonte in January to visit a friend (afterwards will go to Rio and Buzios). My initial impression is I wouldn’t need the Yellow Fever vaccine. But the current CDC map has Belo Horizonte within the highlighted risk area for Yellow Fever. Have you heard anything? Thanks!
    -Jonathan

  24. Tony says:

    Jonathan, that is a tricky one. Since I can’t tell you what you should do I’ll tell you what I’d do. If I were to stay within the boundaries of the city of Belo Horizonte, I wouldn’t take the vaccine. As stated on the blog post, there have been no cases of urban yellow fever for a considerable number of years. The rural areas are a different matter, there I would take the vaccine.

    All the best!

  25. Ruth says:

    Hi Tony,
    My husband is traveling to Brazil in March. He will be visiting Belo Horizonte, Araxa, Catalao, Uberabia, and Uberlandia. Do you have any information about the need for a yellow fever vaccination in those areas. He will be there about four days? Thank you.

  26. Tony says:

    Hi Ruth, you husband should really get the vaccine, as he will be visiting rural areas in the risk zone (where there have been cases of the disease). Do remember he must take the shot 10 days prior to travel.

  27. Hello Tony,

    Just curious. I’ll be travelling to Rio de Jeneiro on March 19, 2009 to attend the Third STOP-TB Partners’ Forum from March 23 to 25.

    Does Rio belong to the free-risk area not? If not, must I have a yellow fever shot? I”m confused as I have been advised to do so in order to be able to travel to Brazil.

    Thanks,
    Hyginus Hardoyo

  28. Tony says:

    Hyginus, Rio is on a risk-free area. Brazilian authorities are not asking at the moment for an International Certificate of Vaccination Against Yellow Fever regardless of where the passenger comes from. Safe travel!

  29. Kelli says:

    Hi. I’m going to Excelsior in Rio De Janerio in a little over a week. I know that’s not a high risk area for yellow fever, but my trip also includes a two night stay at Bourbon cataratas in Iguassu Falls…. where is that in terms of the risk areas?? I need to know should I be concerned and go and get a vaccination???

  30. Tony says:

    Kelli, Foz do Iguaçu is a risk area, do take the vaccine.

  31. Eileen says:

    Thank you for the information, but I still have a question. My daughter is going to Brazil next week on a college trip, they will visit Rio, Sau Paulo, and Brazilia. They will be in cities. I did notice Brazilia is in the yellow risk area. Should she get the vaccine? The college professor who is taking them, says it is not necessary, but I’m not sure that is correct??? Thanks!

  32. Tony says:

    Eileen, the Brazilian Health authorities are definitely advising the vaccine for anyone visiting Brasilia. Strictly speaking, there have been no cases of urban yellow fever yet, but if you are going to be visiting any parks or similar spaces then there is a risk. The local authorities in Brasilia have organized several mass campaigns of vaccination against yellow fever, so that will give you a real indication of the importance of taking the shot – unless there are medical reasons preventing your daughter from doing so.

  33. Jackie says:

    Hi Tony,

    Thanks for posting this information, it’s really helpful. I see back in March you were saying that Brazilian authorities were not asking for Yellow Fever Vaccination Certificates regardless of where the person is coming from. I was wondering if that’s still the case, because I’ll be in Peru and Ecuador before I fly into Brazil in July. I’m not going to any risk areas in any of those three countries, and can’t get the vaccine due to an immune system suppressant I’m currently taking.

    Thanks,
    Jackie

  34. Tony says:

    Jackie, there’ve been no changes I’m aware of.

  35. Jackie says:

    Thanks for the info!

  36. Phil says:

    Hi Tony, my question is somewhat similar to Jackie´s. I am entering Brazil from Colombia, crossing at Leticia to Tabatinga. I have had the yellow fever vaccination, but I dont have the certificate since it was stolen along with some other stuff a few weeks back.

    I do, however, have a photocopy of the certificate. Will this be sufficient for entry into Brazil?

    Thanks

  37. Tony says:

    Phil, see point number 7 on the text. No changes have been posted at the Brazilian Ministry of Health’s website.

  38. Marco says:

    Hi Toni,
    I’m going to Venezuela in December and, later on, entering Brazil from there via Santa Elena do Uairén. Are there any updates regarding the yellow fever vaccinations rules at the border?

    I’m also travelling to Manaus and likely some areas in Amazonas. In principle I’d prefer avoiding vaccines but I’m seeing you list my destinations among the risk areas…and I try to minimize risks. Could you please advice me?
    Thanks a lot

  39. Tony says:

    Marco, there’ve been no changes to the vaccination rules. At present, no yellow fever certificate is required to enter Brazil. However, since yellow fever is present in Brazil, do find out what are the rules on other countries along your route, as you might be required to present a certificate if your departure point is Brazil.