Rio de Janeiro’s mayor has just made a worrying announcement. This coming summer Rio is to face its worse dengue fever epidemic in history. The conclusion was reached through the comparison of current and old data. So far this year, and long before the summer months when most cases are recorded, Rio has seen 160,000 cases of dengue fever with 121 deaths.

An informed traveler is the best possible traveler and for that reason we want to refer you once again to our blog post 10 facts about dengue fever in Brazil. It was written with the help of a medical specialist on the disease and it contains information on dengue fever.

Thinking of cancelling your trip to Rio because of the upcoming dengue fever epidemic? We don’t feel you should necessarily do that. Get the information and understand the risks associated to dengue fever before you take such decision.

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Even if you are not an American citizen, the US government’s CDC website should be your starting point for any consultation on health issues related to your upcoming trip to Brazil. You will find the information under the section Health Information for Brazil.

It contains thorough, reliable and up-to-date information on all health issues, including a section on vaccines and another section on items you might want to bring with you on your trip.

Whenever a new fact emerges the CDC releases a travel notice. On the last few days there have been notices on yellow fever, dengue, H1N1 flu and measles.

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RELATED POSTS:
10 facts about dengue fever in Brazil
10 facts about yellow fever in Brazil
swine flu (H1N1) in Brazil
yellow fever: important update

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On 10 facts about dengue fever in Brazil, our main entry devoted to dengue fever on this blog, we explained how the dengue epidemic coincides with the rainy season. What with the rainy season well under way, dengue is back to the headlines: Risco de dengue deixa em estado de alerta 17 capitais, diz ministério. Alert on 17 capitals due to the risk of dengue fever. Among the capitals mentioned there are plenty of important tourist destinations such as Aracaju, Belém, Belo Horizonte, Brasilia, Fortaleza, Maceió, Manaus, Natal, Rio de Janeiro, Salvador de Bahía, São Luís, Recife or Vitória.

Our advice:

1. Do not panic. Dengue fever is endemic. It appears every year in most of the country.
2. Be informed. Read 10 facts about dengue fever in Brazil to know more about the disease and to learn how to prevent becoming a victim of dengue fever.
3. When you reach your destination, seek up-to-date information locally. There isn’t a single online source with up-to-date information on dengue fever on all the destinations mentioned above.

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RELATED POSTS:
10 facts about dengue fever in Brazil
10 facts about yellow fever in Brazil
swine flu in Brazil

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updates:

• from 1 January 2010 till 3 April 2010, 50 deaths resulting from the disease.
• 29 Oct 2009, 1368 deaths resulting from the disease.
• 23 Sep 2009, 1047 deaths resulting from the disease.
• 16 Sep 2009, 899 deaths resulting from the disease.
• 10 Sep 2009, 731 deaths resulting from the disease.
• 02 Sep 2009, 657 deaths resulting from the disease. Continues discrepancies between the death toll figures issued by the governments of the different Brazilian states and the Ministry of Health means I will no longer update the tally for individual states. A very clear picture has emerged where the southern states are, by far, the most affected by the flu epidemic.
• 31 Aug 2009, 575 deaths resulting from the disease.
• 27 Aug 2009, according to official figures, the number of new cases of swine flu is decreasing throughout the country. The 1st week of August registered 1,578 serious cases, the 2nd week the number went down to 826 and on the 3rd week there were 273 new cases.
• 26 Aug 2009, 557 deaths resulting from the disease. Most deaths have occurred in the southeastern and southern states of the country: São Paulo (223 deaths), Paraná (151), Rio Grande do Sul (98) and Rio de Janeiro (55) lead the toll. The number of cases on the north and northeast regions is very small.
• 21 Aug 2009, 488 deaths resulting from the disease. Florianópolis and 19 other cities from the state of Santa Catarina declare emergency status due to the advance of swine flue.
• 20 Aug 2009, 404 deaths resulting from the disease.
• 18 Aug 2009, media reports fall in the number of influenza A cases attended at São Paulo hospitals.
• 18 Aug 2009, 379 deaths resulting from the disease.
• 14 Aug 2009, 339 deaths resulting from the disease.
• 12 Aug 2009, 274 deaths resulting from the disease.
• 10 Aug 2009, 191 deaths resulting from the disease.
• 07 Aug 2009, 167 deaths resulting from the disease.
• 04 Aug 2009, 129 deaths resulting from the disease.
• 03 Aug 2009, 92 deaths resulting from the disease.
• 01 Aug 2009, 76 deaths resulting from the disease.
• 31 Jul 2009, 68 deaths resulting from the disease. To control the spread of the virus, classes will resume two weeks later than usual in several states, including Rio de Janeiro and São Paulo.
• 28 Jul 2009, 55 deaths resulting from the disease
• 27 Jul 2009, 45 deaths resulting from the disease
• 26 Jul 2009, 39 deaths resulting from the disease
• 24 Jul 2009, 1566 cases of swine fever confirmed and 33 deaths resulting from the disease
• 22 Jul 2009, 29 deaths resulting from the disease
• 21 Jul 2009, 20 deaths resulting from the disease
• 16 Jul 2009, 1175 cases of swine fever confirmed and eleven deaths resulting from the disease
• 09 Jul 2009, 1027 cases of swine fever confirmed and two deaths resulting from the disease
• 08 Jul 2009, 977 cases of swine fever confirmed and one death resulting from the disease
• 06 Jul 2009, 905 cases of swine fever confirmed and one death resulting from the disease
• 04 Jul 2009, 885 cases of swine fever confirmed and one death resulting from the disease
• 29 Jun 2009, 627 cases of swine fever confirmed and one death resulting from the disease
• 22 May 2009, nine cases of swine fever confirmed
• 09 May 2009, eight cases of swine fever confirmed
• 07 May 2009, first four cases of swine fever confirmed
• 05 May 2009, no confirmations or dismissals of suspect cases yet
• 04 May 2009, no confirmations or dismissals of suspect cases yet
• 03 May 2009, in spite of repeated claims by the government that the country is prepared to face the flu, not a single suspect case has been confirmed or disregarded yet. We don’t know whether this is due to technical incompetence or deliberate concealment of information

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Up until today, there are no travel restrictions whatsoever imposed on travellers arriving from other countries.

Up-to-date information on ANVISA‘s website, the Brazilian’s government body responsible for disease control. It has a version in English but no up-do-date information can be found on that section.

I’m also adding a link to the US’s CDC website with up-to-date information on the topic:

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RELATED POSTS:
10 facts about dengue fever in Brazil
10 facts about yellow fever in Brazil

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Dengue fever is a regular visitor of this blog. If last year it was Rio de Janeiro that suffered a devastating epidemic, this year the bad news come from the state of Bahia. So far this year there have been 26.597 cases, a 291% increase over 2008. 28 deaths have been confirmed and there are another 59 still unconfirmed.

Among the seven cities worst affected by the epidemic there are two tourist destinations: Ilhéus y Porto Seguro.

You have complete information on dengue fever at this blog’s entry 10 facts about dengue fever in Brazil.

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I’ve just updated the entry 10 facts about yellow fever in Brazil and made some modifications under the light of recent changes announced by the Brazilian health authorities. I’ve incorporated two major changes:

• Brazil is no longer asking for an International Certificate of Vaccination Against Yellow Fever regardless of where the passenger comes from. This might change in the future but at the moment the certificate is not required.
• the Brazilian authorities have recently changed their advice regarding risk areas. 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.

You can check out the changes on points 4 and 7 of the above-mentioned blog post.

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The considerable increase in the number of cases of dengue fever in Natal has forced its local authorities to declare state of emergency (Dengue: Prefeito Carlos Eduardo decreta estado de emergência).

In the first three months of 2008 there were 2.568 cases of dengue fever and 272 of hemorrhagic dengue fever, resulting in two deaths (in comparison, in the entire 2007 there were 6.107 cases of dengue fever and 163 of hemorrhagic dengue fever). The number of cases might seem small when compared with Rio de Janeiro, but do bear in mind Natal is considerably smaller than Rio. There are also reasons to suspect the number of deaths might be higher than what the authorities are acknowledging.

At the entry 10 facts about dengue fever in Brazil you have the basics of what you need to know about dengue fever. If you are planning a trip to Natal, be informed beforehand. For the time being, we do not recommend cancelling your trips to the region.

We are informing about the situation in Rio at Dengue fever epidemic in Rio.

I’ve posted a similar warning, in Spanish, at Dengue en Natal.

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Dengue fever is endemic in Brazil and each year it reaches epidemic proportions. In 2008, dengue fever is being felt in earnest in Rio de Janeiro, where the epidemic is particularly virulent this year. From the beginning of 2008, and only in the capital, there have been more than 50.000 cases of the disease with 51 people dying as a result. In the whole of the Rio de Janeiro state, more than 75.000 cases and 83 deaths [figures updated on April 15]. The public health system has collapsed and health assistance is precarious. The army has been sent it and field hospitals have been set up.

Most cases are concentrated around the capital, Rio de Janeiro. Of all the main tourist destinations on the state of Rio, only Angra dos Reis should be avoided at all costs, as the outbreak is quite virulent there as well. Paraty, Ilha Grande, Búzios, Cabo Frio and Arraial do Cabo are ok.

The situation is not likely to improve until the end of the rainy season, between June and July. You are strongly advise to reconsider a trip to Rio de Janeiro (the city) until the situation has improved considerably. The fact that famous (and wealthy) people have caught dengue fever in the city should give an indication of the size of the problem.

For more information, you are advised to read the post I wrote a few weeks ago: 10 facts about dengue fever in Brazil

1. Dengue fever is one of the biggest threats to the health of those living in Brazil and of those visiting the country as well.

Dengue hemorrhagic fever can cause death.

2. Dengue fever is spread throughout most of Brazil.

Contrary to what happens with yellow fever, dengue is present both in rural and urban areas. In many places it occurs in the form of epidemics. From January to November 2007 there were 536,519 cases of dengue fever in Brazil. In the entire 2007, there were 1,541 cases of dengue hemorrhagic fever, with 158 deaths. The fight against dengue fever is hindered by precarious hygiene and sanitation standards in most of the country, the insufficient resources made available by the authorities at all levels, and the attitude of part of the population. According to a recent poll, 91% of the population know what needs to be done to erradicate the mosquito than transmits dengue; however, 55% do nothing about it as their neighbours do nothing either.

Google has an online tool that tracks the occurrence of dengue fever cases in Brazil. It can be checked at Dengue trends: Brazil.

3. Cases of dengue fever increase during the rainy season.

The mosquito that transmits dengue fever becomes active with rain and high temperatures. 86% of the cases registered in 2007 occurred between January and May.

4. So far, there is no vaccine against dengue fever.

Primary prevention of dengue fever consists on avoid being bitten by the mosquito that transmits the disease. Cover your exposed skin and your clothes with repellent.

5. Dengue is transmitted through the bite of the Aedes Agypti mosquito.

The fight against dengue is synonym whth the fight against the mosquito. The adult mosquito is middle-sized, dark with white markings on the sides and the upper part of the thorax. It has white rings on its legs. It is found on houses and their vicinities. It needs clean water to deposit its eggs.

6. Dengue fever is not transmitted between humans.

7. There are four serotypes of dengue fever: 1, 2, 3, 4. Type 4 is the only one not found in Brazil.

Update: type 4 has finally made it to Brazil.

8. Two forms of dengue fever are found in Brazil: classic dengue fever and dengue hemorrhagic fever.

On average, symptom manifest between 5 and 6 days after the infection.

The main symptoms of classic dengue fever are high fever (39° to 40°C); severe headache; rashes (bright red on the lower limbs and the chest); muscle and joint pains; nausea and vomiting.

Initially, the symptoms of dengue hemorrhagic fever are the same as those of classic dengue. After the third or fourth day, hemorrhages appear. It the disease is not treated inmmediately, it can lead to the death of the patient.

If symptoms appears, immediate medical care is need – do go to a hospital or health centre.

9. There is no specific treatment for classic dengue fever.
Aspirins should be avoided as they may favour the appearance of hemorrhages. It is important that the patient prevents dehydration through increased oral fluid intake.

Dengue hemorrhagic fever should be trated in hospital.

10. Dengue fever can be caught more than once (although it will never be the same type). Those who have contracted dengue fever in the past should be extra careful as dengue hemorrhagic fever seems to develop almost exclusively on patients that had had classic dengue fever before.

MORE INFORMATION:

Combata a Dengue. Website of the Brazilian Ministry of Health, in Portuguese only. Given the size of the problem and the fact that dengue fever does not discriminate between residents and visitors, one would have expected a more proactive attitude from Brazilian authorities when it came to informing tourists about the risks of dengue fever. I haven’t found any mention of dengue fever on the Brazil Tourism Portal, also belonging to the Brazilian government.

One wonders what are the reasons behind this silence and reaches the conclusion that the authorities want to avoid at all costs associating yet another negative issue to the image of a country already blemished by violence, precarious infrastructures and lack of tourist information. If a blogger with no financial support and the collaboration of a doctor can write a entry like the one you are reading now, why shouldn’t a government be able to do something similar?

The U.S. government’s CDC Dengue Fever Fact Sheet can be consulted for further information in English.

This entry has been entirely written with the medical supervision of dr. Gustavo R. Bonzón, to whom we are grateful for this co-operation. Any mistakes contained in the text are the sole responsibility of the blog.

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RELATED POSTS:
dengue fever alert: state of Bahia (2009)
Dengue fever epidemic in Rio (2008)
Dengue fever in Natal (2008)

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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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RELATED POSTS:
10 facts about dengue fever in Brazil

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