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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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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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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UPDATE: Ten facts about yellow fever in Brazil

Yellow fever has hit the headlines once again. The Brazilian authorities have re-issued a health alert for visitors coming to Brazil and intending to visit certain regions of the country where yellow fever is endemic. The recent deaths of a handful of people in Goiania and Brasilia have provoked a sudden rush to the health centres.

The basic facts about yellow fever in Brazil remain the same:

1. It is strongly recommended that people visiting the states of Acre, Amazonas, Amapá, Distrito Federal, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará, Rondônia, Roraima and Tocantins be vaccinated against yellow fever.

2. Additional areas of potential risk have been identified in the western areas of the states of Santa Catarina, Paraná (including the area around Iguassu Falls), Piauí, São Paulo and on the southern part of the state of Bahia. No cases of yellow fever have been recorded on these areas but visitors are advised to get the vaccine.

3. Any other part of the country not included above is risk-free. The popular tourist destinations where there is no risk of catching yellow fever and, therefore, no need to get the vaccine, include:

State of ALAGOAS: Maceió, Maragogi, the Rota Ecológica and the rest of the state.
State of BAHÍA: Salvador, Morro de São Paulo, Praia do Forte. For the southern coast of the state (Porto Seguro, Arraial d’Ajuda, Trancoso, Caraíva) the vaccine is recommended.
State of CEARÁ: Fortaleza, Canoa Quebrada, Jericoacoara and the rest of the state.
State of PARAÍBA: João Pessoa and the rest of the state.
State of PARANÁ: Ilha do Mel and the rest of the coast of the state.
State of PERNAMBUCO: Recife, Olinda, Porto de Galinhas, Fernando de Noronha and the rest of the state.
State of RÍO DE JANEIRO: Río de Janeiro, Paraty, Ilha Grande, Búzios, Arraial do Cabo, Cabo Frío and the rest of the coast of the state.
State of SANTA CATARINA: Bombinhas, Camboriu, Florianópolis and the rest of the coast of the state.
State of SÃO PAULO: Santos, Guarujá, Ilhabela, Ubatuba and the rest of the coast of the state.
State of SERGIPE: Aracaju and the rest of the state.
State of RIO GRANDE DO NORTE: Natal, Pipa and the rest of the state.

The latest information can be found on the Brazilian Health Minister website: Ministério da Saúde. As usual in Brazil, the information contained on the Ministry’s homepage is only in Portuguese.

However, a reader of this blog has reported the existence of a website of the same Ministry, but under a different subdomain (and with no link from the Ministry’s homepage) with information in English on yellow fever: Febre amarela (I certainly can’t see how a visitor to the Ministry’s webpage would find their way to the page in English). The information contained here is of a general nature and does not relate specifically to the current crisis, as does the Portuguese-only information of the homepage. So, those wanting to read more about yellow fever in English can do so at the link provided; those wanting to find out information in English on the current crisis, will be left waiting.

Yellow fever is a serious disease. If in doubt, get the vaccine. You should do so at least 10 days prior to travel.

[UPDATE: Yellow fever alert]

I am reproducing the information on vaccines that appears at the Portal Brasileño de Turismo (run by the Brazilian government).

Yellow fever vaccine
For tourists who have been in transit over the past three months, or who are coming from certain countries – Angola, Benin, Bolivia, Burkina Faso, Cameroon, Colombia, Ecuador, Gabon, Gambia, Ghana, Guinea Bissau, French Guiana, Liberia, Nigeria, Peru, the Democratic Republic of the Congo, Sierra Leon, Sudan, Venezuela and Zaire -, an International Certificate of Vaccination against yellow fever is required.
The yellow fever vaccine is also recommended for all national and international tourists who intend to visit the following Brazilian states: Acre, Amazonas, Amapá, Federal District, Goiás, Maranhão, Mato Grosso do Sul, Pará, Rondônia, Roraima and Tocantins.

Not counting the cases mentioned above, no other vaccines are required for travellers entering Brazil.

The biggest health problem, for which there is no preventive treatment, is dengue fever. The disease is widespread, and it is transmitted by the mosquito Aedes aegypti. In recent years, there have been massive outbreaks of dengue fever in regions of the states of Rio, São Paulo, and most recently, Mato Grosso do Sul. Typical syntomps include high fever, headache, muscular pain, nausea and vomit.

As there is no vaccine against dengue, the only advice that can be given is to avoid being bitten by the mosquito (easier said than done). The mosquito lives in places where there are pools of clean water (for instance, in discarded tyres).

To obtain information on other health problems, including malaria and yellow fever, you are advised to get in touch with a doctor.

SEE ALSO:
- 10 facts about dengue fever in Brazil
- 10 facts about yellow fever in Brazil
- Health care
- Vaccines
- Dengue fever epidemic in Rio
- Dengue fever in Natal

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