There are no compulsory vaccinations required to enter Brazil from Europe or North America, but a list of recommended jabs and health recommendations can be found at fitfortravel.nhs.uk. A yellow fever certificate may be a requirement if you are entering from another South American country, and you should take your vaccination records with you. Certain health precautions should be taken on your travels, especially if you’re staying for any length of time or visiting more remote regions: in this case it is wise to travel with your own medical supplies. Taking out travel insurance is vital, and you should be especially aware of dengue fever, a significant problem in Rio and other cities during the Brazilian summer (Dec–April). But you should not let health issues make you unduly paranoid – if you need it, good medical care is available cheaply for all but the most serious of problems.

Pharmacies and medical treatment

Most standard drugs are available in pharmacies (farmácias), which you’ll find everywhere – no prescriptions are necessary. A pharmacy will also give free medical advice, and they’re a good first line of defence if you fall ill.

If you are unlucky enough to need medical treatment in Brazil, forget about the public hospitals – as a foreigner, you have virtually no chance of getting a bed unless you have an infectious disease, and the level of health care offered by most is poor. You can get good medical and dental care in private hospitals and clinics: North Americans will think it fairly inexpensive, but Europeans used to state-subsidized health care may not. A doctor’s visit will cost on average R$100–160, and drugs are relatively cheap. Hotels in big cities will have lists of English-speaking doctors; ask for a médico. Outside the larger centres, you will probably have to try out your Portuguese. Any Brazilian doctor will also understand – although not necessarily speak – Spanish.

Chagas’ disease

Chagas’ disease is endemic in parts of the Northeast and the Amazon. Although it is difficult to catch, it can lead to serious heart and kidney problems that appear up to twenty years after infection. The disease is carried in the faeces of beetles that live in the cracks of adobe walls, so if sleeping in an adobe hut, make sure nothing can crawl into your hammock; either use a mosquito net or sling the hammock as far from walls as you can. The beetle bites and then defecates next to the spot: scratching of the bite will rub in the infected faeces, so before scratching a bite that you know wasn’t caused by a mosquito, bathe it in alcohol. If you are infected, you will have a fever for a few days that will then clear up as if nothing untoward happened. Though the disease can be treated in its early stages, it becomes incurable once established. If you travel through a Chagas area and get an undiagnosed fever, have a blood test as soon as possible afterwards.

Dengue fever

Dengue fever, a viral disease transmitted by mosquito bites, is increasingly common in all Brazilian cities. It is highly seasonal, peaking in the southern hemisphere summer (Dec–April). The symptoms are debilitating: light but persistent fever, tiredness, muscle and joint pains (especially in the fingers), and nausea and vomiting. There is currently no cure for dengue, so it is likely that you will feel pretty grim for a week or so even with treatment, and you should be aware that some of its complications can be dangerous. The same precautions against mosquito bites outlined in the section on malaria apply here too; the difference is that the dengue mosquito comes out during the day rather than at night.

There is one dangerous form of dengue, hemorrhagic dengue, which kills hundreds of people a year in Brazil. Tourists tend not to get it, since you almost always need to have had a previous attack of dengue to be vulnerable to it. It is particularly dangerous to children. If dengue-like symptoms are accompanied by bleeding from the nose, ears or gums, highly bloodshot eyes, blood in your vomit or urine or a pin-prick red rash, get yourself to a private hospital fast.

Diarrhoea, dysentery and giardia

Diarrhoea is something everybody is likely to get at some stage, and there’s little to be done except drink a lot (not alcohol) and bide your time. You should also replace salts, preferably by taking oral rehydration salts (one after each episode), or by mixing a teaspoon of salt and eight of sugar in a litre of purified water. You should seek help if you can’t keep any fluids down at all (sucking ice cubes can be a good way to stay hydrated).

If your diarrhoea contains blood or mucus, the cause may be dysentery or giardia. With a fever, it could well be caused by bacillic dysentery and may clear up without treatment. Nevertheless, a course of antibiotics such as ciprofloxacin is advised. It is best to consult a doctor or pharmacist about which antibiotic to take as different bugs may be resistant locally, and you should avoid taking Loperamide (Imodium) if at all possible. Note that these drugs also destroy “gut flora” that help protect you. Once your symptoms have disappeared you may be a bit intolerant to milk, spicy food and alcohol, and it is a good idea to stick to small, bland meals.

Similar symptoms without fever indicate amoebic dysentery, which is much more serious, and can damage your gut if untreated. The usual cure is a course of metronidazole (Flagyl), an antibiotic that may itself make you feel ill, and should not be taken with alcohol. Similar symptoms, plus rotten-egg belches and farts, indicate giardia, for which the treatment is again metronidazole. If you suspect you have any of these, seek medical help. It would be wise to travel with a supply of antibiotics if you are going off the beaten track for several weeks, but you should only take them if there is definitely blood in your diarrhoea and it is impossible to see a doctor.

Food and water

Many diseases are directly or indirectly related to impure water and contaminated food, and care should be taken in choosing what to eat and drink. You should, of course, take particular care with seafood, especially shellfish – don’t eat anything that’s at all suspicious. Fruit and salad ingredients should be washed in bottled or purified water or, preferably, peeled. Ultimately, you are going to run some risks with all food, so if you’re going to enjoy your stay to the full, you can’t be too paranoid.

Even in the most remote towns and villages mineral water (água mineral), either sparkling (com gás) or still (sem gás), is easily available and cheap. As with food, it’s difficult to be on guard all the time while drinking; be aware that fruit juices are often diluted with water, and ice is rarely made with filtered water outside a smart hotel.

In many Brazilian cities tap water is clean enough to drink (and locals do so all the time); though it will be free of diseases, you may still get mildly sick from any bacteria in the water supply that your body is not used to. If you are travelling in remote areas, consider taking a water purification agent, such as iodine, with you. To avoid dehydration be sure to drink plenty of non-alcoholic liquids, always carry a bottle of water on long trips and check that the seal on any bottled water you use is intact.

Hepatitis A

Wherever you go in Brazil, protection against hepatitis A is a sensible precaution. The disease is transmitted through contaminated water and food, resulting in fever and diarrhoea, and it can also cause jaundice and liver damage; good food and hand hygiene are the best preventatives. Gammaglobulin injections are the traditional protection but require regular boosters. A newer vaccine – Havrix – is very effective and lasts for up to ten years if you have a booster jab after six months.

HIV and AIDS

Brazil has a relatively high number of people with AIDS and HIV, though the number has declined significantly since the 1990s when it seemed that the epidemic was getting out of control. Indeed, the Brazilian anti-AIDS programme is considered by the UN to be the most successful in the developing world. There are many reasons for this: free, universal provision of anti-retroviral drugs (ARVs); a dramatic increase in the awareness of, and availability of, condoms, spurred by government programmes (especially and controversially within the sex worker community); and needle exchange programmes.

Brazil also has some of the funniest and most imaginative safe-sex campaigns anywhere, particularly in evidence during Carnaval.

The best preventative for transmission is to use a condom, which is also a sensible way to avoid catching other STDs. They are widely available in pharmacies, where you should ask for a camisinha. A majority of Brazil’s HIV carriers are concentrated in the big cities, and the gay community is the highest risk group. As anywhere else, anal sex or sex with a prostitute are high-risk activities. The situation with blood and blood products has now improved enormously, but in more remote parts of the country, especially the Amazon, make sure that if you have an injection it is with a needle you see being removed from its packaging, or carry your own needles with you.

Malaria

Malaria is endemic in northern Brazil: Amazônia, Southern Pará and much of rural Rondônia are the riskiest areas. It may be advisable to avoid some areas entirely if you are travelling with children as malaria can be a much more serious issue for them. In recent years rates have climbed as mosquitoes have become more resistant to insecticides and drugs, and a small number of tourists die avoidably every year. However, with simple precautions you can minimize the chances of catching it, even in highly malarial areas. Make no mistake, though, without the correct precautions and prophylaxis, malaria can kill.

There are two kinds of malaria in Brazil: falciparum, which is more serious but less common, and vivax. Both are transmitted by anopheles mosquitoes, which are most active at sunrise and for an hour or so before sunset. Even in very malarial areas, only around five percent of anopheles are infected with malarial parasites, so the more you minimize mosquito bites, the less likely you are to catch it.

Make sure that you use insect repellent: the most commonly used in Brazil is Autan, often in combination with Johnson’s Baby Oil to minimize skin irritation. The most effective mosquito repellents – worth looking out for before you leave home – contain DEET (diethyl toluamide). DEET is strong stuff, so follow the manufacturers’ instructions, particularly with use on children. If you have sensitive skin, a natural alternative is citronella or, in the UK, Mosi-guard Natural, made from a blend of eucalyptus oils (though still use DEET on clothes and nets). Wear long-sleeved shirts and trousers, shoes and socks during the times of day when mosquitoes are most active. You should also sleep under a sheet and, crucially, use a mosquito net. Nets for hammocks (mosqueteiro para rede) are reasonable and easily available in Amazonian cities and towns. Mosquito coils also help keep the insects at bay.

Prevention and treatment

When taking preventive tablets it’s important to keep a routine and cover the period before and after your trip with doses; doctors can advise on which kind to take. As resistance to chloroquin-based drugs increases, mefloquin, which goes under the brand name of Lariam, has become one of the most recommended prophylactics for travellers to Brazil. This can have very strong psychiatric side effects, though, and its use is controversial. The websites cdc.gov/travel/regionalmalaria and fitfortravel.nhs.uk are useful resources, giving advice on risk areas in Brazil and the best methods of protection.

Malaria has an incubation period of around two weeks. The first signs of malaria are remarkably similar to flu – muscle and joint pains and weakness that last for a day or two before the onset of malaria fever proper – and may take months to appear: if you suspect anything, go to a hospital or clinic immediately. You will need immediate treatment and a blood test to identify the strain.

Malaria treatment is one public-health area where Brazil can take some credit. Dotted in malarial parts of the Amazon are small malaria control posts and clinics, run by the anti-malaria agency SUCAM – ask for the posto da SUCAM. They may not look like much, but the people who staff them are very experienced and know their local strains better than any city specialist. Treatment in a posto is free, and if you do catch malaria you should get yourself taken to one as quickly as possible; don’t shiver in your hammock and wait for it to pass. If in a city and you get the same symptoms (a fever and the shakes), make sure you get a blood test right away; you’ll get your results in a few hours and quick diagnosis is vital. Remember that the incubation period means that the symptoms may only appear after you return home – make sure to tell your doctor where you’ve been if you get a fever shortly after your return home.

Rabies

Though the government has had great success in containing the disease in recent years, rabies does exist in Brazil – feral dogs (which should not be petted) in the cities and bats in the Amazon are the biggest dangers. If you are bitten or scratched, wash the wound immediately with soap and running water for five minutes and apply alcohol or iodine. If possible try to see whether the animal itself has any rabies symptoms. Seek treatment immediately – rabies is fatal once symptoms appear, and you may also need to get a tetanus jab. If you’re going to be working with animals or planning a long stay, especially in rural areas, you should consider a rabies vaccination beforehand. Although this won’t give you complete immunity, it will give you a window of 24–48 hours to seek treatment and reduce the amount of post-exposure vaccine you’ll need if bitten.

Yellow fever

Getting a yellow fever vaccination, which offers protection for ten years, is recommended for most regions outside of Fortaleza, Recife, Rio de Janeiro, Salvador and São Paulo (see cdc.gov/travel for more details). This viral disease is transmitted by mosquitoes and can be fatal, but is extremely rare even in places where it is endemic. Symptoms include headache, fever, abdominal pain and vomiting, and though victims may appear to recover, without medical help they may suffer from bleeding, shock and kidney and liver failure. While you’re waiting for help, it is important to keep the fever as low as possible and prevent dehydration.

In the Amazon

Given the remoteness of many parts of the Amazon and the prevalence of insects and snakes, health care takes on a special significance. If you are trekking through forest or savannah, long trousers are a good idea, and it is vital to wear good boots that protect your ankles from snake bites, chiggers (mites) and scorpions. You should never trek alone.

Snakes are timid and, unless you’re unlucky, only attack if you step on them. Many of the most venomous snakes are tiny, easily able to snuggle inside a shoe or a rucksack pocket. Always shake out your hammock and clothes, keep rucksack pockets tightly closed and take special care when it rains, as snakes, scorpions and other nasty beasties quite sensibly head for shelter in huts.

If you do get bitten by a snake, try to kill it for identification – but only if this can easily be done. Contrary to popular belief, cutting yourself and sucking out blood will do you more harm than good. It goes without saying that you should get yourself to a doctor as soon as possible. Health posts in the nearest town may have serum, but you must know the type of snake involved.

Due to the humidity, any cut or wound gets infected very easily. Always clean cuts or bites with alcohol or purified water before dressing. As a general rule, leave all insects alone and never handle them. Even the smallest ants, caterpillars and bees can give you nasty stings and bites, and scorpions, large soldier ants and some species of bee will give you a fever for a day or two as well.

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