For an ambulance in Brazil, call 192, or an emergency number.

Good medical care is available in the larger cities but may be difficult to find in rural areas. Medical care in Brazil may be extremely expensive.

Each Brazilian pharmacy has a licensed pharmacist. Most are well supplied.

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Before You Go

Health Insurance

If your health insurer doesn’t cover you for medical expenses incurred abroad, you’ll need to purchase extra travel insurance. Find out in advance if your travel insurer will make payments directly to providers or reimburse you later for overseas health expenditures.

Recommended Vaccinations

Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received. This is mandatory for countries that require proof of yellow-fever vaccination upon entry, but it’s a good idea to carry it wherever you travel.

In Brazil

Availability & Cost of Health Care

Good medical care is available in the larger cities but may be difficult to find in rural areas. Medical care in Brazil may be extremely expensive.

Each Brazilian pharmacy has a licensed pharmacist. Most are well supplied.

Infectious Diseases

The diseases of most concern are mosquito-borne infections, including malaria, yellow fever and dengue fever, which are not a significant concern in temperate regions.

Dengue

Found throughout Brazil, dengue is transmitted by Aedes mosquitoes, which bite preferentially during the daytime and are more common in densely populated, urban environments.

Dengue usually causes flu-like symptoms, including fever, muscle aches, headaches, nausea and vomiting, often followed by a rash. There is no vaccine or treatment for dengue fever except to take analgesics such as acetaminophen/paracetamol and to drink plenty of fluids.

Hepatitis A

Hepatitis A is the second most common travel-related infection after traveler’s diarrhea. It’s a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. The illness occurs throughout the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though hepatitis A occasionally causes severe liver damage. There is no treatment.

The vaccine for hepatitis A is extremely safe and highly effective. If you get a booster six to 12 months later, it lasts for at least 10 years. You really should get it before you go to Brazil or any other developing nation. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under the age of two, they should instead be given a gamma globulin injection.

Malaria

Malaria is transmitted by mosquito bites, usually between dusk and dawn. The main symptoms are high spiking fevers, which may be accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may involve the central nervous system and lead to seizures, confusion, coma and death.

Taking prophylaxis (malaria pills) is strongly recommended for forested areas within the nine states of the Amazonia region.

If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.

Typhoid

Typhoid fever is caused by ingestion of food or water contaminated by a species of salmonella known as Salmonella typhi. Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. Either diarrhea or constipation may occur.

Unless you expect to take all your meals in major hotels and restaurants, typhoid vaccine is a good idea.

Yellow Fever

Yellow fever is a life-threatening viral infection transmitted by mosquitoes in forested areas. The illness begins with flu-like symptoms, which may include fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting. These symptoms usually subside in a few days, but one person in six enters a second, toxic phase characterized by recurrent fever, vomiting, listlessness, jaundice, kidney failure, and hemorrhage, leading to death in up to half of the cases. There is no treatment.

The yellow-fever vaccine is strongly recommended for all travelers to Brazil, except those visiting only Rio de Janeiro, São Paulo and the coastal areas south of São Luís. Proof of vaccination is no longer required from travelers arriving from a yellow fever–infected country in Africa or the Americas.

Other Infectious Diseases

Schistosomiasis

This parasitic infection is acquired by skin exposure to contaminated fresh water; it occurs in almost all states of the Northeast and two states (Minas Gerais and Espírito Santo) in the Southeast. When traveling in these areas, you should avoid swimming, wading, bathing or washing in bodies of fresh water, including lakes, ponds, streams and rivers. Salt water and chlorinated pools carry no risk of schistosomiasis.

Environmental Hazards

Insect Bites & Stings

To prevent mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Bring along a good insect repellent, preferably one containing DEET, which should be applied to exposed skin and clothing, but not to eyes, mouth, cuts, wounds or irritated skin. Products containing lower concentrations of DEET are as effective, but for shorter periods of time. In general, adults and children over the age of 12 should use preparations containing 25% to 35% DEET, which usually last about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last about three hours. Neurologic toxicity has been reported from DEET, especially in children, but appears to be extremely uncommon and generally related to overuse. DEET-containing compounds should not be used on children under the age of two.

Insect repellents containing certain botanical products, including oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours. DEET-containing repellents are preferable for areas where there is a high risk of malaria or yellow fever. Products based on citronella are not effective.

For additional protection, you can apply permethrin to clothing, shoes, tents and bed nets. Permethrin treatments are safe and remain effective for at least two weeks, even when items are laundered. Permethrin should not be applied directly to skin.

Don’t sleep with the window open unless there is a screen in the window frame. If sleeping outdoors or in accommodations that allow entry of mosquitoes, use a bed net, preferably treated with permethrin, with edges tucked in under the mattress. The mesh size should be smaller than 1.5mm. If the sleeping area is not otherwise protected, use a mosquito coil, which will fill the room with insecticide throughout the night. Repellent-impregnated wristbands are not effective.

Snake Bites

Snakes and leeches are a hazard in some areas of South America. In the event of a venomous snake bite, place the victim at rest, keep the bitten area immobilized and move the victim immediately to the nearest medical facility. Avoid tourniquets, which are no longer recommended.

Tap Water

Tap water in Brazilian cities such as Rio and São Paulo is generally safe to drink, but it tastes awful. In remote areas, tap water may be suspect. Many hotels and guesthouses filter their water – be sure to inquire about the status where you’re staying. Vigorous boiling for one minute is the most effective means of water purification, though you can also use a water filter, ultraviolet light (such as a steripen) or iodine pills.

Traveling with Children

In general, children under the age of nine months should not be brought to areas where yellow fever occurs, since the vaccine is not safe in this age group.

When traveling with young children, be particularly careful about what you allow them to eat and drink; diarrhea can be especially dangerous in this age group and the vaccines for hepatitis A and typhoid fever are not approved for use in children who are under the age of two years.

The two main malaria medications, Lariam and Malarone, may be given to children, but insect repellents must be applied in lower concentrations.