Health Concerns and Emergencies
If your travels to Brazil will only include visits to urban areas or resorts outside the Amazon region, you shouldn't need any special vaccinations or medications. Just be sure that all of your usual immunizations are up-to-date. You may also want to consider a typhoid immunization. This was once a nasty shot that could cause fever and pain for several days afterwards, but there is now a new oral vaccine with few, if any side effects. If you haven't been immunized for Hepatitis A & B, you should also consider having those vaccines. In general, the worst things that visitors to Brazil are exposed to are things they would be subject to at home: colds or flu, occasional digestive upsets, allergies, athlete's foot, etc.

There are only a few "exotic, tropical" diseases which need to concern travelers to Brazil, and for the most part this only applies to more adventurous travelers who will be visting rural or jungle areas in the North (Amazônia) and Center-West, or who are traveling to Brazil directly from certain countries.

YELLOW FEVER - To enter Brazil, a yellow fever vaccination certificate is required from travellers over 9 months of age coming from infected areas, unless they are in possession of a waiver stating that immunization is contraindicated on medical grounds. The following countries or areas are regarded as infected:

Africa: Angola, Cameroon, Gabon, Gambia, Ghana, Guinea, Kenya, Mali, Nigeria, Sudan, Zaire.

America: Bolivia, Colombia, Ecuador, Peru.

Vaccination is recommended for travellers to rural areas in the states of Acre, Amapá, Amazonas, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Pará, Roraima, Rondônia and Tocantins.

You can be vaccinated in your home country, or you can wait until you reach Brazil and be vaccinated there. There are public health vaccinations stations at major airports and bus stations. The vaccination consists of a single shot, with a validity of 10 years. Unpleasant side effects are uncommon. After being vaccinated, you will receive a yellow certificate on a standard international form, which is your proof of vaccination if traveling to or from countries that require a certificate of yellow fever vaccination. The card, like the vaccine, is good for 10 years. If you know you will need a yellow fever vaccination, try to get it as soon as possible before traveling to any infected zone, because it can take at least 10 - 15 days for the vaccination to produce an immune response to the disease.

MALARIA - Malaria risk exists throughout the year at altitudes below 900m (±2500 ft.) in some rural areas of the states of Acre, Amapá, Amazonas, Maranhão, Mato Grosso, Pará, Rondônia, Roraima and Tocantins as well as in the outskirts of Manaus and Porto Velho. Risk is high in areas of mining and agricultural colonization: the north of Mato Grosso; the south of Pará, the northern part of Rondônia, the west of Amapá; the settlement areas in the valley of the Acre river and along the road to Cruzeiro do Sul, the areas of the Yanomani and Macuxis in Roraima and those bordering Maranhão and Pará; and scattered regions in the State of Amazonas and along the Javari, Madeira, Purus, Solimões and Negro rivers. In the other states outside the Amazon region, only a few local cases occur, in rural areas, usually originating from infection imported from the Amazon region. In Brazil, P. falciparum (one of the malaria bacteria) is highly resistant to chloroquine and resistant to sulfadoxine-pyrimethamine reported. Recommended prophylaxis in risk areas: Mefloquine

(The information above is from http://wwwlb.aub.edu.lb/~webuhs/chm/travel/ab.html)

There is presently no vaccination for malaria. You will need to take malaria prophylaxis (preventive medication) beginning at least one week before entering an infected area and continue to take it for 4 - 6 weeks after leaving the area. Even then, prophylaxis isn't guaranteed, so any unusual fevers or other symptoms that appear for as long as 12 months after leaving a malaria area should be reported to your physician as possible malaria.

There are three related organisms that can cause malaria, and in different areas they have developed resistance to different anti-malarial drugs or agents. For this reason, you will have to consult carefully with your physician about which treatment is the right one for you, based on the area you will be visiting and also the potential serious side effects of some of the newer anti-malarial drugs. A good resource for identifying the kind of treatment you may want to take can be found at www.traveldoctor.co.uk. This is also an excellent resource for other travel medicine related questions.

DENGUE - Dengue, like yellow fever and malaria, is a mosquito-borne viral disease that can be an issue even in urban areas like Rio de Janeiro. It seems to appear in spurts, with sudden epidemics making the news, although it can be contracted at any time. There is no vaccine or prophylactic treatment. Dengue (once called "breakbone fever") causes high fevers and severe joint and bone pain. In its more simple form, dengue is rarely fatal. It is now known that there are at least 4 variants of the dengue virus. Once a person has been infected by one variant, they become immune. However, it appears that people who have developed immunity to one dengue virus, but are subsequently infected by one of the other variants, run the risk of having the considerably more dangerous hemorrhagic version of the disease. For this reason, it's important to take all the usual common sense precautions for avoiding mosquito bites to reduce any chance of contracting dengue, in any of its forms. Treatment is basically palliative, for the purpose of treating the symptoms and making the patient more comfortable. Because of the risk of hemorrhage, medical authorities in Brazil strongly warn against using pain-killers and fever reducers like acetylsalicylic acid (aspirin) and related NSAIDS like ibuprofen (Motrin) or naproxen (Aleve) any time there is a suspicion that a fever may be caused by dengue because they can promote bleeding. Instead, patients should use acetominophen fever reducers (Panadol, Tylenol, etc.) which are widely available in Brazil. Anyone concerned may want to bring prolonged action acetominophen tablets (8-hour Tylenol) which are not currently sold in Brazil. These have the advantage of requiring fewer doses and possibly enabling patients to get extended sleep without having to be awakened for another dose! Otherwise, treatment includes keeping the patient hydrated and resting until symptoms abate.

Because of their incubation periods, all three of these mosquito-borne diseases can appear AFTER you've returned home. Be sure to tell your doctor where you've been if you suddenly develop high fevers after your trip is over, and if there were any known outbreaks of any of these diseases in the places you were visiting.

You can reduce your chances of catching any of these diseases by following these common-sense precautions against mosquito bites:

When traveling to areas where the disease is endemic you can reduce the risk of becoming infected with the virus by employing preventive measures such as protecting yourself from mosquito bites:

- Apply insect rellent to your skin and clothes when going outside

- When possible, wear long-sleeved shirts and long pants whenever you are outdoors.

- Place mosquito netting over infant carriers when you are outdoors with infants.

- Consider staying indoors at dawn, dusk, and in the early evening, which are peak mosquito biting times.

- Make sure any window and door screens are intact so that mosquitoes cannot get indoors.

- Use mosquito nets around beds at night while asleep.

Many of the mosquitoes that carry these viruses are especially likely to bite around dusk and dawn. If you are outdoors around these times of the day, it is important to apply insect repellent. But there are also mosquitoes that bite during the day, and these mosquitoes have also been found to carry some of these viruses, too. The safest decision is to apply repellent containing the active ingredient DEET whenever you are outdoors.

Apply insect repellent sparingly to exposed skin. The more DEET a repellent contains the longer time it can protect you from mosquito bites. A higher percentage of DEET in a repellent does not mean that your protection is better, just that it will last longer. DEET concentrations higher than 50% do not increase the length of protection. Choose a repellent that provides protection for the amount of time that you will be outdoors. Repellents containing DEET are sold in pharmacies and supermarkets in Brazil. Look for the "Autan" or "Off" brands.

There is one other insect-borne disease that travelers should be aware of, although they are normally at very low risk of contracting it:

CHAGAS DISEASE - Also known as American trypanosomiasis, this is a potentially serious disease caused by trypanosomes which is endemic to South and Central America. It is spread by biting beetle-like bugs called assassin bugs or kissing bugs ("barbeiro" in Portuguese).

The disease is present in most rural areas particularly where there is a human presence. This is because the bugs that spread the disease live in the walls of mud huts where they venture out at night to feed. Victims are usually bitten while they are sleeping. Travellers to these areas are most at risk but avoidance is straightforward. True jungle areas of the Amazon are mainly free of the disease and visitors to cities or remote jungle ruins are not at risk.

The bugs become infected by feeding on the blood of someone who has the disease. They then excrete infective trypanosomes in their feces which enter the blood of a subsequent victim through the bite wound. Chickens, dogs and opossums also harbour the disease. Other ways of getting the disease include blood transfusions from an infected blood donor and actual ingestion of an infected bug or its feces. Earlier in 2005 there was an unusual outbreak of Chagas Disease in the southern state of Santa Catarina which caused some fatalities among residents and tourists who had purchased and drunk sugar cane juice at a roadside stand. Evidently there were infected bugs (or their feces) in the bundles of sugar cane fed into the juice extracting machine. Similar outbreaks, for the same reasons, have been reported occasionally in the past in other parts of Brazil. These have been rare and limited occurrences, however.

Symptoms of Chagas Disease include swelling around the site of the bite followed by enlargement of the lymph glands and fever. Long term symptoms include damage to the heart causing sudden death and paralysis of the gut causing difficulty in swallowing and severe constipation. There is no vaccine or preventative drug treatment available and treatment of the disease is difficult since no drug is currently able to kill the parasites without harming the host. Early treatment provides the best possibility of eliminating the bugs.

Avoidance of the bites is the best strategy. When travelling through an endemic region try not to sleep in adobe huts where the locals sleep, keep away from walls when sleeping and use mosquito nets. Spraying the insides of rooms with an insecticide spray is a good idea. Blood from Brazilian blood banks is screened for the disease, but if possible, someone needing a blood transfusion may wish to explore an autologous transfusion (using the person's own blood). Visitors also may want to forego the pleasures of sugar cane juice ("caldo de cana") from rural roadside stands.

Other than these diseases, uncommon in countries from which most visitors come, there are few other risks facing a traveler to Brazil. More information about them can be found at www.traveldoctor.co.uk.

OTHER HEALTH CONSIDERATIONS - Brazilians are very hygene conscious, and in general visitors run few risks of problems from food or drink in Brazilian homes or restaurants. In other words, you CAN eat the salads! You can also drink the water in most urban areas, use it to brush your teeth, and cook with it. Tap water is often very highly treated with chlorine or other chemicals which cause it to taste unpleasant, and most Brazilians use bottled mineral water ("agua mineral") for drinking. Bottled water is cheap and available virtually everywhere, including stores, restaurants and snack bars/fast food outlets. It comes with carbonation ("com gas") or without ("sem gas") in bottles or foil-sealed individual plastic cups. If you can't get bottled water, and are concerned about what you are drinking, chlorine water purification tablets are available. If you can't find them, mix ten drops of chlorine bleach in a gallon (4 liters) of tap water and allow it to sit for at least half an hour before using. You can also just boil water for at least ten minutes at a full boil, then allow it to cool (covered) before using.

Fruits and vegetables you buy yourself that will be eaten raw and unpeeled should be well-washed before use. To be absolutely sure, you may want to soak these fruits and vegetables in a chlorine water purifying solution. Drops or tablets for this are sold in supermarkets, usually in the produce section. However, you can accomplish the same thing by making a solution of 10 drops of chlorine bleach per liter (quart) of water. Just mix it up in the sink or a separate dishpan or basin and let the fruit and vegetables soak for half an hour.

Gay Travel Brazil visitors whose activities include time at saunas should keep an eye open for common fungal infections like athlete's foot or jock itch. Travelers may also find themselves developing rashes and fungal infections in skin folds and other areas (especially the crotch) that aren't regularly exposed to sun and air. This can be a particular problem during the warmer months, when the tropical heat and humidity cause extra perspiration and it's difficult to keep "problem areas" cool and dry. It's a good idea to bring some good anti-fungal creme or ointment with you, and/or dusting powder containing a good antifungal like miconazole. Doing like the Brazilians do, showering with soap and water several times a day and drying off well, will help keep problems away. After showering (or after returning to your hotel/apartment from a sauna) it's a good idea to apply some anti-fungal creme or powder to any potential "problem areas," including your crotch and feet. This should help prevent most problems, or take care of them if you've developed an infection. If you've forgotten, anti-fungal products like Lamisil are sold in Brazilian pharmacies. If you should develop peskier problems, like cutaneous candidiasis, you may also need to take oral anti-fungals, which you should discuss with a doctor. These are also available in Brazil, often in generic format, as are the cremes/ointments. It may take weeks or months to clear up this kind of infection, so be prepared! But following the preventive suggestions above should avoid such problems.

Cases of diarrhea should be treated with over-the-counter Imodium (loperamide hydrochloride) tablets. Take two tablets after the first episode and one after each subsequent run to the toilet (up to eight tablets per day) until the problem stops. If the diarrhea doesn't stop within 12 - 24 hours, or is accompanied by a fever and joint aches, you may have a bacterial infection. If you're not allergic to antibiotics, try starting a course of a wide-spectrum drug like amoxicillin or azythromicin (usually available without a prescription in Brazil). You can do this in conjunction with the Imodium. If you start a course of antibiotics BE SURE TO COMPLETE THE RECOMMENDED COURSE even if the symptoms disappear quickly. This will prevent the creation of antibiotic-resistant strains of the bacterium. If your diarrhea is of bacterial origin such treatment should bring relief within 12 - 36 hours. If it doesn't, call a doctor or go to a hospital emergency room (see our Health Emergencies page). But remember to continue taking the antibiotics for the full course of treatment unless told otherwise by a doctor. While you are taking the antibiotics, it's a good idea to eat yogurt with active cultures at least once a day to try to repopulate your gut with the beneficial bacteria that the drugs will be killing off. This can prevent a reocurrence of diarrhea caused by a lack of beneficial bacteria in your system. It's also essential to keep yourself very well hydrated during a bout of diarrhea. Drinking Gatorade is an excellent way to stay hydrated and replace the essential salts that your body will lose because of the diarrhea. Fortunately, Gatorade can be found in any Brazilian supermarket and at many juice bars.

HIV/AIDS and STDs are also an issue for travelers to Brazil, in spite of Brazil's outstanding campaigns to prevent and treat these diseases. If you plan not to be celibate during your stay in Brazil, you need to take all the precautions and protections you would at home. In particular, this means using condoms ("camisinhas" or "preservativos" in Portuguese) whenever you're engaging in anal sex. We recommend that you bring a supply of your favorite condoms and lube from home (particularly if you or your hoped-for partners require XL-sized condoms) but if you forget them you can find these items in Brazil, although perhaps not in as wide a range of choices as you're used to in your own country. K-Y lubricant is sold in all well-stocked pharmacies in Brazil, including in handy pocket-sized tubes. Two well-known Brazilian brands of condoms are Jontex and Preserv, both made by international manufacturers. If you do need XL-size condoms, you should be able to find them at larger, well-stocked pharmacies. The Brazilian brand is "Preserv Extra," and some of our market researchers tell us they're the biggest condoms on the market, outdoing even U.S. and European brands! Other sizes are available, as well. If you need them for any reasons, most anti-retroviral drugs are also available in Brazil. If you need emergency treatment because of an "accident," or you think you've picked up some other STD, please see our page on Health Emergencies for information about finding local hospitals or doctors who can assist you.

Traffic accidents and urban violence also present health risks for travelers. Please read our page about Staying Safe in Brazil for ways to reduce these kinds of risks.

If you take prescribed medication, be sure to have a sufficient supply of everything you need before coming to Brazil. If you do run out, most medications are available in well-stocked Brazilian pharmacies, often in less expensive generic versions not available in our home countries. Many drugs that require a prescription in our home countries can be bought over-the-counter in Brazil (even though the packaging says a prescription is required). These include many antibiotics, anti-hypertensives, allergy medicines, anti-fungals, corticosteroid ointments, drugs for erectile dysfunctions, etc. Drugs that would be considered "controlled substances" in the U.S. or other countries, like opiates, sleeping pills, many anti-depressants, etc. usually DO require a prescription in Brazil, written by the doctor on a special two-part form, one copy of which must be kept by the pharmacy. If you need a prescription for such drugs in Brazil, see the information on the Health Emergencies page in Gay Travel Brazil's Essentials section to find a doctor.

If you do find yourself needing medical attention, also refer to the Health Emergencies page for more information. The standard of medical practice in Brazil is quite high, and there are good private hospitals available, some of which accept foreign medical insurance. If you're staying at a hotel and suddenly need a physician, the front desk can usually call a bilingual doctor who will come to your room on a "house call." Costs for this service are usually very reasonable compared to similar services in our home countries!

Before traveling, be sure to check with your health insurance company about what they will and won't cover while you are traveling abroad. If you need travel health insurance or medical evacuation insurance, you should purchase it before your trip. There is more information about such insurance on our Health Emergencies page.

Some visitors to Brazil are interested in availing themselves of high quality medical procedures which are not covered by insurance and which could be prohibitively expensive in their home countries. These include dental work and cosmetic surgery, a specialty for which Brazil is world famous (not all of those beautiful Brazilians one sees were born that way; many have had a bit of help from a skilled surgeon). If you are interested in such services, please contact us at Gay Travel Brazil. We can help you find reliable and well-qualified bilingual practitioners and assist you with your arrangements, including recovery periods following surgical procedures. You may also find additional information about these topics in our Forums.

Health Emergencies
Before you travel, check with your health insurance carrier to find out if you're covered abroad. Some U.S. insurers, like Blue Cross or Kaiser, do cover you when you're traveling. Others don't, so you may want to take out a travel health insurance policy before leaving the country. The same applies to non-U.S. travelers. You also may want to consider signing up for emergency medical evacuation insurance.

MedJetAssist (www.medjetassistance.com) offers a variety of plans, depending on how much you travel and how long you stay abroad. It's reasonable and provides a lot of peace of mind! For non-U.S. travelers, similar services are offered elsewhere. Just Google on topics like "travel medical insurance" and "medical evacuation service" to find companies in other countries.

For minor problems, check with your hotel's front desk. They can usually arrange for a "house call" to your room by a doctor.

The quality of medical care in Brazil is very good. All of the following facilities in major cities are understood to offer 24-hour emergency services:

Rio de Janeiro

For urgent care (like a case of diarrhea that won't go away, or other problems that aren't life-threatening) you can go to Clínica Galdino Campos, Av. N. S. Copacabana, 492 - Copacabana Tel. (21) 2548-9966 The clinic is near many of the hotels popular with our readers and they will make "house calls" to your hotel room, if necessary.

In case of an EMERGENCY, go to the emergency room of the Copa d'Or Hospital on R. Figueiredo Magalhães, 875 - Copacabana - Phone (21) 2545-3600. Emergencies (including ambulance service): Tel: 2545-3666 It's considered one of the best private hospitals in Rio. They supposedly accept U.S. Blue Cross insurance.

In Rio, many people think the best resource for any NON-EMERGENCY problems is the Rio Health Collective, Banco Nacional building (room 303), Av. das Américas 4430, Barra de Tijuca. The Collective is a non-profit-making organization, its phone-in service (tel 021/3325-9300 ext. 44) is free, and it provides names of qualified professionals who speak foreign languages. Of course, Barra is pretty far out for those staying in Copacabana, but the Health Collective should have names of physicians in Copacabana or Ipanema/Leblon that will be closer to where you're staying. Alternatively, your consulate should have a list of professionals who speak an appropriate language. The U.S. consulate in Rio has such a list available online, although it's a bit difficult to find. Go to www.embaixada-americana.org.br, then select the English-language pages for the consulate in Rio, then "U.S. Citizen Services", then "other services" and finally "list of hospitals/doctors."

São Paulo

Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi Tel. (11) 3747-1233 Ambulance Service: (11) 3747-1000 Foreign Patient Services: (11) 3747-1301 during business hours Monday through Friday. After hours call the main number. Considered one of the best hospitals in Brazil, but not located close to the center of the city.

Closer to the city center are:

Hospital Samaritano, R. Conselheiro Brotero, 1486 - Higienópolis Tel. (11) (11) 3821-5300

Hospital Nove de Julho, R. Peixoto Gomide, 625 - Cerqueira Cesar - Tel. (11) 3147-9999 Emergencies: (11) 3147-9775

Hospital das Clínicas (University of São Paulo Hospital) - General Emergencies: Av. Dr. Enéas de Carvalho Aguiar, 255  Cerqueira César/Cardiac Emergencies: Incor - Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César Tel. (11) 3069-6000

Hospital Beneficiência Portuguesa, R. Maestro Cardim, 769 - Paraíso Emergencies: Basement of Block 5,
Tel. (11) 3253-5022 - Extensions ("Ramais") 1132, 1514, 1542 e 1553

Curitiba

Hospital Santa Cruz, Av. do Batel, 1889 - Batel Tel. (41) 312-3000

Hospital Universitário Cajuru PUCPR, Av. São José, 300 Cristo Rei Tel. (41) 360-3000

Florianópolis

Ask your hotel for information. You can also try

Hospital Governador Celso Ramos, R. Irmã Benvarda, s/n - Centro Tel. (48) 251-7000

Hospital de Caridade, R. Menino Deus, s/n - Centro Tel. (48) 221 7500

Porto Alegre

Hospital de Clinícas, R. Ramiro Barcelos, 2350, Santana Tel. (51) 3316-8000/3316-8484

Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 596 - Cristo Redentor Tel. (51) 3341-1300

Hospital Cristo Redentor, R. Domingos Rubbo, 20, Cristo Redentor Tel. (51) 3361-4324/3361-2125

Instituto de Cardiologia, Av. Princesa Isabel, 395 Tel. (51) 3230-3630

Salvador

Hospital Espanhol, Av. Sete de Setembro, s/n - Barra Emergencies: (71) 3264-1573/1574

Hospital Português, Av. Princesa Isabel, 914 - Barra Avenida Emergencies: (71) 3203-5159/5148/5149

Recife

Hospital Albert Sabin, R. Sen. José Henrique, 141 - Ilha do Leite Tel. (81) 3421-5411

Hospital Memorial São José, Av. Agamenon Magalhães, 2291 - Boa Vista Tel. (81) 3216-2206

Real Hospital Português de Beneficência, Av. Portugal, 163 - Derby Tel. (81) 3416-1122

Fortaleza

Hospital Batista Memorial, R. Professor Dias da Rocha, 1530 - Aldeota Tel. (85) 261-2999

Belém

Hospital Adventista de Belém, Av. Almirante Barroso, 1758 - Marco Tel. (91) 246-8686

Manaus

Hospital Adventista de Manaus, R. Gov. Danilo Areosa, 139 - Distrito Industrial Tel. (92) 3237-7076

Prontocord - Hospital do Coração, Av. Sen. Álvaro Maia, 1445 - Praça 14 Tel. (92) 3621-7500

Sociedade Portuguesa Beneficiente Amazonas, Av Joaquim Nabuco, 1.359 - Centro Tel. (92) 3622-3939

Brasília

Hospital Daher Lago Sul, SHIS - QI 07 - Conj. F - Lago Sul Tel. (61) 248-4848

Hospital Santa Lúcia, SHLS Quadra 716, conj.C Tel. (061) 445-0000

Belo Horizonte

Hospital Felício Rocho, R. Timbiras, 3585 - Barro Preto Tel. Tel. (31) 3339-7101/ 3339-7130/ 3335-7000

Prontocor (Cardiac Hospital), Rua Levindo Lopes, 357 - Savassi Tel. (31) 3215-8080 Emergencies: Rua Sergipe, 1456 - Savassi (31) 3223-2323

Gay Travel Brazil hopes you'll never need this information, but better safe than sorry!

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