Vaccines and health for Brazil: what to ask a travel clinic

This page is not medical advice

I am not a doctor, and this page cannot tell you what you need. What a clinic recommends depends on where in Brazil you are going, when, what you will be doing, and your own health and history, and that guidance changes. The yellow fever picture in particular has changed more than once in the last decade.

A travel clinic is the authority. This page is here to make that appointment more useful: what to book, when, and the questions worth asking.

Book six to eight weeks out, and bring your itinerary

Travel clinics book weeks out in a lot of US cities. Some vaccines are a series rather than a single shot, some need time to take effect, and a yellow fever certificate is not valid the moment you get it.

Take these with you:

• Your itinerary with specific regions and dates, not just “Brazil”
• What you will actually be doing: an Amazon lodge is a different conversation from Rio, Iguazu and a beach
• Your vaccination records, or your best reconstruction of them
• A list of everything you take, with generic names

Yellow fever, the one that needs a real answer

Two different questions get mixed together here, and separating them is most of the work.

Is the vaccine recommended for where I am going? That is a medical question. The thing that surprises Americans is that Brazil’s risk areas have not been confined to the Amazon. Guidance has at times covered parts of the Southeast and the South, which catches people planning a Rio, Minas and Iguazu trip. Ask the clinic about your route by name.

Is proof required to cross a border? That is a separate, non-medical question, and the answer depends on where you are arriving from, not only where you are going. It also runs in the other direction: some countries ask for a certificate from travelers arriving from Brazil. If your trip crosses at Foz do Iguaçu into Argentina or Paraguay, or continues to another South American country, ask about that specific leg rather than about Brazil in general.

The certificate is an ICVP, the yellow card. Keep it wherever you keep your passport.

Do not settle either question from a forum post, or from this page. Take both to the clinic and to the official sources on the day you fly.

The others worth naming in the appointment

Commonly raised for Brazil. This is a list of things to ask about, not a list of things you need:

• Routine vaccinations up to date, including measles
• Hepatitis A
• Typhoid
• Hepatitis B
• Rabies, if the itinerary involves remote areas or animal contact
• Whatever the clinic is watching at the time, since outbreaks move

Ask about dengue specifically. Brazil has run a domestic vaccination program, and what Brazilians can get is not necessarily what a clinic at home can give you.

Mosquitoes bite in the daytime here, and that is the useful part

The mosquito that carries dengue, chikungunya and Zika is Aedes aegypti. Two things about it are worth changing your behavior over: it lives in cities and breeds in standing water on balconies and in gutters, and it bites during the day, heaviest in the early morning and late afternoon.

Americans picture jungle and evenings, so they put repellent on at dinner in Rio and skip it walking around at 9am, which is backwards.

What actually reduces the risk:

• A repellent with DEET or picaridin, applied over your sunscreen and reapplied through the day
• Long sleeves and pants at dawn and dusk
• Sleeping with air conditioning or intact screens
• Permethrin-treated clothing if you are going to the Amazon or the Pantanal
• Noticing standing water near where you are sleeping

Repellent is sold in every pharmacy here, though the formulations differ from home. If you have a brand that agrees with your skin, bring it.

Malaria is a different question and largely an Amazon-basin one. A Rio, Iguazu, Salvador and Floripa trip is not the same conversation as a river lodge. Ask.

If you are pregnant or trying to be, Zika is a conversation to have with your doctor before you book, not after.

Water, ice and food

In most Brazilian cities the tap water is treated, and most Brazilians still drink filtered or bottled water anyway. Hotels and restaurants serve filtered water, and ice in a state capital is normally fine.

Honestly, water is not usually what gets people. It is a sudden change of diet, a lot of dendê oil, more fresh fruit than they are used to, and heat. Go slower for the first two days than you think you need to.

Street food is part of this trip and I am not going to tell you to skip it. Choose stalls that are busy, where the food is cooked in front of you and arrives hot.

The pharmacies here are genuinely excellent

One of the few pleasures of getting sick here. Farmácias are everywhere, open late, some open around the clock, clean and well stocked, and the pharmacist will actually talk to you. Droga Raia, Drogasil, Pacheco, and Panvel in the south. Many will check your blood pressure, and some give injections.

Two things to know. Plenty of medications that need a prescription at home do not here, and the reverse is true too. And brand names differ, so bring a written list of the generic names of anything you take. Keep your own prescriptions in their original labeled containers with a copy of the prescription.

What I would put in the bag

• Prescriptions in original packaging, plus that list of generic names
• Sunscreen from home. The sun here is stronger than it looks and sunscreen is not a bargain locally
• Oral rehydration salts and something for an upset stomach
• Motion sickness tablets if your trip has boats or mountain roads in it
• Your travel medical insurance details, saved offline on your phone

If something goes wrong

Ambulance is 192, fire is 193, police is 190. Save them before you need them.

The public system (SUS) treats emergencies, including for foreigners. Private hospitals in the capitals are very good and will want insurance details or payment up front. Assume your US health plan does not cover you here: buy travel medical insurance that includes evacuation, and carry the policy number where you can reach it without wifi.

For anything minor, start at the pharmacy.