The World Health Organization (WHO) has issued health advice for travellers intending to attend the 2016 summer olympics or paralympics in Brazil later this year.

Key Messages

1. Before departure

Travellers to Brazil should consult the travel advice issued by their national authorities.

Health services affiliated to the public Unified Health System of Brazil (Sistema Único de Saúde, SUS) are free of charge for all individuals, including visitors.

Information is available on the government websites [list provided at the end of the fact sheet] (in Portuguese).

2. Vaccine preventable diseases

A medical consultation should be scheduled as early as possible before travel but at least 4–8 weeks before departure in order to allow sufficient time for immunization schedules to be completed for both routine vaccines and vaccines indicated according to the specific destinations.

a. Routine vaccines

Travellers should be vaccinated according to their national immunization schedule, which will vary from one country to another.

Since July 2015, Brazil has interrupted measles transmission, following an outbreak associated with an imported case. As measles is still endemic or circulating in many countries, measles vaccinations should be up to date to prevent importation of the virus to Brazil.

Similar considerations apply for rubella, which was eliminated from Brazil in 2009.

Wild poliovirus has been eliminated from Brazil since 1989. To prevent the re-introduction of polio into Brazil, travellers from countries where polio cases have recently occurred should be fully immunized.

For travellers at risk of serious complications of influenza, vaccination should be considered.

WHO advises pregnant women not to travel to the Olympics or any area where Zika virus is circulating.

b. Travel-related vaccines

Depending on the specific travel itinerary, additional vaccines might be considered for some travellers. Unvaccinated travellers should be offered such vaccines in accordance to their national recommendations.:

• Hepatitis A: Brazil is an intermediate endemicity country and prone to hepatitis A outbreaks

• Hepatitis B: The risk of contracting hepatitis B is likely to be low, except for travellers engaging in high risk behaviours such as tattoos and injecting drug use. Hepatitis B vaccine was introduced into the national immunization schedule in Brazil in 1998

• Typhoid fever: The incidence of typhoid fever in Brazil is highest in the North and North-East, including Amazonas and Manaus which is hosting the Olympic football tournament

• Rabies: The risk of rabies infection in Rio de Janeiro and the remaining five cities hosting the Olympic football tournament is negligible

• Yellow fever: A single, lifetime dose of Yellow Fever vaccine is recommended for all travellers older than 9 months visiting areas at risk of yellow fever transmission. The vaccination should be conducted at least 10 days before departure. The vaccine confers lifelong protection. Vaccination is not recommended for travellers limiting their stay to the following cities hosting Olympic and Paralympic Games’ events: Rio de Janeiro, Salvador, São Paulo.

3. Mosquito-borne diseases

Personal protective measures

Although the risk of mosquito borne disease is lower during winter, travellers should still take personal protective measures to prevent mosquito bites. These include:

• Whenever possible, wearing clothes (preferably light-coloured) that cover as much of the body as possible during the day

• Using repellents that contain DEET (diethyltoluamide), or IR 3535, or icaridin andare applied to exposed skin or to clothing and used in strict accordance with the label instructions, especially regarding the duration of protection and timing of re-application. If repellents and sunscreen are used together, sunscreen should be applied first and the repellent thereafter

• Choosing sanitary accommodations with piped water and physical barriers such as proper window and door screens to prevent mosquitoes from entering rooms

• Avoiding areas in cities and towns with no piped water and poor sanitation, which constitute ideal breeding grounds for mosquitoes.

Dengue and Chikungunya

There is no vaccination for chikungunya. Dengue vaccination is not recommended for travellers.

Zika virus disease

Zika virus infection usually causes a mild disease, and many cases of Zika virus infection are asymptomatic.

Zika virus is primarily spread by mosquitoes, though sexual transmission has increasingly been documented.

Recommendations to national health authorities and health care providers:

• To advise pregnant women not to travel to areas of ongoing Zika virus outbreaks, including Brazil;
• To advise women who inadvertently become pregnant or discover they are pregnant in or shortly after returning from Brazil, and/or other areas with ongoing Zika virus transmission, to contact their health care providers;
• To advise pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks to ensure safe sexual practices or abstain from sex for the duration of their pregnancy;
• To advise travellers to practice safe sex or abstain from sex during their stay in Brazil, and/or other areas with ongoing Zika virus transmission, and for at least eight weeks after their return. If men experience symptoms of Zika virus disease, they should adopt safer sex practices or abstain from sex for at least six months;
• To advise travellers returning from Brazil, and/or other areas with ongoing Zika virus transmission, not to donate blood for at least four weeks after departure from the area

Malaria

The risk of malaria transmission is negligible or non-existent except in the administrative region of Amazonas, corresponding to the Northern states of Brazil. This includes the city of Manaus which is hosting some of the Olympic football matches.

Based on the risk assessment by Brazilian health authorities, the national guidelines do not include recommendations on malaria chemoprophylaxis. Therefore, the access to these drugs while in Brazil will be limited and antimalarial drugs should be purchased before travelling.

4. Food and water safety

Gastrointestinal infections can be common in Brazil, so travellers are advised to take precautions:

• frequent hand washing and always before handling and consuming food;
• making sure that food has been thoroughly cooked and remains steaming hot;
• choosing safe water (e.g. bottled water or, if in doubt, water vigorously boiled);
• avoiding any uncooked food, apart from fruits and vegetables that can be peeled or shelled;
• avoiding foods at buffets, markets, restaurants and street vendors if they are not kept hot or refrigerated/on ice.

5. Other health risks

Traffic accidents and injuries, mostly caused by motor vehicle crashes, are the leading causes of death among travellers under the age of 55 years.

After heavy rainfall, flash floods and landslides, especially in urban areas, have been a frequent cause of injuries and other emergencies.

Travellers should be aware of the presence of poisonous animals, such as scorpions and snakes, and take precautions to avoid any contact with such animals.

Useful Links:

Link to WHO’s news release:

http://who.int/ith/updates/20160621/en/

Link to WHO’s page on General precautions for travellers:

http://who.int/ith/precautions/en/