1. Amazon basin (incl Manaus):
The risk of malaria is high.
Recommended adult regimen:
Mefloquine 250mg weekly. Begin 2-3 weeks before travel to affected area and continue for four weeks after leaving.
Doxycycline 100mg daily. Begin one to two days before travel to affected area and continue for four weeks after leaving.
Atovaquone 250mg plus proguanil 100mg daily (Malarone). Begin one to two days before travel to affected area and continue for seven days after leaving.
Healthcare professionals only may check with the National Travel Health Network and Centre (NaTHNaC) on 0845 6026712 (9.00-11.45am & 1.00-3.45pm, Mon, Tue, Thu, Fri; 9.00-11.45am, Wed; closed on Bank Holidays).
2. Rest of the country:
There is a very low risk of malaria. Advise mosquito bite avoidance.
3. Iguacu Falls:
There is no risk of malaria. Advise mosquito bite avoidance.
Travellers should be up to date with routinely recommended vaccinations according to the routine UK immunisation programme.
Vaccination could be considered for travellers whose activities put them at increased risk, including those visiting friends and relatives, and frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor.
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.
Vaccination is recommended for travellers aged 9 months and older travelling to the states of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goias, Maranhaõ, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima and Tocantins, and designated areas in the states Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina and São Paulo (see below for Sao Paulo city). Vaccination is also recommended for travel to Iguaçu Falls.
Vaccination is not recommended for travel only to areas not listed above including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador and Sao Paulo.
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.
Vaccination recommended for travellers at increased risk of developing severe disease and/or of exposure to TB, including unvaccinated children under 16 years of age who are going to live for more than 3 months in this country and unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk because of their work (eg, healthcare workers, prison staff and vets).