1. Amazon basin (incl Manaus):
There is a low risk of malaria. Advise mosquito bite avoidance.
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.
Special risk groups
In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [>70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).
Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.
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.
Note: Outbreak ongoing since January 2017
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), Espírito Santo, Goias, Maranhaõ, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rio de Janeiro (including Rio de Janeiro city), Rondônia, Roraima, São Paulo (see below for São Paulo city) and Tocantins, and designated areas in the states Bahia, Paraná (including Iguaçu Falls), Piauí, Rio Grande do Sul and Santa Catarina.
São Paulo city: monkey cases have been reported in several urban areas of the city. For visitors to these areas, scrupulous mosquito bite avoidance should be advised, and for some, yellow fever vaccination may be considered after careful individual risk assessment. Specialist advice should be sought.
Vaccination is not recommended for travel only to the cities of Fortaleza or Recife, or other areas not listed above.
International Certificate of Vaccination or Prophylaxis (ICVP) required if arriving from Angola or Democratic Republic of Congo.
- applies to travellers from 9 months of age.
If a receiving country requires an ICVP as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption can be considered.
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).