Brazil

Destination overview

Brazil is the fifth-largest country in the world, the most populated in South America, and home to the world's largest Portuguese-speaking population. The country is divided into 5 geographic regions (South, Southeast, Central-West, North, and Northeast), 27 federative units (26 states and 1 federal district), and 5,570 municipalities. According to the latest population census, Brazil is home to 203 million people, with 85% of the population residing in urban areas. The country has an expansive 16,886 km (10,492 miles) border that contains 33 twin cities, which are cross-border neighboring cities that grow into an extended urban area, making Brazil a destination for transient populations from both within and across its borders. Brazil's borders comprise 9,320 km (5,791 miles) of rivers and 5,568 km (3,460 miles) of watershed. Chile and Ecuador are the only 2 South American countries that do not share a border with Brazil.

Although classified as an upper-middle-income country, Brazil is a nation of extremes. The social and economic disparities from one state to another and from rural to urban areas impose different and unique challenges to travelers. Lack of sanitation and safe water still affects 15 million people living in cities, and about 25 million people in rural areas must walk long distances to reach a safe water source. With a coastline of 7,491 km (4,655 miles), Brazil is famous for its beaches and folkloric festivals (Box 11.2.1.1). During 2019–2023, Brazil was among the 3 most visited countries in South America. The country is famous for large mass gathering events and a host of urban and natural destinations (see Mass Gatherings chapter; Box 11.2.1.2; Box 11.2.1.3).

United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage sites include the historic towns of Olinda (Pernambuco) and Ouro Preto (Minas Gerais). Both display unique baroque architectural styles. There is also the historical center of São Luis (Maranhão), combining French, Dutch, and Portuguese influences from the sixteenth century (Map 11.2.1.1).

Box 11.2.1.1

Box 11.2.1.2

Box 11.2.1.3

Notes

Abbreviation: TD, travelers' diarrhea.

Map 11.2.1.1

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SOURCE:

Centers for Disease Control and Prevention

A map of Brazil highlighting its states, major rivers, and cities. The map shows Brazil bordered by Venezuela, Guyana, Suriname, French Guiana, Colombia, Peru, Bolivia, Paraguay, Argentina, and Uruguay, with the Atlantic Ocean to the right and the Pacific Ocean to the left. Major locations such as Brasília, Rio de Janeiro, São Paulo, and Manaus are labeled. Key rivers like the Amazon, Negro, and Madeira are also shown. The states, including Amazonas, Pará, Bahia, and São Paulo, are outlined and named. A small map at the bottom right shows Brazil's location within South America.

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Infectious disease risks

Brazil has had a history of high vaccination coverage, especially for the vaccine-preventable diseases related to the first 12 months of life (polio, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, measles, mumps, and rubella). However, a decline in vaccination rates over the past decade has allowed for measles and yellow fever outbreaks to resurge after many years of control.

Although there is no mandatory proof of vaccination to enter the country, the Ministry of Health recommends that international tourists be up to date on their vaccinations prior to arrival in Brazil (in particular vaccines for COVID-19, yellow fever, polio, measles, rubella, diphtheria, and tetanus vaccines). Hepatitis A vaccination is also recommended, regardless of destination in the country. Since Brazil is popular for mass gathering events, tourists attending those festivities should be advised to receive the meningococcal vaccine as well as a seasonal influenza vaccine. Additionally, hepatitis B vaccination should be considered for most travelers, but especially for anyone who could be exposed to blood or other body fluids (e.g., through medical services, sexual contact, tattooing).

Foodborne, waterborne, and environmental diseases

In 2019, nearly 1,000 foodborne and waterborne outbreaks were documented nationwide, with a significant proportion lacking etiologic confirmation. Brazil has been free of cholera cases since 2005.

Fungal infections

A variety of fungi in the South and Southeast Regions are endemic to Brazil. Inhaling the spores of fungi typically present in the soil (e.g., Coccidioides, Histoplasma, Paracoccidioides) can cause respiratory illness and occasionally more severe disease (e.g., meningitis, bone infections). Travelers should beware of bat guano in caves and use caution before disturbing soil that may harbor Histoplasma spores from bat or bird feces.

Leptospirosis

The majority of leptospirosis cases are related to outbreaks that occur every year after heavy flooding, particularly in urban areas (see Leptospirosis chapter). Advise travelers to avoid potential sources of infection, such as stagnant water, and seek safe and dry places during heavy rain conditions. Additionally, counsel travelers to seek medical care for appropriate diagnosis and treatment in cases of fever after a potential exposure.

Schistosomiasis

Schistosoma mansoni is the most common freshwater parasite in the Northeast Region, state of Minas Gerais, and state of Espírito Santo. Advise travelers to refrain from engaging in activities like bathing, swimming, or wading in untreated, non-chlorinated freshwater, such as lagoons and dams contaminated with infected cercariae (see Schistosomiasis chapter). Bathing or swimming in saltwater does not pose a risk of infection.

Soil-transmitted helminths

Parasitic infections caused by soil-transmitted helminths such as roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and hookworms (Ancylostoma duodenale and Necator americanus) are common in Brazil. These parasites are typically associated with very poor sanitary conditions and are often found in the poorer peripheries of urban centers and in rural villages. These helminths infect the human intestines through direct contact with contaminated soil (skin penetration by larvae) or ingestion of contaminated food, soil, or water. Cutaneous larva migrans, a creeping and serpiginous skin rash associated with intense itching, is a common skin infection in travelers to Brazil, particularly those visiting beaches, public squares, or public parks (see Post-Travel Dermatologic Conditions chapter). Exposure comes from contact with sand and soil contaminated with Ancylostoma braziliensis (related to dog and cat feces) or Ancylostoma caninum (dog feces).

Travelers' diarrhea

Many restaurants serve food in a buffet style, where people share utensils when assembling their plates, posing challenges in terms of food safety. In these venues, instruct travelers to conduct proper hand hygiene and to be cautious about mayonnaise-containing dishes, which are often linked to Staphylococcus aureus toxin and Salmonella spp. outbreaks. To decrease chances of travelers' diarrhea (TD), travelers should abstain from consuming raw vegetables, any water that is not bottled and factory sealed, and food sold by street vendors (see Travelers' Diarrhea chapter). Avoid ice, except from industrialized or potable water sources.

Typhoid fever

Typhoid fever can be a life-threatening disease and poses a substantial threat to travelers going to Brazil. There were 4,955 suspected cases and 1,127 confirmed cases of typhoid fever during 2010–2019, mainly in the Northern Region. While in general it is safe to eat meat and eggs in Brazil, some restaurants and small vendors may not consistently adhere to sanitary regulations. If uncertain, advise travelers to request well-cooked poultry or meat dishes. Consider vaccinating most travelers against typhoid, especially travelers who stay with friends or relatives or who visit smaller cities, villages, or rural areas (see Typhoid and Paratyphoid Fever chapter).

Respiratory infections and diseases

Coronavirus disease 2019

All travelers going to Brazil should be up to date with their COVID-19 vaccines. For current information on COVID-19 epidemiology in Brazil, visit the Brazilian Ministry of Health's COVID-19 portal. For current COVID-19 recommendations for U.S. residents traveling to Brazil, consult the U.S. Embassy and Consulates in Brazil website.

Influenza

Due to regional variations in climate and geography, influenza seasonality may peak at various times throughout the year, especially in the north of the country. In the south and southeast, the influenza season usually peaks during April–June. Diagnosis using molecular assays is available throughout the 27 states (see Influenza chapter).

Tuberculosis

The burden of tuberculosis remains high in Brazil, with Rio de Janeiro, the most visited city, having the highest incidence of tuberculosis in the country (see Tuberculosis chapter). However, short-term travelers are not considered to be at high risk for infection unless visiting specific crowded environments. Consider pre- and post-travel tuberculosis testing for travelers who anticipate prolonged exposure to people known to have, or at high risk for having, tuberculosis (e.g., those working in hospitals, prisons, or homeless shelters).

Sexually transmitted infections

HIV

The HIV infection rate in Brazil is approximately 0.5% among adults aged 15–49 years. Men who have sex with men, sex workers, and drugs or alcohol users are more likely than the general population to be infected with HIV. The Brazilian Unified Health System provides free comprehensive HIV care. Pre- and post-exposure prophylaxis are available at certain health facilities and prescribed after careful medical judgment. Discuss options for pre-exposure prophylaxis with travelers at risk for acquiring HIV infection before departure.

To prevent HIV and other sexually transmitted infections, condoms are freely available at public health clinics, tourist centers, and various other locations in many cities. Male condoms can be found in pharmacies, convenience stores, and supermarkets across Brazil, while female condoms are less widely available (see Sex and Travel chapter).

Mpox

During the global mpox outbreak of 2022, Brazil had the second-highest number of cases in the world. The disease spread throughout Brazil, but cases were concentrated in large cities such as São Paulo city (38%) and Rio de Janeiro (13%). Encourage travelers to use barriers methods of protection and to avoid direct contact with someone (or the belongings of someone) who has a suspected or confirmed lesion due to the disease's high contagion potential.

In Brazil, vaccination is offered free of charge as a post-exposure prophylaxis for people living with HIV aged 18 and above with CD4 <200 cells/mm³ as well as for those who had direct contact with body fluids of a suspected or confirmed case. The evaluation of exposure risk is conducted by trained healthcare professionals at Unified Health System facilities, which are part of the public healthcare system in Brazil.

Vector-borne diseases

Vector-borne diseases (e.g., bacterial, viral, parasitic) are present in many areas of Brazil. These infections are among the leading causes of febrile illness in travelers returning from South America.

Chikungunya, dengue, and Zika

The 3 main arboviral diseases in Brazil are chikungunya, dengue, and Zika. These are transmitted mainly by Aedes aegypti, which are widespread throughout Brazilian cities. The incidence rate for all 3 of these diseases together was 766 out of 100,000 people in 2022. Outbreaks occur during the rainy season, November–May.

Diagnosis can be challenging because these arboviral diseases have similar clinical presentations in the acute phase, are often prevalent in the same area, and can co-infect people. Travelers to Brazil should take measures to protect themselves from mosquito bites (see Mosquitoes, Ticks, and Other Arthropods chapter). Other insect-borne arboviruses circulate periodically in Brazil, including Mayaro, Oropouche, West Nile, St. Louis encephalitis, Venezuelan equine encephalitis, eastern equine encephalitis, and western equine encephalitis viruses.

Chikungunya

Chikungunya was initially identified in Brazil in 2014, reaching a peak in 2016 with 277,882 cases. Since then, 70,000–170,000 cases/annually have been recorded, with the Northeast and Southeast Regions responsible for approximately 90% of the burden. The chikungunya vaccine should be considered in travelers ≥65 years, especially those with underlying medical conditions, who plan to spend 2 weeks or more in areas where mosquitoes are present. The vaccine should also be considered in those ≥18 years who plan to stay in Brazil for 6 months or more (see Chikungunya chapter).

Dengue

Dengue is the most common arbovirus in Brazil, and the 4 DENV serotypes (DENV-1 through DENV-4) vary in prevalence from year to year and from region to region (see Dengue chapter). While the annual average is around 1 million cases, Brazil reported a significant increase in 2025, confirming 5.9 million cases.

Zika

Brazil experienced a large Zika outbreak in 2015–2016, totaling 265,156 cases those 2 years. Since then, cases have averaged <10,000 per year (see Zika chapter).

Hantavirus

More than 2,000 cases of hantavirus have been reported in all 5 regions of Brazil during 1993–2022. Risk for urban travelers is low, but increases for those visiting suburban, rural, and semi-rural hotels and hostels, where rodents can be found.

Leishmaniasis

Brazil accounts for more than 90% of visceral leishmaniasis (VL) and approximately 37% of cutaneous leishmaniosis (CL) in the Americas region. In Brazil, both diseases are transmitted through the bite of female sand flies (Lutzomyia longipalpis), which can transmit the parasites Leishmania brasiliensis, Leishmania amazonensis, and Leishmania guyanensis for CL and Leishmania infantum for VL. The cutaneous form is characterized by granulomatous ulcerative lesions affecting the skin and mucous membranes with a relatively low mortality rate. VL, also known as kala-azar disease, is a systemic condition marked by enlargement of the spleen and liver. The case-fatality rate for VL in Brazil varies by region, ranging from 7% to 15%, but it can reach as high as 90% if left untreated (see Leishmaniasis chapter).

The majority of CL and VL cases are concentrated in the North and Northeast Regions, followed by states in the Southeast Region such as Minas Gerais. Urban dogs are the main reservoir of Leishmania infantum parasites. The increasing number of stray or unwanted dogs and cats is a growing concern in Brazil's larger cities. To avoid being bitten by Lutzomyia flies, travelers should practice insect-bite precautions from dusk to dawn, when sand flies are more active (see Mosquitoes, Ticks, and Other Arthropods chapter). Ecotourists and adventure travelers might be at increased risk, but even short-term travelers in endemic areas have developed leishmaniasis.

Lymphatic filariasis

Brazil is on the verge of being free of lymphatic filariasis (LF), once considered to be endemic to 4 cities in the Recife Metropolitan Region: Recife, Olinda, Jaboatão dos Guararapes, and Paulista. By 2020, all these areas had successfully met the targets set by the World Health Organization (WHO) to stop annual transmission, and the last transmission assessment survey indicated interruption of the transmission of LF in Recife. The last case was diagnosed in 2017, suggesting minimal or no risk to travelers (see WHO website).

Malaria

According to WHO World malaria report 2023, Brazil has the second-highest burden of malaria in the Region of the Americas. Three parasite species predominate in Brazil: Plasmodium vivax (85%), Plasmodium falciparum (approximately 15%), and Plasmodium malariae (<0.2%). Malaria is endemic in 8 states: Maranhão, Mato Grosso, and six states of the North Region (Acre, Amapá, Amazonas, Pará, Rondônia, and Roraima). Together they account for 99% of all malaria cases in Brazil. Rare cases and sporadic foci of transmission are present in rural and forested areas in the states of Espírito Santo, Goiás, Minas Gerais, Mato Grosso do Sul, Piauí, Rio de Janeiro, São Paolo, and Tocantins. Autochthonous cases have recently decreased, but imported cases of P. falciparum have increased in states bordering Venezuela, such as Roraima, due to an increase of migrants and mining-related activities.

Deletion of the PfHRP 2/3 genes have been increasingly detected in samples from Acre and Amazonas. Therefore, rapid diagnostic tests that rely on detecting the P. falciparum histidine-rich protein 2 (PfHRP 2), such as the only U.S. Food and Drug Administration (FDA)-approved rapid diagnostic test in the United States, should be interpreted with caution.

Recommend malaria chemoprophylaxis for travelers going to malaria-endemic areas of Brazil (see Yellow Fever Vaccine and Malaria Prevention Information, by Country and Malaria chapters; and Map 1.5.18), although only insect-bite precautions and mosquito avoidance are recommended for the aforementioned rural and forested areas with rare cases. There is no malaria transmission at Iguaçu Falls or in the cities of Brasília, Rio de Janeiro, and São Paolo.

Map 1.5.18

SOURCE:

Centers for Disease Control and Prevention

A map of Brazil highlighting malaria prevention recommendations. The regions are color-coded: orange areas show where both chemoprophylaxis and mosquito avoidance are recommended, primarily covering Amazonas, Acre, Roraima, Rondônia, Pará, and Maranhão. Brown areas recommend mosquito avoidance only, including the cities of Belém, São Luis, and Cuiabá. Striped areas indicate that mosquito avoidance is recommended only in rural, forested regions, including Piauí, Tocantins, Minas Gerais, Goiás, Mato Grosso do Sul, São Paulo, Espírito Santo, and part of Rio de Janeiro. Beige areas show regions with no known malaria transmission, covering most coastal states as well as Paraná, Santa Catarina, and Rio Grande do Sul.

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Rickettsial diseases and other tick-borne diseases in Brazil

Tick-borne rickettsial diseases in Brazil include febre maculosa and Brazilian spotted fever, which are caused by etiologic agents from the same genus (Rickettsia) that causes Rocky Mountain spotted fever in the United States. Febre maculosa can evolve to a sepsis syndrome that has a high case-fatality rate if not treated at the early onset of symptoms. Most cases occur in the South and Southeast Regions, where in the spring season (October) cases tend to peak. There is a syndrome under investigation in Brazil that is similar to Lyme disease, but the tick and the etiological agent have not yet been identified. Advise travelers to avoid tick bites (see Rickettsial Diseases and Mosquitoes, Ticks, and Other Arthropods chapters).

Trypanosomiasis

In the last decade, approximately 85% of cases of acute Chagas disease have been reported in the North Region. Most states in the Northeast Region and the state of Minas Gerais have controlled Chagas disease through a combination of improved housing conditions and insecticide spraying for the vector. Although the risk is extremely low for travelers and ecotourists, those sleeping outdoors in rural areas or staying in poor-quality housing (e.g., taipa or pau-a-pique houses) are at a greater risk of acquiring this disease, especially when visiting Tocantins, Acre, Amapá, Amazonas, and Pará States in the North Region and Pernambuco and Maranhão in the Northeast Region.

Oral transmission has now surpassed vectorial transmission. Outbreaks have been associated with raw or undercooked food, especially the very popular açaí palm fruit juice (Amazonian fruit eaten throughout Brazil) and sugar-cane juices that are contaminated when the triatomine (the bloodsucking insects hosting Trypanosoma cruzi) or their feces are accidently crushed into the juices during preparation. In these cases, the incubation period can be anywhere from 3 to 22 days.

Yellow fever

The last urban yellow fever outbreak in Brazil was in 1942, but the country still experiences seasonal cases and sporadic outbreaks due to the sylvatic cycle spillover (see Yellow Fever chapter and Map 1.5.3). In recent years, outbreaks reached the southeastern coast, including Rio de Janeiro, São Paulo, and historically lower-risk rural areas. Over 2,000 cases and about 700 deaths have been reported since the beginning of 2018, including fatalities in unvaccinated travelers. Vaccination is recommended for travelers ≥9 months old going to the states of Acre, Amapá, Amazonas, Distrito Federal (including the capital city, Brasília), Espírito Santo, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraná, Piauí, Rio de Janeiro (including the city of Rio de Janeiro and all coastal islands), Rio Grande do Sul, Rondônia, Roraima, Santa Catarina, São Paulo (including the city of São Paulo and all coastal islands), Tocantins, and designated areas of Bahia. Vaccination is also recommended for travelers going to Iguaçu Falls.

For those traveling to risk areas without contraindications, vaccination should occur at least 10 days before travel. For up-to-date geographical risk information, see the Yellow Fever Vaccine and Malaria Prevention Information, by Country chapter. Some Latin American countries may require proof of vaccination at airline counters for travelers leaving Brazil. Consult the Brazilian Health Regulatory Agency (ANVISA) website (in Portuguese), or the consulate and the respective airline company for more information. Brazil does not require proof of yellow fever vaccination to enter the country.

Map 1.5.3

SOURCE:

Centers for Disease Control and Prevention

This map shows yellow fever vaccination recommendations for Brazil and its neighboring countries. The majority of Brazil is shaded yellow indicating that yellow fever vaccination is recommended. Teal areas, which include parts of northern region of Argentina and the western part of Ecuador, show regions where vaccination is generally not recommended. Beige areas show that vaccination is not recommended. This the Brazilian states of Ceará, Rio Grande Do Norte, Paraíba, Pernambuco, Alagoas, Sergipe, and part of Bahia.

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Environmental hazards and risks

Natural disasters

During 2013–2022, 93% of the 5,570 Brazilian municipalities reported some form of water-related disaster, usually followed by an increased incidence of leptospirosis, acute diarrheal diseases, or dengue. Natural disasters with debris may increase the risk of exposure to potentially venomous scorpions, spiders, or snakes, and overcrowded shelters may increase the risk of outbreaks of respiratory diseases (see Poisonings, Envenomations, and Toxic Exposures During Travel chapter).

Animal bites

Rabies

Overall, the risk for rabies infection in Brazil is low due to routine, national rabies campaigns for cats and dogs (see Rabies chapter). The last human case acquired through a dog bite was in 2015. Since then, bats have been the main source, especially in the North Region. The best preventive measure is to avoid animal bites, although pre-exposure vaccination may be considered for travelers who expect contact with bats.

Snakes and scorpions

Poisonous snakes are a hazard throughout much of Brazil, although deaths from snake bites are rare. More than 80% of cases are related to the genus Bothrops, with Jararaca and jararacuçu as the 2 main species from this genus in Brazil. Each species and life-cycle stage will confer different combinations of proteolytic and coagulant venomous characteristics. Symptoms can vary from pain, edema, or bruising, to local and systemic hemorrhage due to renal failure and changes in coagulation. In some areas of the country, specific antivenoms are available; hence being able to identify the snake species (or taking a picture) might prove critical to delivery of optimal medical care. Scorpion stings are a growing concern in the country, and most stings reported are attributed to scorpion in the genus Tityus (for the management of bites and stings, see the Zoonotic Exposures: Bites, Scratches, and Other Hazards and Poisonings, Envenomations, and Toxic Exposures During Travel chapters).

Climate and sun exposure

Ensure travelers are familiar with climatic conditions at their destinations before they go. Temperatures 40°C (>104°F) are common in cities along the coast and in the Amazon basin during October–March (see Sun Exposure in Travelers and Heat and Cold Illness in Travelers chapters).

Safety and security

Crime

Many of Brazil's urban centers have elevated crime rates. The U.S. Consulate advises all travelers to remain vigilant regarding their surroundings and possessions. While pickpocketing and petty crimes are the most common threats, some attackers might be armed and under the influence of drugs. Avoid wearing attention-grabbing jewelry and carrying expensive electronics. This is especially important in common tourist areas, such as beaches and nightclubs, although deserted streets are also dangerous (see Safety and Security Overseas chapter). Drug-related violence has resulted in clashes with police in some tourist areas. Several Brazilian cities have established specialized police units that patrol areas frequented by tourists and aid crime victims. Advise travelers to be familiar with their travel itineraries regarding high crime rate areas before departure and to never resist when threatened.

Political unrest

Political demonstrations might disrupt public and private transportation. Encourage travelers to register with the U.S. Department of State's Smart Traveler Enrollment Program to receive advisories and alerts for areas they plan to visit.

Prostitution

Although commercial sex work is legal, operating a brothel and financial exploitation of sex workers are both against the law (see Sex and Travel chapter).

Traffic-related injuries

Road conditions can vary significantly depending on the region and whether a toll fee is required. With the implementation of a zero-tolerance drinking and driving law in 2008, Brazil reduced road crashes substantially. However, they are still a significant contributor to morbidity and mortality. Motor vehicle crashes in Brazil are a leading cause of injury and death among U.S. travelers (see Injury and Death During Travel chapter). Travelers can expect police checkpoints during evenings and nights in many urban areas. The use of seat belts is mandatory, and motorcyclists are legally obligated to wear helmets. Children ≤10 years old must be seated in the back seat. Brazilian federal law requires infants ≤1 year of age to use rear-facing car seats, children 1–4 years of age to use forward-facing car seats, and children 4–7.5 years of age to use booster seats. For any road crash with victims, regardless of the severity, the 24-hour emergency ambulance service number (192) should be dialed along with the Road Federal Police number (191).

Availability and quality of medical care

In Brazil, public health services are free, even for foreign visitors. Visitors can access emergency care through the Unified Health System or via Unidade de Pronto Atendimentos (UPAs; medium-sized emergency units) for various medical conditions. Private facilities are available, and travel insurance is required for their use (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter). For a list of private medical services, check the U.S. Embassy in Brazil website. The toll-free emergency number for ambulances is 192, and the Brazilian Ministry of Health offers information in Portuguese for international visitors including recommended hospitals for large events in Brazil.

Medical tourism

Brazil offers a growing number of private clinics that provide advanced medical procedures for international clients (see Medical Tourism chapter). The country has become a significant destination for cosmetic surgery and elective medical treatments. While care quality varies, Brazil boasts some facilities comparable to those in the United States. Travelers should research their chosen clinic and ensure that access to emergency medical services is readily available.

Acknowledgements

The following authors contributed to the previous version of this chapter: Alexandre Macedo De Oliveira.