Brazil Embassy: 202-745-2700 Brasilia GMT -3 hrs

Entry Requirements:
Passport/Visa: A valid passport and visa are required.
HIV Test: Not required.
Vaccinations: A yellow fever vaccination certificate is required from travelers arriving from infected areas. A certificate is also required if arriving from Africa from Angola, Cameroon, Gabon, Gambia, Ghana, Guinea, Kenya, Mali, Nigeria, Sudan, and Zaire. Americas: Certificate required if arriving from Bolivia, Colombia, Ecuador, Peru.
Telephone Country Code: 55

Embassies/Consulates: U.S. Embassy: Avenida das Nacoes, Lote 3, Brasilia. Tel: 55-61-321-7272; Web: (www.embaixada-americana.org.br.
Consulates: Avenida Presidente Wilson 147, Rio de Janeiro. Tel: 55-21-2922-7117, Web: (www.consulado-americano-rio.org.br); Rua Padre Joao Manoel 933, Sao Paulo. Tel: 55-11-3081-6511, Web: www.amcham.com.br/consulate; Rua Goncalves Maia 163, Recife. Tel: 55-81-3421-2441; Rua Oswaldo Cruz 165, Belem. Tel: 55-91-242-7815; Rua Recife 1010, Adrianopolis, Manaus. Tel: 55-92-633-4907; Rua Pernambuco 51, Pituba, Salvador da Bahia. Tel: 55-71-345-1545, 345-1548; Instituto Cultural Brasil-Estados Unidos (IBEU), Rua Nogueira Acioly 891, Aldeota, Fortaleza. Tel: 55-85-252-1539; The Instituto Cultural Brasil-Norteamericano, Rua Riachuelo, 1257, Centro, Porto Alegre. Tel: 55-512-225-2255.
Canadian Embassy: Setor de Embaixadas Sul, Avenida das Naçoes, Lote 16, 70359-900, Brasilia DF. Tel: 55-61-321-2171; Fax: 55-321-4529; E-mail: brsla@dfait-maeci.gc.ca; Web: www.dfait-maeci.gc.ca/brazil/brasilia/bsa-menu-e.html.

Hospitals / Doctors:
Brasilia: Hospital de Base (600 beds); most specialty services including trauma; 24-hour emergency room.
Casa de Saude Santa Lucia; some specialty and emergency services.
Sao Paulo: Hospital Samaritano; 24-hour emergency services.
Clinica Hamermesz; highly recommended by expats.
Albert Einstein Hospital. Excellent facility, but nurses may be undertrained.
Rio de Janeiro: Hospital Miguel Couto (117 beds); some specialty services including trauma and emergency.
Hospital Souza Aguiar (480 beds); most specialty services including orthopedics, trauma, and emergency.
The Evangelical Hospital; efficient, capable facility.
Hospital Israelita Albert Sabin, 56, rua Lucio de Mendonca, Tijuca, Rio de Janeiro; Medical Director: Jair Fernandes, MD; Francisco Magalhaes, MD; Tel: 568-8822 or 294-6343.
Anapolis (Goias): Hospital Evengelico; mission hospital staffed by British expats.
Cuiaba (Mato Grosso State): Sao Rafael Hospital; advanced facility with CT, MRI. ultrasound, but nursing care may not be adequate.
Manaus: Adventist Hospital. Mineiros (Goias).

AT&T Dial: 000-8010 -- -- MCI Dial: 000-8012

Current Advisories & Health Risks
AIDS/HIV: The highest HIV/AIDS rate in South America occurs in Brazil. Most cases are reported from Rio de Janeiro and Sao Paulo. Causative factors are heterosexual promiscuity, prostitution, bisexuality, homosexuality (men having sex with men), and IV drug use. Both HIV-1 and HIV-2 occur.

Accidents & Medical Insurance:
Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
Heart attacks cause most fatalities in older travelers.
Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Health insurance is essential.

Chagas’ Disease: Risk is present in most rural areas of eastern and southern Brazil. This disease is transmitted primarily in well-populated rural-agricultural areas where there are adobe-style huts and houses that often harbor the night-biting triatomid (assassin) bugs. Travelers sleeping in such structures should take measures to prevent nighttime bites.

Cholera: This disease is active in this country. Cholera, however, is an extremely rare disease in travelers from developed countries. Cholera vaccine is recommended primarily for people at high risk (e.g., relief workers) who work and live in highly endemic areas under less than adequate sanitary conditions.
The manufacture and availability of the injectable cholera vaccine in the United States ceased in June 2000.
Many countries, including Canada, license an oral cholera vaccine. The oral vaccine is not available in the United States.
Cholera vaccine is not "officially" required for entry into, or exit from, any country. Despite this, some countries, on occasion, require proof of cholera vaccination from travelers coming from cholera-infected countries. Anticipating such a situation, certain travelers may wish to carry a medical exemption letter from their health-care provider. Travel Medicine, Inc., recommends that travelers use the International Certificate of Vaccination (Yellow Card) for this purpose, having their health-care provider state "exempt from cholera vaccine" and validate the exemption with both their signature and their official stamp (the "Uniform Stamp" in the United States).

Dengue Fever: Mosquito-transmitted. Most recent outbreaks have occurred from December through June in southern areas. Risk may be elevated from April through August in more northern areas. Risk is present year-round in Rio de Janeiro State and Sao Paulo and Ceara States. Travelers should take precautions against daytime mosquito bites.

Filariasis: Focally endemic in northeastern urban coastal areas, including Belem, Maceio, and Recife. Travelers to these regions should take measures to prevent insect (mosquito) bites.

Hepatitis: Hepatitis A vaccine is recommended for all nonimmune travelers. The overall hepatitis B carrier rate is between 1%–2%, but may approach 20% in some areas of the Amazon Basin. Hepatitis E is endemic, but levels are unclear. There is no vaccine for hepatitis E. Prevention depends upon avoiding contaminated water and food. Hepatitis B vaccine is recommended for stays over 3 months and for short-term travelers wanting increased protection. Travelers should be aware that the risk of hepatitis B is increased by unsafe sex and the use of unsterile needles and syringes.

Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for: all travelers over age 50; all travelers with any chronic or immunocompromising conditions; travelers of any age wishing to decrease the risk of this illness; pregnant women after the first trimester.

Insect-Transmitted Viral Diseases: Oropouche fever (vectored by biting midges; explosive outbreaks occur), Mayaro virus disease (dengue-like illness, mosquito-vectored; attack rates up to 20% in the Amazon Basin, including Paro State), eastern equine encephalitis, St. Louis encephalitis, Western equine encephalitis, and Venezuelan equine encephalitis are reported. At least 30 other insect-borne viral illnesses are associated with illness in humans.

Leishmaniasis: Cutaneous, mucocutaneous and visceral leishmaniasis occur in rural and periurban areas. Cutaneous leishmaniasis and mucocutaneous leishmaniasis occur nearly countrywide in rural and periurban areas with risk elevated in the more humid areas of northern, north-central, and central states; most visceral leishmaniasis occurs in the semi-arid northeastern states (with sharp increases in Maranhao, Piaui, and Rio Grande do Norte States), but has also been reported as far west and south as extreme western Mato Grosso do Sul State and Rio de Janiero State, respectively. All travelers to these regions should take protective measures to prevent insect (sandfly) bites.

Lyme Disease: The incidence of Lyme disease is unclear, but it appears to be very low. Five cases with “Lyme disease” were reported from Brazil in 1991.

Malaria: Malaria in Brazil is restricted to what is known as the legal Amazon. This area covers all the states of Amazonas, Para, Rondonia, Roraima, Acre, Amapa and also part of the states of Mato Grosso, Tocantins and Maranhão.
At least 80% of malaria cases are reported from Mato Grosso, Para, and Rondonia States. Countrywide, P. falciparum accounts for 40% of officially-reported malaria cases. Nearly all other cases are caused by P. vivax. About 2% of malaria is caused by P. malariae.
Multidrug-resistant falciparum malaria is a major problem, particularly in the Amazon region where chloroquine- and Fansidar-resistant P. falciparum occurs.
All travelers planning an Amazon River cruise should take chemoprophylaxis and measures to prevent mosquito bites.
Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), or doxycycline is recommended in risk areas.
All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.

Onchocerciasis: Risk is present near swift-flowing streams in densely forested highlands in northern Amazonas and Poraima States. Travelers to these areas should take measures to prevent insect (blackfly) bites.

Other Diseases/Hazards: Angiostrongyliasis, brucellosis, cutaneous larva migrans, cryptococcosis, cysticercosis (an important health problem in northeastern Brazil, and probably elsewhere), echinococcosis, human monocytic ehrlichiosis, hepatic capillariasis (from ingestion of embryonated eggs in food or dirt), leprosy (highly endemic in Recife area), leptospirosis (mostly in rat-infested urban slums), mansonellosis, measles, meningitis (epidemics reported from Sao Paulo; most cases due to serogroup B meningococci), respiratory syncytial virus (the most common cause of bronchiolitis in children), Rocky Mountain spotted fever, relapsing fever trachoma, toxocariasis, tuberculosis (a serious public health problem; 25% of children in some areas may be infected), strongyloidiasis, and other helminthic infections.

Plague: Most cases are reported from the drier northern and eastern states from Bahia and Ceara south to Minas Gerais. Thirty-five to 150 cases are reported annually. Travelers to these regions should avoid close contact with rodents (which may be carrying infective fleas). Prophylaxis with tetracycline is protective.

Rabies: High risk, relative to other South American countries. Forty to 120 human cases are reported annually, usually transmitted by stray dogs. Vampire bats have also been implicated. Most cases occur in the northeastern states, but cases are also reported countrywide from both urban and rural areas. Rabies vaccine should be considered for stays of over 3 months or for shorter stays if traveling to locations more than 24 hours travel from a reliable source of postexposure rabies vaccine. All animal bites or scratches should be medically evaluated.

Schistosomiasis: Intestinal schistosomiasis is a major public health problem. Risk is elevated in the northeast. Most cases are reported from Minas Gerais and Bahia States. Risk is present in northern and eastern states from Maranhao south to Parana, including both urban and rural areas. There is no apparent risk in the Amazon Basin. Travelers to risk areas should avoid swimming, wading, or bathing in freshwater ponds, lakes, or streams.

Travelers' Diarrhea: High risk outside of resorts and first-class hotels. Travelers should follow all food and drink precautions. A quinolone antibiotic, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.

Tuberculosis: Tuberculosis is a significant public health problem in this country. Travelers planning an extended stay should have a predeparture TB skin test (PPD test) and be re-rested after leaving this country.

Typhoid Fever: Typhoid vaccine is recommended for extended travel or travel outside of tourist areas. The typhoid vacccine is 60% to 70% effective. Food and drink precautions should therefore continue to be observed.