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Brazil Olympics: Should I see a doctor before leaving Australia?

by Dr Bob Kass - April 13, 2016

I'm off to the Olympics in Brazil. Should I see a doctor before leaving Australia?

The short answer is yes! 

While it is highly unlikely you will contract an "exotic" disease, it would be very disappointing to cop something you could have avoided through sensible advice. This may be the only time you get to experience an Olympic Games.

A consultation entirely focused on vaccines, antimalarials and exotic tropical diseases is not appropriate. The time would be better directed towards helpful hints to reduce the risk of respiratory tract disease (exposure in commuter transport, airports, planes), eating and drinking safely and the management of traveller's diarrhoea. Information on vector-borne (mosquito) disease, particularly Dengue fever and Zika virus disease is very important given the recent concerns.

To advise travellers they will be faced with “developing world’ conditions similar to Africa will mean the more important health messages above and security issues may be lost. In many locations visitors to Brazil will experience conditions little different to their home…...massive stadiums, first class hotels, helpful police and fast food services. Any advice should reflect this reality and also the fact they won't need to venture too far from the “well off areas” to experience areas of extreme poverty and observe third world health issues, such as dysentery, malaria, TB etc.

Brazil is a middle income country which has extremes of poverty and wealth. It is the world's seventh wealthiest economy. Much has been achieved over the last 10 years to reduce the levels of poverty (people living on less than $2 per day). The percentage of those living in poverty has been halved since 2003. Today, less than 2% of Brazilians are defined as living in extreme poverty.

Staying healthy while away is an important aspect of making any trip an enjoyable one.  Before visiting Brazil you may need to have a number of vaccinations.  Some may be routine (recommended for any destination) while others may relate only to this country/ region.
 
Ideally you should see a health service provider 4-6 weeks before leaving to allow time for the vaccines to take effect. Even if you have limited time it is still sensible to visit a health care provider. It is also sensible that you pick up important medications for the management of common travel-related illness. Globe Medical has a range of medical kits to suit your needs.  If you are currently taking medications for an ongoing medical issue, make sure you are carrying adequate supplies and you know the generic name of the medication. Find out more about Travel Medicine services at Globe Medical (Adelaide).

If your travel plans involve more than one country, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Those intending to stay long-term overseas or be residents abroad, may also need additional vaccinations.
 
Yellow Fever is a disease risk in Brazil and a Yellow Fever certificate may be required. Transmission of malaria also occurs in Brazil; predominantly in the Amazonas.

The following summary should not be considered as a substitute for professional medical advice. People differ in their past medical and vaccination history as well as their past experience in travel. Specific advice can only be given in consultation with a health professional.

Globe Medical has recently published (March 2016) an updated version of the Little Book, about staying healthy when travelling. The same size as your passport, the Little Book (now more than 200 pages) provides a comprehensive summary on how to stay healthy while overseas.  It can be purchased online from The Travel Shop for $9.95. All medical kits purchased at Globe Medical include a copy of the Little Book.

An iBook version of the Little Book is available through iTunes

VACCINATIONS

ALL TRAVELLERS

ROUTINE VACCINES

Tetanus/Diphtheria/Pertussis, Measles/Mumps/Rubella, Hepatitis B, Varicella (Chickenpox), Pneumonia (> 65 years)

SPECIFIC VACCINES

Hepatitis A, Influenza

SOME TRAVELLERS

Typhoid, Yellow Fever, Rabies

   

GENERAL HEALTH ADVICE

ALL TRAVELLERS

Eating and Drinking safely, Insect avoidance measures, Traveller’s diarrhoea, Personal security, DVT, Avoiding animal bites

SOME TRAVELLERS

Malaria, Schistosomiasis, Tuberculosis

TRAVELLERS WITH SPECIFIC ISSUES

Immune-suppression, Chronic Disease, Travelling with Children, Travelling when pregnant. Intending to become pregnant on return to Australia.

   

WHAT IS YELLOW FEVER (YF)?

Yellow Fever is a very severe, hemorrhagic and often fatal tropical disease, caused by the YF virus. It is transmitted by a specific mosquito species called Aedes Aegypti.  Monkeys also suffer from this infection. The disease occurs in the African tropics and was once wide spread in the Americas. Fortunately, thanks to the work of American and Cuban researchers in the early 20th century, a combination of mosquito control and vaccination programs, the disease has largely been eliminated from urban areas of the American tropics. Most of the annual 30,000 (estimated) global YF deaths occur in the African tropics.

Countries in South America where there is a risk of contracting YF:

Argentina, Bolivia*, Brazil*, Colombia*, Ecuador*, French Guiana, Guyana, Panama, Paraguay, Peru*, Suriname, Venezuela (and Trinidad in the Caribbean).

* denotes those countries reporting cases in recent years.

In the Americas, from 1985 to 2012, 95% of all yellow fever cases were reported by four countries: Peru (54% of all cases), Bolivia (18%), Brazil (16%), and Colombia (7%). In 2013, 23 cases of yellow fever, including 15 deaths (case fatality rate, CFR: 65.2%), were reported to PAHO/WHO; all of these cases were from Peru and Colombia.

There has been no urban Yellow Fever in Brazil since 1942.

 

AM I LIKELY TO CATCH YELLOW FEVER IN SOUTH AMERICA?

The chance of catching YF on a standard trip to South America is extremely low. Those spending time in rainforest areas of the countries named above are at more risk than those watching Olympic events in urban areas. 

Fatal cases of YF have occurred in unvaccinated tourists visiting rain forest areas.

IS YELLOW FEVER VACCINE COMPULSORY?

YF vaccine is subject to World Health Organization’s (WHO) International Health Regulations (IHR), which means that a country’s quarantine and customs authority is entitled to deny entry to a traveller arriving without proof of YF vaccination (The International Certificate of Vaccination).

This is usually enacted by countries that have the appropriate mosquito vector (Aedes Aegypti) for the human transmission of the YF virus. They are concerned about the possible introduction of the virus into their mosquito population by a traveller incubating the illness (i.e.  the traveller  entering their country within six days of leaving a YF endemic zone country of South America or Africa.  Australia has such a requirement, as do many countries located in the tropics. An Australian citizen arriving without the correct documentation will not be denied entry to Australia but may be counseled and delayed at Customs and Immigration if arriving within 6 days of leaving, for example, Brazil. Were they to arrive at the border of another country with such a requirement, they may be denied entry.

When deciding whether you should have the YF vaccine before leaving home you need to carefully check your plans. The following needs to be considered.

Are you at risk of catching YF?

Are you at risk of being denied entry due to IHR?

EXAMPLE:

Traveller 1 is going only to Rio and Sao Paulo, then on to New York. He doesn’t need the YF vaccine for either protection or IHR.

Traveller 2 is attending Olympic events in coastal urban Brazil, then taking a 5 day tour of the Amazon at Manaus and returning home to Adelaide via the Galapagos. She should have the YF vaccine for both protection and IHR reasons. Ecuador will demand the YF vaccination certificate.

ABOUT THE YELLOW FEVER VACCINE.

The YF vaccine is extremely effective and the protection is long lasting.  As with other live attenuated vaccines, side effects resemble a mild version of the illness. There may be fever, headache, malaise and aching. This occurs in about 10% of recipients some time between 3 and 8 days after vaccination.

For this reason it is unwise to be vaccinated at the last minute before your trip.

Very rarely, severe adverse effects of a neurological or organ failure type can result in hospitalization, even death.  The rates of severe side effects occurring are higher in elderly people, but may also be related to unusual immune responses that cannot be predicted.

Some people should not receive the YF vaccine: pregnant women, those with severe egg allergy, those with immune deficiency due to medications or medical conditions, and those with disorders of the thymus such as myasthenia gravis.  It is very important that you disclose any current and past health conditions to the doctor prior to YF vaccination.

When the doctor considers that the vaccine itself may pose more risk to you than the chance of catching YF, they may issue a certificate of YF vaccine exemption on medical grounds.

ABOUT ZIKA VIRUS DISEASE

Updated Situation as of 12 April 2016

Fifty two countries and territories have reported local Zika virus transmission since March 2016. There has been a significant increase in reports from countries affected in the Asia-Pacific region.

Asia Pacific:

  • American Samoa
  • Cambodia
  • Cook Islands
  • French Polynesia
  • Federated States of Micronesia (Yap)
  • Fiji
  • Indonesia
  • Laos

 

  • Malaysia
  • Marshall Islands
  • New Caledonia
  • Philippines
  • Samoa
  • Solomon Islands
  • Thailand
  • Tonga
  • Vanuatu

Americas:

  • Aruba
  • Barbados
  • Bolivia
  • Bonaire
  • Brazil
  • Colombia
  • Puerto Rico
  • Costa Rica
  • Cuba
  • Curacao
  • Dominica
  • Dominican Republic
  • Ecuador
  • El Salvadore
  • French Guiana
  • Gudaeloupe

 

  • Guatemala
  • Guyana
  • Haiti
  • Honduras
  • Jamaica
  • Martinique
  • Mexico
  • Nicaragua
  • Panama
  • Paraguay
  • Saint Martin
  • Saint Vincent and the Geradines
  • Sint Maarten
  • Suriname
  • Trinidad and Tobago
  • US Virgin Islands
  • Venezuela

Africa:

  • Cape Verde
  • French Guiana
  • Gabon

 

   

 

Following the meeting of the International Health Regulations (IHR) Emergency Committee on Zika virus, the results of new research and information have been released by the World Health Organization:

  • Transmission of Zika is likely to be significantly under reported as the majority of those infected with the disease are asymptomatic.
  • Sexual transmission of Zika virus is likely to be more common than previously assumed. The virus has been identified in semen, saliva, blood, urine, as well as cerebral fluid.
  • There is growing evidence to support the correlation between Zika virus infection and birth abnormalities including, microcephaly, delayed foetal growth, damage to the placenta and injury to the central nervous system of the foetus.
  • A case-controlled study in French Polynesia has identified a possible link between an increase in the incidence of Guillain-Barre Syndrome amongst those infected with Zika.

Important things to consider if travelling to a risk country:

  • Zika virus is spread by the Aedes Aegypti mosquito. This mosquito  also carries diseases such as Dengue, Chikungunya and Yellow Fever and is commonly found in urban areas in still standing water (e.g. saucers under flower pots, small puddles, discarded tyres etc.)

  • Use insect repellents that contain the active ingredients DEET or IR 3535 or Icaridin. Other forms of "natural" repellents are  not effective in providing adequate protection against mosquito bites.

  • Pregnant women should consider postponing non-essential travel to risk countries

  • Men infected with Zika (may not experience symptoms) and pass on the virus to a pregnant partner through sexual intercourse.

  • Symptoms of Zika are similar to that of Dengue, Chikungunya and Malaria. Avoid aspirin and other non-steroidal anti-inflammatory medication until a doctor has ruled out the possibility of dengue. These medications can increase the risk of haemorrhage in severe cases of dengue fever. Paracetamol can be used to relieve pain and fever.

ZIKA FAQ

Read: Globe Medical’s updated Zika FAQ – 10 Facts to help you understand Zika a bit better.


Author

Dr Bob Kass

Dr Bob Kass is Medical Director of Globe Medical. He holds specialist qualifications in paediatrics and public health medicine and is one of Australia's pioneers in the discipline of Travel Medicine. 

Full professional biography​