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This Saturday afternoon, the Socceroos will learn who they play in the first round of the World Cup in Brazil next year.

And, as soon as the first-round draw is announced, the first of thousands of Aussie fans will be booking flights to Brazil to see their heroes in action, and perhaps catch other matches during the month-long football festival that runs from June 12 to July 13.
Ranked 59th in the world, the Socceroos face a tough assignment: They line up against the world’s best teams in 4 divisions or ‘Pots’, each comprising 8 teams. Australia is in Pot 4 with the three other Asian qualifiers – Japan, South Korea and Iran – and the four North-Central American nations – USA, Mexico, Honduras, and Costa Rica.
While we can’t know Australia’s fate, we do know what health challenges fans from all corners of the globe will face in South America’s largest and most populous country.
We’ll cover vaccinations and malaria later in this article, but the most consistent health risk for World Cup spectators right throughout their stay is likely to be dengue fever.

 

A growing problem in tropics

Dengue is not only a year-round problem in Brazil, but also for much of the tropical world. Over 2.5 billion people – more than 40% of the world's population – are now at risk from dengue and there are between 50 and 100 million dengue infections worldwide every year, according to WHO estimates
The latest statistics on dengue cases and fatalities in Brazil spell out the scale of the problem all too clearly.
Last week Brazilian health authorities announced that as of November 21 there had been 1.4 million suspected dengue cases nationwide this year, including 573 deaths. (‘Suspected’ cases are those that show all the symptoms of the disease but were not confirmed by laboratory testing.)
Of the 1.4 million infections nationwide, the southeast has been worst affected by dengue, recording 936,500 cases, or 63.4% of the total. Next came the mid-west region with 271,773 cases (18.4%), followed by the northeast 149,678 (10.1%), the south 70,299 (4.8%), and the north region 48,667 (3.3%). State-by-state figures for the year can be view in a ProMED report.
(It’s worth noting that the following figures represent the proverbial tip of the iceberg. They are the ‘recorded cases’: that is, the ones for which people sought medical help, however many people do not – or cannot - access treatment and their illness goes unreported.)

 

Highest risk in northeast states

Also last week, a team of British entomologists led by Simon Hay of the zoology department at the University of Oxford, examined the seasonal distribution of dengue in the Brazilian cities where the World Cup stadiums are located. The team calculated the percentage of cases which occur during the June-July period during an average year.
Their study revealed good news and bad: For 9 of the World Cup stadiums, the main peak season for dengue will have passed before the World Cup, although the risk may well still be high in the northeast states of Fortaleza, Natal, and Salvador during June and July.
The British researchers determined that the risk of contracting dengue is highest in Natal, capital of Rio Grande do Norte State, as 13.5% of its cases usually occur in June and July. Fans travelling to Rio Grande do Sul State to see a game at Porto Alegre’s Beira-Rio Stadium are at the lowest risk of dengue: Only 0.2% of its average number of cases occurs in the Cup month.
The insect experts calculated the percentage of cases for other host cities to be: Manaus (Amazonas State) 2.1%, Salvador (Bahia) 10%, Fortaleza (Ceara) 9.9%, Recife (Pernambuco) 6.5%, Brasília (Federal District) 3.0%, Cuiabá (Mato Grosso) 3.7%, Belo Horizonte (Minas Gerais) 2%, Rio de Janeiro (Rio de Janeiro State) 2.5%, São Paulo (Sao Paulo State)1.6%, and Curitiba (Paraná) 0.7%.

 

Take prevention measures

It’s impossible to know if 2014 will be an average year for dengue in Brazil. The disease is cyclic, with some years more severe than others.
But, fans from Australia, Europe and other temperate regions outside the tropics should be prepared for dengue from the moment they arrive, according to Dr Eddy Bajrovic, Medical Director of Travelvax Australia.
“With dengue present, World Cup fans can’t afford to be complacent about mosquitoes,” he said.
“There is no vaccine for dengue, so spectators need to know where and when they are most likely to be at risk and how best to protect themselves.
“The disease is spread by two types of Aedes mosquitoes that are found close to human habitation – from the yards of private homes and backpacker hostels, to the gardens of outdoor restaurants and upmarket hotels.

 

Even at the game…

“In fact, it’s quite possible that there will be mosquito breeding sites in and around the stadiums themselves.
“If these mosquitoes are not already carrying the virus, they could bite spectators who are and pass it on to others.”
The number one protection measure is an effective insect repellent applied to exposed skin at all times when outdoors.
“Dengue-carrying Aedes mosquitoes can bite at any time during daylight hours, but their main feeding times are a couple of hours after sunrise and just before sunset,’ Dr Bajrovic added.
“Those are the times when travellers should not only be protected by repellent, but ideally be wearing a long-sleeved shirt, long pants, and shoes and socks if they plan to be outside.”

 

VACCINATIONS AND OTHER HEALTH ISSUES

Hepatitis A: The WHO reports intermediate-high rates of Hepatitis A virus (HAV) in Brazil and vaccination is recommended for all travellers. HAV is spread through faecal contamination of food or water, as well as transfer of the virus through touching everyday objects, so travellers should practice good personal hygiene, wash their hands regularly, and make safe food and water choices. Read more about Hepatitis A.
Hepatitis B: Unlike Hep A, the Hepatitis B virus (HBV) is transmitted via infected blood or bodily fluids. There is an effective vaccine which should be considered, especially if you are planning future overseas travel. A combined Hep A-Hep B vaccine is also available. Read more.
Typhoid: This bacterial disease is spread through contaminated food or water. Vaccination is not likely to be a significant risk if you are staying in quality accommodation for a short stay. However, consider vaccination if you’ll be staying on to see more of Brazil or other countries in the region – especially if (1) your stay will last for more than 4 weeks, (2) if you are staying with local families, or (3) you’re visiting smaller cities, towns, or rural communities, where exposure is more likely. Read more.
Yellow fever: See below under ‘Insects’.
Routine vaccines: Vaccinations that should be current for every overseas trip include measles-mumps-rubella (MMR), diphtheria, pertussis, tetanus, chickenpox, meningococcal disease and seasonal influenza.
Rabies: Rabies is present in dogs, bats, and other mammals in Brazil, but is not considered a high risk – especially for short-stay travellers. However, you should avoid contact with any animals and know the steps to take if bitten.
Jet lag: With Brazil between 13 and 15 hours behind Australia, football fans may also experience jet lag early in their stay. Its symptoms are usually more pronounced in older people and those flying west to east. Fortunately, there are ways to reduce the effects of jetlag. Read more

 

INSECTS
As well as being annoying, insects can spread serious, potentially deadly, diseases in Brazil, including yellow fever and malaria.
Yellow fever: Yellow fever is a risk in certain parts of Brazil. Vaccination is not recommended for travellers whose itineraries include only the cities of Rio de Janeiro, Fortaleza, Recife, Salvador, and/or São Paulo. However, Aussie travellers may be required to show proof of vaccination if returning to Australia within 6 days of leaving Brazil or travelling on to certain South and Central American countries. That’s because the yellow fever-transmitting Aedes mosquitoes are also found in North Queensland, where they also transmit dengue fever. Yellow fever vaccine is recommended for all travellers 9 months of age or older visiting certain areas, so discuss the need for vaccination with a yellow fever-licensed clinic, such as Travelvax, based on your travel plans. Read more about yellow fever in Brazil.
(NB – Yellow fever is a ‘live’ vaccine. If other live vaccines are recommended, they should be given on the same day as the YF vaccine, or separated by a month. Read yellow fever FAQs from the CDC.
Malaria: Areas with malaria include the states of Acre, Amapá, Amazonas, Mato Grosso, Maranhaõ, Para, Rondonia, Roraima, and Tocantins. The disease is present in urban areas, including major cities such as Belem, Boa Vista, Macapa, Manaus, Maraba, Porto Velho, and Santarem. However, malaria is not present in Rio de Janeiro or at Iguazu Falls. While the malaria-transmitting Anopheles mosquitoes can be found around dwellings, they are more likely to be present in rural areas. Discuss the need for malaria prevention medication with your travel doctor or GP: whether or not anti-malarial medication is recommended will depend upon your specific itinerary and the activities you have planned. Read more about malaria in Brazil
Finally, if you develop a fever or get sick after visiting Brazil, seek medical care as quickly as possible. And, don’t forget to mention your recent travel.

Get more advice on dengue, recommended vaccinations and other health-related issues for travel to Brazil and other destinations from Travelvax Australia’s travel health information service on 1300 360 164 (toll free from landlines within Australia).

 

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