Rio 2016 Olympic/Paralympic Games Brazil
First published: 16 May 2016
Last Updated: 13 June 2016
On 16 May Health Protection Scotland published its advice for travellers planning to attend the 2016 Rio de Janeiro Olympics and Paralympics on TRAVAX (for health professionals advising travellers). This guidance was updated on 13 June 2016 to take account of new advice from WHO.
Similar guidance for the general public travelling to the Games can be found on fitfortravel. It is recommended that travellers see their doctor 6–8 weeks before they go. Health Protection Scotland does not provide individual advice to travellers.
The guidance for health professionals advising is replicated below with links to TRAVAX and other pages. To access links to TRAVAX you will require a password. Subscription to TRAVAX is free to those using the service for NHS purposes in Scotland. To register, go to TRAVAX and complete the registration form.
Guidance for Health Professionals
The 2016 Olympics and Paralympics are scheduled to take place in Rio de Janeiro, Brazil from 5–21 August and 7–18 September respectively. Olympic football matches will also be played in 5 other cities; Manaus (in the Amazon region), Salvador, Sao Paulo, Brasilia and Belo Horizonte.
The following information has been compiled to highlight the main issues that practitioners should consider when advising travellers planning to attend the 2016 Rio de Janeiro Olympics and Paralympics.
The potential health risks will vary between individuals attending the Olympics/Paralympics depending on the city being visited, the amount of time spent in Brazil, further travel around the country, onward travel to another destinations and leisure pursuits.
Other general risk factors should also be taken into account e.g. age, pre-existing illness, medical treatment and pregnancy, particularly in the context of participating in mass gatherings.
General Travel Advice
Travel and Health Insurance
It is strongly recommended that all travellers ensure that they obtain adequate personal insurance (including cover for repatriation if necessary) when travelling. There is no reciprocal healthcare agreement with the UK, therefore the European Health Insurance Card (EHIC) is not valid in Brazil. Medical treatment can be very costly and the British Embassy cannot help with payment.
Travellers should be advised to consider their personal safety during the Olympics/Paralympics, this includes reducing the risk of robbery, injury, assault and road traffic accidents. Advice on personal safety is detailed on the fitfortravel Rio Olympics/Paralympics 2016 page and should be discussed with every traveller.
The Foreign and Commonwealth Office (FCO) has produced a guidance leaflet Stay ahead of the Games: travel checklist for those travelling to the Rio Olympics/Paralympics.
Further information and advice on safety/security, terrorism, natural disasters, local laws and customs can be accessed on the Foreign Office website Foreign travel advice for Brazil.
General Health Advice
During the Olympics/Paralympics many sporting venues and surrounding areas are likely to be crowded. This increases the risk of both respiratory and gastrointestinal illness. Food and water precautions should be discussed with all travellers. When in crowded areas travellers should be advised to:
- Wash hands with soap and water or disinfectant, especially after coughing and sneezing.
- Use disposable tissues when coughing or sneezing and dispose of them appropriately.
- Avoid hand contact with the eyes, nose and mouth.
- Avoid direct contact with people who appear unwell, or use of their personal gadgets.
- Maintain good personal hygiene.
Accessing Medical Care in Brazil
Travellers to Brazil are entitled to emergency medical treatment in public hospitals; these are often crowded in large cities. Proof of health insurance or sufficient funds is needed to access private medical clinics/hospitals.
Further advice on receiving urgent and non-urgent medical care in Brazil can be accessed on the FCO website Foreign travel advice for Brazil.
The pre travel consultation provides a good opportunity to check a traveller's history of National Schedule vaccines. Ensure primary courses and recommended boosters have been received for life in UK. In particular: influenza, pneumococcal and MMR.
It is important to discuss the following diseases with all travellers to Brazil:
It is essential to fully discuss all areas that may be visited whilst in Brazil and any likelihood of onward travel to another country as vaccination may be required for both personal protection and certificate purposes (ICVP). Yellow fever (YF) vaccination is recommended for those visiting the very popular tourist destination of Iguazu Falls.
- Visiting Rio de Janeiro is not a risk for YF as it is located in a state with no risk of yellow fever transmission.
There are 5 football stadia being used during the Olympics and the risk of yellow fever varies between them, depending on location:
- Vaccination is recommended for stadia in the following cities: Belo Horizonte (Minas Gerais state), Brasilia (Federal District, Goias state), and Manaus (Amazonas state). These cities, and the states in which they are located have a risk of yellow fever transmission.
- Stadia in the following cities are not a risk for YF, however they are located in a state with areas of risk of yellow fever transmission: Salvador (Bahia state) and Sao Paulo (San Paulo state). If further travel within the state is a possibility, yellow fever vaccination may be recommended.
Carriage of hepatitis B virus (HBV) in the local population in Brazil is considered to be intermediate (2-8%). The risk of HBV should be discussed during the travel consultation, including transmission routes.
Whilst not a usually recommended vaccine it should be considered for those extending their stay beyond the Olympics/Paralympics and travelling to more remote/rural areas for more adventurous pursuits. Discussing the risk of HBV from sexual contact, tattooing, body piercing, sharing drug injecting equipment, may identify some travellers who would benefit from pre-exposure hepatitis B vaccination.
Travellers with medical conditions that could require medical intervention in an emergency situation e.g. diabetes, cardiovascular disease, malignant disease, blood disorders, may be at greater risk of hepatitis B while travelling.
Brazil is designated by WHO as a high risk country for rabies in terrestrial animals. For a short trip to attend the Olympics/Paralympics only, awareness of the rabies risk and the advice to avoid contact with animals and report any bites, may be all that is required. All bats are a potential rabies risk and the risk from vampire bats in rural parts of South America should be reinforced.
Travellers should be advised that if bitten/scratched/licked on the face, by any warm blooded animal while in Brazil, there may be a rabies risk and they should seek medical help immediately and not wait until they return home.
Post-exposure prophylaxis should be available in the cities where the stadia are located. However, Travel Health colleagues in Brazil have informed us that rabies immunoglobulin is available in cities throughout the country but it is mainly of equine origin (ERIG). Human rabies immunoglobulin (HRIG) is only available in specialist centres, located in capitals and some major cities and is reserved for those considered to be at high risk of anaphylactic reaction to the equine product.
Rabies pre-exposure should be considered for those extending their stay beyond the Olympics/Paralympics and travelling to more remote/rural areas for more adventurous pursuits (particularly caving) where access to post-exposure prophylaxis may be problematic.
It is essential to fully discuss all areas that may be visited whilst in Brazil and any likelihood of onward travel to another country as the risk of malaria may vary. In Brazil, the high risk of malaria is present throughout the year in most forested areas below 900m and within the legal Amazonia region. There is a low to no risk of malaria in the remainder of the country.
- For more detailed information on risk areas and prophylaxis, go to the malaria section of the Brazil country record.
Rio de Janerio is located in the low to no malaria risk areas of Brazil. The only football stadium located in a high risk area for malaria is Arena Amazonia in Manaus, Amazonas state. Transmission is highest in jungle, mining, and agricultural areas and in some peripheral urban areas of Manaus. Awareness of malaria risk, mosquito bite avoidance measures and antimalarial prophylaxis is recommended for this area of Brazil.
Travellers to low to no risk areas of Brazil should also practice good mosquito bite avoidance measures as other mosquito-borne infections such as dengue fever, may be present.
It is advisable to purchase insect repellent in the UK prior to travel. See further information on mosquito bite avoidance.
Other Infection Risks
Vector-borne Disease: a wide range of infections transmitted by biting insects are present in Brazil, and all travellers should take precautions to avoid insect bites. Zika virus infection and dengue fever, both transmitted by Aedes mosquitos, are widespread in Brazil in 2016.
It is advisable to purchase insect repellent in the UK prior to travel. See further information on mosquito bite avoidance.
Zika virus (ZIKV) infection is transmitted by Aedes mosquitoes. It was first identified in Brazil in May 2015, and is now widespread; cases have been reported from all regions of the country. The Ministry of Health estimates between 500 000 to 1.5 million suspected ZIKV cases nationally.
Avoidance of mosquito bites, particularly during daylight hours, is recommended for all travellers.
Zika virus infection during pregnancy has been linked to birth defects.
- Pregnant women are advised to postpone non-essential travel to Brazil and the Olympics/Paralympics until this link has been fully clarified.
- Pregnant women who choose to travel to areas with active ZIKV transmission should check with their travel insurance companies that they are covered under their policy.
- Women of child bearing age should practice bite avoidance and additionally use contraception during travel and for 8 weeks afterwards to avoid the risk of Zika virus infection in pregnancy.
Sexual transmission of ZIKV has been documented.
Guidelines on preventing sexual transmission for male and female travellers are detailed on the Zika Virus Infection page.
Dengue fever is a major problem in Brazil. In 2015, 1, 649 008 probable cases of dengue fever, the highest ever, were recorded. Unlike malaria, dengue fever is more common in urban areas where the Aedes mosquito breeding sites are plentiful.
As there is no vaccine against dengue fever virus travellers must take steps to avoid mosquito bites. As many infections are spread by biting insects all travellers should take precautions as standard.
Sexual Health Risks
Discussing sexual health risks including HIV, hepatitis b and C can be difficult but it should be a normal part of the travel consultation. There are certain factors that may increase the risk for travellers:
- Casual sexual relationships, particularly without the use of barrier protection.
- Commercial sex workers may have high rates of infection.
- In some countries commercial sex is very common and exposure to propositioning and even harassment is common. The unprepared traveller may be taken unawares and end up taking risks which would not be normal behaviour at home.
- The use of recreational drugs and alcohol, can lead the traveller into high risk sexual behaviour.
- Infections may be asymptomatic but not non-infectious so they may be transmitted, unknowingly to subsequent sexual partners.
- Travellers should use good quality condoms with any casual partner.
- Expiry dates on condoms should be checked, and only bought from a reputable source.
- Condoms must be used for all forms of sexual contact, including oral sex, and should be donned before any contact is made.
- Travellers should be reminded that while condoms will effectively reduce the possibility of transmission of most infections they are not 100% effective.
Travellers returning home with a fever or feeling generally unwell should be advised to contact their GP and tell them that they have been in Brazil and what they did there. They should also mention if they have been in a malaria or yellow fever risk area.
Any animal bites/scratches/facial licks sustained abroad and resulting treatment, should be reported to the GP as there may be follow up treatment required.
If malaria prophylaxis was prescribed for the trip, it should be continued once out of the risk area as directed. Travellers should be made aware that malaria can develop up to one year after being in a malarious area and any fever within that time should be reported, mentioning travel history.
Travellers who have put themselves at risk of STIs or other blood-borne infections should consult with their GP or sexual health clinic on return for a full sexual health screen and advice on preventing any spread to subsequent sexual partners.