June 27, 2016

Travelers participating in or attending the pre-game events and/or the 2016 Summer Olympics and Paralympics should be aware of the many health concerns at Rio 2016 in Brazil. The threat of infectious disease outbreaks will be especially heightened during the Olympics as mass gatherings create the ideal setting for the importation and spread of diseases. Therefore, education regarding pre-travel immunizations, precautions for food, water, and insect bites, and ensuring an understanding of the local health resources are vital to mitigating the health threats in Brazil.

Let's dive into an in-depth overview of information and tactical tips you can follow to inform you of healtheconcerns at Rio 2016 and help ensure you have a healthy experience while attending the 2016 Summer Olympics and Paralympics.


All travelers and expatriates should ensure they are up to date on routine immunizations including tetanus, diphtheria, pertussis, polio, measles, mumps, rubella, varicella (chickenpox), and influenza. Hepatitis A, Hepatitis B, and typhoid vaccinations are also recommended for most travelers. Officials also recommend the pneumococcal vaccine for travelers over the age of 65 and for travelers with certain chronic medical conditions.

Brazil is classified as a yellow fever endemic country. Yellow fever vaccine or certified waiver requirements are often based on whether you are entering from an endemic area. Be sure to check yellow fever vaccine requirements for the next country (countries) on your itinerary. In addition, as of July 1 2016, Brazilian officials will require that travelers arriving from or traveling to Angola or the Democratic Republic of Congo show proof of yellow fever vaccination received at least 10 days prior to travel. This temporary measure is in response to ongoing yellow fever outbreaks in both countries, and following recommendations from the WHO.

Insect-borne Diseases

Brazil is endemic for several prominent mosquito-borne diseases, including malaria, Zika virus, chikungunya, dengue fever, and yellow fever as well as Chagas disease and Brazilian Spotted Fever. Taking thorough insect bite precautions by covering exposed skin with lightweight, loose-fitting, lightly colored clothing, and using products containing DEET on exposed skin may provide protection against mosquitoes and other hazardous insects. Use of a mosquito net over bedding at night if there is no air conditioning or if rooms are exposed to the outside may also help prevent bites. Although the mosquitoes that carry chikungunya, dengue and Zika virus are known to be “day-biters,” other species of mosquitoes and insects may pose risks at night.

Malaria is a year-round risk in Brazil and is elevated December-May in southern areas, so transmission will be low during the time of the Rio 2016 activities. In addition, there is no risk of malaria transmission in Rio de Janeiro. Nevertheless, there is considerable risk of malaria in at least one Olympic soccer venue, Amazônia Arena (map). 


Map: Areas with risk of malaria and Olympic venue locations

Yellow fever is a risk in most of Brazil, and vaccination is recommended for several of the Olympic venue locations, including Brasilia, Belo Horizonte, and Manaus (map).

Map: Areas with risk of yellow fever and Olympic venue locations

The US CDC maintains a “Watch-Level 1” travel health notice due to chikungunya activity in South America, including Brazil. The CDC's "Watch - Level 1" advisory is the lowest of three advisory levels. This level of travel advisory notifies travelers of baseline or slightly elevated risk at a destination, and emphasizes the need for travelers to practice usual health precautions – predominantly precautions against insect bites, in the case of chikungunya.

In addition, the US CDC maintains an “Alert-Level 2” travel health notice due to Zika virus activity in Brazil. As of May 2016, locally transmitted cases have been identified in all Brazilian states. The CDC's "Alert - Level 2" advisory is the second of three advisory levels, notifying individuals of increased health risks at a destination, often associated with specific risk factors. This level also encourages travelers to take specific actions and emphasizes the need to enhance usual health precautions - predominantly against insect bites, in the case of Zika virus.

The CDC recommends that pregnant women consider postponing travel to any area where Zika virus transmission is ongoing, and that pregnant women consult their doctor before departing if travel is unavoidable. Women who are trying to become pregnant should consult their doctor before departing. On March 8, the WHO similarly recommended pregnant women avoid travel to areas with ongoing Zika virustransmission, and practice safe sex or abstinence for the duration of the pregnancy.

All individuals should take precautions to avoid mosquito bites. Although Zika virus activity has overall decreased, especially in Northeastern states, central states have reported high Zika virus transmission as of the latest report from the Brazilian Ministry of Health in May.

Food- and Waterborne Diseases

Most of Brazil's urban areas have access to water treatment and distribution services. However, system defects, power outages, and water shortages may contaminate tap water. Drinking water in rural areas is more frequently contaminated with potentially dangerous pathogens and chemicals. Officials recommend drinking only bottled or purified water to reduce the risk of traveler's diarrhea or gastrointestinal illness.

To avoid the risk of general food-borne illness, travelers should follow routine food hygiene practices. Ensure that food is properly handled and prepared. Wash raw produce before eating. Consider avoiding raw meat dishes and unpasteurized dairy products, which frequently harbor bacterial and parasitic pathogens. Consider avoiding street vendors and unregulated food establishments, which often have substandard hygiene practices.

In addition, reports of longstanding issues regarding pollutants and contaminants known to endanger human health in Brazilian inland and coastal waters continue to appear. Swimming only in well-chlorinated pools will markedly reduce exposure to many potential diseases. If reportedly contaminated areas cannot be avoided, ensuring that no polluted water is inhaled or swallowed and thoroughly cleansing exposed skin with soap and clean water may reduce risk.

Other Health Risks

According to WHO statistics, the average annual concentration of particulate air pollution in Brazil exceeds recommended thresholds. Air pollution is considerably higher in urban areas, especially in Rio de Janeiro and São Paulo. Individuals with asthma or chronic cardiorespiratory conditions should consult with a healthcare provider prior to travel and carry sufficient medications. On days when air quality is particularly poor, affected individuals should take personal precautions to reduce respiratory stress.

Medical Facilities

Medical care in Brazil can be widely accessible, with well-equipped and -staffed facilities in large cities; however, care in outlying areas is limited. Travelers are encouraged to have medical insurance that is valid in Brazil and should seriously consider medical evacuation insurance. Individuals should check with their medical provider about approved health care facilities.

Summary - Health Concern - Rio 2016

Proper planning and preparedness and knowledge should help reduce health concerns at Rio 2016. Ensure you have proper immunizations, take proper precautions against mosquitoes and ensure the food and water you eat is handled properly. Following these steps can greatly reduce the risks of infection of many diseases at Rio 2016.

Join WorldAware International & AXA Assistance for a comprehensive preparedness webinar for travelers attending the Rio 2016 Olympic and Paralympic Games. Our experts will answer your questions live. Register for the live webinar here