Professional Documents
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journal homepage: www.elsevierhealth.com/journals/tmid
REVIEW
Received 17 March 2014; received in revised form 14 April 2014; accepted 16 April 2014
KEYWORDS
Travel health;
World cup;
Infectious diseases;
Prevention;
Brazil
Summary The next FIFA World Cup will be held in Brazil in JuneeJuly 2014. Around 600,000
international visitors and participants (as well over 3 million domestic travelers) are expected.
This event will take place in twelve cities. This event poses specific challenges, given its size
and the diversity of attendees, including the potential for the transmission of imported or
endemic communicable diseases, especially those that have an increased transmission rate
as a result of close human proximity, eg, seasonal influenza, measles but also tropical endemic
diseases. In anticipation of increased travel, a panel of experts from the Latin American Society for Travel Medicine (SLAMVI) developed the current recommendations regarding the epidemiology and risks of the main communicable diseases in the major potential destinations,
recommended immunizations and other preventives measures to be used as a basis for advice
for travelers and travel medicine practitioners.
Mosquito-borne infections also pose a challenge. Dengue poses a significant risk in all states,
including the host cities. Vaccination against yellow fever is recommended except for travelers
who will only visit coastal areas. Travelers visiting high-risk areas for malaria (Amazon) should
be assessed regarding the need for chemoprophylaxis. Chikunguya fever may be a threat for
Brazil, given the presence of Aedes aegypti, vector of dengue, and the possibility of travelers
* Corresponding author. Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia. Tel.: 57 300 884 74 48.
E-mail addresses: arodriguezm@utp.edu.co, ajrodriguezmmd@gmail.com (A.J. Rodriguez-Morales).
http://dx.doi.org/10.1016/j.tmaid.2014.04.004
1477-8939/ 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Gallego V, et al., The 2014 FIFA World Cup: Communicable disease risks and advice for visitors to Brazil
e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
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V. Gallego et al.
bringing the virus with them when attending the event. Advice on the correct timing and use of
repellents and other personal protection measures is key to preventing these vector-borne infections. Other important recommendations for travelers should focus on preventing water
and food-borne diseases such as hepatitis A, typhoid fever, giardiasis and travelers diarrhea.
Sexually transmitted diseases (STD) should be also mentioned and the use of condoms advocated.
This review addresses pre-travel, preventive strategies to reduce the risk of acquiring
communicable diseases during a mass gathering such as the World Cup and also reviews the
spectrum of endemic infections in Brazil to facilitate the recognition and management of infectious diseases in travelers returning to their countries of origin.
2014 Elsevier Ltd. All rights reserved.
Introduction
The FIFA World Cup is to be held in Brazil for the second
time in 2014 (the first occasion was in 1950). Around
600,000 international visitors and participants (as well
over 3 million domestic travelers) are expected for the
event, which will take place in twelve cities around the
country (the largest in South America) between the 12th of
June and the 13th of July, 2014. It is a unique opportunity
for Brazil to showcase the beauty and diversity of its many
tourist attractions (including one the New Seven Wonders
of the World, Christ the Redeemer in Rio de Janeiro).
While Brazil has successfully hosted a number of large international gatherings, this event poses specific challenges, given its size and the diversity of attendees. This
was extensively discussed at the past XVIII International
Congress for Tropical Medicine and Malaria, XLVIII Congress
of the Brazilian Society of Tropical Medicine and 3rd Latin
American Congress of Travel Medicine, which took place in
Rio de Janeiro, on September 23e27, 2012, as part of the
activities organized by the Latin American Society for
Travel Medicine (Sociedad Latinoamericana de Medicina
del Viajero, SLAMVI, http://www.slamviweb.org) [1].
There is potential for transmission of imported or endemic
communicable diseases, especially those that have an
increased transmission rate as a result of close proximity
of multiple asymptomatic but infected individuals, eg,
seasonal influenza [2], but also tropical diseases that are
endemic in Brazil, such as malaria, dengue, leishmaniasis,
among others. In addition, such high-profile events may
also attract deliberate release of biological or other
agents, which should be also considered. For example
after the September 11, 2001 terrorist attacks in the
United States of America, preparedness and response was
raised also in international sports events, such as the PanAmerican games, which particularly included enhanced
surveillance and rapid detection of terrorist-induced or
natural outbreaks for timely intervention to limit exposure
and to implement prophylaxis [3e5]. Then, these are also
considerations that should be considered by national
health authorities in Brazil in anticipation of the FIFA
World Cup 2014.
Strategies to reduce the risk and mitigate the impact of
acquiring communicable diseases during a mass gathering
such as the World Cup and the Olympic Games, should
include pre-travel consultation, enhanced epidemic intelligence to promptly detect incidents, the provision of
standard operating procedures for epidemic response, and
training and pre-accreditation of food suppliers to reduce
food-borne disease outbreaks [2]. International mass
gatherings pose specific challenges not only to implementing control measures due to the mobility of the attendees but also with regard to recognition and
management of infectious diseases in travelers returning to
their countries of origin. There is a huge commitment to
make the event safe for all who visit the country, including
authorities and travel medicine experts and practitioners in
Brazil [2,6e8]. Particularly, during the last three years,
then, in order to plan and prepare health system conditions, particularly at the host cities, the Federal Government of Brazil, with the joint action of the Ministry of
Health and the Ministry of Sports, installed in May 2011, the
Technical Camera of Health (Camara Tematica de Saude),
with the objective to promote interaction between
different government sectors, define orientations, strategic
projects, responsibilities and goals to attain and also to
assess and advise the execution of preparatory actions for
the FIFA World Cup 2014 in relation to health [9]. Innovative
measures have been even taken regarding the implementation of new health strategies, for example the inclusion of bags with health aid devices and defibrillators for
all the players [10].
In anticipation and preparation for the increased travel,
to and from Brazil, a panel of experts from the Latin
American Society for Travel Medicine (SLAMVI) developed
the current recommendations regarding the risk of the main
communicable diseases at major potential destinations,
particularly the host cities, recommended immunizations
and other preventives measures to be used as advice for
travelers and travel medicine practitioners, taking in
consideration the epidemiology of infectious diseases in the
country and its regions, states and cities. These recommendations constitutes a scientific summarized version of
an already online report in Spanish of SLAMVI at its website
for healthcare professionals (http://www.slamviweb.org/
es/home/RECOMENDACIONES%20PARA%20LOS%20VIAJEROS
%20A%20LA%20COPA%20MUNDIAL%20DE%20FUTBOL%20BRA
SIL%202014.pdf) and also for travelers (http://www.
slamviweb.org/es/home/Muncial%20de%20Futbol%20Con
sejos%20para%20Viajeros%20SLAMVI.pdf).
Please cite this article in press as: Gallego V, et al., The 2014 FIFA World Cup: Communicable disease risks and advice for visitors to Brazil
e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
dx.doi.org/10.1016/j.tmaid.2014.04.004
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About Brazil
Brazil is the largest country in both South America and the
Latin American region. It is the Worlds fifth largest country, both by geographical area and by population. It is the
largest Lusophone country in the World, and the only one in
the Americas. Bounded by the Atlantic Ocean on the east,
Brazil has a coastline of 7491 km (4655 mi) (Fig. 1). It is
bordered on the north by Venezuela, Guyana, Suriname and
the French overseas region of French Guiana; on the
northwest by Colombia; on the west by Bolivia and Peru; on
the southwest by Argentina and Paraguay and on the south
by Uruguay (Fig. 1) [11].
With a total area of 8,514,876.599 km2 (3,287,612 sq
mi), including 55,455 km2 (21,411 sq mi) of water, Brazil
spans three time zones (from UTC-4 in the western states,
to UTC-3 in the eastern states (and the official time of
Brazil) and UTC-2 in the Atlantic islands). Brazil is the only
country in the World that lies on the equator while having
contiguous territory outside the tropics. Brazilian topography is also diverse and includes hills, mountains, plains,
highlands, and scrublands. Much of the terrain lies between
200 m (660 ft) and 800 m (2600 ft) in elevation. The main
upland area occupies most of the southern half of the
country. The northwestern parts of the plateau consist of
broad, rolling terrain broken by low, rounded hills [11,12].
Brazil is a federation composed of 26 States in 5 five
geopolitical regions (north, northeast, central west,
southeast and south) (Fig. 1), one Federal district (which
contains the capital city, Braslia) and Municipalities
(Fig. 1). Among those states (ST) and cities (CI), 12 of them
will be host cities (between 1 and 3 per region) for the FIFA
World Cup 2014 (Fig. 1) [12,13].
The practice of travel medicine in Brazil began in 1997.
However, there are few specialized travel medicine services
in the country. Most of them are located in the southeast
region of the country, but there are a lot of public services
specialized in tropical, parasitic and infectious diseases,
available to attend those diseases in travelers [8,14,15].
Fig. 1 Map of Brazil, showing regions of the country, states (ST) and the host cities for the FIFA World Cup 2014 (in yellow stars),
as well the areas of yellow fever, malaria and dengue transmission.
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
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V. Gallego et al.
Table 1 Specific destinations (host cities and states, by country regions) and endemic infectious diseases of concern for
travelers to Brazil with recommendations for yellow fever vaccine according geographical areas.
Destination
Host City
Belo Horizonte
Brasilia
Cuiaba
Curitiba
Fortaleza
Manaus
Natal
Porto Alegre
Recife
Rio de Janeiro
Salvador
Sao Paulo
Statesa
North Region
Acre
Amapa
Amazonas
Para
Rondo
nia
Roraima
Tocantins
Northeast Region
Alagoas
Bahia
Ceara
Maranha
o
Paraba
Pernambuco
Piau
Rio Grande do Norte
Sergipe
Central West Region
Federal District
Goia
s
Mato Grosso
Mato Grosso do Sul
Southeast Region
Espritu Santo
Minas Gerais
Rio de Janeiro
Sa
o Paulo
South Region
Parana
Recommendations of
Malariab
Dengue
Leishmaniasis
Schistosomiasis
Yellow fever
vaccine
Vector avoidance
measures
No
No
No
No
No
Yes
No
No
No
No
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
Yes
Yes
No
No
Yes
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes, west
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
Yes
Yes
No
Yes, south
and west
No
Yes
No
No
Yes, south
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes, some
municipalities
No
Yes
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
No
No
No
Yes
Yes
Yes
Yes
No
Yes
No
No
No
Yes
No
No
Yes, north
Yes
No
Yes, northwest
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
Yes, west
Yes, west
Yes, west
Yes
Yes
Yes
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
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of treatment for P. falciparum malaria is artemetherlumefantrine or artesunate plus mefloquine. In the case
of P. vivax the recommended treatment is chloroquine plus
primaquine (7e14 days) [17]. Any traveler visiting endemic
areas (Fig. 1) and presenting with fever should be assessed
during and/or after the travel. Malaria is characterized by
fever and influenza-like symptoms, including chills, headache, myalgias, and malaise; these symptoms can occur at
intervals. Uncomplicated disease may be associated with
anemia and jaundice. In severe disease, seizures, mental
confusion, kidney failure, acute respiratory distress syndrome, coma, and death may occur. Malaria symptoms can
develop as early as 7 days (usually 14 days) after initial
exposure in a malaria-endemic area and as late as several
months or more after departure. Suspected or confirmed
malaria, especially P. falciparum, is a medical emergency,
requiring urgent intervention as clinical deterioration can
occur rapidly and unpredictably. [19] P. vivax infections are
characterized either by a long incubation or a long-latency
period between illness and relapse e in both cases up to
8e12 months [20,21]. Then, even in this setting, in
returning travelers with fever, malaria should be ruled out
(travelers should be informed of this possibility and
educated about the long incubation period of P. vivax malaria and about need to seek care and inform the clinician
about possible malaria exposure in case symptoms indicative of malaria occur). Malaria diagnostic tests are available
in all the health services in the northern region of the
country and in reference centres for infectious diseases in
teaching hospitals in others areas. In 2012, 2,325,775 malaria microscopy tests were done in Brazil. Also specialized
travel medicine clinics are available in non-endemic areas
such as Sao Paulo and Rio de Janeiro [8].
5
municipalities of Piau state (northeastern region), the
western and southern area of the state of Bahia (northeast
region), north of Espirito Santo (southeastern region),
northeastern area of Sa
o Paulo (southeast region) and
western areas of the states Parana
, Santa Catarina and Rio
Grande do Sul (south region) (Fig. 1) (Table 1). In the period
February to April 2009, 28 human cases of yellow fever
were reported in Southwestern region of the state of Sao
Paulo, with a 39.3% case fatality rate [22]. In addition,
between September 2008 and June 2009, another outbreak
of yellow fever in previously unvaccinated populations
resulted in 21 confirmed cases with 9 deaths (43% case fatality rate) in the southern state of Rio Grande do Sul [23].
All travelers visiting Iguazu falls should have a yellow fever
vaccination. This is not recommended for travelers visiting
cities such as Ro de Janeiro, Sao Paulo, Salvador, Recife
and Fortaleza (Fig. 1) (Table 1). Unvaccinated individuals
traveling to areas where vaccination is recommended
should be vaccinated at least 10 days prior to travel. Public
education is needed about the risk of disease and indications for vaccination, including contraindications and
precautions for persons who might be at increased risk of
severe adverse events [23].
Dengue is considered endemic at most of the states and
regions of Brazil, except for southern region states. During
2013, the incidence of disease was estimated in 731.5
cases/100,000pop, however states such as Mato Grosso
reached 3062 cases/100,000pop (30.6 cases/1000pop)
(Table 2). Major cities such as Sao Paulo and Rio de Janeiro
are also endemic. In the states of Santa Catarina, Rio
Grande do Sul and Parana (south region) disease occurs as
imported form. In addition to this, the months of June and
July are cool in the southern and southeastern region states
(Fig. 1). Daytime mosquito bite prevention using repellent
on exposed skin is highly recommended (Table 1). Accommodation with screens and air conditioning for prevention
of some vector borne infections will be useful in this
matter.
Chikunguya fever can be also a threat concern for Brazil,
given the presence of Aedes aegypti, vector of dengue, and
the possibility of travelers importing cases into the country
[14]. This is a real threat in view of the ongoing situation
with outbreaks of chikunguya in the Caribbean region (over
3000 cases between December 2013 and March 2014) in
French Guiana, Guadaloupe, Martinique, St. Barthelemy,
St. Martin, Anguila, Aruba, Dominica, St. Kitts & Nevis, St.
Maarten and UK Virgin Islands [24]. Thus, local surveillance
of this possibility in travelers from those areas arriving
Brazil for the World Cup should be also considered.
Thanks to a coordinated multi-country programme in the
Southern Cone countries, the transmission of Chagas disease by vectors and via blood transfusion was interrupted in
Brazil in 2006 [25]. Seroprevalences have rapidly decreased
in the last years. As a consequence, the current rates in
children aged between 0 and 5 years old is of the order of
105, a clear indication that transmission, if it is occurring,
is only accidental [26,27]. However, is still currently highly
relevant in the country, because since 2005 (in Santa Catarina state) reports of food-borne cases and outbreaks have
been described in Brazil, but also in other countries of Latin
America [28]. Contamination occurred when complete or
partial parts of the triatomine bugs or their Trypanosoma
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
dx.doi.org/10.1016/j.tmaid.2014.04.004
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V. Gallego et al.
Table 2 Dengue incidence rates (cases/100,000pop) in
Brazil by regions and states, 2011e2013.
Region and state
2011
2012
2013
North Region
Rondo
nia
Acre
Amazonas
Roraima
Para
Amapa
Tocantins
Northeast Region
Maranha
o
Piau
Ceara
Santa Catarina
Rio Grande do Sul
Central West Region
Mato Grosso do Sul
Mato Grosso
Goia
s
Federal District
Brasil
752.6
206
2571.70
1779.20
322.1
253.8
418.7
855.4
368
179.1
322.6
747.8
731.4
334.6
251.2
285.5
189.9
282.6
449.6
205.9
1147.60
1036.80
278.4
131.4
339.3
2.8
3.4
369.5
347.5
202.5
565.6
129.4
400.5
257.9
207
315.4
143.9
399.1
207.7
224.6
819.4
413.5
79.3
387.7
637.1
891.5
229.9
356.1
888.4
215.9
342
308.6
148.4
334.3
1116.20
69.6
17.2
42.6
1.5
1.6
471.5
367.3
1054.70
398.3
54.2
303.9
301.3
544.4
364.9
467
195.3
117.3
235.4
616.4
273.3
53.4
156.5
355.7
529.6
342.3
93.6
295.6
37.9
413.1
1097
2044.6
1796.9
1303.8
511
241.2
624
5.8
4
1806.1
3062.3
1128.7
2233.6
428
731.5
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
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and Santa Catarina) [44]. The risk for travelers is considered to be minimal [45,46].
Schistosomiasis
Another important tropical disease is schistosomiasis (only
due to Schistosoma mansoni) [47], which poses a risk for
travelers when swimming in contaminated rivers, canals,
streams, ponds or lakes [32,48]. Areas with significant risk
include Baha and Minas Gerais (Fig. 1) as well Sergipe,
Alagoas, Pernambuco, Paraiba and the state of Ro Grande
do Norte and the Federal District (Table 1). Transmission
occurs largely in rural areas and not in cities. There is no
risk when visiting ocean beaches.
7
HIV/AIDS cases in Latin America (with over half-million people infected), with a national incidence rate of 20.2 cases/
100.000pop for year 2012. The highest rate is reported in the
south region of the country (30.9), followed by north region
(21.0), southeast (20.1), central west region (19.5) and
northeast region (14.8) [49]. In addition, Hepatitis B, syphilis
and other bacterial STD are highly prevalent particularly in
the young, sexually active population [50]. Studies have
shown that travelers visiting Latin America, including Brazil,
engage in sexual activities that put them at risk of acquiring
STD and transmitting it, both in their home country and in the
visiting country [51e53]. Condom use should be recommended for travelers with the potential to engage in sexual
relationships when visiting Brazil. On December 5, 2013,
UNAIDS launched the campaign: Protect the goal. Salvador,
Bahia, was chosen to host the global campaign. The slogan of
the initiative, From Soweto to Salvador illustrates the
historical and cultural link that the city has with Africa and
highlights the continuity started in South Africa in World Cup
2010 World Cup campaign. This campaign uses the popularity
of football to show messages on HIV prevention [54].
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8
Leptospirosis is another environmental, zoonotic and
water -borne concern, given the fact that this disease is
highly endemic, reported in most states, counts for almost
20,000 cases between 2007 and 2011 [65]. The disease has
been associated with swimming, wading, kayaking, and
rafting in contaminated lakes and rivers. As such, it is a
recreational hazard for travelers who participate in outdoor
sports in addition to consuming contaminated food and
beverages [66e68].
Foodborne illnesses
Although these are infectious diseases concerns usually in
mind when travel to tropical countries, such as Brazil, other
risk should be considered. Travelers diarrhea and foodborne diseases are highly common and prevalent [32,69]. In
addition to bacteria (such as Campylobacter, Shigella,
Salmonella) and viruses (norovirus, rotavirus, astrovirus,
hepatitis A); parasites should be considered, particularly
including Giardia intestinalis, Cryptosporidium sp,
Entamoeba histolytica, Strongyloides stercoralis, Taenia
solium and Taenia saginata. Typhoid fever is also reported
in Brazil with outbreaks reported during last decade in the
state of Sao Paulo [70]. Brucellosis, bovine tuberculosis and
listeriosis are also reported in Brazil [71]. In the past,
outbreaks of cholera have been reported in the country
[72], but currently the risk is low. Immunization is neither
required nor routinely recommended.
Recently, aiming to prevent foodborne illnesses during
the 2014 FIFA World Cup, Brazil has developed a risk-based
evaluation tool able to assess and grade Brazilian food
services in cities that will host football matches. This tool
has been used by the Brazilian sanitary surveillance officers
during the inspection of facilities where food services. This
has been considered an innovative preventative sanitary
action because it was created based on scientific information, statistical calculation and on risks of foodborne diseases occurrence [69].
Immunizations
Currently no vaccines are required by the Government of
Brazil on arrival to the country. However, as a general
suggestion, all travelers should be up-to-date on their
routine vaccines, including hepatitis A, influenza, measles,
mumps and rubella [32], but also tetanus, diphtheria,
pertussis, pneumococcal and varicella if possible, as not all
persons would be candidates for these last two vaccines in
many countries [76]. Unfortunately, recent data of travelers
to Brazil, eg. from Boston, USA, revealed that 71%, 58%, and
50% received vaccines for yellow fever (YF), typhoid, and
hepatitis A, respectively. Fewer received influenza and
hepatitis B vaccines (14%, 11%) [59]. Recommended vaccines include hepatitis A (if not included as routine vaccine
V. Gallego et al.
in the country of origin of the traveler), hepatitis B, typhoid
fever, rabies, meningococcal meningitis and yellow fever.
Yellow fever vaccine according to the destinations (Table
1). Meningococcal vaccine should be considered for the
associated risk as has been recommended in other previous
World Cups and massive sports events [2,77]. Given the fact
that the 2014 FIFA World Cup Brazil will undoubtedly ensure
that the individual stadiums will be crowded with spectators, and this may increase the risk of the transmission of
disease from asymptomatic infected individuals [77].
Meningococcal outbreaks have occurred during/after other
mass gatherings (e.g. the Hajj). This has led countries such
as Saudi Arabia to require quadrivalent meningococcal
vaccine of all pilgrims. Is important to note that vaccines
available in most parts of the world do not protect against
meningococcus B, a serotype that has caused outbreaks in
Brazil in the past [78].
Regard measles, the interruption of the circulation of
indigenous viruses in Brazil occurred in 2000, and since
then, the country has recorded sporadic reports of illness
related to the imported cases. From the year 2013, measles
cases are occurring in the cities of Fortaleza, Recife, Sao
Paulo, Belo Horizonte, Curitiba, and Brasilia (689 cases),
which will host the FIFA World Cup. Travelers to Brazil
during the World Cup should be vaccinated against measles,
mumps and rubella (MMR) with the aim of preventing the
introduction of the virus in the country, even more
considering the current outbreaks in USA (at California,
New York City and Washington) and Canada (at British
Columbia and Ontario) [79], countries of origin of a significant number of travelers to Brazil. Measles outbreaks in
the past have demonstrated that unvaccinated persons
place themselves and their communities at risk for measles
and that high vaccination coverage is important to prevent
the spread of measles after importation [80].
Conclusions
As in previous FIFA World Cups, 2014 Brazil will be a major
international sporting and cultural event for the host
country [81]. Brazil is already a popular tourist destination
in Latin America. Healthcare sector administration in Brazil
is prepared to deploy medical resources at any stage of the
event, and for any unexpected health-compromising
events, including but not limited to infectious diseases
and mass casualty events [1,8]. Beyond attention during the
World Cup, travelers to Brazil may encounter Brazilendemic infections that could be diagnosed after returning to their countries of origin [32]. Despite pronounced
reductions in the morbidity and mortality due to infectious
diseases over the past six decades, these still pose a public
health problem in Brazil [82]. This review will be helpful to
clinicians and travel medicine practitioners for prevention
and travel-health advice as well for the evaluation of
travel-related conditions in returning travelers from the
Brazil World Cup. Compared to other recent reports [32],
current recommendations would lead to specific regional
destination advice facilitating the assessment of risk according to individual and collective itineraries of travelers
going to Brazil for the FIFA World Cup and other related
activities.
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[16]
[17]
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Conflict of interest
The authors have no conflict of interest to disclose.
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Acknowledgment
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
dx.doi.org/10.1016/j.tmaid.2014.04.004
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e A review from the Latin American Society for Travel Medicine (SLAMVI), Travel Medicine and Infectious Disease (2014), http://
dx.doi.org/10.1016/j.tmaid.2014.04.004