The Travel Health and Vaccine Specialists

Health Alert


Yellow Fever in Brazil

Updated October 3, 2017

What is the current situation?

The Brazilian Ministry of Health has reported an ongoing outbreak of yellow fever. The first cases were reported in the State of Minas Gerais in December 2016, but confirmed cases have since been reported in the neighboring states of Espirito Santo, São Paulo, and Rio de Janeiro. Cases have occurred mainly in rural areas, with most cases being reported from Minas Gerais state. Some cases have resulted in death. Health authorities in the affected states, with assistance from the Brazilian Ministry of Health, are conducting mass vaccination campaigns among unvaccinated residents of affected areas.

In response to this outbreak, health authorities have recently expanded the list of areas in which yellow fever vaccination is recommended for travelers. Yellow fever vaccination is now recommended in all of Espirito Santo and Rio de Janeiro states, including the city of Rio de Janeiro; São Paulo state, with the exception of the urban area of the city of São Paulo; and a number of municipalities in Bahia.

State of Bahia: new areas in which yellow fever vaccination is recommended for travelers Expand expand Collapse
The Brazilian Ministry of Health maintains a list of all other municipalities in Brazil for which yellow fever vaccination continues to be recommended (not including recently added municipalities). It is located at

Note: because yellow fever vaccination was previously recommended and continues to be recommended in western parts of the states of São Paulo and Bahia, some municipalities in each of these states are included on this older list.

Anyone 9 months or older who travels to these areas should be vaccinated against yellow fever. People who have never been vaccinated against yellow fever should not travel to areas with ongoing outbreaks. CDC no longer recommends booster doses of yellow fever vaccine for most travelers. However, a booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 years ago and who will be in a higher-risk setting, including areas with ongoing outbreaks. Because of the ongoing outbreak, travelers to the Brazilian states of Minas Gerais, Espirito Santo, Sao Paulo, Rio de Janeiro, and parts of Bahia may consider getting a booster if their last yellow fever vaccination was more than 10 years ago. Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. For more information on booster shots, see “Clinician Information,” below.

Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever vaccine provider well in advance of travel.

Expanded Yellow Fever Vaccine Recommendation Areas in Brazil

Vaccine recommended
Vaccine recommended due to current outbreak Vaccine recommended
Low elevation Vaccine recommended due to current outbreak
High elevation Vaccine not recommended
São Paulo City Note: Vaccination is not recommended for travel that is limited to the urban areas of São Paulo City. Because the edge of urban areas can be difficult to map, infection risk in the outskirts of the city may be difficult to determine. The decision to vaccinate should also consider duration of travel, and the possibility of travel outside São Paulo City. This map shows the urban areas of the São Paulo município based on data from OpenStreetMap and the MODIS satellite sensor.

What is yellow fever?

Yellow fever is a disease caused by a virus spread by mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

How can travelers protect themselves?

Get yellow fever vaccine:

Visit a yellow fever vaccination (travel) clinic and ask for a yellow fever vaccine.
You should receive this vaccine at least 10 days before your trip.
After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you on your trip.
For most travelers, one dose of the vaccine lasts for a lifetime. Consult a travel medicine provider to see if additional doses of vaccine may be recommended for you based on specific risk factors.
In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.
Prevent mosquito bites:

Cover exposed skin by wearing long-sleeved shirts and pants.
Use an EPA-registered insect repellent containing DEET, picaridin, oil of lemon eucalyptus (OLE), IR3535, or 2-undecanone (methyl nonyl ketone). Always use as directed.
If you are also using sunscreen, apply sunscreen first and insect repellent second.
Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
Most repellents, including DEET, can be used on children older than 2 months.
Follow package directions when applying repellent on children. Avoid applying repellent to children’s hands, eyes, or mouth.
Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
If treating items yourself, follow the product instructions carefully.
Do not use permethrin directly on skin.
Stay and sleep in screened or air conditioned rooms.
Use a bed net if the area where you are sleeping is exposed to the outdoors.
Clinician Information:

Yellow Fever Vaccine Booster Doses: Recommendations of the Advisory Committee on Immunization Practices, 2015
Yellow Fever in CDC Health Information for International Travel -“Yellow Book” Clinical and Laboratory Guidance
Diagnostic Testing
Testing for Vaccine Adverse Events
Additional Information:

FAQ’s about Yellow Fever
Avoid Bug Bites-Information for travelers
Insect Repellent Use and Safety
Yellow Fever Vaccine Information Statement (VIS)
Authorized U.S. Yellow Fever Vaccine Centers
Page created: February 01, 2017
Page last updated: September 21, 2017
Page last reviewed: September 21, 2017
Content source: Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)