The day is finally upon us! With only hours to go until the 2014 World Cup begins in Brazil, excitement has reached fever pitch and it is unlikely you will be able to walk down many streets in England without seeing red and white flags displayed to support the national team. When we see these millionaire footballers such as Wayne Rooney and Frank Lampard on our television screens, many probably see them as god-like figures, superstars with such vast wealth and fame that they are immune to everything else around them, whether it is criticism, scorching hot weather or disease. However, underneath all the money and glamour, they are just human beings like the rest of us. Yesterday Medical Specialists™ Pharmacy reported how the entire England camp are having to take antimalarial Malarone to fend off malaria, showing they are still at risk of contracting any number diseases whilst in Brazil, as any other holidaymaker would be whilst visiting the particularly at-risk regions. There are 12 host cities for the 2014 World Cup, including Manaus in the Amazon region where England begin their World Cup campaign on Saturday. Health risks for individuals in Brazil for the event will vary according to the stadia hosting the game, duration in the country, other places being visited around Brazil or other countries and leisure pursuits. In addition, age, pregnancy, pre-existing medical conditions and medications, are all issues to take into account. Here Medical Specialists™ Pharmacy discuss some of the diseases that are common in Brazil. Malaria It is vital to disclose exactly which regions you are visiting in Brazil and the possibility of travelling to any neighbouring countries, as malaria risks can vary considerably. Arena Amazonai in Manaus is one stadium in a ‘high risk’ area for malaria, but the remaining 11 stadia are situated within ‘low to no’ malaria risk areas. People are advised to increase their malaria awareness, take antimalarial tablets such as Malarone and learn mosquito bite avoidance measures. The latter is especially vital as there may be a risk of other mosquito-borne infections such as dengue fever. Sexually transmitted infection A staggering 3.7 million football fans are expected to descend onto Brazil this week, a country where prostitution is legal. As such, Brazil’s one million sex workers will be looking to cash in on the influx of extra potential customers. However, it is worth remembering that Brazil is one of numerous countries in South America with high rates of sexually transmitted infection and HIV, although recent intervention from the Brazilian government has led to condom distribution increasing more than 45% between 2010 and 2011 (from 333 million to 493 million condoms). Holidays may be a time to have fun, but it shouldn’t be at the expense of your health. Medical Specialists™ Pharmacy advise all UK travellers to pack good quality UK-manufactured latex condoms and use one each and every time you have sex. Dengue fever Dengue fever is a huge problem in Brazil. In fact, last year there were a record 1.4 million suspected dengue fever cases reported in the country. UK travellers should be aware that there is a risk of dengue fever in certain stadia to be hosting games during the peak dengue season in their area. All are found in the north-east of the country: Fortaleza (Ceara state), Natal (Rio Grande Do Norte state), Recife (Pernambuco state) and Salvador (Bahia state). Travellers should take precautions to avoid mosquito bites due to the fact there is no vaccine to protect against the dengue fever virus. Using insect repellent and sleeping under a mosquito net are two ways to help protect yourself. Yellow fever Similar to malaria and dengue fever, yellow fever is transmitted through mosquito bites. However, the disease is preventable by a vaccination, especially recommended to those who are visiting the highly popular tourist destination Igazu Falls. Even if going into a low-risk yellow fever area, travellers are still advised to apply a DEET-containing insect repellent to exposed skin and consider other mosquito-bite prevention methods, for both indoors and outdoors. Just a single dose of the yellow fever vaccine offers protection against the disease for around 10 years, but must be administered at least ten days before a trip. Moreover, many countries require you to have a yellow fever vaccination certificate before entry, although exemption certificates can be provided for people unable to have the vaccination on medical grounds. Rabies Rabies is transmitted through the saliva of an infected animal, commonly through a bite, scratch or lick on broken skin, and Brazil is deemed to be a ‘hisk risk’ country for rabies in animals by the World Health Organisation. For those only in Brazil to attend World Cup, it may just suffice to increase awareness of the rabies risk, avoid contact with animals (including bats), as well as report any bites for assessment. However, those planning to stay in Brazil after the tournament has finished to travel to more remote and rural areas - i.e. for caving trips where immediate access to treatment is unavailable – may be advised to have a rabies vaccine.