Chapter 10 Popular Itineraries The Americas & the Caribbean

David O. Freedman

DESTINATION OVERVIEW

Iguassu Falls (Iguaçu in Portuguese, the language of Brazil; Iguazú in Spanish, the language of Argentina) in the Atlantic rainforest region of South America straddles the border of the southern Brazilian state of Paraná and the northern Argentine province of Misiones.

Brazil, occupying most of eastern South America, is immense and varies from tropical plains and jungle at the equator to cooler uplands in the south. Brazil is a developing nation in the lower half of the world’s economies, but the highly industrialized south, which includes São Paulo, is affluent, with modern infrastructure. Argentina is located in the southern part of South America, between the Andes Mountains and the Atlantic Ocean. Except for a tiny northernmost fringe, which is tropical, all of Argentina is temperate, characterized by a cool, dry climate in the south and a more moderate climate in the central portion of the country. Argentina is a developing nation but is in the upper half of the world’s economies. In addition, Paraguay is only a few miles away from the falls, so many people travel into Paraguay during the same trip. Most visitors to the falls stay in either the city of Foz do Iguaçu, Paraná, or in Puerto Iguazú, Misiones, each about 12 miles from the falls and each a well-developed, modern city. However, there is one sizeable hotel right at the falls in each of the separate national parks on either side of the border. This UNESCO World Heritage site also protects an astounding diversity of tropical wildlife. There are airports called Iguassu Falls in both countries, but travelers can fly to the Brazilian airport (IGU) only from Brazil or Lima, Peru, and to the Argentinean airport (IGR) only from Argentina.

Higher than Niagara Falls, Iguassu is rivaled only by southern Africa’s Victoria Falls, which are higher but narrower. Iguassu Falls is a waterfall system consisting of 275 falls along 1.67 miles (2.67 km) of the Iguassu River, varying from 210 to 270 ft (64 to 82 m) in height. The main feature, the Devil’s Throat, is a U-shaped cliff, 490 by 2,300 ft (149 by 701 m), which marks the border between Argentina and Brazil. Two-thirds of the falls are on the Argentine side of the gorge, giving the Brazilian side the best view. However, one cannot directly approach the falls from the Brazilian side. Travelers visiting the Argentine side are able to pass over and under the actual falls on a series of catwalks and trails. The bridge connecting the 2 sides of the river is a number of miles away and crosses the Brazil-Argentina border.

US travelers require a visa, which must be obtained in advance, to enter Brazil. Many organized day trips and commercial taxis do not stop at the Brazilian immigration post, and this seems to be tolerated. However, a US citizen in Brazil without a visa in his or her passport may face arrest or imprisonment if stopped for any reason by authorities during the short visit. US travelers staying on the Brazilian side on a single-entry Brazilian visa can legally reenter Brazil after a day trip to Argentina. US travelers do not require a visa to enter Argentina but must make an advance online payment and present a printed receipt at time of entry. Ideally, one should visit both sides, but most people do not, because their stay is too short to deal with the somewhat complicated logistical issues.

HEALTH ISSUES

The infrastructure in tourist accommodations around Iguassu Falls is good, and most travelers are tourists staying only for a short time. Travelers visiting the usual accommodation and dining facilities are at modest risk for enterically transmitted diseases. Consuming raw fruits or vegetables, unpasteurized dairy products, or foods or beverages from street vendors increases one’s risk of foodborne infection (see Chapter 2, Food & Water Precautions). Travelers may wish to carry an antibiotic to self-treat clinically severe travelers’ diarrhea (see Chapter 2, Travelers’ Diarrhea). Hepatitis A and B vaccines are recommended for all travelers and typhoid vaccine only for those with adventurous dietary habits or who plan to eat away from usual tourist locations.

Yellow Fever

Yellow fever virus circulates in monkeys and mosquitoes in the forested regions along the Iguassu and Paraná rivers. All travelers, even those on a typical 1- to 2-day itinerary, should be vaccinated. Although requirements may change, at present neither Brazil nor Argentina requires that any travelers have an International Certificate of Vaccination or Prophylaxis for yellow fever. However, because of an ongoing yellow fever outbreak in Brazil that began in 2016, health authorities have recently expanded the list of areas in which yellow fever vaccination is recommended for travelers. For the most current list, visit the CDC travel notice about the outbreak.

Malaria

No malaria transmission occurs at the falls or in surrounding areas. In assessing the malaria risk for travelers and recommended preventive measures, the entire itinerary, style of travel, and location of accommodations need to be taken into consideration. Typical travelers on fixed itineraries and staying at the hotels at the falls or in upscale accommodation in the adjacent towns would not be considered at risk for malaria. If the itinerary includes travel to other areas of Brazil, Argentina, or Paraguay where malaria is present, travel health providers should consult the country-specific information in Chapter 2, Yellow Fever & Malaria Information, by Country, and Map 2-06.

Rabies

Both terrestrial animal and bat rabies are risks in parts of Brazil, but no cases in animals or humans have been reported around Iguassu Falls. Pre-exposure vaccine is not necessary for typical travelers, but travelers should be educated about avoiding animals and seeking medical care for any bite injuries or bat exposures that occur.

Leishmaniasis

This protozoan disease, transmitted by sand flies, occurs in Brazil, where it is most common in the Amazonian and northeast regions but is present in Paraná, and has seen a recent increase in Misiones, Argentina. Preventive measures include minimizing outdoor activities to the extent possible, especially from dusk to dawn, when sand flies generally are the most active; wearing protective clothing; applying insect repellent to exposed skin; using bed nets treated with a pyrethroid-containing insecticide; and spraying dwellings with residual-action insecticides.

Chagas Disease (American Trypanosomiasis)

Risk to travelers is unknown but is thought to be negligible. Few travelers stay in houses constructed of mud, adobe brick, or palm thatch, where the vectors live.

Dengue, Zika, Chikungunya

Three arboviral diseases, dengue, Zika, and chikungunya, occur in urban and rural areas in the Iguassu Falls region (see relevant sections in Chapter 4 - Infectious Diseases Related to Travel). Insect precautions will reduce risk. Zika can be sexually transmitted from a person who has Zika to his or her sex partners, even while they are not symptomatic. Because Zika infection in a pregnant woman can cause serious birth defects, women who are pregnant should not travel to areas with Zika. Travelers should consult the CDC Travelers’ Health website for the most current recommendations for Zika.

Schistosomiasis

Schistosomiasis, transmitted in freshwater lakes and rivers, is a public health problem in many states in Brazil. Historically, rare cases have been reported from the Iguassu area, but no recent data are available. Cautious travelers should avoid freshwater exposure while visiting the area.

BIBLIOGRAPHY

1. Jentes ES, Poumerol G, Gershman MD, Hill DR, Lemarchand J, Lewis RF, et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis. 2011 Aug;11(8):622–32.
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