CDC Yellow Book 2024Popular Itineraries
Iguaçu (also spelled Iguazú and Iguassu) Falls, in the Atlantic rainforest region of South America, straddles the border of the southern Brazilian state of Paraná, the northern Argentine province of Misiones, and Paraguay. This UNESCO World Heritage site protects an astounding diversity of tropical wildlife.
The Iguaçu waterfall system, one of the largest in the world, consists of 275 falls along 1.67 miles (2.67 km) of the Iguaçu River, ranging 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), marking the border between Argentina and Brazil. Two-thirds of the falls are on the Argentine side of the gorge, and one cannot directly approach the falls from the Brazilian side. Travelers visiting the Argentine side can pass over and under the falls by a series of catwalks and trails. A bridge that crosses the Brazil–Argentina border is several miles away from the gorge site. Paraguay is only a few miles away from the falls, so many people travel to Ciudad del Este in Paraguay for duty-free shopping during the same trip.
Most visitors to Iguaçu Falls stay in either the city of Foz do Iguaçu, Paraná (in Brazil), or in Puerto Iguazú, Misiones (in Argentina), each about 12 miles from the falls and each a well-developed modern city. There is also one sizeable hotel located next to the falls in each of the national parks on either side of the border. Airports in bordering cities provide connecting service to other cities within their respective countries. Foz do Iguaçu International Airport (IGU) in Brazil also has occasional connections to neighboring countries.
For tourist visits up to 90 days, US citizens do not require a visa to enter Brazil. Many organized day trips and tourist taxis do not stop at the Brazilian immigration post coming from either Paraguay or Argentina, and this seems to be tolerated. US travelers staying on the Brazilian side 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.
Map 10-18: Iguaçu Falls
Infectious Disease Risks
The infrastructure in tourist accommodations around Iguaçu 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 foodborne diseases. Municipal water is treated but not safe for drinking. Consider prescribing an antibiotic for travelers to empirically self-treat diarrhea (see on-line YB chapter). All travelers should be up to date on their routine immunizations. All travelers should receive hepatitis A vaccine, although typhoid vaccine may be reserved only for those with adventurous dietary habits or who plan to eat away from usual tourist locations. Detailed country-specific travel advice can be found on the CDC Travelers’ Health destination page.
Respiratory Infections & Diseases
Coronavirus Disease 2019
For current information on COVID-19 in Argentina, Brazil, or Paraguay, consult the appropriate US Embassy website. See the US government’s COVID-19 international travel requirements and recommendations.
Soil- & Waterborne Infections
Schistosomiasis (see Sec. 5, Part 3, Ch. 20, 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 Iguaçu area, but no cases have been reported in Iguaçu Falls since 2012.
Chikungunya, Dengue & Zika
Three arboviral diseases, chikungunya (see Sec. 5, Part 2, Ch. 2, Chikungunya), dengue (see Sec. 5, Part 2, Ch. 4, Dengue), and Zika (see Sec. 5, Part 2, Ch. 27, Zika), occur in urban and rural areas in the Iguaçu Falls region. Instruct travelers to take measures to protect themselves from mosquito bites (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods). Find the most recent Zika travel information for women who are pregnant or trying to become pregnant at Zika travel information.
This protozoan disease, transmitted by sandflies (see Sec. 5, Part 3, Ch. 14, Cutaneous Leishmaniasis, and Sec. 5, Part 3, Ch. 15, Visceral Leishmaniasis), occurs in Brazil and is most common in the Amazonian and northeast regions. A few cases of both cutaneous and visceral leishmaniasis occur in Paraná state, including near Iguaçu Falls, every year. Leishmaniasis is also found in Paraguay and, over the last few years, increasingly in northern provinces of Argentina.
No malaria transmission occurs at the falls or in its surrounding areas. In assessing the malaria risk for travelers, consider the entire itinerary (e.g., travel to other regions of Brazil). If the itinerary includes travel to areas where malaria is present (see Map 2-04), consult the country-specific information (Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country; Sec. 5, Part 3, Ch. 16, Malaria; and the CDC Malaria webpage.
The risk of American trypanosomiasis (see Sec. 5, Part 3, Ch. 25, American Trypanosomiasis / Chagas Disease) to travelers is unknown but thought to be negligible. Few travelers stay in houses constructed of mud, adobe brick, or palm thatch, where the vectors live.
Yellow fever virus (see Sec. 5, Part 2, Ch. 27, Yellow Fever) circulates in monkeys and mosquitoes in the forested regions along the Iguaçu and Paraná rivers. All travelers, even those on a typical 1- to 2-day itinerary, should be vaccinated against yellow fever. Although requirements may change, at present neither Brazil nor Argentina require travelers to provide proof of vaccination against yellow fever when entering the country. Many neighboring countries, including Paraguay, require visitors coming from Brazil to present an International Certificate of Vaccination or Prophylaxis documenting yellow fever vaccination.
Environmental Hazards & Risks
Animal Bites & Rabies
Both domestic animal and bat rabies are risks in parts of Brazil, but no cases in mammals or humans have been reported around Iguaçu Falls. Many visitors will encounter coatis, long-tailed mammals weighing between 4 to 18 pounds (2 to 8 kg), that live in groups and often approach humans for food. Counsel travelers to avoiding engaging with these animals because bites have been reported, although the risk of rabies is unknown. Nevertheless, rabies preexposure vaccine is not necessary for typical travelers. Educate travelers to seek appropriate medical care for any bite injuries, including those from domestic and wild animals (e.g., coatis, monkeys, foxes, etc), or bat exposures that occur (see Sec. 4, Ch.7 Zoonotic Exposures: Bites, Stings, Scratches & Other Hazards).
The following authors contributed to the previous version of this chapter: David O. Freedman
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