World Cup Fever is well underway. Some 600,000 people are traveling from around the world to attend a portion of the 2014 FIFA World Cup, which began on June 12th in Sao Paulo Brazil, and will continue until July 13th. Millions more are watching the games on TV. In fact, my husband is English, so he’s been on the hunt for a good way to watch the games now that he lives in the United States. Surprisingly, we’ve discovered that unless you have terrestrial cable or satellite, finding a way to watch the 2014 World Cup means going down to the local sports bar and watching it over dinner. Which, as it turns out, is probably one of the safer bets – considering the traveling risks to parts of Brazil. But hey, more power to you if you can and are willing to make the voyage.
Brazil is a country with several vector-borne infection transmission zones, making travel guidance difficult. The risk of dengue is high throughout the country and has no treatment or prevention beyond using insecticide sprays to keep the mosquitoes at bay. The U.S. Centers for Disease Control and Prevention has advised vaccination for those attending inland matches in yellow fever hotspots. Immunizations for measles and influenza have also recommended, given that these infections thrive in large crowds. Malaria is a disease with continued prevalence in Brazil, particularly in the Amazon region. However, most of the common areas of travel are without significant risk of transmission.
That being said, four of the 12 World Cup stadiums are located in regions endemic with yellow fever, and one with a risk of malaria – Manaus; which was where the England vs. Italy game took place on June 14th.
According to many studies, malaria cases have decreased overall, but the annual incidence of dengue has increased over the last two decades, and transmission areas of yellow fever also have grown larger. Much of the morbidity and even mortality due to the infectious diseases found in Brazil are either vaccine-preventable or reduced by avoidance of mosquitoes, use of insect repellent, and/or the use of prophylactic medication.
Due to the recommendations from the Football Association, England players began taking their 12-day course of medications to combat malaria, despite a seemingly low risk of contraction. Having consulted with an expert at the London School of Hygiene and Tropical Medicine, the team was prescribed Malarone for the 23-man playing squad, and 49 additional travelling back office and/or administrative staff.
All were given their first pill 48 hours before they departed for Manaus, but while the drug is effective in preventing and treating malaria, it can cause side effects over the course of the treatment for 1 in 10 people taking the drug. The most common of those include diarrhea, nausea, vomiting, stomach pain, and headaches.
Manager Roy Hodgson was quoted having said, “As far as I’m concerned, I’ve got to go with medical opinion. If the doctors are telling me that when we go to Manaus the players must take malaria tablets, whether it has side effects or not, what do I do? I can’t turn around and say, ‘We will not take malaria tablets,’ because the bottom line is it’s better to have stomach cramps or whatever it is for one player in 10 than have someone contract malaria, because that would be unthinkable."
Upon looking back, any of those side effects may be considerations for England’s inevitable defeats at the 2014 World Cup. Though, my husband would likely say that’s just an excuse for a team who hasn’t been able to gain a win since 1966.
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Carissa Andrews is an passionate author and freelancer from Minnesotan with a focus in creative writing.