Tropical South America This section includes general information about health hazards as reported by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The region includes Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela. It covers the narrow coastal strip of the Pacific Ocean, the high Andean range with numerous peaks 5,000 to 7,000 meters high, and the tropical rain forests of the Amazon basin, bordered to the north and south by savanna zones and dry tropical forest or scrub. Arthropod-borne diseases are an important cause of ill health in rural areas. Malaria (in the falciparum, malariae, and vivax forms) occurs in all ten countries or areas, as do American trypanosomiasis (Chagas' disease), and cutaneous and mucocutaneous leishmaniasis. There has been an increase of the latter in Brazil and Paraguay. Visceral leishmaniasis is endemic in north-east Brazil, with foci in other parts of Brazil, less frequent in Colombia and Venezuela, rare in Bolivia and Paraguay, and unknown in Peru. Endemic onchocerciasis occurs in isolated foci in rural areas in Ecuador, Venezuela, and northern Brazil. The bites of blackflies may cause unpleasant reactions. Bancroftian filariasis is endemic in parts of Brazil, Guyana, and Suriname. Plague has been reported in natural foci in Bolivia, Brazil, Ecuador, and Peru. Among the arthropod-borne viral diseases, jungle yellow fever may be found in forest areas in all countries except Paraguay and areas east of the Andes; in Brazil it is confined to the northern and western states. Epidemics of viral encephalitis and dengue fever occur in some countries of this area. Bartonellosis, or Oroya fever, a sandfly-borne disease, occurs in arid river valleys on the western slopes of the Andes up to 3,000 meters. Louse-borne typhus is often found in mountain areas of Colombia and Peru. Foodborne and waterborne diseases are common and include amebiasis, diarrheal diseases, helminthic infections, and hepatitis A. The intestinal form of schistosomiasis (bilharziasis) is found in Brazil, Suriname, and north-central Venezuela. Paragonimiasis (oriental lung fluke) has been reported from Ecuador, Peru, and Venezuela. Brucellosis is common and echinococcosis (hydatid disease) occurs, particularly in Peru. Bolivia, Brazil, Colombia, Ecuador, Peru, and Venezuela all reported cases of cholera in 1996. Other diseases include rodent-borne arenavirus hemorrhagic fever in Bolivia and Venezuela, and rodent-borne pulmonary syndrome in Brazil and Paraguay. Rabies has been reported from many of the countries in this area.