Wednesday, February 15, 2017

WHO: Updated Yellow Fever Vaccination Recommendations For Brazil


Just over a month. in WHO Risk Assessment: Yellow Fever In Brazil, we looked at early reports of an outbreak of Yellow Fever in Minas Gerais - Brazil's second most populous state - which had climbed from 12 suspected cases reported right after New Year's to 110 suspected cases, including 30 deaths, across 15 municipalities as of the 12th of January.
That outbreak has continued to expand (see WHO Jan 27th Update) into the States of Espírito Santo and São Paulo.  Minas Gerais State, as of 24 January, had recorded a total of 404 cases and 87 deaths (suspected and confirmed), and the State of Bahia was investigating a handful of suspected cases.
Two weeks ago our CDC posted a Level II Travel Notice: Yellow Fever in Brazil,  and warned that because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever vaccine provider well in advance of travel.

While Yellow Fever has been successfully eradicated from North America and Europe for decades, the mosquito vectors that transmit the virus are still present in some regions.
And just as with Dengue, Chikungunya, Malaria, and most recently Zika, the potential for limited re-introduction of Yellow Fever is not zero (see  Could Yellow Fever Return to the United States?  by Peter Hotez and Kristy Murray).
With hundreds of thousands of revelers expected to take part in next week's Carnival - and nearby regions of Brazil reporting Yellow Fever - the World Health Organization has issued updated vaccination recommendations for people planning to visit Brazil.

Yellow fever vaccination recommendations for International Travellers related to current situation in Brazil

14 February 2017

This is an update to the WHO advice posted on 31 January 2017.

As of 13 February 2017, yellow fever virus transmission continues to expand towards the Atlantic coast of Brazil in areas not deemed to be at risk for yellow fever transmission prior to the revised risk assessment published by WHO in the Disease Outbreak News of 27 January 2017, and supported by the scientific and technical advisory group on geographical yellow fever risk mapping (GRYF). 

The revised risk assessment was based on epidemiological evidence and ecological factors. The expanded areas at risk of yellow fever transmission remain the same as in the Disease Outbreak News of 27 January 2017 and the WHO travel advice of 31 January 2017, and include:

Bahia State: extension of the areas at risk for yellow fever transmission with the inclusion of the following municipalities in the south and south-west of the state: Alcobasa; Belmonte; Canavieiras; Caravelas; Ilheus; Itacare; Mucuri; Nova Visosa; Porto Seguro; Prado; Santa Cruz Cabralia; Una; Urusuca; Almadina; Anage; Arataca; Barra do Chosa; Barro Preto; Belo Campo; Buerarema; Caatiba; Camacan; Candido Sales; Coaraci; CondeUba; Cordeiros; Encruzilhada; Eunapolis; Firmino Alves; Floresta Azul; Guaratinga; Ibicarai; Ibicui; Ibirapua; Itabela; Itabuna; Itagimirim; Itaju do Colonia; Itajuipe; Itamaraju; Itambe; Itanhem; Itape; Itapebi; Itapetinga; Itapitanga; Itarantim; Itororo; Jucurusu; Jussari; Lajedao; Macarani; Maiquinique; Mascote; Medeiros Neto; Nova Canaa; Pau Brasil; Piripa; Planalto; Posoes; Potiragua; Ribeirao do Largo; Santa Cruz da Vitoria; Santa Luzia; São Jose da Vitoria; Teixeira de Freitas; Tremedal; Vereda; Vitoria da Conquista. 

• Espírito Santo State: at risk for yellow fever transmission with the exception of the urban area of Vitoria.

• Rio de Janeiro State: at risk for yellow fever transmission in the following northern municipalities bordering Minas Gerais and Espírito Santo States: Bom Jesus do Itabapoana; Cambuci; Cardoso Moreira; Italva; Itaperuna; Laje do Muriae; Miracema; Natividade; Porciuncula; Santo Antonio de Padua; São Fidelis; São Jose de Uba; Varre-Sai; Campos dos Goytacazes; São Francisco de Itabapoa; São João da Barra.

Currently there is no evidence of yellow fever virus transmission in the large metropolitan areas of the East Coast such as Rio de Janeiro, San Salvador, and Sao Paulo.

The determination of new areas considered to be at risk for yellow fever transmission is preliminary and updates will be provided regularly. 

In view of the evolving situation, and considering that travellers for the Carnival in the next few weeks may take side tours outside the main cities, the current advice by the WHO Secretariat for international travellers going to areas of Brazil deemed to be at risk, including the above mentioned ones, is the following:
  • Vaccination against yellow fever at least 10 days prior to the travel. Note that, as per Annex 7 of the International Health Regulations(2005), a single dose of a yellow fever vaccine approved by WHO is sufficient to confer sustained immunity and life-long protection against yellow fever disease. Travellers with contraindications for yellow fever vaccine (children below 9 months, pregnant or breastfeeding women, people with severe hypersensitivity to egg antigens, and severe immunodeficiency) or over 60 years of age should consult their health professional for advice;
  • adoption of measures to avoid mosquito bites;
  • awareness of symptoms and signs of yellow fever;
  • seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission.
For 2017 updates on yellow fever vaccination requirements and WHO vaccination recommendations for travellers see Annex 1 and country list on the WHO International Travel and Health website.

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