Thursday, March 23, 2017

Brazil: Yellow Fever Updates From The MOH, The CDC, and University of Wisconsin


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As we've discussed so often in the past (see The International Exchange Rate Of Infectious Diseases) - in this highly mobile and interconnected 21st century - we are no longer protected by vast oceans or prolonged travel times against the importation of exotic and potentially deadly infectious diseases.

An infected, but still asymptomatic traveler can board a plane in Beijing, Rio,  Cairo, or Los Angeles and be in any international city in less than 24 hours.

It's a harsh lesson that South Korea learned when a single imported  MERS carrier sparked a brief but intense mini-epidemic (186 patients across 16 hospitals) in the summer of 2015.


This is also assumed to be the mechanism that delivered West Nile to New York City in 1999, Dengue to South Florida in 2009, Chikungunya to the Caribbean in 2013, and most recently Zika to South, Central and North America.

In the past few years we've seen (in North America alone) imported cases of MERS, H5N1, H7N9, Ebola, and Lassa Fever - to name just a few of the more exotic viruses.  Other, more mundane viruses (Dengue, Zika, Measles, mumps, etc.) arrive daily.

All of which means that Brazil's growing Yellow Fever Epidemic, which we've been following since early January (see latest WHO: Yellow Fever Update - Brazil), is more than just of humanitarian and academic interest.

Just last week the ECDC released a Rapid Risk Assessment On Introduction Of Yellow Fever To Europe.

Today, three updates.  First, excerpts from the latest Brazilian MOH Surveillance report, followed by an updated Travel Advisory from the CDC, and then some excerpts from a fascinating report from the University of Wisconsin on the toll Yellow Fever is taking on Brazil's howler monkey population.

Registration Date: 03/20/2017 

SURVEILLANCE


Ministry of Health updates reported cases of yellow fever in the country

The cases mainly involve the Southeast and are residents in rural areas or who had contact with wild areas for work or leisure

The Ministry of Health updated the information passed by state health departments on the situation of yellow fever in the country. Until this Friday (17), were confirmed 448 cases of the disease. In all, 1,561 suspected cases were reported, of which 850 remain under investigation and 263 were discarded. Of the 264 reported deaths, 144 were confirmed, 110 are still investigated and 10 were discarded.


Routine vaccination for yellow fever is offered in 19 states (Acre, Amazonas, Amapá, Pará, Rondônia, Roraima, Tocantins, Distrito Federal, Goiás, Mato Grosso do Sul, Mato Grosso, Bahia, Maranhão, Piauí, Minas Gerais, São Paulo, Parana, Rio Grande do Sul and Santa Catarina) with recommendation for immunization. Note that in Bahia, Piauí, São Paulo, Paraná, Rio Grande do Sul and Santa Catarina, vaccination does not occur in all municipalities. In addition to the areas with a recommendation at this time is also being vaccinated in stages the population of Rio de Janeiro and Espirito Santo. All people living in these places should take two doses of the vaccine over a lifetime.
         (Continue . . . )


The CDC has updated their Feb 1st travel advisory (see CDC Level II Travel Notice: Yellow Fever in Brazil), with additional vaccination recommendations:


Yellow Fever in Brazil

Alert - Level 2, Practice Enhanced Precautions

What is the current situation?

The Brazilian Ministry of Health has reported an ongoing outbreak of yellow fever starting in December 2016. The first cases were reported in the State of Minas Gerais, but confirmed cases have since been reported in the neighboring states of Espirito Santo, São Paulo, and Rio de Janeiro (not Rio de Janeiro City). Cases have occurred mainly in rural areas, with most cases being reported from Minas Gerais state. Some cases have resulted in death. Health authorities in the affected states, with assistance from the Brazilian Ministry of Health, are conducting mass vaccination campaigns among unvaccinated residents of affected areas.

In response to this outbreak, health authorities have recently expanded the list of areas in which yellow fever vaccination is recommended for travelers. The expanded list of areas in which yellow fever vaccination is now recommended includes: the entire State of Espirito Santo; the State of Rio de Janeiro, with the exception of the urban areas of Rio de Janeiro City and Niterói; the State of São Paulo, with the exception of the urban areas of São Paulo City and Campinas.

Also included are the following municipalities in the southern and southeastern parts of the State of Bahia:

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.

The Brazilian Ministry of Health maintains a list of all other municipalities in Brazil for which yellow fever vaccination continues to be recommended (not including recently added municipalities). It is located at http://portalsaude.saude.gov.br/images/pdf/2015/novembro/19/Lista-de-Municipios-ACRV-Febre-Amarela-Set-2015.pdf.

Note: because yellow fever vaccination was previously recommended and continues to be recommended in western parts of the states of São Paulo and Bahia, some municipalities in each of these states are included on this older list.

Anyone 9 months or older who travels to these areas should be vaccinated against yellow fever. People who have never been vaccinated against yellow fever should not travel to areas with ongoing outbreaks. CDC no longer recommends booster doses of yellow fever vaccine for most travelers. However, a booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 years ago and who will be in a higher-risk setting, including areas with ongoing outbreaks. Because of the ongoing outbreak, travelers to the Brazilian states of Minas Gerais, Espirito Santo, Sao Paulo, Rio de Janeiro, and parts of Bahia may consider getting a booster if their last yellow fever vaccination was more than 10 years ago. Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. For more information on booster shots, see “Clinician Information,” below.

Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever vaccine provider well in advance of trave
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And our last stop is an article published by the University of Wisconsin-Madison News. Follow the link to read it in its entirety.

Yellow fever killing thousands of monkeys in Brazil
March 21, 2017 By Kelly April Tyrrell
In a vulnerable forest in southeastern Brazil, where the air was once thick with the guttural chatter of brown howler monkeys, there now exists silence.

Yellow fever, a virus carried by mosquitoes and endemic to Africa and South America, has robbed the private, federally-protected reserve of its brown howlers in an unprecedented wave of death that has swept through the region since late 2016, killing thousands of monkeys.

(Continue . . . )

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