DE FAAKTO OUTBREAK INTELLIGENCE
14 MARCH 2019
SITUATION-UPDATE-YELLOW FEVER BRAZIL & THE AMERICAS
PAN AMERICAN HEALTH ORGANIZATION IS REPORTING,
BRAZIL
- Brazil is once again reporting a substantial outbreak of yellow fever
- This is important news since more than 2.8 million Americans [USA] visit Brazil each year
- Current seasonal period (2018-2019)
- 50 confirmed human cases of yellow fever
- 12 deaths due to yellow fever
- 07 March 2019, the number of human cases reported during the current season is substantially lower than observed during the previous season
- During the 2017-2018 yellow fever season, Brazil reported 1376 human cases, including 483 deaths
- In response to Brazil’s yellow fever outbreak, the Centers for Disease Control and Prevention (CDC) issued a Level 2 Travel Alert during May 2018 recommending visitors to Brazil protect themselves by getting the vaccination at least 10 days before departure to Brazil [Alert Level 2, Practice Enhanced Precautions].
Vaccination
- Vaccination is the most important means of preventing yellow fever
- The yellow fever vaccine is safe, affordable and a single dose provides life-long protection against yellow fever disease
- A booster dose of yellow fever vaccine is not needed
- 17D yellow fever vaccine
- YF-Vax (Sanofi Pasteur)
WHO Risk Assessment
- Yellow Fever is transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact
- There is currently a moderate risk at regional level due to the possible movement of the individuals of affected states to adjacent areas and neighboring countries and particularly if there is arrival of unvaccinated visitors over the festive end of year season. The current overall risk is low at the global level
- There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care to treat dehydration, respiratory failure and fever and antibiotic treatment for associated bacterial infections is recommended
About Yellow Fever
- Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The “yellow” in the name refers to the jaundice that affects some patients
Symptoms of Yellow Fever
- fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue
- A small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days
Where does Yellow Fever Occur?
- The virus is endemic in tropical areas of Africa and Central and South America
How is Yellow Fever Controlled?
- Vaccinations
- Vector control
- Epidemic Preparations
How Yellow Fever Symptoms Progress
- Once contracted, the yellow fever virus incubates in the body for 3 to 6 days. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days
- A small percentage of patients, however, enter a second, more toxic phase within 24 hours of recovering from initial symptoms. High fever returns and several body systems are affected, usually the liver and the kidneys. In this phase people are likely to develop jaundice (yellowing of the skin and eyes, hence the name ‘yellow fever’), dark urine and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Half of the patients who enter the toxic phase die within 7 – 10 days
Treatment
- Good and early supportive treatment in hospitals improves survival rates. There is currently no specific anti-viral drug for yellow fever but specific care to treat dehydration, liver and kidney failure, and fever improves outcomes. Associated bacterial infections can be treated with antibiotics
2018 Outbreaks
- Nigeria
- Netherlands
- Republic of Congo
- French Guiana
- Brazil
- Global immunization experts have warned against stagnation of Yellow Fever vaccinations in Africa
- Immunization programs have been rolled out in Senegal, Ethiopia, Nigeria, Ghana
PAHO-Epidemiological Update-Yellow Fever 06 March 2019 https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=yellow-fever-2194&alias=47954-6-march-2019-yellow-fever-epidemiological-update&Itemid=270&lang=en
WHO Website Resources
https://www.who.int/en/news-room/fact-sheets/detail/yellow-fever
https://www.who.int/csr/don/archive/disease/yellow_fever/en/
http://CDC https://wwwnc.cdc.gov/travel/notices/watch/yellow-fever-nigeria
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De Faakto Outbreak Intelligence
15 November 2018
Ministry of Health Brazil, U.S. Center for Disease Control & Outbreak News Today are recommending vaccination for anyone travelling to or living in areas of Brazil at risk for Yellow Fever
The period of greatest transmission of yellow fever is from December to March. Metropolitan regions of Rio de Janeiro, Minas Gerias and São Paulo are among the areas at risk of infection, Brazil health officials warned today.
- People who have never been vaccinated against yellow fever should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.
- There is a large, ongoing outbreak of yellow fever in multiple states of Brazil.
- Since early 2018, a number of unvaccinated travelers to Brazil contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State)
- Several have died.
- Travelers to Brazil should protect themselves from yellow fever by getting yellow fever vaccine at least 10 days before travel, and preventing mosquito bites.
- In addition to areas in Brazil where yellow fever vaccination has been recommended since before the recent outbreaks, the vaccine is now also recommended for people who are traveling to or living in: All of Espirito Santo State, São Paulo State, Rio de Janeiro State, Paraná State, Santa Catarina State, and Rio Grande do Sul State, as well as a number of cities in Bahia State.
CDC,
https://wwwnc.cdc.gov/travel/notices/alert/yellow-fever-brazil
Outbreak News Today,
