Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

[Sally Furniss]

Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina
Source: PAHO

Yellow fever is a zoonosis of the tropical regions of South America and Africa, which occurs in two distinct epidemiologic cycles: jungle and urban. In the jungle cycle, the virus spreads among monkeys and humans, who may be infected when they enter the jungle and are bitten by mosquitoes infected with the yellow fever virus. Urban yellow fever has long been eradicated from the Americas, with the last cases occurring in Brazil in 1942.

Since the 1970s, the area where jungle yellow fever (JYF) cases have occurred has been restricted to the northern region of the South American continent. From 1985 to December 2007, 3,837 cases of JYF have been reported, with 2,229 deaths.

In 2007 and the beginning of 2008, Brazil reported an intense and extensive epizootic of Jungle Yellow Fever in an area encompassing 6 states (Goi?s, the Federal District, Mato Grosso do Sul, Minas Gerais, Tocantins, and S?o Paulo). The State Health Departments have confirmed the epizootic based on laboratory and clinical epidemiological criteria. In the past two months, 26 confirmed human cases were reported in 3 Federal States (Goi?s, Mato Grosso do Sul, and the Federal District); 13 of the patients died. The affected areas have high vaccination coverage. Nevertheless, as part of ongoing control measures, health authorities have intensified vaccination for people living in or traveling to affected areas.

On 15 January 2008, the national health authorities of Paraguay reported their first confirmed cases of Jungle Yellow Fever. One of the cases was confirmed using molecular techniques; the other four, by epidemiological nexus. As of 11 February 2008, 4 other suspected cases of JYF have been reported. All the confirmed cases reported by the national health authorities come from a rural area of San Pedro department in the northern part of the country. National health authorities have intensified epidemiological surveillance for the detection and investigation of suspected cases, and yellow fever vaccination for people living in or traveling to the affected area.

On 17 January 2008, the national health authorities of Argentina reported finding dead monkeys in Pi?alito Park, San Pedro department, Misiones province. On 4 February 2008, yellow fever was confirmed in one of the primates using molecular techniques. Although there is high vaccination coverage in the area, national health authorities have intensified vaccination for people living in or traveling to the affected area with no previous vaccination history.

For many years, jungle yellow fever has caused numerous high-mortality epidemics. The clinical manifestations of infection from the yellow fever virus can vary greatly, from asymptomatic or subclinical forms with non-specific symptoms, to hemorrhagic fever, which develops in 15-25% of infected patients and which presents a case fatality of around 50%.

Currently, the recommended strategy for vaccination against yellow fever is to focus on protecting the population living in or traveling to areas with any risk of transmission, where epizootics or human cases were recently reported, thus avoiding massive vaccination and re-vaccination.

The Pan American Health Organization is providing technical support to these countries through advisors in its Country Offices and at Headquarters in Washington, DC, in accordance with requests from the countries.

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).

[Treyfish]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

<table class="formlayout" summary=""><tbody><tr><td align="right" nowrap="nowrap">Subject</td><td align="left" nowrap="nowrap">PRO/AH> Yellow fever, laboratory diagnosis</td></tr></tbody></table>

YELLOW FEVER, LABORATORY DIAGNOSIS**********************************A ProMED-mail post<http://www.promedmail.org>ProMED-mail is a program of theInternational Society for Infectious Diseases<http://www.isid.org>Date: 16 Feb 2008From: Charles Calisher<calisher@cybersafe.net>[This moderator has questioned why media reports of suspected YFcases in South America say lab confirmation tests take weeks toproduce a result. Arbovirus diagnostic expert (and former ProMEDvirus disease moderator) Charlie Calisher provides the followingexplanation. - Mod.JW]Laboratory diagnosis of yellow fever virus infections in humans andother vertebrates-------------------------------------------------------------------The flaviviruses (family _Flaviviridae_, genus _Flavivirus_) havebeen called "a Hall of Mirrors" because many of them are socross-reactive in antigenic/serologic tests that it is difficult orimpossible to determine with which virus one is working and yellowfever virus (YFV) vaccine only complicates the diagnostic picture (1).In the early years of laboratory diagnosis of YFV infection,hemagglutination-inhibition (HI) was used to detect antibody. Thistest is not specific for YFV virus infection; HI detectscross-reacting antibody to other flaviviruses. Nonetheless, becauseYFV is only distantly related to most other flaviviruses, detectionof HI antibody can be used as a primary screening tool.Complement-fixation (CF) tests are less sensitive (lower titers) thanare HI tests but are more specific than HI tests. Positive reactionsby either test require confirmation by still other tests, such asneutralization (N). Whereas the former 2 tests can provide a resultwithin hours, the latter takes as long as a week or more to rule outheterologous reactivity; i.e., infection with a flavivirus other thanYFV, and N antibody to YFV may persist for many decades.Immunofluorescence antibody (IFA) tests also are useful (2) and canbe easily adapted to detect either IgM (early response) or IgG (laterresponse) antibody to the virus. IFA tests can be done with tissuesfrom the human or other vertebrate at autopsy or necropsy or withinvertebrates (suspected vectors), or done with cell cultures inwhich the virus has been amplified. It should be recognized, however,that tests of samples containing live virus and manipulation ofspecimens containing live virus pose hazards to the unimmunizedlaboratory worker.In recent decades, IgM capture enzyme-linked immunosorbent assays(MACELISA) have been used with considerable success. Either serum orcerebrospinal fluids can be tested this assay, as they can by othertests) and the presence of IgM antibody to YFV is at leastprovisional evidence for a recent infection with that virus. Still,confirmations by other tests are required for assurance and pairedacute- and convalescent-phase serum samples are necessary todemonstrate a significant (usually 4-fold or greater) rise or fall inantibody titer.Detection of Councilman bodies by microscopic examination of livertissue from humans has been used by pathologists to diagnoseinfection with YFV. Councilman bodies are acidophilic inclusionbodies in the cytoplasm of hepatocytes but this method is not at allspecific for YF because such cells may be seen in tissues frompatients with a variety of virus infections, autoimmune hepatitis, orhereditary hepatitis.Whereas serologic evidence for YF virus infection, whether byMACELISA, IFA, HI, CF, N or other assays, is often taken asconfirmatory when done properly and with paired samples, detection ofYFV or of YFV RNA provides greater certainty. Thus, use of PCR (4, 5)or antigen detection assays (6) is favored when lives and time are ofthe essence and a guaranteed diagnosis is needed. In addition,obtaining a virus by isolation (cell cultures, suckling mice, otherlaboratory hosts) provides one with a biological entity that can beamplified for later studies.Under emergency epidemic or possible epidemic conditions, the best test is the one that (a) is available, and (b) will provide a resultquickly, specifically, and inexpensively. The practicality of the situation always requires a good clinical appraisal, a rapid test,and leaving the sophisticated details for later. Use of a poor ornon-specific test will be misleading and may cost lives and wastetime and money.Finally, an unconscionable delay (i.e., any unnecessary delay) inmaking a proper diagnosis of YF is unacceptable.References:1. Monath, T.P., R.B. Craven, D.J. Muth, C.J. Trautt, C.H. Calisher,and S.A. Fitzgerald. Limitations of the complement fixation test fordistinguishing naturally acquired from vaccine induced yellow feverinfection in flavivirus hyperendemic areas. Am. J. Trop. Med. Hyg.29:624 634, 1980.2. Monath, T.P., C.B. Cropp, D.J. Muth, and C.H. Calisher. Indirectfluorescent antibody test for diagnosis of yellow fever. Trans. RoyalSoc. Trop. Med. Hyg. 75:282 286, 1981.3. Poland, J.D., C.H. Calisher, T.P. Monath, W.G. Downs, and K.Murphy. Persistence of neutralizing antibody to yellow fever virus 3035 years following immunization with 17D yellow fever vaccine: astudy of World War II veterans in 1975 1976. Bull. W.H.O. 59:895 900, 1981.4. Sanchez-Seco MP, Rosario D, Hernandez L, Domingo C, Valdes K,Guzman MG, Tenorio A. Detection and subtyping of dengue 1-4 andyellow fever viruses by means of a multiplex RT-nested-PCR usingdegenerated primers. Trop. Med. Int. Health 11:1432-1441, 2006.5. Nordstrom H, Falk KI, Lindegren G, Mouzavi-Jazi M, Walden A, ElghF, Nilsson P, Lundkvist A. DNA microarray technique for detection andidentification of 7 flaviviruses pathogenic for man. J. Med. Virol.77:528-540, 2005.6. Monath T.P. and Nystrom R.R. Detection of yellow fever virus inserum by enzyme immunoassay. Am. J. Trop. Med. Hyg. 33:151-157, 1984.--Charles H. Calisher, Ph.D.Professor, Arthropod-borne and Infectious Diseases LaboratoryDepartment of Microbiology, Immunology and Pathology3195 Rampart Rd., Delivery Code 1690, Foothills CampusFort Collins, CO 80523-1690College of Veterinary Medicine and Biomedical SciencesColorado State University<calisher@cybersafe.net>

[sharon sanders]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

Outbreak Notice

Yellow Fever in Paraguay

This information is current as of today, February 21, 2008 at 22:07
Updated: February 21, 2008

Situation Information

The Paraguay Ministry of Health (MOH) has reported to the World Health Organization (WHO) the first cases of yellow fever disease identified in Paraguay in more than 30 years. As of February 20, 2008, seven confirmed cases of yellow fever in humans have been reported from the Department of San Pedro, in the east central region of Paraguay (1, 2). Of these seven cases, four have been confirmed by laboratory testing in Paraguay. The Paraguay MOH has also reported four suspected cases of yellow fever in San Lorenzo, an area near the capital city, Asuncion (1, 3, 4). In addition, a team of scientists from the Pan American Health Organization (PAHO) has been sent to Paraguay to help investigate this outbreak and provide laboratory support. The Paraguay MOH has strengthened public health containment measures, with implementation of yellow fever vaccination for people living in or traveling to the affected areas. The information and recommendations in this notice are considered interim and will be updated as further information becomes available.

Although some rural, forested areas of Paraguay are known risk areas for yellow fever, the above reports suggest the presence of yellow fever in other areas of Paraguay, including possible transmission in urbanized areas. Investigations are taking place to determine if urban transmission is truly occurring. The cases in San Pedro are most likely jungle yellow fever, which occurs when mosquitoes transmit the virus from monkeys to humans. However, when the virus is introduced into urban areas it can be transmitted by mosquitoes from one human to another. This form of transmission is known as urban yellow fever and can spread rapidly through susceptible populations where mosquito vectors are abundant.

Paraguay currently requires yellow fever vaccination for persons entering Paraguay from countries listed as endemic for yellow fever (see Paraguay country-specific requirements). Until further notice, CDC is temporarily expanding its yellow fever vaccination recommendation for Paraguay (below) to protect travelers’ health.
Recommendations for Travelers

On the basis of these case reports and the vaccination campaign taking place among the local population, travelers are strongly advised to follow the expanded CDC yellow fever vaccination recommendations for Paraguay:

• Until further notice, yellow fever vaccination is now recommended for all travelers older than 9 months who are going to all areas of Paraguay.
• The complications from yellow fever vaccine are greater for certain groups of people, such as those younger than 9 months or older than 60 years, pregnant women, and those whose immune systems are compromised. For more information about these and other yellow fever vaccine precautions and contraindications, please see the Prevention information in the Yellow Fever section of CDC Health Information for International Travel 2008. These travelers (or their parents) should discuss the risks and benefits of vaccination for travel to Paraguay with their physicians.

Since yellow fever is spread by the bite of an infected mosquito, travelers are also reminded to:

• Use insect repellent on exposed skin surfaces when outdoors, particularly during the day.
  • Repellents containing 30&#37; to 50% DEET (N,N-diethyl-m-toluamide) are recommended for adults. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication.
  • Repellents containing picaridin are available in the United States in formulations of up to 15% concentration, which require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the United States.
  • For additional information regarding the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
• Wear long-sleeved shirts and long pants when outdoors. Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don't use permethrin on skin.)

Additional Information

For more information about the emerging yellow fever situation in South America, see the following resources:

1. Notice from the World Health Organization dated February 20, 2008: Yellow fever in Paraguay.
2. Announcement from the Pan American Health Organization (PAHO) dated February 11, 2008: Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina.
3. Press Release from PAHO dated February 15, 2008: Yellow fever in Paraguay.
4. Notice from Paraguay Ministry of Health dated February 18, 2008: see http://www.mspbs.gov.py/ver_noticia.php?id=128.

For more information about yellow fever risk and yellow fever vaccine, see the following sections of CDC Health Information for International Travel 2008:

• Yellow fever (including precautions and contraindications to vaccine)
• Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country

[KBD]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

Por Jason Gale
21 de fevereiro (Bloomberg) -- O surto de febre amarela que
matou mais de uma dezena de pessoas em regi?es de floresta da
Am?rica Latina nos ?ltimos dois meses pode ter se espalhado para
a periferia de Assun??o, capital do Paraguai, disse a
Organiza??o Mundial da Sa?de (OMS).
Os m?dicos est?o realizando exames em quatro pessoas com
suspeita de ter a doen?a, que ? transmitida por um mosquito.
Essas pessoas vivem no munic?pio de San Lorenzo, a 20
quil?metros de Assun??o, disse a OMS em comunicado divulgado
ontem em seu site. Os 33 casos previamente confirmados no
Paraguai e no Brasil eram da chamada febre amarela selv?tica,
cujo v?rus se dissemina entre macacos e seres humanos.
Se ficar comprovado que os casos suspeitos de San Lorenzo
s?o febre amarela urbana, esse ser? o primeiro surto da doen?a
no continente em mais de meio s?culo. Os ?ltimos casos
informados da doen?a ocorreram no Brasil, em 1942, segundo o
escrit?rio regional da OMS em Washington, nos Estados Unidos.
N?o h? um tratamento espec?fico para a febre amarela, que ?
transmitida pela picada dos mosquitos infectados de regi?es
tropicais da ?frica e das Am?ricas.
Entre os sintomas iniciais est?o a febre, que desaparece em
alguns dias. Em alguns casos, ela causa complica??es como
inflama??o do f?gado e hemorragia, disseram em seu site os
Centros para o Controle e a Preven??o de Doen?as (CDCs) de
Atlanta. Cerca de metade dos pacientes que entram nessa fase
t?xica morrem no per?odo de 10 a 14 dias, segundo a OMS.
O presidente do Paraguai, Nicador Duarte, declarou estado
de emerg?ncia na tentativa de controlar a doen?a, informou a
British Broadcasting Corp. (BBC) no ?ltimo dia 16 de fevereiro,
um m?s ap?s o primeiro caso da febre em uma pessoa ter sido
confirmado.

T?tulo em ingl?s:
'Yellow Fever May Have Spread to Paraguay's Capital, WHO Says'

[KBD]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

Yellow Fever May Have Spread to Paraguay's Capital, WHO Says

By Jason Gale
Feb. 21 (Bloomberg) -- A yellow fever outbreak that has
killed more than a dozen people in jungle areas of Latin America in
the past two months may have spread to the outskirts of Paraguay's
capital, Asuncion, the World Health Organization said.
Doctors are testing four people suspected of having the
mosquito-borne disease from the San Lorenzo municipality, 20
kilometers (12 miles) from Asuncion, the WHO said in a statement
on its Web site yesterday. The 33 cases previously confirmed in
Paraguay and Brazil had so-called jungle yellow fever, in which
the virus spreads among monkeys and humans.
If the San Lorenzo cases are confirmed as urban yellow
fever, it would be the first such outbreak on the continent in
more than half a century. The last reported cases occurred in
Brazil in 1942, according to the WHO's regional office in
Washington, D.C.
There is no specific treatment for yellow fever, which is
transmitted by the bite of an infected mosquito in tropical
regions of Africa and the Americas.
Initial symptoms include fever that disappears after a few
days. In some cases, it causes complications including liver
inflammation and hemorrhaging, the Centers for Disease Control
and Prevention in Atlanta said on its Web site. About half of
the patients who enter this toxic phase die within 10 to 14
days, according to the WHO.
Paraguay's President Nicador Duarte declared a state of
emergency in an effort to control the disease, the British
Broadcasting Corp. reported on Feb. 16, a month after the
country's first human case was confirmed.

Mass Vaccination

The nation, which borders Brazil, Argentina and Bolivia,
requested 2 million doses of yellow fever vaccine from the WHO
to prevent further spread, the Geneva-based United Nations
agency said. Seven confirmed jungle yellow fever cases occurred
in San Pedro Department, it said.
Paraguay's Health Ministry is implementing mass
vaccinations for people at the highest risk of infection, insect
control measures and heightened surveillance to ``prevent
serious public health consequences given the current low level
of immunization among the people living in the affected area,''
the WHO said.
In 2007 and the beginning of 2008, Brazil reported an
``intense and extensive'' outbreak in animals in an area
encompassing six states, the Pan American Health Organization
said in a statement last week. In the past two months, 26 human
cases were reported in Goias and Mato Grosso do Sul states, and
the Federal District. Of those, 13 were fatal, it said.
Earlier this month, Argentina confirmed the infection in
one of 17 dead monkeys in Pinalito Park, in Misiones Province.
Urban yellow fever is spread by Aedes aegypti, which
prefers to live close to humans rather than in jungles, where
other Aedes species are the main carriers.
The last epidemic of yellow fever in North America occurred
in New Orleans in 1905, according to the CDC.

[Sally Furniss]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

Yellow fever deaths rise to 19 in Brazil

The Brazilian authorities confirmed two more deaths caused by yellow fever on Thursday, which brought to 19 the number of mortal cases of the tropical disease, local press reported Friday.

The two new victims, a 65-year-old woman and a 44-year-old man, were registered respectively in the states of Goias and Mato Grosso du Sul. Both were infected by the virus in January.

According to the Folha de Sao Paulo newspaper, it's the first fatal case caused by yellow fever in the state of Mato Grosso do Sul.

By far Brazil has reported 35 confirmed cases of yellow fever, of which 21 were in the state of Goais, and among the 19 yellow fever deaths in Brazil, 13 were in the state.

At present, all cases reported in Brazil are so-called wild yellow fever, which does not spread from person to person.

According to the Health Ministry, since last December, about 13million doses of yellow fever vaccines have been distributed in the country.

Yellow fever is a viral disease that is transmitted to humans through the bite of infected mosquitoes. It has caused extensive epidemics in Africa and America.

http://english.people.com.cn/90001/90782/90880/6364088.html

[Sally Furniss]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

1st case of yellow fever reported in Argentina

BUENOS AIRES, Argentina: A farmworker has become the first person diagnosed in Argentina with yellow fever since a recent outbreak of the mosquito-borne disease claimed eight lives in neighboring Paraguay, authorities said Monday.
The 24-year-old worker contracted the disease in the northeastern province of Misiones that borders Paraguay, said a public health official, Jose Guccione.
He added the man was "out of danger" after a weeklong hospitalization and expected to fully recover.
Eight people died in an outbreak of yellow fever last month in Paraguay, the first confirmed cases there since 1974.
Guccione said a vaccination campaign was under way in Argentine provinces bordering Paraguay.
<!-- sidebar --><!-- /170 x 60 ad -->
<!-- /sidebar --> An estimated 30,000 people worldwide die annually from the disease, according to the World Health Organization. Symptoms can include fevers, vomiting, jaundice and bleeding from the mouth, nose, eyes and stomach.

http://www.iht.com/articles/ap/2008/03/03/america/LA-GEN-Argentina-Yellow-Fever.php

[Sally Furniss]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

PAHO Weekly Report 08-14 Mar 2008


PARAGUAY - YELLOW FEVER OUTBREAK UPDATE

The Ministry of Health confirmed 24 cases, including 8 deaths since the onset of the Yellow Fever outbreak in January. 33% (8) of the confirmed cases are female and 67% (16) of the confirmed cases are male. The last suspected case was notified on 6 March. As of 13 March, around 1.5 million people have been vaccinated in Paraguay. In order to assist with vector control, an entomologist from the Caribbean Epidemiology Center arrived 11 March, and another from Brazil will arrive on 16 March. The Ministry of Health and a communication team are providing educational information for the community in order to achieve greatest participation in vector control. PAHO and Ministry of Health personnel were transferred on 8 March to South San Pedro in order to adjust and implement vector control measures and vaccination in the interior Departments of the country. ... : The Spanish Agency for International Cooperation (AECI), OFDA/USAID and the government of Italy are supporting this emergency through PAHO/WHO in areas related to vaccination, vector control, and surveillance activities, among others.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/EDIS-7CQTWA?OpenDocument

[Sally Furniss]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

DREF update

Period covered by this update: 12 February to 19 March, 2008.

Situation
In January of 2008, there was a dengue and yellow fever outbreak reported in Paraguay; exactly one year ago, a similar outbreak left 17 people dead. At this time 550 cases of dengue have been detected, along with 57 suspected cases of yellow fever, according to the General Direction of Vigilance of Health (Direcci?n General de Vigilancia de la Salud - DGVS) of the Ministry of Public Health and Social Welfare (Ministerio de Salud P?blico y Bienestar Social - MSPBS), including four new cases in the department of ?eembucu.
Up until 13 March, the DGVS examined a total of 57 patients with signs of yellow fever. 22 cases of yellow fever were confirmed (11 in the department of San Pedro, ten in the Central department and one in the department of Caaguazu). 23 cases were discarded and the remaining 12 suspected cases are currently under investigation. To date, eight people have died as a result of yellow fever.
On 6 March, the department of ?eembucu informed the Centre of Inter-institutional Operations (Centro de Operaciones Interinstitucionales - COI), that there were various febrile cases under study with four suspected cases confirmed to date. It was then decided to form a team in order to vaccinate, promote hygiene and sanitation and to destroy the breeding grounds of the mosquitoes Aedes aegypty and haemagogus. House visits are still ongoing, as well as community awareness activities for the prevention of the disease.
The Minister of Health has changed certain yellow fever vaccination campaign strategies, indicating that they will only be administered to adults and children from 1 to 60 years of age and that the vaccinations in high, medium and low risk areas will be done according to the guidelines established by the COI. The Extended Immunization Program (Programa Ampliado de Inmunizaciones - PAI) has delivered 2,399,000 yellow fever vaccines in different regions of the country and has stored an additional 1,045,000. At this time PAI reports to have vaccinated 1,750,000 people since the onset of the outbreak.
According to immunologic studies the yellow fever vaccine (LD17YF) is safe, but two percent of every two million people vaccinated develop the serious side effect described as Acute Viscerotropic Disease. The Ministry of Public Health and Social Welfare informed there were 192 cases of adverse reactions to the vaccine of which 157 are minor cases, 19 are being studied, seven have been discarded, five are moderate and four are serious.
The dengue epidemic maintains a steady rate of decline since no new cases have arisen in the last few weeks. The general director of the Ministry of Public Health and Social Welfare for the dengue and yellow fever campaign stated that the campaign will continue especially to raise awareness to the communities. There have been 5,636 cases of suspected Dengue reported. However, since people often self-medicate and do not seek medical attention, it is estimated that there are approximately 150,000 unreported cases of Dengue. This confirms the need to continue to increase awareness among the population.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/EDIS-7D3PKN?OpenDocument

[Sally Furniss]

Re: Update on Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina

Brazil reports 21 deaths from yellow fever this year

BRASILIA, April 5 (Xinhua) -- Twenty-one people have died of yellow fever in Brazil so far this year, the country's Health Ministry has confirmed, local media reports said Saturday.

The reports, quoting statistics released by the Health Ministry, said 40 of the 70 suspected yellow fever cases reported in Brazil this year had been confirmed.

The central state of Goias has been hardest hit by the epidemic, where 21 people were confirmed as having contracted yellow fever, of whom 13 died.

The people dying from the disease have either never been vaccinated or the vaccines they received have been inactive, the ministry said.

An estimated 30,000 people worldwide die annually from the mosquito-borne disease, according to WHO. Symptoms can include fever, vomiting, jaundice and bleeding from the mouth, nose, eyes and stomach.

http://news.xinhuanet.com/english/2008-04/06/content_7927935.htm

[Snowy Owl]

Yellow Fever in Argentina - Updated

Yellow Fever in Argentina - Updated

This information is current as of today, April 18, 2008 at 07:03

Updated: April 17, 2008

http://wwwn.cdc.gov/travel/contentYellowFeverArgentina.aspx

Situation Information

New! Updated yellow fever risk
map for Argentina
On March 3, 2008, the Argentina Ministry of Health (MOH) reported their first official human case of yellow fever for 2008 in Misiones Province. As of March 26, the Argentina MOH has reported 5 confirmed cases of yellow fever, including one death (all in Misiones Province). Prior to the onset of human cases, yellow fever disease was confirmed as the cause of death for at least one monkey found in Pi?alito Park, San Pedro Department, Misiones Province, in the northeastern corner of Argentina, bordered by Brazil and Paraguay. In response, Argentina MOH officials are increasing yellow fever vaccination in humans living in the surrounding areas and are recommending yellow fever vaccination for specific risk areas. Based on these recommendations, CDC is expanding the areas in Argentina for which yellow fever vaccine is recommended (see below).

Since late 2007, emerging yellow fever disease has been reported in monkeys and humans from many South American countries. For reports of geographic expansion of yellow fever in other South American countries, please see CDC?s outbreak notices about yellow fever in Brazil and Paraguay.

Recommendations for Travelers
Travelers are strongly advised to follow the existing CDC yellow fever vaccination recommendations for Argentina:

Yellow fever vaccination is recommended for all travelers older than 9 months who are going to the northern and northeastern forested areas of Argentina, including Igua?u Falls and all areas bordering Paraguay and Brazil. These areas include:

All departments of Misiones and Formosa Provinces
Department of Bermejo in Chaco Province
Departments of Ber?n de Astrada, Capital, General Alvear, General Paz, Ituzaing?, Itat?, Paso de los Libres, San Cosme, San Miguel, San Mart?n and Santo Tom? in Corrientes Province
Departments of Valle Grande, Ledesma, Santa B?rbara and San Pedro in Jujuy Province
Departments of General Jos? de San Mart?n, Oran, Rivadavia and Anta in Salta Province

See the Updated CDC Yellow Fever Risk Map for Argentina.

The complications from yellow fever vaccine are greater for certain groups of people, such as those younger than 9 months or older than 60 years, pregnant women, and those whose immune systems are compromised. For more information about these and other yellow fever vaccine precautions and contraindications, please see the prevention information in the Yellow Fever section of CDC Health Information for International Travel 2008. These travelers (or their parents) should discuss the risks and benefits of vaccination for travel to this area of Argentina with their physicians.
Since yellow fever is spread by the bite of an infected mosquito, travelers are also reminded to:

Use insect repellent on exposed skin surfaces when outdoors, particularly during the day.

Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended for adults. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication.
Repellents containing picaridin are available in the United States in formulations of up to 15% concentration, which require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the United States.
For additional information regarding the use of repellent on infants and children, please see the ?Insect and Other Arthropod Protection? in Traveling Safely with Infants and Children and the ?Children? section of CDC?s Frequently Asked Questions about Repellent Use.

Wear long-sleeved shirts and long pants when outdoors. Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don't use permethrin on skin.)
Additional Information

For more information about the emerging yellow fever situation in South America, see the following announcements:

Notice from the Argentina Ministry of Health dated March 17, 2008: http://www.msal.gov.ar/htm/Site/noti...la.asp?Id=1206
Update from the Pan American Health Organization (PAHO) dated March 31, 2008: Jungle Yellow Fever (JYF) in Brazil, Paraguay, and Argentina
For more information about yellow fever risk and yellow fever vaccine, see the following sections of CDC Health Information for International Travel 2008:

Yellow fever (including precautions and contraindications to vaccine)
Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country


Content Source:
Division of Global Migration and Quarantine
National Center for Preparedness, Detection, and Control of Infectious Diseases