Global & Disaster Medicine

Archive for the ‘Yellow Fever’ Category

A fractional dose (1/5) of the 17DD yellow fever vaccine: Effective?

 

NEJM

“….In 2016, the response to a yellow fever outbreak in Angola and the Democratic Republic of Congo led to a global shortage of yellow fever vaccine. As a result, a fractional dose of the 17DD yellow fever vaccine (containing one fifth [0.1 ml] of the standard dose) was offered to 7.6 million children 2 years of age or older and nonpregnant adults in a preemptive campaign in Kinshasa. …………

A fractional dose of the 17DD yellow fever vaccine was effective at inducing seroconversion in most of the participants ….”

 


Brazil: 407 yellow fever cases have been reported in that country since July of 2017, including 118 deaths.

Tucson.com

“…..Brazil’s Health Ministry says a massive yellow fever vaccination campaign has reached less than 20 percent of the targeted population since it began three weeks ago.

Authorities have confirmed 407 cases in the current outbreak, including in areas not previously considered at risk. Of those, 118 have died…..”


Brazil: The weekly yellow fever update shows another steep rise in the number of confirmed cases, which are now at 353, an increase of 140 cases from the previous week.

CIDRAP

Brazil at Night


From 1 Jul 2017-30 Jan 2018, 213 yellow fever cases were confirmed in Brazil, including 81 deaths.

Brazil Ministry of Health

Brazil at Night

Brazil at Night

 

 


From 1 July 2017 through 14 January 2018, 35 confirmed human cases of Yellow Fever were reported in Brazil (Figure 1), including 20 deaths and 145 suspected cases who are under investigation.

WHO

World map showing yellow fever vaccination requirements by country, May 2016.

 

 


Yellow Fever: Since September 2017, 34 laboratory-confirmed cases, including 20 deaths were reported by the Brazilian authorities. Watch out during Carnival which will take place from 9 to 14 February 2018

ECDC

Yellow fever cases in Brazil, 16 January 2018


Between July of 2017 and the end of the year, there were 11 confirmed cases of yellow fever reported in Brazil, and since 2016, there have been 777 confirmed cases, 261 deaths.

CIDRAP

“…..Between January 2016 and December 2017, seven countries and territories of the Region of the Americas reported confirmed cases of yellow fever: the Plurinational State of Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Suriname….”

Map: South America showing areas at risk for Yellow Fever Transmision in Columbia, Venezuela, Guyana, Suriname, French Guiana, Brazil, Paraguay, and parts of Ecuador, Peru, Bolivia, Argentina, and Uruguay

Yellow fever virus has three transmission cycles: jungle (sylvatic), intermediate (savannah), and urban.

 

 


The two confirmed cases of Yellow Fever in Brazil (1 fatal)

WHO

Yellow fever – Brazil

Disease outbreak news
24 November 2017

Between July and mid-October 2017, a total of 71 suspected yellow fever cases were reported in São Paulo State, Brazil. Of these, two were confirmed, six are under investigation, and 63 were ruled out. The two confirmed cases (one of which was fatal) were reported from Itatiba from 17 September through 7 October 2017.

From July to early November, 580 epizootics in non-human primates (NHPs) were reported in São Paulo State, with an increase in the number of cases reported from 10 September 2017. Of these, 120 were confirmed for yellow fever, 233 are under investigation, 74 were classified as undetermined, and 153 were ruled out. The highest number of epizootics was registered in the health surveillance area of Campinas, where epizootic episodes were reported for the first time in the municipalities of Campo Limpo Paulista (in the week ending 23 September 2017), Atibaia (in the week ending 30 September 2017), and Jarinu (in the week ending 14 October 2017). Epizootics in NHPs were also recently reported in large parks located within the urban area of São Paulo City (in the week ending 14 October 2017).

Public health response

The detection of two confirmed yellow fever human cases and epizootics in the state of São Paulo, as well as confirmed yellow fever epizootics in the urban area of São Paulo City, prompted national authorities to begin vaccination campaigns in areas previously considered not at risk for yellow fever transmission. In addition, state and municipality health authorities are strengthening health care services and carrying out risk communication activities.

WHO risk assessment

These are the first human cases of yellow fever that have been reported in Brazil since June 2017. These cases, alongside the occurrence of epizootics in the urban area of São Paulo City and in municipalities that were previously considered not at risk for yellow fever, are a public health concern. Although Brazilian health authorities have swiftly implemented a series of public health measures in response to this event, including mass vaccination campaigns, it may take some time to reach optimal coverage in these areas given the large number of susceptible individuals. Currently, the number of unvaccinated people in São Paulo City remains high at around 10 million. If yellow fever transmission continues to spread to areas that were previously considered not at risk for yellow fever, ensuring the availability of vaccine and implementing control measures would pose significant challenges.

To date, there has been no evidence of transmission by Aedes aegypti in relation to this outbreak in Brazil which began in 2016. Although entomological studies conducted in selected municipalities of São Paulo revealed low levels of Ae. aegypti and Aedes albopictus infestation (pupa index range: 0% – 3.1%), the risk of sustained arbovirus transmission is ever present.

The risk of spread at the regional level is considered to be low given the high vaccination coverage in neighbouring countries; however, the detection of a human case of yellow fever in Oiapoque, the border river between French Guiana and Brazil in August 2017 by French health authorities indicates that the risk of regional spread exists. The risk at the global level is considered to be low and limited only to unvaccinated travellers returning from affected areas. Travelers who return home while infected with yellow fever virus may increase the risk of establishing local cycles of yellow fever transmission in areas where the competent vector is present.

WHO continues to monitor the epidemiological situation and assess the risk according to the latest available information.

WHO advice

Advice to travellers planning to visit areas at risk for yellow fever transmission in Brazil includes receiving yellow fever vaccine at least 10 days prior to traveling, following measures to avoid mosquito bites, and being aware of yellow fever symptoms and signs. WHO continues to promote health seeking behaviour when travelers are in and when they have returned from an area at risk for yellow fever transmission.

As per Annex 7 of the International Health Regulations (2005), a single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease. Booster doses of yellow fever vaccine are not needed.

The WHO Secretariat does not recommend any restrictions on travel or trade with/to Brazil according to the information currently available for this event.


EPA Registers the Wolbachia ZAP Strain in Live Male Asian Tiger Mosquitoes in order to reduce their population thereby reducing the spread numerous diseases of significant human health concern

EPA

 

 For Release:  November 7, 2017

On November 3, 2017, EPA registered a new mosquito biopesticide – ZAP Males® – that can reduce local populations of the type of mosquito (Aedes albopictus, or Asian Tiger Mosquitoes) that can spread numerous diseases of significant human health concern, including the Zika virus.

ZAP Males® are live male mosquitoes that are infected with the ZAP strain, a particular strain of the Wolbachia bacterium. Infected males mate with females, which then produce offspring that do not survive. (Male mosquitoes do not bite people.) With continued releases of the ZAP Males®, local Aedes albopictus populations decrease. Wolbachia are naturally occurring bacteria commonly found in most insect species.

This time-limited registration allows MosquitoMate, Inc. to sell the Wolbachia-infected male mosquitoes for five years in the District of Columbia and the following states: California, Connecticut, Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Maryland, Missouri, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, and West Virginia. Before the ZAP Males® can be used in each of those jurisdictions, it must be registered in the state or district.

When the five-year time limit ends, the registration will expire unless the registrant requests further action from EPA.

EPA’s risk assessments, along with the pesticide labeling, EPA’s response to public comments on the Notice of Receipt, and the proposed registration decision, can be found on www.regulations.gov under docket number EPA-HQ-OPP-2016-0205.


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

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