Yellow fever vaccination in India - Government versus Private sector

What are the pros and cons of Yellow Fever Vaccination in Government versus Private sector in India.
Yellow Fever Vaccine is one of the last vestiges of the License Raj regime that the government of India used to prefer in the older years.
While there may have been justification for "controlling" Yellow Fever vaccination in the yesteryears when access to good quality vaccination was difficult and importing the same impossible, this is no longer the case.
Nowadays Yellow Fever vaccination at Government level is associated with lots of Corruption, poor quality vaccine and lots of wasted time.
Here are the pros & cons of the Yellow Fever vaccination in the Government versus Private sector in India
Government Centers
- PROS
1. Cheaper Vaccine
2. Government Certificate of vaccination
3. Well known - relatively easily accessible
CONS
1. Poor quality vaccine - Chinese/ Russian vaccine at lowest tender price
2. Increased range of side-effects - More fever, local swelling, pain etc.
3. Huge waste of time - Need to take appointment 1 day prior, then be punctual and hope that a VIP has not taken your turn. Also fixed days, and centers located at only 22 places in India.
4. Multi-dose Vaccine - More chances of side-effects, need a minimum number of customers to open the vial, individual vaccination cannot be given.

Private Centers
PROS
1. Faster vaccination
2. Individuals can be vaccinated at their convenience.
3. STAMARIL - A better quality, French made vaccination by Sanofi Aventis - a well known multinational vaccine manufacturer.
4. Less side-effects

CONS
1. Expensive
2. Tough to locate the clinics since not well advertised
3. Worry about proper certification - Preferable to go to a center providing the WHO Yellow Booklet with International Certificate of Vaccination

Hope this helps you decide what is the best option in your situation for taking the Yellow Fever vaccination in India.

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow fever - Maps of Countries at Risk

Reference:

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/yellow-fever.aspx (accessed July 2010)

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow fever - Prevention through Vaccination

While mosquito control is the ultimate prevention strategy to prevent mosquito borne diseases like Yellow Fever, Malaria and Dengue, this is certainly not practicable for most African and South American countries at the present point of time.
According to WHO, Vaccination is the single most important measure for preventing yellow fever. In high risk areas where vaccination coverage is low, prompt recognition and control of outbreaks through immunization is critical to prevent epidemics. To prevent outbreaks throughout affected regions, vaccination coverage must reach at least 60% to 80% of a population at risk. Few countries in Africa currently have this level of coverage.

Preventive vaccination can be offered through routine infant immunization and one-time mass campaigns to increase vaccination coverage in countries at risk, as well as for travelers to yellow fever endemic area. WHO strongly recommends routine yellow fever vaccination for children in areas at risk for the disease.

The yellow fever vaccine is safe and affordable, providing effective immunity against yellow fever within one week for 95% of those vaccinated. A single dose provides protection for 30–35 years or more, and probably for life. Serious side effects are extremely rare. Serious adverse events have been reported rarely following immunization in a few endemic areas and among vaccinated travelers (e.g. in Brazil, Australia, the United States, Peru and Togo). Scientists are investigating the causes.

The risk of death from yellow fever is far greater than the risks related to the vaccine. People who should not be vaccinated include:

* children aged less than 9 months for routine immunization (or less than 6 months during an epidemic);
* pregnant women – except during a yellow fever outbreak when the risk of infection is high;
* people with severe allergies to egg protein; and
* people with severe immunodeficiency due to symptomatic HIV/AIDS or other causes, or in the presence of a thymus disorder.

Travelers, particularly those arriving to Asia from Africa or Latin America must have a certificate of yellow fever vaccination. If there are medical grounds for not getting vaccinated, International Health Regulations state that this must be certified by the appropriate authorities.

Reference
http://www.who.int/mediacentre/factsheets/fs100/en/index.html

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow Fever - Populations at Risk

Populations at risk

Forty-five endemic countries in Africa and Latin America, with a combined population of over 900 million, are at risk. In Africa, an estimated 508 million people live in 32 countries at risk. The remaining population at risk are in 13 countries in Latin America, with Bolivia, Brazil, Colombia, Ecuador and Peru at greatest risk.

There are an estimated 200 000 cases of yellow fever (causing 30 000 deaths) worldwide each year. Small numbers of imported cases occur in countries free of yellow fever. Although the disease has never been reported in Asia, the region is at risk because the conditions required for transmission are present there. (1)

Countries with risk of yellow fever transmission - CDC 2010

Africa			Central and South America
Angola Benin Burkina Faso Burundi Cameroon Central African Republic Chad Congo, Republic of the Côte d’Ivoire Democratic Republic of the Congo Equatorial Guinea	Ethiopia Gabon The Gambia Ghana Guinea Guinea-Bissau Kenya Liberia Mali Mauritania Niger	Nigeria Rwanda Sierra Leone São Tomé and Principe Senegal Somalia Sudan Tanzania Togo Uganda	Argentina Bolivia Brazil Colombia Ecuador French Guiana Guyana Panama Paraguay Peru Suriname Trinidad and Tobago Venezuela

References:

1. http://www.who.int/mediacentre/factsheets/fs100/en/ (accessed July 2010)

2. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/yellow-fever.aspx (accessed July 2010)

Yellow Fever - Diagnosis & Differential Diagnosis

In order to make a yellow fever diagnosis, your doctor will ask questions about a number of things (including recent medical and travel history), perform a physical exam, and recommend certain tests. As part of diagnosing a yellow fever virus infection, the doctor will also rule out other more common causes of possible yellow fever symptoms, such as the flu or the common cold. If the doctor thinks a person is at risk for yellow fever, he or she can order certain tests. These tests can include Blood tests, Cerebrospinal fluid tests (CSF), Electrocardiograms (EKGs). These individual tests will not definitely diagnose yellow fever, but they can be helpful. To make a definitive diagnosis of yellow fever, the doctor will draw a blood sample and send it to a commercial or public health laboratory for confirmation. (1)
The diagnosis of yellow fever is made through examining the blood using various techniques in order to demonstrate the presence of either yellow fever viral antigens (the part of the virus that initiates the patient's immune response) or specific antibodies (the cells produced by the patient's immune system that are specifically directed against the yellow fever virus). (2)
Specific diagnosis depends on isolation of virus from blood, demonstration of viral antigen in serum by enzime-linked immunosorbent assay ( ELISA ) or of viral RNA by polimerase chain reaction ( PCR ) during the period of infection. Serologic diagnosis include IgM antibody-capture ELISA, hemagglutination inhibition (HI), complement fixation (CF) or neutralization (N) tests. It’s important to consider that IgM, HI and N antibodies appear within 5 - 7 days and CF antibodies within 7 - 14 days after onset. Thus, paired acute and convalescent sera should be tested ( interval of 14 days ). (3)
Common Differential Diagnosis
Leptospirosis: Increased erythrocyte sedimentation rate, total WBC elevated with neutrophilia and trans aminases levels slightly elevated .
Dengue fever: Indistinguishable from yellow fever in the initial stages; jaundice is, however, a rare sign.
Malaria: It must be always excluded by serial blood examination, even when the diagnosis of yellow fever is confirmed, due to the possible concomitant of both diseases. Anemia without hemorrhagic manifestations, splenomegaly and low levels of transaminases take account of malaria.
Hepatitis: The insidious onset, usually without renal disease ( suggestive ) + presence of viral markers of hepatitis in sera confirm the diagnosis. (3)

References:

1. http://virus.emedtv.com/yellow-fever/yellow-fever-diagnosis.html (accessed July 2010)

2. http://science.jrank.org/pages/7444/Yellow-Fever-Diagnosis.html (accessed July 2010)

3. http://www.medstudents.com.br/dip/dip2.htm (accessed July 2010)

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow Fever Vaccination Centers in India

The Government of India has designated certain Government Hospitals and Agencies as Centers for Yellow Fever Vaccination.

Here is a list of these Government Centers

(EDIT : Please see the latest updated list of government centers here)

Vaccination centres For Yellow Fever For International Travellers

Delhi:
Health Organization, Palam Airport. (Tue. and Thursday 1400 - 1600 hrs) Tel. 3295507.

Public Health Laboratory, Municipal Corporation, Town Hall, Alipur Road, Mon & Fri 1000 - 1200 hrs. Tel. 252 2058

Dr. Ram Manohar Lolia Hospital (Wed & Sat 1100 to 1300 hrs) Tel: 3365525 / 3735337

International Inoculation Centre, Mandir Marg, New Delhi - 110001

TravelSafe Clinic, Delhi - The only ISTM registered private Travel Health Clinic in Delhi NCR. H. no. 436, Sector 28, NOIDA. Tel 09810806594, 09872303775, 0120-2453202

Mumbai:

Health Office, Mumbai Airport.

Port Health Organisation, Seamens Medical Examination Organization, Nav Bhawan

TravelSafe Clinic, Mumbai - Shop no. 3, Navratan apartments,  Near Four wheel world showroom, Maitri park, Sion Trombay Road,
Chembur, Mumbai -400071. Please contact Malini- 9867694813 for appointments

For general queries you can contact our Central Office (in Chandigarh) too at 0172-5092585, 0172-4663775, 09872303775

Calcutta:

All India Institute of Hygiene and Public Health.

Health Organization, Dum Dum Airport.

Port Health Organization.

Cochin: Port Health Organization

Goa: Urban Health Organization, Panaji.

Hyderabad: Institute of Preventive Medicine

Jamnagar: Irwin Hospital

Kandla: Port Health Organization.

Kasauli: Central Research Institute

Lucknow: Balrampur Hospital

Chennai: King Institute of Preventive Medicine, Guindy.

Port Health Officer / Assistant Port Health Officer / Assistant Airport Health Officer, Port Health Organization.

Marmugao: Port Health Organization

Porbandar: Office of the Civil Surgeon

Pune: Department of Preventive & Social Medicine, BJ Medical College

Vishakhapatamam: Port Heath Organization.

Reference
http://www.indiaatbest.com/india_welcome.htm

Unfortunately, due to bureaucratic red tape and governmental apathy and indifference, most of these centers have restricted working hours, need for prior appointment and rude staff whose attitude leaves a lot to be desired.
Hence, many enterprising private doctors have been providing this vaccination to people needing the yellow fever vaccine. This vaccine is called STAMARIL (manufactured by Sanofi Aventis at France) and imported under license of Drug Controller Authority of India.
When provided along with the WHO International Certificate of Vaccination, the vaccination is internationally accepted with a validity of 10 years.

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (rjavascript:void(0)eplace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow Fever - Common Symptoms

There are many symptoms of yellow fever. The symptoms vary from person to person and one person may not experience all of the symptoms. Some of the most common symptoms of yellow fever are high fever, chills, headache, muscle aches, vomiting, backache etc.
Symptoms of yellow fever usually appear between 3 and 6 days after being infected by a mosquito. Yellow fever must be monitored by a doctor. After a brief recovery period, the infection may lead to shock, bleeding, and kidney and liver failure. (1)
Liver failure causes jaundice (yellowing of the skin and the whites of the eyes), which gives yellow fever its name. (2)
In mild cases of yellow fever, symptoms usually last one to three days. In more severe cases, there can be three stages of symptoms. About half the people who enter the third stage will die within 10 to 14 days; the other half recover. Shortly before death, the person can become very confused and extremely agitated. In severe cases, the person will go into a coma two to three days before they pass away. (3)

References:
1. http://www.mamashealth.com/yellow.asp. (accessed July 2010)
2. http://www.dhpe.org/infect/yellow.html. (accessed July 2010)

3. http://virus.emedtv.com/yellow-fever/yellow-fever-symptoms-p2.html. (accessed July 2010)

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.

Yellow Fever - Key Facts

KEY FACTS (1)

• 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.
• Yellow fever infection can cause severe illness and death. Up to 50% of severely affected persons without treatment will die from yellow fever.
• There are an estimated 200 000 cases of yellow fever, causing 30 000 deaths, worldwide each year.
• The virus is endemic in tropical areas of Africa and Latin America, with a combined population of over 900 million people.
• The number of yellow fever cases has increased over the past two decades due to declining population immunity to infection, deforestation, urbanization, population movements and climate change.
• There is no cure for yellow fever. Treatment is symptomatic, aimed at reducing the symptoms for the comfort of the patient.
• Vaccination is the single most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and appears to provide protection for 30–35 years or more. The vaccine provides effective immunity within one week for 95% of persons vaccinated.

Reference

1. http://www.who.int/mediacentre/factsheets/fs100/en/ (accessed July 2010)

Yellow Fever - An Introduction

Yellow fever is a serious viral disease that is usually transmitted by a type of mosquito known as the Aedes aegypti mosquito. Yellow fever mainly occurs in sub-Saharan Africa (countries to the south of the Sahara desert), South America and in parts of the Caribbean. There have not been any recent cases of yellow fever in north America, Europe or Asia. Yellow fever can be fatal. About 5% of people who get yellow fever die from the condition.(1)
Yellow fever was once one of the most feared epidemic diseases in the world with the capacity to bring devastation to almost every continent. Mass vaccination campaigns in the mid 20th Century succeeded in bringing the disease under control for over 40 years but since the late 1980s, this deadly disease has returned, putting at risk a new generation in West and Central Africa and threatening to erupt into devastating urban epidemics. (2)

References:
1. http://www.nhs.uk/Conditions/yellow-fever/Pages/Introduction.aspx (accessed July 2010)
2. http://www.who.int/csr/disease/yellowfev/introduction/en/index.html (accessed July 2010)

All information provided by Dr Gaurav Gupta, MD, Charak Clinics. Stamaril, Yellow Fever Vaccine is available at Charak Clinics, Chandigarh, North India for all travelers to Endemic Countries in Africa / Central & South America with WHO certificate of vaccination valid for 10 years. For details write to us at drgaurav-at-charakclinics.com (replace -at- by @) or call at 91-172-5092585, 91-9872303775 during Office Hours.