In the News - Yellow Fever in Brazil

This information is current as of today, December 21, 2011 at 04:09 EST

Updated: December 19, 2011

Current Situation

Yellow fever is a risk for travelers to most areas of Brazil, except coastal regions. During 2009, an outbreak of yellow fever, including a number of deaths, occurred in parts of southeastern Brazil that had not been affected by yellow fever for many years. In response, the Brazil Ministry of Health has gradually expanded the list of municipalities for which yellow fever vaccination is recommended in the four southeastern states of São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul.

Globally, yellow fever occurs in sub-Saharan Africa and tropical South America and is spread to people through the bite of infected mosquitoes. Symptoms can include sudden onset of fever, chills, headache, backache, nausea, and vomiting.

Yellow Fever Risk Areas in Brazil

Currently, Brazil and CDC recommend yellow fever vaccination for travelers to the following states:

• All areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, and Tocantins.
• Other designated areas of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. Vaccination is also recommended for travelers visiting Iguassu Falls.
• Vaccination is NOT recommended for travel to the following coastal cities: Rio de Janeiro, São Paulo, Salvador, Recife, and Fortaleza.

Refer to the updated 2011 Brazil Ministry of Health yellow fever vaccination map  (PDF) to see the states where yellow fever vaccine is recommended.

To determine if yellow fever vaccination is recommended for a specific municipality in Brazil, you may consult the following list of yellow fever vaccine recommendations, organized by municipality and state  (PDF). To more easily use this list of Brazilian municipalities, which contains terms in Portuguese, see the following legend for English translations.

Recommendations for US Travelers

Vaccine

Brazil currently does not require yellow fever vaccination for entrance into the country. However, travelers are strongly urged to get the yellow fever vaccine before traveling to an area of Brazil with risk of yellow fever virus transmission. (See Yellow Fever Risk Areas in Brazil above.) For additional information, see CDC yellow fever vaccination recommendations and requirements for Brazil.

Protection from Mosquito Bites

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

• When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. Always apply sunscreen before applying insect repellent.
  • Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), oil of lemon eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
  • In general, repellents protect longer against mosquito bites when they have a higher concentration (%) of the active ingredient. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often just 1-2 hours.
  • The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children over 2 months old.
  • Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
  • For more information about the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” section in Traveling Safely with Infants and Children in CDC Health Information for International Travel 2010 and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
  • For more information on the use of insect repellents, visit Mosquito and Tick Protection.
• Wear loose, long-sleeved shirts and long pants when outdoors.
• Spray clothing with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: Don't use permethrin on skin.)

Visit the Brazil destination page on the CDC Travelers’ Health website for information about other steps to take to ensure a safe and healthy trip to Brazil.

Additional Information

For more information about yellow fever risk and yellow fever vaccine, see the Yellow Fever section of CDC Health Information for International Travel 2012.

Source

Experiences of Yellow Fever vaccination at Government Center in India

Mumbai - Seamen Medical

Days : Monday to Friday (Closed on all Public Holidays) 
documents required: original passport, 3 nos rupee 100:00 denomination notes only(change , and 1000/500 notes not allowed) 
Maximum entries:80 ( Now changed to 100 daily)

Due to being a primary centre for sea cadets, I think the crowd here is more disciplined and cordial. You have to register by going early morning at least before 7:00 am. People start entering their name in the list and sign the paper sheet maintained by one of the people in the queue.
The office opens at 10:30 am. You have to be sure u r within 100 on the list. You then have to wait there and cannot go out or anywhere else to be sure u get the place in the queue. If u leave the place and go , your no is dropped off and next person becomes eligible in your place.
This is on 3rd and 4th March 2011 . I wanted to get both my children vaccinated. So I started research few days back.First thing I did is to find information on this site. Then I called on the no and they just told me that I need to reach Ballard Estate as early as possible on the same day and see that I am within 100 people in queue. Get 3 notes of 100 rs. and original passport only. So I took a train from pune at night on 3rd March 2011 and reached Mumbai CST at 6:00 am. From there took a taxi to The Ballard estate , though it is just 10 minutes walking distance from CST.
There were already some people there waiting I got nos 34 and 35 for my kids. Some people said they were waiting there from night 12:00 , some sleeping there itself, a couple turned up in morning and said they had come there in the night at around 12:00 , entered their names they were 14th and 15th in the list and left , were at home and came back in the morning to wait in the queue. We asked the people there that can we go out till Gateway of India and come back, they suggested not to leave the place as the people there will replace us if we r not present there. So from 6:00 am till 12:30 when we finished with vaccine we were in the queue. Yet there were discussions and some said we were lucky there r few people today and all is peaceful, on some days there are more than 200 people crowding and fighting to get a place the same day.
There was an incident . A lady with her 2 year old child had come for her kids vaccination. Her kid was troubling her so she had entered her name at no 43 and taken her kid for a walk. She returned at 10:30 when they were letting people in the office where vaccine is given. The person asked her to wait and did not allow her to go in and told her she had lost her no in the queue , as she was not present there. Luckily the lady's husband was engineer in navy so she was able to get a chance after talking to the Doctor.
We get the certificate right there. Then after 12:30 we went to Gateway of India and Prince of Wales Museum , were dead tired. I had reservations for deccan queen 5:10 pm was in pune by 8:40 pm. Hectic Day! 
Source

Latest update (Dec 2011) - WHO detects new Yellow Fever cases in Senegal !

The Ministry of Health in Senegal notified the WHO of three cases of yellow fever in Kédougou and Saraya Health districts, near the border with Mali and Guinea Conakry on 26 October 2011.

The index case was a 25 year-old female who developed symptoms of fever, headache and vomiting, with no history of yellow fever vaccination. She consulted the health military post of Kédougou on 23 July 2011. The case was detected as part of a surveillance project for dengue and chikungunya conducted in the region. The WHO reference laboratory for Yellow Fever at the Institut Pasteur in Dakar confirmed the case (IgM by ELISA test and Plaque Reduction Neutralization Test or PRNT) on 10 October 2011.

Two other cases - 29 year-old female and 3 year-old male - were reported on 10 and 11 August 2011. All three cases have fully recovered. An outbreak investigation team assessed the situation in the Kédougou and Saraya districts from 8 to 29 August 2011, where a total of 76 people (suspected cases and their contacts, including 10 deaths) were identified. Laboratory tests conducted showed no evidence of recent yellow fever infection among the 76 people. However, the tests (IgG) indicated that 20 of them had previously been exposed to yellow fever virus or yellow fever vaccine.

The health districts of Kédougou and Saraya benefited from a preventive mass vaccination campaign in December 2007, where the vaccination coverage was 94.9% and 94.8% respectively.

The Ministry of Health of Senegal plans to organize a vaccination campaign in mid-December 2011, targeting the non-vaccinated individuals aged nine months and above, excluding pregnant women in Kédougou, Saraya and Salémata health districts. The mass vaccination campaign aims to protect the susceptible population living in the area, which appears to have increased due to recent migration from neighboring countries. A total of 159,626 doses of vaccine from the GAVI-funded yellow fever emergency vaccine stockpile has been released by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) for the campaign.
Source

Now a comprehensive website for Yellow fever vaccination in India !

Finally, we have managed to launch the first and only comprehensive website providing all the relevant information on yellow fever disease & its vaccination in India at www.yellowfevervaccine.in 
This website has a large amount of information about Yellow fever disease and its vaccination, including symptoms and complications of the disease, list of centers providing the vaccine in India, advantages of vaccination in private center, contraindications for not taking the vaccines, potential precautions for taking the vaccine, contact information for Charak Clinics - the leading private vaccination center for yellow fever vaccination in India, and certificates, testimonials and FAQs, and lots more ! All in an easy to understand, comprehensive website.
We would love to have your feedback and suggestions regarding the same.
Write to us regarding the website, or for any more information at drgaurav-at-charakclinics.com.

Can people with Egg Allergy take the Yellow Fever Vaccine ?

Yellow fever vaccines are required to visit some tropical countries. However, the vaccine is cultured in eggs.

Last week I had two people who claimed to be "allergic to eggs" and had been refused vaccination by the Government Vaccination Center/ other private centers.

They wanted to know if they could safely take the vaccine for personal protection as well as the embassy regulations of African / South American countries.

On careful history taking it became apparent that both did not suffer from true egg allergy. They complained of abdominal bloating/ gassiness/ mild stomach upset if they ate eggs.

This is not a contra-indication for the Yellow Fever Vaccine.

The latest clinical guidelines for food allergies caution against administering the yellow fever vaccines to patients with a history of severe allergic reactions to eggs or chicken. If you have a history of any of the following reactions to egg, you should avoid the yellow fever vaccine:

• Hives (Chapake in Hindi)
• Angioedema (Swelling over the face/ body)
• Allergic asthma
• Anaphylaxis (Severe reaction leading to injections/ hospitalization)

If you have had a less severe reaction to eggs, or chicken you can probably tolerate the yellow fever vaccine.

If you plan to travel to a region where yellow fever is a problem, it is possible to have allergy testing done with the vaccine itself to determine if it would be possible for you to tolerate it. Any attempt to try the vaccine should be done in a medical setting that can care for any potential reactions.

If testing determines that you have a potential for severe reaction to the vaccine, or if your doctor determines that it is not safe for you given your history of reactions, it is possible to get a medical waiver that will allow you to visit countries that require the yellow fever vaccination for entry.

In our case, since there was no contra-indication, we gave these people a test dose intradermally, and once there was no reaction to the test dose, after half hour we gave them the complete dose without any side-effects.

Finally, it is important to remember that getting a waiver is difficult since you would need to "prove" that you are allergic to egg with further blood / skin testing and then attach this report along with the waiver letter from your doctor. Otherwise your waiver certificate may not be accepted by the Embassy.

Hence I would recommend getting a proper history before labeling someone as "allergic to eggs" and denying them the Yellow Fever Vaccine.

Read more here

http://foodallergies.about.com/od/eggallergies/f/egg-allergy-yellow-fever-vaccine.htm

http://allergies.about.com/od/medicationallergies/a/vaccinesfoods.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/00001620.htm

Here is the latest CDC recommendation regarding egg allergy with Yellow Fever Vaccination:

If international travel regulations are the only reason to vaccinate a patient hypersensitive to eggs, efforts should be made to obtain a waiver. A physician's letter stating the contraindication to vaccination has been acceptable to some governments. (Ideally, it should be written on letterhead stationary and bear the stamp used by health department and official immunization centers to validate the International Certificate of Vaccination.) Under these conditions, the traveler should also obtain specific and authoritative advice from the embassy or consulate of the country or countries s/he plans to visit. Waivers of requirements obtained from embassies or consulates should be documented by appropriate letters and retained for presentation with the International Health Certificate. If vaccination of an individual with a questionable history of egg hypersensitivity is considered essential because of a high risk of exposure, an intradermal test dose may be administered under close medical supervision. Specific directions for skin testing are found in the package insert.

And now we are the first & only Hospital in Punjab to be on IAMAT !

Congratulations are in order.

Charak Clinics has created history by being the sole authorized center in Punjab to affiliated to International Association for Medical Assistance to Travelers

Now in addition to providing Yellow Fever Vaccination for travelers from North India to African and South American countries, we are providing medical assistance to Travelers from all over the world visiting Punjab and North India.

You can see our profile (after logging in to the IAMAT website) here .

This will further help assure prospective customers for Yellow Fever Vaccination, and travelers, about our highest standard of Immunization and Medical Care.

Yellow fever Vaccination is a legal obligation

If you are travelling or transiting through areas that are infected with yellow fever, many countries require you to be vaccinated. A record of your vaccination must be entered and validated in your International Certificate of Vaccination. It is best to get the vaccination to make sure that you meet the varying entry requirements. For the latest information on the list of countries that are infected with yellow fever, look here. Talk to your travel agent and also consult with your doctor (preferably at least two months before traveling) to arrange for this and other travel vaccinations. You must have the yellow fever vaccine at least 10 days before to a yellow fever endemic country, otherwise you may be quarantined compulsorily (kept forcibly in a hospital for a week to make sure that you do not have Yellow Fever).

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.