Yellow Fever Vaccine study reveals link between immunity and cells' starvation response

One of the most effective vaccines in history has been the yellow fever vaccine, which was developed in the 1930s and has been administered to more than 500 million people.

Scientists at Emory Vaccine Center studying immune responses to the yellow fever vaccine have identified a gene whose activation in key immune cells is a sign of a robust response. The gene, called GCN2, encodes a protein involved in sensing amino acid starvation and regulates the process of autophagy, a response to starvation or stress within cells.

The findings highlight a link between antiviral defenses and an ancient way that cells adapt to scarcity, and could help researchers develop vaccines against challenging viruses such as HIV or dengue. The results suggest that vaccine additives (called adjuvants) that are effective in stimulating GCN2 and autophagy would be especially potent in stimulating long-lasting immunity.

The results are scheduled for publication Thursday by the journal Science.

"This is an example of taking a system-wide approach to studying vaccine responses, and how it can reveal new insights about the functioning of the immune system," says senior author Bali Pulendran, PhD. "We were not thinking about the stress response pathway and immunity until our analysis pointed us in that direction."

Pulendran is Charles Howard Candler professor of pathology and laboratory medicine at Emory University School of Medicine and a researcher at Yerkes National Primate Research Center. The co-first authors of the paper are postdoctoral fellows Ravesh Ravindran, PhD and Noor Khan, PhD.

A single dose of the live attenuated viral yellow fever vaccine can protect against disease-causing forms of the virus for decades. Investigators led by Pulendran have been dissecting immune responses to the yellow fever vaccine, taking a genome-wide "systems biology" approach.

They started by looking at all the genes that are turned on a few days after human volunteers were vaccinated against yellow fever and asked: which genes' activations are the signatures of especially strong immune responses later? In particular, Pulendran and his colleagues looked for responses by CD8 "killer" T cells, which are important for eliminating virally-infected cells from the body.

One gene that stuck out was GCN2, because it was induced quickly after vaccination and was a sign that the immune system would later respond with lots of CD8 T cells.

GCN2 was known to be a sensor inside cells that detects low levels of amino acids, the building blocks for proteins. GCN2 regulates the process of autophagy, in which cells respond to starvation or stress by ceasing growth and beginning to digest themselves.

In the Science paper, Pulendran and his colleagues show that GCN2's function is especially critical in dendritic cells, whose job is to "present" information about viruses and other pathogens to the rest of the immune system. Dendritic cells lacking GCN2 are less able to activate CD8 T cells, they found.

Mice that lacked GCN2 had impaired responses to yellow fever vaccine and to inhaled influenza vaccine, the researchers found.

They also found that infection with yellow fever leads to a depletion of amino acids within dendritic cells. When viruses infect dendritic cells, it appears that the viruses start using up the building materials on hand. This tips the dendritic cells into autophagy and raising an alarm with the rest of the immune system, Pulendran says.

"This may have evolved as a mechanism of pathogen sensing that is capable of detecting the footprints of a pathogen, such as depleted amino acids in a local microenvironment," he says.

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Could Yellow Fever Return to the United States?

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In the summer-fall of 1878 an epidemic of yellow fever destroyed the city of Memphis, Tennessee.  Likely introduced into the Caribbean by trade from the West Coast of Africa and later brought up the Mississippi River by a steamer ship (the Emily B. Souder) with sick and dying sailors, yellow fever killed an estimated 5,000 Memphis residents, almost one-third of its population who did not flee the city that August [1].   According to Molly Caldwell Crosby in her detailed account, the summer-fall 1878 yellow fever epidemic in the Mississippi Valley was possibly “the worst urban disaster in American history” [1].

Among the factors responsible for the 1878 tragedy were an unusually warm winter and spring that year, which helped Aedes aegypti mosquitoes  to flourish in the Mississippi Valley, together with a lack of adequate urban drainage and a functioning sewer system, and a susceptible (non-immunized) population – the yellow fever vaccine would not be developed for another 50 years.

Today, the world’s yellow fever-endemic areas are restricted to Sub-Saharan Africa (figure image) and tropical regions of South America, but there are a few red flags suggesting the possibility that the “yellow jack” (a historical term used to once describe yellow fever) could return to the US.  The Ae. aegypti mosquitocan now be found in many areas of the southern United States.  This is an area where US poverty rates are at their highest, along with its fellow travelers poor urban housing and neglected foci of standing water.  The area has also experienced unusually warm winters and springs over the past few years.  Indeed, dengue fever, another arbovirus infection transmitted by Ae. aegyptimosquitoes, was recently shown to have emerged in Houston, Texas in 2003.  Although Max Theiler received the Nobel Prize for developing the yellow fever vaccine in 1951, vaccination rates in the US are practically non-existent except among travelers to endemic areas.

There are several examples of US vulnerability to yellow fever, including our home city of Houston, which has recently emerged as a true gateway city and globalization hub. For instance, today, Houston hosts the world’s largest number of Nigerians expats (who provide important and skilled expertise for our city’s oil and energy industry), and there are direct flights to and from Lagos, the largest Nigerian city.  A recent study from the Division of Global Migration and Quarantine of the CDC (Centers for Disease Control and Prevention) found thatUS travelers to Nigeria are especially likely to decline vaccination, despite the fact that its urban areas are at especially high risk for yellow fever outbreaks. The culmination of travelers returning to Houston from endemic areas, subtropical climate, high prevalence of Ae. aegypti mosquitoes, and areas of dense housing overlapped with poverty place Houston at risk for yellow fever emergence.

We need to seriously evaluate the risks of the major southern cities of the US, including Houston, but also New Orleans, Tampa, and Miami for their vulnerability to Aedes-transmitted arbovirus infections, such as yellow fever. As we have pointed out, cities such as Houston have emerged as important endemic zones for neglected tropical diseases. While we are aware that US urban areas may not be as vulnerable to yellow fever as Memphis was more than a century ago, there is still an important risk that needs to be considered as part of our national emergency preparedness, particularly in light of an emerging dengue problem (i.e., another Ae. Aegypti mosquito transmitted virus infection) in Houston and other southern coastal US areas.

Sudan Reports Widespread Yellow Fever Outbreak, 14 Dead

December 4, 2013

Sudan’s Federal Ministry of Health (FMOH) has notified the World Health Organization (WHO) of an outbreak ofyellow fever that is affecting 12 localities in West and South Kordofan states.

A total of 44 suspected cases and 14 deaths have been reported from October 3 to November 24, 2013 in the localities of Lagawa, Kailak, Muglad and Abyei in West Kordofan and Elreef Alshargi, Abu Gibaiha, Ghadir, Habila, Kadugli, Altadamon, Talodi and Aliri in South Kordofan.

Field investigations carried out by the FMOH revealed that the initial suspected cases were reported among seasonal workers coming from the eastern states of Sudan who had traveled to West Kordofan for work in October. Subsequent cases were reported among locals in both West and South Kordofan states, following the arrival of the workers.

Blood samples that were collected during the field investigation tested positive for Yellow Fever by IgM ELISA Assay at the National Public Health Laboratory of the FMOH in Khartoum. The samples were retested at theInstitute of Pasteur in Senegal and were confirmed to be that of Yellow Fever. Subsequent seroneutralizing (PRNT) testing by WHO researchers also confirmed presence of yellow fever.

The field investigation also found evidence of Aedes aegepty mosquitoes in the areas where the infected persons were found. A. aegepty is one vector that can sustain transmission of yellow fever.

WHO is assisting the FMOH to strengthen surveillance efforts and to conduct active case searches in and around the region. So far no suspected cases have been reported from any of the areas outside of where the initial outbreak occurred. The FMOH is now organizing a massive vaccination program against yellow fever in the affected areas to prevent further infection.

According to a WHO report, it is estimated that yellow fever infects between 840,000 and 1.7 million people in Africa each year, resulting in about 29,000 to 60,000 deaths.

An outbreak last year in the Darfur region of Sudan resulted in 849 suspected cases and 171 deaths. Around five million people were vaccinated against yellow fever in the five states of Darfur following the outbreak. In 2005, a yellow fever outbreak was also reported from the South Kordofan state, resulting in 615 suspected cases and 183 deaths. A vaccination campaign followed targeting about 1.6 million people in the region.

Yellow fever, also known as Yellow Jack, is an acute viral hemorrhagic virus that affects 20 percent of an area’s population where it is commonly found. Most cases only cause a mild infection with fever, headache, chills, back pain, loss of appetite, nausea and vomiting. In these cases, the infection generally lasts three or four days.

In about 15 percent of cases, sufferers can enter a toxic phase of the disease with recurring fever accompanied by jaundice due to liver damage and abdominal pain. Bleeding in the mouth, eyes and gastrointestinal tract is also common at this stage and vomit may contain blood. This toxic phase is lethal in about 20 percent of cases, making the overall mortality rate for the disease about three percent. In severe epidemic outbreaks, mortality may rise to 50 percent or more.

For those who survive their infection, they usually do so without any organ damage and they are provided with a lifelong immunity to the virus.

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Yellow Fever immunization receives support from GAVI Alliance in Nigeria

he GAVI Alliance announced on Tuesday that it would support Nigeria’s first new national campaign against yellow fever in close to three decades.

The campaign will protect up to 60 million people by targeting individuals between the ages of nine months and 45 years. The new campaign to administer lifelong protection against the deadly disease will last three years.

“Vaccination is the most effective preventive measure against yellow fever,” Seth Berkley, the CEO of the GAVI Alliance, said. “Many millions of Nigerians who are currently vulnerable to this disease will receive lifelong protection against its potentially fatal effects.”

Nigeria is the last of the 13 highest-risk Central and West African countries to conduct a yellow fever campaign. In 2012, the World Health Organization and UNICEF estimated that just 25 percent of the six million children born each year in Nigeria received yellow fever vaccines as part of a routine infant package.

Yellow fever is still a significant issue in the region, due to high cross-border transmission and increased contact between humans and infected mosquitoes.

“Recent yellow fever outbreaks in Nigeria’s neighboring and nearby countries is a cause for serious concern,” Berkley said. “The resurgence of this disease puts millions of lives at risk, especially in towns and cities where large and uncontrollable outbreaks are more likely.”

There are an estimated 200,000 cases of yellow fever each year. The disease kills 30,000 people annually.

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In 1792 they set off to undo slavery but ended up sending yellow fever across the Atlantic

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Pandemic

A tale of unintended consequences

‘Ship of Death: A Voyage that Changed the Atlantic World’ by Billy G. Smith

The sad irony is that the Hankey set sail from England in 1792 on the noblest of missions.

The ship’s abolitionist passengers hoped to create an inspirational colony on an island off the west coast of Africa where Africans would be employees rather than slaves. “If we succeed, it promises happiness to millions of living and millions of unborn people,” wrote Philip Beaver, a leader of the expedition.

Instead, as Billy G. Smith recounts, the pioneers fueled one of the most devastating plagues in Western history. The colonists toted water to their ship from streams on the African mainland, not knowing that the mosquitoes that bred in the water carried yellow fever.

When the cargo ship sailed off on further ventures, crisscrossing the Atlantic for six months, it brought yellow fever to dozens of ports in the West Indies, North America and Europe. Other ships had carried yellow fever, but not with such lethality: “Until the Hankey’s voyage in 1793, the concatenation of conditions that was to detonate the yellow fever bomb had never been present in so many places at the same time and with such ferocity,” Smith writes. “The result was a pandemic that killed hundreds of thousands people.”

The Hankey, infamous in its own time, fell into obscurity within decades. Apparently by chance, Smith, a historian at Montana State University, came across references to the ship in shipping records in Philadelphia, where the epidemic killed one of every 10 residents. He tracked the ship’s voyages, matching them with yellow fever reports, and created a narrative that, the author says, “brings together peoples who lived thousands of miles apart who discovered . . . that far-distant events could have impacts, sometimes fatal, on their own lives.” It’s an apt lesson, he points out, for our ever-shrinking globe.

Yellow Fever: Have You Been Vaccinated?

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The current worldwide shortage of the Yellow Fever vaccine is expected to last until January 2014, but The Tropical Medical Bureau have secured sufficient stock of the vaccine for the foreseeable future and are encouraging anyone planning to travel to a Yellow Fever region to receive the vaccine from their 22 clinics nationwide.

Proof of Yellow Fever cover is a requirement of entry for some countries in Africa and South America. If an individual cannot prove they have received the vaccine at least 10 days before entry they will be stopped at immigration and will be unable to complete their journey.

According to Dr Graham Fry, Medical Director of the Tropical Medical Bureau "It is extremely important to have a Yellow Fever vaccination. Contracting Yellow Fever is highly unpleasant, symptoms can include nausea, muscle pains, headaches and in some cases liver damage, which can lead to death."

For further information or to book an appointment, contact the Tropical Medical Bureau on 1850 487674 or visit tmb.ie.

Why Dengue and Yellow Fever Could Be Coming to a City Near You ?

This past summer, Aedes aegypti—the invasive African mosquito best known for carrying the potentially deadly diseases dengue and yellow fever—made its unexpected debut in California, squirming up from Madera to Clovis to Fresno and the Bay Area.

For a blood-sucking nightmare, Aedes aegypti is surprisingly attractive: Its dark skin and bright white polka-dots make it hard to miss. Unfortunately, it is also notoriously difficult to control. According to the Centers for Disease Control and Prevention (CDC), Aedes aegypti can lay its eggs in less than a teaspoon of liquid and survive without water for months.

While Aedes aegypti has long resided in Texas and the southeastern United States, this is the first time it's reached California. News outlets have covered the story extensively, but few have mentioned climate change's role in the mosquito's spread. The CDC says it's "likely thatAe. aegypti is continually responding or adapting to environmental change." In a 2012 report, the World Health Organization (WHO) pointed out that "temperatures, precipitation and humidity have a strong influence on the reproduction, survival and biting rates" of Aedes aegypti.Climate change studies predict that dengue—which infects as many as 100 million people a year—will expose an additional 2 billion by 2080. In 2009, the mosquito kicked off a Florida outbreak of dengue in a state that hadn't seen the disease in more than 70 years, and Thailand is currently undergoing its worst dengue epidemic in more than 20 years.

Dengue's initial symptoms often resemble the flu, but advanced infections—which cause lung and heart problems, severe abdominal pain, and bleeding from the nose and mouth—kill 15,000 people in 100 countries annually.

Yellow fever is no picnic, either: The disease was one of the world's most feared before the development of a vaccine in 1936. Its name comes from the illness' trademark jaundice, and it also causes severe stomach bleeding (often resulting in black vomit). It kills 15 percent of those infected and closer to 50 percent when left untreated.

In the past, yellow fever in the United States made its way as far north as New York City. In 1793, an outbreak even wiped out 10 percent of Philadelphia. Luckily, citizens figured out that they could stop its spread by overturning containers of standing water where mosquitoes bred, and yellow fever was largely eradicated in the United States. In the last 40 years, there have been only nine cases of yellow fever in the United States, all of which were contracted abroad. But in Africa and Central and South America, it's a much bigger problem: Roughly 200,000 new cases of yellow fever occur every year. Over the last 20 years, outbreaks have occurred in more countries with more frequency, especially in sub-Saharan Africa. In 2010,Uganda had its first outbreak in more than 40 years. WHO reports the increasing number of cases is likely linked to climate change.

There is no vaccine for dengue, and American citizens typically do not get vaccinated against yellow fever unless they travel to a region where it's endemic. So far, there have been no cases of dengue or yellow fever connected to California's new Aedes aegypti, and none of the insects have tested positive for the diseases. But public health officials remain vigilant. "We were shocked," one insect control official in Madera, California, told the Los Angeles Times. "We never expected this mosquito in California."

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Sudan Reports Yellow Fever Outbreak, 20 Suspected Cases In West Kordofan State

The World Health Organization (WHO) has been notified by the Sudanese Health Ministry of a yellow fever outbreak  in West Kordofan state, according to a WHO Regional Office for the Eastern Meditteranean news release.

Based on the information available, the outbreak appears to be localized  in the El-Reif El-Shargi and Lagawa localities of the state.

More than 10 blood samples have been tested for yellow fever from suspected cases  in El-Reif El-Shargi locality in West Kordofan state by the National Public Health Laboratory in Khartoum. At least three samples have tested positive for the virus. 

According to the WHO release, between 3 October and 2 November 2013, a total of 20 suspected cases of yellow fever were reported, including seven deaths, presenting a case fatality rate of 35%.

Patients were from Al-behara camp, Tabag and Alarda in Lagawa locality. Al-Behara is a camp for seasonal workers for gum arabic plantation.

In addition, patients were originally from east Sudan who travelled a month ago to Kordofan and have started residing at Al-Behara camp. The workers usually travel in groups from east Sudan. Currently, an estimated number of 200 people are residing in the camp.

The WHO  has sent supplies to the State Ministry of Health comprising of medical equipment, life-saving medicines, laboratory tools, cleaning tools and disinfectant, mosquito nets and insecticides to the affected area.

During the last quarter of 2012, there was an outbreak of yellow fever in Darfur region. The total number of suspected yellow fever cases has reached 849, including 171 deaths (case–fatality rate 20.1%).

Three emergency vaccination campaigns were conducted resulting in approximately five million people vaccinated in the five states of Darfur.

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Comment: It is recommended that all travelers from India to Sudan and other african countries take Yellow Fever vaccination to protect themselves against this deadly mosquito borne disease.

New Yellow Fever Card for Ghanaian and South African Travellers

The Federal Government of Nigeria through its health ministry has announced that the issuance of a new yellow fever card has commenced and the replacement would take full effect on the 1st of October, 2013.

Passengers traveling to a country requiring a yellow fever vaccination card need to obtain the new standardized even if they have a still valid old style Nigerian issued on. Especially for Accra and Johannesburg! Passengers from now on will not be accepted for profiling without the complete travel documents including the YFC to avoid extensive delays at the gate waiting for passengers to come from Port Health.

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Yellow fever mosquito discovered in California

Some scientists say that climate change is a possible explanation for the mosquito’s spread into the Golden State.

National Monitor, Rina Shah | October 19, 2013

Yellow and dengue fever, tropical illnesses rarely found in California, may become a seasonal threat after two types of mosquitoes known for carrying the illnesses were seen around the state, reports SF Gate.  Experts are trying to kill off the mosquitoes before the threat becomes a reality.
Specialists in mosquito control are going door-to-door in several Bay Area counties to hunt for signs of Aedes aegypti, also called the yellow fever mosquito, which was found in San Mateo County in August. The same mosquito type was seen in at least two other California counties over the summer.  Over the past three years, there have also been reports of the Aedes albopictus, also known as the Asian tiger mosquito, in Los Angeles County.  Public health officials are concerned that they could spread to other parts of the state.
Earlier this year, the Daily Democrat reported that experts in the west Sacramento area in California were evaluating a potential threat of West Nile Virus.  Many dead birds were found and 18 tested positive for West Nile Virus.  Additionally, 58 mosquito tests have also been positive for the disease.  Though more intense in Sacramento County, West Nile Virus was also presenting in other areas.  Yolo County had six dead birds and 19 mosquito samples that were infected.  There was one human case that has been confirmed by the California Department of Public Health.  To respond to the threat, officials were considering aerial spraying to kill mosquitoes and prevent the further spread of the virus.
The New York Department of Health explains that West Nile Virus is a mosquito-borne illness that can be spread to humans.  Reducing the risk of being bit by a mosquito reduces the risk for contracting the disease.  Twenty percent of individuals that are infected by the virus develop West Nile fever, which shows mild symptoms similar to a fever or common infection.  A less likely development is West Nile encephalitis, which is more severe, including symptoms such as tremors, high fever, paralysis, and coma.  According to the Centers for Disease Control and Prevention, other illnesses transmitted by mosquitoes include dengue fever, malaria, yellow fever, and several diseases that cause encephalitis.
It is unclear why the mosquitoes that carry dengue and yellow fevers are starting to spread into California.  Some scientists say that climate change is a possible explanation.  However, controlling the mosquito population is a reliable method for decreasing the risk of infections carried by mosquitoes.
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Cameroon Conducts Major Yellow Fever Vaccination Campaign

10/9/2013 7:49 PM ET

Cameroon's Ministry of Health has carried out a yellow fever mass vaccination campaign with a reported 94% coverage of the targeted population of 663,900 in 13 health districts considered to be at high risk for yellow fever, according to the World Heath Organization (WHO).

The UN health agency said the vaccination campaign was carried out between August 27 to September 1, 2013 in the Littoral Region, following laboratory-confirmation of two cases with yellow fever in the area in April 2013. The index case was a 43-year-old woman from Ndom Health district who became ill on March 15, 2013.

"The patients were laboratory confirmed at the Institute Pasteur of Cameroon by IgM ELISA (antibody) test, which was followed by the seroneutralizing test (PRNT) for yellow fever by the Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever," the agency said in a statement.

The suspected yellow fever cases were reported from Cameroon's South-West area in 2012. The cases were identified as part of the surveillance system which identifies patients with fever and jaundice within 14 days of onset.

WHO country office in Cameroon has been working with health authorities in the field investigation and response to the outbreak, with an ongoing surveillance for yellow fever in the African country.

The GAVI Alliance and the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG1) supported the reactive mass vaccination campaign. The health districts considered to be at high risk for yellow fever are Dibombari, Edea, Loum, Manjo, Manoka, Mbanga, Melong, Ndom, Ngambe, Nkondjock, Nkongsamba, Pouma and Yabass.

The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), Medecins Sans Frontieres (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.

by RTT Staff Writer

GPs in UK warned yellow fever vaccine supplies are 'limited'

GPs have been advised they may have to ration the use of yellow fever vaccine after the manufacturer reported delays in the supply of the vaccine lasting until next year.

Sanofi Pasteur MSD is currently experiencing a delay in the manufacturing process of yellow fever vaccine Stamaril, in a situation it says is likely to continue until January 2014.

Public Health England said it was aware of the problem, and that it was advising patients to check whether their local vaccination centre had adequate supplies of the vaccine before going there.

A spokesman for Sanofi Pasteur MSD said they had a ‘temporary manufacturing issue’ with Stamaril and that the company awaited the results of a ‘quality investigation’.

The spokesman added: ‘Sanofi Pasteur MSD expects the shortage in supply to last until January 2014. Sanofi Pasteur MSD is communicating with the MHRA and is also in touch with customers regarding the impact of the shortage in yellow fever vaccine supplies for the UK. We are working closely with the regulatory authority to find a solution.’

Public Health England said: ‘PHE is aware the yellow fever vaccination supplies are limited. As yellow fever vaccine can only be administered in registered yellow fever vaccination centres, we strongly advise health professionals advising travellers to check the National Travel Health Network and Centre website for the latest information on yellow fever. Travellers should consult their nearest yellow fever vaccination centre or check the NaTHNaC website for further advice.’

RCGP immunisation lead Dr George Kassianos said that the problems came as there was only one manufacturer of yellow fever vaccine and advised that rationing may be necessary.

He said: ‘Where there is shortage, and if we had to ration the vaccine, I would suggest we give priority to first-time vaccinees, as those who had a dose of this live vaccine before would almost certainly have adequate antibody to protect them from this infectious disease – one dose gives life-long immunity.’

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Comment: The importance for India lies in the fact that Stamaril, the Yellow Fever vaccine from Sanofi Aventis is the sole brand available in the private sector, and hence our supply is likely to remain affected too till these 'manufacturing issues' are sorted out.

Question about Yellow Fever Vaccine & Vitiligo

Q: I have read on the government website that Yellow Fever vaccination should not be given in 'immune diseases'. My son has Vitiligo & I am worried that this may be a problem for giving him Yellow Fever Vaccine.
A: There is no problem in giving Yellow Fever Vaccine to a person with Vitiligo. Vitiligo is an auto immune condition, and giving this vaccine is not going to be a contraindication. Yellow Fever vaccine is a live vaccine, and hence it is NOT recommended if the person has severe immuno-deficiency (very low immunity). There is no issue in giving yellow fever vaccine for people who have auto-immune diseases (like vitiligo). 

Nigeria brings in to use new Yellow Fever cards to prevent fraud

Nigeria formally brought into use an updated certificate for yellow fever vaccination (yellow fever) yesterday in Abuja.

Flagging off the official distribution yesterday in Abuja, the minister of health, Prof Onyebuchi Chukwu, cautioned Nigerians to get updated with the new one so that they don’t get embarrassed when they travel out of the country.

He said that the security-enhanced yellow fever cards had been in circulation for some time and so the old cards will no longer be valid by October.

The minister said that the new yellow fever card comes with at least seven enhanced security features, including special-security ink and stamp, owing to a row between Nigeria and South Africa last year over the authenticity of yellow cards issued to travellers from Nigeria.

Chukwu said that easy access to the old N500 cards was “part of the confusion” leading to the diplomatic row with South Africa, which deported hundreds of Nigerians at the height of the yellow fever card impasse.

A consultant specialist in charge of port health services, Dr Sani Gwarzo, said, “No two offices have the same code. As soon as we see a yellow card, we see the code.

, we know from which office it comes from.”

The new cards spell the end of decentralised printing and distribution of yellow fever cards by individual state governments and the private sector, which the National Council on Health permitted years ago in efforts to make the cards easily accessible to travellers.

Immunisation for yellow fever can also be accessed at its six international airports, nine seaports, 16 land borders, and new port health services offices opening up in all 36 states.

- See more at: http://leadership.ng/news/170913/new-yellow-card-officially-comes-use-minister#sthash.nwzOEFrT.dpuf

Comment: Given that there have been rumors of fake Yellow Fever Vaccination cards circulating in India too, it is certainly possible that a similar step may need to be initiated to prevent misuse of WHO vaccination cards at some point of time

Yellow Fever Vaccine in short supply in Isle of Man

Health officials have declared the vaccination that guards people against yellow fever is in limited stock in the Isle of Man. 

The people of the island have been advised not to go to Africa or South America due to the shortage as these countries have infection of yellow fever. This disease is caused by a virus belonging to the Flaviviridae family and is passed on by mosquitoes.

Vaccines for yellow fever are in limited stock since July and would be carried on till January 2014. Symptoms such as high fever, jaundice, low blood pressure and kidney failure are symptoms of the disease.

It's a wide-spread disease in tropical Africa and South America. Nearly, 200,000 cases are reported every year and 30,000 die of the disease. This figure is estimated by the World Health Organization. There are four centers registered for providing Vaccination for Yellow Fever in the Isle of Man.

The pace where you practice your GP may not be a registered center for yellow fever vaccination, they may give you advice and provide vaccination against yellow fever, still they won't be capable of administering vaccination for yellow fever, said a spokesman.

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Comment: So the shortage of Yellow Fever vaccine is not only an Indian phenomenon, the bureaucracies of other countries can be as lethargic as ours !

FAQ on Yellow Fever vaccination during pregnancy

Question: My wife is 6 months pregnant and we are traveling to Ethiopia, should she take the Yellow Fever Vaccine ?
Ans. Pregnancy is NOT a contraindication for Yellow Fever Vaccination, but is a precaution.
Given that Yellow Fever cases have been recently reported from Ethiopia, I would suggest that the vaccination for Yellow Fever may be given in this situation after counseling that it is not likely to cause any problems at this stage of pregnancy. 
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Alternatively, you can take the vaccination in Ethiopia after the delivery of the baby, but it is preferable to wait for at least 4 months if the mother is breastfeeding the baby in this situation.
You can contact the Travel health experts at TravelSafe Clinic for a medical waiver in this case.

Yellow fever in Ethiopia

31 MAY 2013 - The Ministry of Health of Ethiopia is launching an emergency mass-vaccination campaign against yellow fever from 10 June 2013. This is in response to laboratory confirmation of six cases in the country on 7 May 2013.

The campaign aims to cover more than 527, 000 people in the following six districts: South Ari, North Ari, Benatsemay, Selamago, Hammer, and Gnangatom and one administrative town (Jinka) in South Omo Zone of the Southern Nations, Nationalities and Peoples’ region (SNNPR) of Ethiopia.

The International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG11) will provide over 585,800 doses of yellow fever vaccine for the mass vaccination campaign run by the Ministry of Health in Ethiopia, with support from the GAVI Alliance and other partners. WHO is closely supporting the outbreak investigation, capacity building for case management, resource mobilization for outbreak management, and monitoring preventive and control activities in the field.

The six laboratory-confirmed cases are from South Omo, in the Southern Nations, Nationalities and Peoples' region. The cases were identified through the national surveillance programme for yellow fever. The index case was a 39-year-old man who presented with fever and jaundice and haemorrhagic signs in January 2013. He was laboratory-confirmed by IgM (antibody test). Differential diagnosis for other flaviviruses was negative.

The laboratory confirmation was done by Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.

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Parent Question about Yellow fever vaccine & breast feeding 9 month baby?

Ques: Hello sir, I am from chennai, right now residing in west africa. I want to bring my family.I have a 9 months breastfeeding baby. is it advice that both of them can take yellow fever vaccination.please reply
regards 
Ans. Yes, Both the mother & the baby can take the vaccination if the baby is above 6 months.

Regards

Dr Gupta

CDC Update on Polio status in Israel, recommendations for travelers

Current Situation in Israel

On June 3, 2013, the WHO Disease Outbreak News reported detection of WPV type 1 in samples of sewage from Rahat, a Bedouin village in the Southern District of Israel. WHO assessed the risk of spread to other countries as “low to moderate” at that time (see the WHO report).

By July 15, testing had identified a total of 10 WPV-positive sampling sites in the Southern District (some with multiple WPV-positive specimens collected serially). WHO issued an update and assessed the risk of spread as “moderate to high” (see the WHO report). Since then, some sampling sites in the Central District have also yielded positive results.

On August 15, WHO issued further information indicating WPV had been detected in 67 sewage samples taken during February 3, 2013, through August 4, 2013. These samples were taken from sites in the Southern and Central Districts. WHO also indicated that positive stool specimens had been collected from some healthy children who had been fully-vaccinated with IPV (see the WHO report).

No human polio cases have been identified in Israel to date. Childhood vaccination coverage in Israel with 4 doses of IPV is very high (90%–95%). Israel also has an extensive system of environmental surveillance (i.e., testing of sewage samples for poliovirus). The Israel Ministry of Health is recommending increased attention to hand washing and undertaking catch-up vaccination of children who have not completed the polio vaccination series. On August 4, 2013, the Ministry of Health also initiated a campaign to vaccinate all children born since 2004 (and aged >2 months) in the Southern District with bivalent oral polio vaccine (OPV). On August 18th, the Ministry of Health extended the campaign nationally to vaccinate all children born since 2004.

At this time, CDC recommends that all travelers to Israel be fully vaccinated against polio and practice good personal hygiene and cleanliness. In addition, adults should receive a one-time IPV booster dose before traveling to Israel. See the Vaccine section in Chapter 3, Poliomyelitis,CDC Health Information for International Travel, for specific vaccination details.

Comments:  This update confirms what many experts have been suggesting for long, we need intensive surveillance to actually stamp out Polio from the World, once & for all. With the resistance in some Muslim communities, along with political issues, this challenge of polio eradication still remains, and we cannot afford to become lax in our commitment in India & the world to eradicate Polio once & for all. 

Polio in Somalia, Kenya and Ethiopia, Alert Level 2

Centers for Disease Control and Prevention: Alert Level 2: Additional Precautions: September 6, 2013 

According to the website: Global Polio Eradication Initiative, dated 4 September 2013, 160 cases of polio were reported in Somalia since April 2013. These are the first cases of wild poliovirus reported in Somalia since 2007.

Also, 13 cases of polio were reported in Kenya. These are the first confirmed cases of wild poliovirus in Kenya since July 2011. One of the cases mentioned comes from the Somali region of Ethiopia. This is the first reported case of wild poliovirus in Ethiopia since 2008.
The CDC recommends that all travelers to Somalia, Kenya and Ethiopia to ensure you receive vaccines against polio. In addition, adults should receive a booster dose of polio vaccine.
Because of the risk of inter-regional transmission, the CDC recommends the booster dose of polio for adults who will travel to Djibouti, Eritrea, South Sudan and Yemen, as well as for travelers who work in the middle hospitals, refugee camps and other humanitarian organizations. Any type of work can put travelers in contact with carriers of the disease.

Source: http://wwwnc.cdc.gov/travel/notices/alert/polio-somalia-kenya

Latest Dengue statistics from India

Published Date: 2013-09-01 21:27:11
Subject: PRO/EDR> Dengue/DHF update (72): Asia 
Archive Number: 20130901.1917233

DENGUE/DHF UPDATE (72): ASIA

India:
- Metro Kamrup, Assam state. 29 Aug 2013. Dengue 18 current cases; Deaths 3.
http://www.business-standard.com/article/pti-stories/three-dengue-deaths-in-guwahati-113082900777_1.html

[Maps of India can be seen at
http://www.mapsofindia.com/maps/india/india-political-map.htm and
http://healthmap.org/r/1pSH. - Mod.TY]

- Delhi. 28 Aug 2013. Dengue as of 24 Aug 2013, 96 cases; Dengue virus circulating type 2.
http://articles.timesofindia.indiatimes.com/2013-08-28/delhi/41537121_1_dengue-fever-dengue-wards-spreading-mosquito-borne-viral-disease

- Bophal, Madhya Pradesh state. 26 Aug 2013. Dengue 17 cases; Deaths 2.
http://timesofindia.indiatimes.com/city/bhopal/Dengue-outbreak-Health-department-presses-panic-button/articleshow/22062626.cms

[Two deaths among 17 cases is a very high number and leads one to wonder whether the total number of cases is underreported and much higher.

- Mumbai, Maharashtra state. 28 Aug 2013. Dengue (conf.) 381 cases; Deaths 2.
http://www.mumbaimirror.com/mumbai/others/23-yr-old-dies-of-dengue-2nd-death-in-Aug/articleshow/22108271.cms

- Odisha state. 29 Aug 2013. Dengue since 1 Jun 2013, (conf.) 2087 cases; Municipalities most affected: Cuttack 885 cases, Khordha 364 cases, Angul 265 cases.
http://health.india.com/news/odisha-dengue-update-29-new-cases-reported/

- Angul district, Odishia state. 26 Aug 2013. Dengue 190 cases; Increasing.
http://newindianexpress.com/states/odisha/Dengue-cases-shoot-up-to-190-in-Angul/2013/08/26/article1752539.ece

Dengue cases increase in Thailand

Published Date: 2013-09-01 21:27:11
Subject: PRO/EDR> Dengue/DHF update (72): Asia 
Archive Number: 20130901.1917233

DENGUE/DHF UPDATE (72): ASIA
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Thailand
Date: Thu 29 Aug 2013
Source: Pattaya Mail [edited]
http://www.pattayamail.com/news/10-000-with-chiang-mai-dengue-fever-29722


More than 10 000 patients in the northern province of Chiang Mai have suffered dengue fever this year [2013] with 8 fatalities from the virus, according to a top Public Health Ministry official.

Chiang Mai Public Health Office deputy director Dr Surasingha Wisarutrat said 10 017 persons have been diagnosed with dengue fever since January [2013], with 9320 of the afflicted being Thais, while 697 were migrant workers from neighbouring countries. He said that 8 have died from the disease and added that the most affected were Mae Ai district followed by Mae Taeng and Doi Tao districts.

Dr Surasingha said the Chiang Mai Health Office has urged all communities in the province to help implement pro-active measures to prevent the spread of the disease. He said that although the dengue fever epidemic has declined, the effort to destroy larvae breeding sites should continue.

The public health office will conduct a Big Cleaning Day in villages and communities beginning in September [2013] to eradicate the mosquito larvae.

--
Communicated by:
PRO/MBDS


[According to the above newswire, the numbers of dengue fever cases in Thailand are increasing. The newswire reported that 10 017 persons have been diagnosed with dengue fever since January 2013, including 9320 Thai nationals and 697 migrant workers from neighbouring countries; 8 persons died of dengue fever. The most affected were Mae Ai district, followed by Mae Taeng and Doi Tao districts.

The Thailand Ministry of Public Health's Bureau of Epidemiology national disease surveillance (Report 506) stated that from 1 Jan 2013 to 25 Aug 2013, a total of 62 087 cases were reported from 77 provinces, and the morbidity rate was 97.74 per 100 000 population. There were 7 deaths; the morbidity rate was 0.01 per 100 000 population. The cases were 97.3 percent Thai, 1.9 percent Burmese, 0.5 percent other, 0.1 percent Laotian, 0.1 percent Cambodian; 0.0 percent Chinese, Vietnamese and Malaysian. Seehttp://www.boe.moph.go.th/boedb/surdata/506wk/y56/en/d66_3456_en.pdf.

The patient numbers in Thailand tripled last year's (2012) figure. They could reach 150 000 cases this year (2013), and the fatalities could rise to 100-150. See PRO/MBDS posting "Dengue - Thailand (06) 20130621.1419."