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.

Source

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. 
Source
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.

Source

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
****************************

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."

Fresh cholera cases reported from Senegal, Guinea, Congo, Somalia, Niger & Pakistan

Published Date: 2013-09-03 15:59:12
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (41): Africa, Asia 
Archive Number: 20130903.1913649

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (41): AFRICA, ASIA
*********************************************************
Source: Afriquinfos.com [machine trans. edited]
http://afriquinfos.com/articles/2013/8/28/guinee-cholera-fait-morts-enregistres-kouroussa-229484.asp


The cholera epidemic has produced 8 deaths among 27 cases reported in the locality of Banfele, located in the prefecture of Kouroussa in Upper Guinea, it was learned from sources close to the Department of Health. The epidemic was declared in this area on 3 Aug 2013 and has caused the mobilization of health services, which have deployed a logistics team to halt the spread of the disease.

Solutions have been distributed to the populations of Banfele, and latrines and other wells used by the inhabitants have been disinfected. In addition to these 8 deaths, there have been 10 more caused by cholera in Low Guinea and in Middle Guinea, in the prefecture of Mamou, among the 150 cases reported in these 2 regions since the month of January 2013.

The Ministry of Health and Public Hygiene has, among other measures to counteract this epidemic, conducted awareness campaigns in areas which have experienced cases of cholera.

Cholera - Congo DR (South Kivu)
Date: Wed 21 Aug 2013
Source: Radio Okapi (Kinshasa) [machine trans. edited]
http://radiookapi.net/actualite/2013/08/21/sud-kivu-19-cas-de-cholera-enregistres-en-une-semaine-minova/


19 cases of cholera have been registered in a week in the locality of Kasunyu in the territory of Minova (South Kivu). This information was delivered on Tue 20 Aug 2013 by the chief physician of the area of Minova, Dr. Chito-ryu Bagula, who attributes the resurgence of this disease to the consumption of water from Lake Kivu and the absence of public latrines. He called on the inhabitants of Kasunyu to observe sanitary practices to avoid a greater spread of the disease.

Approximately 15 000 inhabitants of the locality of Kasunyu use water from Lake Kivu for consumption and other domestic needs. "The only existing wells may not be sufficient for the entire population of this locality," stated Dr. Chito-ryu Bagula. The leader of the locality of Kasunyu, Safari Murebua, said that the swampy terrain does allow the building of latrines.

 Cholera - Somalia
Date: Tue 13 Aug 2013
Source: RFI.fr (Radio France Internationale) [machine trans. edited]
http://www.rfi.fr/afrique/20110813-somalie-entre-famine-cholera-humanitaire-epidemie-urgence


Somalia, already the victim of famine, is now faced with an epidemic of cholera. The WHO says it is very concerned about the spread of the disease in the country. Cholera has already killed 181 people at least since the beginning of 2013, according to the WHO.

Cholera - Guinea-Bissau, Niger, Senegal
Date: Sat 17 Aug 2013
Source: The Global Dispatch [edited]
http://www.theglobaldispatch.com/guinea-bissau-cholera-outbreak-risks-expected-to-linger-for-several-months-79357/


The West African country of Guinea-Bissau has reported 700 cases of cholera thus far in 2013, making it the country in the region with the most cases, according to an IRIN (the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs) report.

Guinea-Bissau's poorest region, southern Tombali, is the worst hit, with 225 cases and 21 deaths as of late July [2013], said Nicolau Almeida, a health ministry director.

The UN Children's Fund (UNICEF) reported last month [July 2013] that there have been 742 cases in Guinea-Bissau, 416 in Niger and 368 in Sierra Leone. The outbreak in Guinea-Bissau is a continuation of the 2012 epidemic, when 3359 people contracted cholera.

"To confirm a new epidemic, the 2012 outbreak should have been declared over" by demonstrating the absence of _Vibrio cholerae_ in diarrhea [cases], said Inacio Alvarenga, an epidemiologist with WHO.

"For reasons I'm not aware of, the government did not test cases in the 1st weeks of the year [2013]. These cases did not disappear but got spread around," he continued. "I don't think we will hit the 2008 level [when 14 204 people were infected and 225 killed], but the disease risks will be lingering for several months like in 1996-1998."

IRIN does point out that the numbers so far this year [2013] in Guinea-Bissau are down from 2012 levels.

Cholera - Pakistan (Federally Administered Tribal Areas)
Date: Fri 16 Aug 2013
Source: Express Tribune [edited]
http://tribune.com.pk/story/590683/deadly-disease-two-dead-over-300-affected-in-kurrams-cholera-outbreak/


Two people have died, while 320 others have fallen ill since Mon 12 Aug 2013, following a cholera outbreak in Kurram Agency.

Assistant Political Agent Fazal Naeem told The Express Tribune central parts of the agency were the most affected. He added that 250 tribesmen have been shifted to Sadda Headquarters of Lower Kurram in addition to Hangu.

Naeem said Dhand and Kudiad Khel were the worst-hit areas and that vaccinations began amid tight security. He claimed nearly all the locals have been vaccinated, adding tribesmen were instructed not to drink water directly from the well and boil it first instead.

Meanwhile, political administration official from Parachinar Naseem Khan said around 100 people have been shifted to Parachinar Headquarters Hospital, adding that critical patients were admitted, while the others were discharged after medical aid.

Comment: This is an easily preventable disease with proper sanitation, and should have been controlled years back. However political & economic factors have lead to a continuous transmission & even resurgence in many countries. Travelers to these countries are advised to take 2 doses of oral cholera vaccine (Shanchol)