Riteish Deshmukh, Bollywood actor is suffering from Yellow fever

Before you come to any conclusions about actor Riteish Deshmukh being down with the yellow fever disease, here's what it is all about. 

Riteish is ready with his second Marathi production venture 'Yellow'. After dealing with a serious topic like sex education in his first film, 'BP Balak Palak', Riteish will explore the topic of Down syndrome in 'Yellow'. The actor recently took to a micro-blogging site to show how he has made his phone cover yellow as well. 'My mobile turns YELLOW,' he wrote. Riteish sure knows how to promote his film well. The film 'Yellow' stars Mrinal Kulkarni, Upendra Limaye, Manoj Joshi and others.

TNN | Mar 26, 2014, 01.35PM IST
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If I am going to a country on WHO list, but has not had any Yellow Fever cases in years, do I still need the Yellow Fever vaccine?

Q: If I am going to a country on WHO list of countries, but has not had any Yellow Fever cases in years, do I still need the Yellow Fever vaccine?
A: What you are basically saying is that if the country has not had any cases of Yellow Fever disease reported for many years, is there still a risk of catching Yellow Fever. The answer is YES.
Here is a brief excerpt from a leading Travel Health Expert
"Mind the phenomenon  "epidemiologic silence" - the zoonotic (yellow fever) virus may be present for decades in the forest without "outbreak". Some cases of yellow fever in tourists in South America described in the literature were in unvaccinated tourists doing a cruise for a few days near Manaus - not during an outbreak. Remind the epidemics in the rift valley in Kenya in the nineties  - the came out of the blue, but the virus was present there in the nature all time. We personally described in Clinical Infectious Diseases 2002; 35:e113-6  a Belgian lady who catched yellow fever within a FEW days during a stay in Gambia, 5-stars hotel, but visiting game parks during daytime - fatal -  there were no human cases for decades in Gambia (probably because of the good vaccination coverage), so indeed the disease may be present in nature, lingering around between mosquitos and monkeys in the trees
Fons Van Gompel MD, DTM.

Chief Physician of the Medical Services & Travel Clinic
Institute for Tropical Medicine Antwerp Belgium."

Comment: What this means is that while no humans may be getting infected, the Yellow Fever virus can still survive in the wild, being transmitted in monkeys & mosquitoes. Hence if you are going to an area with 'possible' Yellow Fever, even if this has not happened in years, it is preferable to be vaccinated, unless you have contraindications to the same. Talk to your travel health doctor, or call the experts in India at +91 - 8010777722

Traveling to India - what is the 'most important' vaccines the tourist needs - Expert Opinions

Q: What vaccines are the 'most important' when traveling to developing countries like India?
A: These are excerpts from our discussion in the ISTM list (International Society of Travel Medicine) for the tourist who is reluctant to take a lot of vaccines, or cannot afford them (vaccines are ridiculously expensive in USA & many other developed countries).
Of course there is a list of vaccines/ travel health recommendations from CDC that will provide a comprehensive overview to travelers, but for an individual, here are some guidelines that may be helpful.

Dr John D Wilson has summarized things quite well, and here is his view

>> The patient should take some responsibility in decision-making, since it
>> is his money, and his body which would be affected by disease or side
>> effects.
>>
>> Consider outlining for him each disease (what the disease is like, how it
>> feels, incidence, morbidity, etc), and each vaccine (efficacy, side effects
>> and cost), then make recommendations, let him decide, and intervene if he
>> is making a big mistake. Emphasize that if there is risk for a given
>> disease, getting the vaccine is much safer than getting the disease.
>>
>> Priority:
>> 1. Hep A (highest priority)
>> 2. MMR, 2 doses a month apart before departure, very important - explain
>> how common measles is in India, and how communicable it is, and what
>> happens to susceptibles if they are on a plane with someone with early
>> undiagnosed but communicable measles
>> 3. Influenza vaccine is probably more important than typhoid vaccine if
>> the trip is short
>> 4. Tdap (more for home risk) - show him the NEJM video of a pertussis
>> patient   http://www.nejm.org/doi/full/10.1056/NEJMicm1111819 - there
>> will be is the opportunity for 2 more Td to complete the series over the
>> next year after return - tell him I've seen tetanus twice; each patient was
>> on a respirator in the ICU for 6 weeks.
>>
>> For the short trip, incidence of typhoid fever is 0.1% per year, or 0.004%
>> (40 per million) for a 2 week trip.
>> Polio and hep B are even farther down the list. There are reasons to give
>> a compressed series of polio vaccine, but it is less essential than those
>> above.
>>
>> An antimalarial, insect repellent, azithro for diarrhea treatment. Talk to
>> him about jet lag.
>>
>> For a short trip, point out that his preference to minimize vaccines
>> make tight food/water precautions and aggressive mosquito precautions
>> (malaria, JE, dengue) even more important. And avoid stray dogs.
>>
>> If the trip is long (or he is returning again in the near future to India
>> or another place with typhoid), oral typhoid vaccine, rabies vaccine, polio
>> vaccine, hep B vaccine, mefloquine trial, purchase of a bednet, purchase of
>> clothing with permethrin and perhaps sunblock, are all
>> long-term investments.
>>
>>
>> John D. Wilson, M.D.
>> The Travel Clinic, USA


COMMENTS: Some of the other experts agreed with the list in general, but also commented about possible need of Malaria Pills (except in low risk places like Delhi, Bangalore). 
I would like to consider Typhoid & Rabies Vaccine as well, given the significant morbidity and misdiagnosis with Typhoid, and high level of Antibiotic resistance. The high number of Dog bites occurring in India, are a reason that Rabies vaccine may be considered here as well.

Mosquitoes that spread dengue and yellow fever found at Melbourne Airport

Mosquitoes that spread the potentially deadly dengue and yellow fever viruses have been found at Melbourne Airport in what appears to be a serious breach of Australia's stringent quarantine system.

The discovery has sparked fears that colonies of the mosquitoes could be spreading into the surrounding environment and travelling interstate on passenger and cargo planes.

The same type of mosquitoes are also believed to have been found at airports in Adelaide and Perth.

Fairfax Media can reveal that bio-security officers from the Department of Agriculture discovered the mosquitoes during a routine inspection of the plastic, water-filled bollards used to manage traffic in and around the airport.

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The mosquitoes were first detected in bollards inside the airport's baggage tunnels.

Health authorities have begun implementing an eradication plan to deal with the potential threat to public health. The plan has involved spraying baggage tunnels with insecticide and poisoning the breeding sites in the bollards with larvicide.

"Department of Agriculture and the state Health Department are liaising with the airport to ensure all identified breeding sites are effectively treated," a Department of Agriculture spokesman said.

"[The department] is currently undertaking enhanced surveillance at the airport, including daily monitoring of mosquito traps."

The aedes aegypti mosquito, which is a common "vector" for spreading diseases like dengue and yellow fever, are typically found in tropical and subtropical climates such as in Queensland, Africa and Asia.

The symptoms of dengue fever, also known as breakbone fever, include fever, headache, joint and muscle pain, vomiting and diarrhoea. Its advanced but rare forms – dengue haemorrhagic fever and dengue shock syndrome – can result in organ damage, coma and death.

Sources say an investigation is under way to discover how the mosquitoes slipped through Australia's stringent quarantine protocols.

The revelations come as the federal government is pushing to cut costs in the Department of Agriculture. About 230 jobs are tipped to go in the next financial year, including 34 in Victoria.

Community and Public Sector Union national secretary Nadine Flood said the union was "deeply concerned" about the impact of ongoing cuts on frontline bio-security and border protection services. "The risk here is that government saves a dollar now but faces massive costs down the track when dealing with disease."

The Victorian Department of Health reports 64 people had dengue fever in Victoria from January to early March, down from 79 people in the same period in 2013 and 105 in 2012. These cases typically involved infected travellers returning home.

Read more: http://www.theage.com.au/victoria/mosquitoes-that-spread-dengue-and-yellow-fever-found-at-melbourne-airport-20140315-34tno.html#ixzz2wlliDVkw

Yellow Fever Mosquito likely to stay in California Valley

FRESNO, Calif. (KFSN) -- A potentially dangerous mosquito species that was first spotted in the Valley last year, maybe here to stay.

Local biologists were hoping the winter killed off the Aedes Aegypti, more commonly known as the "yellow fever" mosquito. But this month, biologists found three of them in traps they set throughout Clovis.

Jodi Holeman, a biologist with the Consolidated Mosquito Abatement District, says the mosquitoes were caught by a trap set along Twain Ave. The first was found on Mar. 7th, and another was found 10 days later on Mar. 17th. A third "yellow fever" mosquito was found on Mar. 10th in a trap set at a nearby neighborhood.

The mosquito species has a distinct black and white pattern. They can carry yellow fever, dengue and Chikungunya. That's why officials are also setting special traps to catch live mosquitoes for disease testing. So far none in California have tested positive for diseases.

"The concern is if somebody is traveling abroad, picks up that illness and comes to this area, we now have something that can transmit it to other people. That didn't exist before," Holeman said.

Holeman says the mosquitoes are usually found in the tropics. Experts haven't been able to explain why they suddenly started showing up in the valley last June, but they hoped they wouldn't survive the winter.

Steve Mulligan, the district manager of the Consolidated Mosquito Abatement District, says they are trying to determine whether or not the Aedes Aegypti population will be larger this year.

"It will be again probably be active in that local area where we found it last year and possibly spread out from there," he said.

He says the Valley is looking at warmer weather which is good for mosquito breeding. He points to the fact that it's been a dry year, but he says it doesn't take much for the mosquitoes to breed.

"People are starting to irrigate their lawns and that irrigation can fill up containers," he said. He points to containers like water bowls for pets, bird baths, toys and especially dishes under plants.

By cracking down on water sources for breeding, Mulligan says it won't just help control the yellow fever mosquito population, but the common mosquito as well. Those can carry West Nile Virus, which is still, and always will be, a concern.

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Comment: This does not mean that Yellow Fever disease is likely to return to US in the immediate future, but travelers to countries having Yellow Fever disease require to be screened more vigilantly when they travel back to US or any other country having these mosquitoes.

Brazil World Cup healthy travel - NATHNAC UK recommends

7th March 2014 – If you're lucky enough to be travelling to Brazil for the World Cup now is the time to seek travel health advice.

With less than 100 days to go until kick off, Public Health England (PHE) and the National Travel Health Network and Centre (NaTHNaC) have published a factsheet for UK travellers going to Brazil with information on how to stay healthy.

Dr Dipti Patel, joint director at NaTHNaC says in a prepared statement: "We would encourage fans to seek travel health advice early, ideally 4 to 6 weeks before travel, to ensure they have ample time to organise any preventive measures like vaccinations or antimalarial tablets that they may need. It’s also very important that people take out comprehensive health insurance."

Even if you are travelling last minute, it’s never too late to get advice; some vaccines can be given at short notice and antimalarial tablets, if needed, can be started just before travel, including on the day you leave.

Brazil is a huge country, with a variable climate, so your health risks will depend on where you are going and what you are doing.

Yellow Fever - vaccination

There is a risk of yellow fever in many parts of Brazil and the state of Amazonas is recognised as a yellow fever zone. Manaus, where England plays its first match, is the capital of the state of Amazonas.

Yellow fever is a viral disease. It's transmitted via the bite of an infected Aedes mosquito. These mosquitoes feed predominantly during daylight hours.

You can try to prevent bites by applying insect repellent, ideally containing 30-50% DEET, to exposed areas of skin and covering up as much as possible with loose-fitting, lightweight clothes. You can apply an insecticide, such as permethrin, to clothing, which will kill mosquitoes on contact but permethrin should not be used directly on the skin.

Yellow fever symptoms vary from a flu-like illness that gets better on its own over several days to a severe illness with organ failure and death.

Yellow fever vaccine should be given to those travelling to the states of Acre, Amapá, Amazonas, Distrito Federal, Goias, Maranhaõ, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima and Tocantins,and specific areas in the states of Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina and São Paulo. Vaccination is also recommended for travel to Iguaçu Falls.

Yellow fever (YF) vaccine is not recommended if you're only travelling to coastal cities, including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador and Sǎo Paulo.

Vaccination can only be given in approved yellow fever vaccination centres (YFVC). If you're lucky your local GP may be a YFVC, but if not, you can find one on the NaTHNaC website.

YF vaccine must be given 10 days or more before your trip to be effective and to be officially accepted by the country to which you are travelling. Travellers who are leaving sooner than the 10 day interval should discuss with their YFVC whether to get YF vaccine. An official record of your vaccination may be requested by immigration officials.

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Yellow fever vaccination for 2 month pregnant lady to Nairobi, Kenya - what to do ?

I have a 2 month pregnant lady going to stay with her husband in Nairobi, Kenya, and planning for delivery there, should she be vaccinated against Yellow Fever Vaccination or be given a waiver? 

Here is how I proceeded

First question in my mind - Is it safe to use this vaccine in Pregnancy, especially in the first trimester?

Yellow fever vaccination is a PRECAUTION ( & not a contraindication) in pregnancy. Since this is a live vaccine and there is a theoretical risk of transmission of the virus to the baby (though this has never been proven to have ever happened!) it is to be used only if the benefits of vaccination outweigh the risks.

As per Drugs.com 

"Yellow fever vaccine has been assigned to pregnancy category C by the FDA. Animal studies have not been reported. There are no large-scale controlled safety studies; however, congenital abnormalities have not been reported. The seroconversion rate to vaccines is significantly lower in pregnant women. Serologic testing should be considered to document an immune response. There is a concern that transplacental passage of the virus may occur. The theoretical risks of immunization may be outweighed by the risk of infection and complications to the mother and fetus if the mother is travelling to an area where there is a high risk of acquiring yellow fever infection. Nonimmune women should generally postpone vaccination and travel to endemic/epidemic areas during pregnancy. If travel and/or exposure is unavoidable, vaccination is preferable after the first trimester. Infants of vaccinees should be monitored for congenital infection and other possible adverse effects. Yellow fever vaccine should be given to a pregnant woman only if clearly needed. The U.S. Centers for Disease Control and Prevention (CDC) recommend postponing travel and yellow fever vaccination until 9 months after delivery. If a pregnant woman is traveling to or transiting through areas where a vaccination certificate is required but the disease is not currently a threat, the CDC advise carrying a physician's waiver along with documentation of the waiver on the immunization record."

There are contradictory references regarding using this vaccine in the first trimester, this French reference  states that if you have to give the vaccine, the best chances of an immune response are in the first trimester.

The second question in my mind is - Is it effective to give the vaccine in pregnancy?

As seen above, the immune response is sub optimal, and should ideally be checked later. However, these tests are NOT available easily, and would probably be very expensive as well.

Finally, the third and probably the most important question in my mind - is the lady at a high risk for getting Yellow fever disease where she is traveling?

As per this source onTripavisor

"In April 2011, the World Health Authority and therefore the UK National Travel Health Network and Centre, NaTHNaC, changed their advice to travellers,  it now says -

"There is a low potential for exposure to yellow fever in the North Eastern province, the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in Coastal province, and the cities of Nairobi and Mombasa."

Vaccination is now not normally recommended if you are only visiting these areas.

The remaining areas of Kenya are in the red area on the WHO map, which WHO calls the 'endemic' area. They think the disease may be there all the time or may come and go but they also admit ❝the level of transmission may be low and escape detection when only human case surveillance is employed❞. Basically they suspect it is there because they know it is in the countries bordering that area but can't prove it either way, so they err on the side of caution.

In May 2013 the Kenyan Government launched an exercise in association with the WHO and others to gather info to support a case to have Kenya removed from the high-risk list of countries and reclassified as a low-risk or no-risk country."

In conclusion : There is a negligible risk of getting Yellow Fever if the lady stays in Nairobi,Kenya till delivery.  The risk of Yellow fever vaccine in pregnancy at first trimester is theoretical, but exists. In this situation, looking the benefit versus risk, I would likely issue a medical waiver to this lady and advise her to take the vaccination as per CDC recommendations, 9 months after the delivery of the baby. In the meantime, avoiding insect bites, and avoiding travel to areas with a high risk of Yellow Fever disease would be advised. 

National Travel Health Network & Center - NaTHNaC, Britain updates Polio guidelines for India

Clinical Updates

5 February 2014

India: Poliomyelitis vaccination requirement for resident national travellers from countries reporting polio cases - update

On 13 January, 2014 the World Health Organization (WHO) announced that India had been polio free for three years [1]. It is anticipated that the South East Asia Region of the World Health Organization will also announce polio free status in March 2014 [2, 3].

India remains vulnerable to the re-introduction of poliomyelitis viruses and is currently implementing measures to minimise this risk. Mass polio immunization campaigns are being implemented [3].

In addition, as of 1 March 2014, the Government of India will implement a requirement for oral polio vaccination (OPV),given at least four weeks before departure to India, from all resident national travellers from polio endemic (infected) countries (Afghanistan, Nigeria and Pakistan) and  re-infected (importation) countries (Ethiopia, Kenya, Somalia and Syria [3, 4]. It is not mandatory for foreign nationals residing in the seven polio infected countries or for passengers in transit through these countries to receive vaccination with OPV before travel to India [4].

Indian residents who are travelling ‘outbound’ to countries with ongoing polio transmission are also required to receive a dose of OPV at least four weeks before departure. It is not mandatory for foreign nationals residing in India to receive the OPV before travelling on to polio infected countries [4].

The list of polio infected countries may be amended by the Ministry of Health and Family Welfare, Government of India, depending on polio virus detection.

All travellers, independent of destination, should have completed a primary vaccination course for polio (inactivated vaccine) according to the UK schedule.

NaTHNaC recommends that travellers visiting countries where cases of wild type polio have been reported since January 2010 (this includes India) should have received a booster dose of polio-containing vaccine if they have not received one within the past 10 years.

Country specific travel health advice for India can be found on the NaTHNaC Country Information Page.

References

1. World Health Organization. Polio Global Eradication Initiative. India’s Anniversary: Celebrating Three Years Polio-Free [Accessed 5 February, 2014]. Available at:http://www.polioeradication.org/tabid/488/iid/347/

Default.aspx

2. World Health Organization, Regional Office for South-East Asia. India three years polio-free. 13 January 2014. [Accessed 5February, 2014]. Available at:http://www.searo.who.int/mediacentre/features/2014/sea-polio/en/index.htm

3. World Health Organization. South East Asia Regional Office (SEARO). Keeping the polio virus at bay. [Accessed 5 February, 2014]. Available at:http://www.searo.who.int/india/topics/poliomyelitis/polio_

eradication/en/index.html

4. Ministry of Health and Family Welfare, Government of India, Requirements of polio vaccination for International Travellers between India and polio infected countries, [Accessed 5 February 2014] Available at: http://mohfw.nic.in/showfile.php?lid=2634

Links

Global Polio Eradication Initiative

World Health Organization: Polio

NaTHNaC News Item: World Health Organization announces that India is polio free

NaTHNaC Clinical Update 20 January, 2014: Changes to NaTHNaC Country Information Pages: Polio

Government of India, Requirements of polio vaccination for international travellers

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Why do mosquitoes bite us?

Multiple sensory cues draw mosquitoes to hosts

Feb 28, 2014 by Leslie Church

It may seem like mosquitoes will bite anything with a pulse, but they're actually quite strategic in picking their victims. A new study from The Rockefeller University looked at the interaction of different sensory cues—carbon dioxide, heat and odor—that attract mosquitoes to humans, and found that it takes a combination of at least two of these to send the bugs biting.

While scientists have known that CO2 drives mosquitoes to humans, researchers from Leslie Vosshall's Laboratory of Neurogenetics and Behavior wanted to flesh out the details of how this worked. So they used a genome editing technique to engineer a mutant version of the Aedes aegypti mosquito, which spreads yellow fever. The mutant was missing a specific gene, known as Gr3, which codes for a carbon dioxide receptor. Without Gr3, the mosquitoes were unable to detect the gas.

Led by postdoc Conor McMeniman, the researchers first looked at the mutant mosquitoes' behavior inside a chamber that held a plate heated to the temperature of human skin. Normal mosquitoes weren't attracted to the warmth unless carbon dioxide was also emanating from it, and mutants weren't drawn to the plate at all. The team found a similar interaction between lactic acid—a compound in human breath and skin odor—and CO2: attraction to the odor was dependent on the presence of carbon dioxide.

"Relying on multiple sensory cues helps organisms make informed decisions about context-dependent behaviors," says McMeniman. "In the case of a female mosquito, this would allow her to accurately hone in on a human host to blood feed."

When the scientists tested the ability of these CO2-blind mutants to find humans in a real-world set-up, the difference between mutants and normal mosquitoes was less significant. The insects were examined in a humid, greenhouse-type enclosure in Australia, where human volunteers sat and captured the insects as they landed on them. McMeniman devised a way to make the mutant mosquitoes glow in the dark, and counted them afterward. The mosquitoes without CO2-sensing abilities were only impaired by 15 percent. The mutants were clued in by other factors—the combination of heat and odor coming off the human subjects. However, when a similar concept was tested on a larger scale, with a mouse as the subject, the mutants were much less likely to bite, meaning that without carbon dioxide as a cue, the effect of odor and heat are diminished as the insect moves farther away from the host.

For mosquitoes, access to blood is crucial. It is only the female mosquitoes that bite, and the blood they collect is necessary to produce fertile eggs.

"Because blood feeding is such an important behavior for the mosquito, evolution has built in these mechanisms that ensure the most efficient use of the insect's energy," says McMeniman. "There are a lot of things that give off heat, and it would be a waste for a mosquito to try to bite all of them. But with several factors present, the insect can increase her chances of a fruitful bite in a cluttered sensory environment."

Understanding the genetic basis of mosquito attraction to humans can help inform the design of chemical repellents to block host-seeking behavior in both Aedes aegypti and Anopheles gambiae, which spreads malaria.

"There is some research being done into repellents that target a single sensory modality, such as preventing the mosquito from perceiving odor, but we've shown that this would not be sufficient," says McMeniman. "Manipulating mosquito sensory perception from several angles would be a better strategy toward to deterring them from finding and infecting humans."

 Explore further: Mutant mosquitoes lose their appetite for humans

More information: "Multimodal Integration of Carbon Dioxide and Other Sensory Cues Drives Mosquito Attraction to Humans." Conor J. McMeniman, Román A. Corfas, Benjamin J. Matthews, Scott A. Ritchie and Leslie B. Vosshall. Cell 156: 1060-1071 (February 27,2014) DOI: 10.1016/j.cell.2013.12.044

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Yellow fever vaccine is now available in the island of mann, Europe

Yellow fever vaccine is now available in the island of mann.

This vaccine has been unavailable since last summer, however all three local designated yellow fever vaccine centres are now booking appointments for those travellers requiring it.

The yellow fever vaccine must be given at least 10 days prior to travel into a yellow fever area.

Yellow fever (YF) virus is an arthropod borne virus of the flaviviridae family.

Other flaviviruses include dengue and Japanese encephalitis viruses.

The areas at risk for transmission of YF are in tropical regions of Africa and South America.

accination against YF is available and should be recorded in an international certificate of vaccination or prophylaxis.

The illness yellow fever has a high mortality rate.

The vaccination centres are: Castletown Medical Centre. Phone 686939; Hailwood Medical Centre, Governor’s Hill, Douglas, phone 686949; and Ramsey Group Practice, Bowring Road, Ramsey. Phone 813881.

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