Traveling abroad? A heads-up: Yellow fever vaccine is in short supply

Travelers headed to certain parts of the globe should be aware that yellow fever vaccine is in short supply.

Local providers of the vaccine generally said they have the product but recommend getting an appointment well ahead of any trips to make sure doses are available.

Only certain pharmacies and clinics are approved by the state and federal governments to distribute the vaccine — 22 in the Omaha metro area, four in Lincoln and 16 elsewhere in Nebraska. Forty-three clinics distribute the vaccine in Iowa, the federal Centers for Disease Control reports.

Mosquitoes carry the yellow fever virus in many African and South American countries. Some countries require proof of having had the yellow fever vaccine.

Most people who contract yellow fever overcome it, but it can be deadly, said Dr. Rudolf Kotula, an infectious disease specialist who founded Methodist Physicians Clinic's travel clinic, 10060 Regency Circle. In severe cases, Kotula said, there can be gastrointestinal bleeding.

There is no treatment once the disease is contracted, he said. So it's wise to get the vaccination and to use insect repellent with DEET in it when in a place where there's a risk of getting the disease, he said.

The only supplier of the vaccine to the U.S., the Sanofi Pasteur pharmaceutical firm, said allocation limitations to clinics should lighten this month and be lifted entirely by the middle of the second quarter, which would be in May. A spokesman didn't address why there's a shortage.

But Alison Kingston, a staff pharmacist with the only metro-area Hy-Vee Supermarket authorized to distribute the vaccine, said a manufacturer's representative told her that the shortage could continue through June.

Kingston said that through the shortage Sanofi has allocated only 15 doses per 150 days to her pharmacy, at 178th and Pacific Streets. Nevertheless, Kingston said, the pharmacy still has a few doses.

Marty Feltner, a pharmacist and vaccination coordinator for Kohll's Pharmacy & Homecare, said he has some doses at his two stores that are authorized to handle the yellow fever vaccine — the 84th and Center Streets store, which is the company's travel clinic, and the store at 51st and L Streets.

“Until the shortage is done, it's by appointment,” Feltner said. “I'm optimistic that in two to three months, it's going to be over.”

Feltner said that the vaccination costs about $125 and that some insurance packages participate in the payment and some don't.

Mary Lee Lusby will travel to Brazil to watch two World Cup soccer matches in June.

Lusby, a Nebraska Methodist College dean, recently went to Methodist Physician Clinic's travel clinic for a couple of vaccinations. That's when she learned about the yellow fever vaccine shortage.

“I actually had to return to get my immunization because they didn't have it on hand,” said Lusby, 61. Three days later, they had it.

Pharmacists said they are experiencing no other vaccine shortages.

Kingston at Hy-Vee recommended that travelers make appointments two to three months ahead of their trip and ask specifically about the availability of yellow fever vaccine. The Hy-Vee clinic operates jointly with Alegent Creighton Health.

The vaccine, which is injected into the shoulder, is good for 10 years. It takes the antibodies 10 to 14 days to develop.

Szuhua Lambdin, nurse practitioner at the University of Nebraska-Lincoln Health Center, said Thursday that she's been restricted to 20 doses per month, and she was down to five. But Friday, her clinic reported, another shipment came in.

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Comment: As per the International Society of Travel Medicine List serve discussion involving multiple travel health experts, the vaccine shortage is likely to continue in to the second quarter of 2014, and vaccine may be available in June 2014

Yellow Fever Reported In Democratic Republic Of Congo, Mass Vaccination Campaign To Commence In One Week

A total of 139 suspected, probable and confirmed cases of yellow fever, including 6 death were reported in the North and in the South of Democratic Republic of Congo beginning in March, which has prompted a reactive mass vaccination campaign that is planned for 1 May 2014.

According to a World Health Organization alert, six laboratory-confirmed cases with yellow fever virus infection were reported. Of these, 3 were from Bondo health zone, Orientale Province, 2 from Buta health zone, Orientale Province and 1 from Kikondja health zone, Katanga Province.

The index case, a 40-year-old man from  Bondo district  became ill with fever and jaundice on 10 December 2013. His yellow fever vaccination status is not known. Laboratory confirmation was conducted by the Institute National of Biomedical Research (INRB) in Kinshasa, which showed IgM positive by ELISA test. Reconfirmation of the laboratory test was conducted by the regional reference laboratory for yellow fever at the Institut Pasteur in Dakar, Senegal with a more specific test for yellow fever (plaque reduction neutralization test or PRNT), with exclusion of exclusion of other arbovirus.

Preliminary outbreak investigations revealed that in Bondo and the health district of Buta, at least 116 suspected cases were reported. For more infectious disease news and information, visit and “like” the Infectious Disease News Facebook page.

In Kikondja district, the index case was a 19 year-old woman reported by the Health Center of Ntwadi on 17 February 2014. The case was laboratory-confirmed by INRB and IP Dakar. Following identification of the index case, an outbreak investigation was conducted in 3 villages, Katongue, Kimbuvu and Lukila, where 23 suspected cases were identified.

International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG²), approved the provision of 559 876 doses of yellow fever vaccine and operational costs for a reactive mass vaccination campaign.

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Saudi Arabia reports 2 more deaths from MERS

The Seattle Times, 04/11/2014

Saudi health authorities said Wednesday that 11 people in the western city of Jiddah have contracted the Middle East respiratory syndrome, resulting in two recent deaths and prompting officials to temporarily shutter the emergency unit at one of the city's biggest hospitals. Among those who tested positive for MERS was an employee at Jiddah's King Fahd hospital. The potentially fatal disease is related to SARS and was first identified in 2012 in the Middle East, where most cases since have been diagnosed. Officials at King Fahd hospital began referring incoming patients to other medical facilities on Tuesday so the emergency ward could be thoroughly cleaned and disinfected, according to the kingdom's health ministry. Authorities said they expected to reopen the emergency ward at the hospital within 24 hours. A nurse at another hospital in the city had also earlier contracted the virus. The deaths bring to at least 66 the number of people who died in the kingdom, which is at the center of the MERS outbreak.

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Foster Farms salmonella outbreak continuing in USA - CDC

The Seattle Times, 04/14/2014

A salmonella outbreak linked to Foster Farms chicken isn't over and has now infected 524 people in 25 states and Puerto Rico, federal health officials said. The Centers for Disease Control and Prevention reported in January that the outbreak, which has been going on since March 2013, appeared to be over. But the agency said there was an uptick in illnesses in February. It released the latest figures on Wednesday. Though no one has died, the CDC says the outbreak strains have been resistant to several commonly prescribed antibiotics, and 37 percent of those infected have been hospitalized, a higher rate than normal. More than three–quarters of the 524 reported illnesses are from California, according to the CDC. The outbreak led to a public health alert from the U.S. Department of Agriculture for raw chicken packaged at three Foster Farms facilities in California. The agency later said Foster Farms facilities in Fresno and Livingston had made substantive changes to their slaughter and processing and could stay open.

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Killer Yellow Fever mosquito spotted in California for the first time in 35 years

• Aedes aegypti is a tiny black-and-white mosquito that bites during the day
• It is known to carry yellow fever, dengue fever and other diseases
• Last eradicated from the San Francisco Bay Area in 1979
• Now detected 13 times since January near Menlo Park in San Mateo County
• It's stings can be painless and often go unnoticed 
• They lay their eggs in shallow water, so officials have warned residents to check their yards

By DAILY MAIL REPORTER

PUBLISHED: 21:02 GMT, 13 April 2014 | UPDATED: 08:40 GMT, 14 April 2014

A deadly mosquito that hasn't been seen in the San Francisco Bay Area since the 1970s has been detected south of the city, with officials warning residents to eliminate standing water and take other precautions.

The county's vector-control agency has again issued a warning that a potentially dangerous mosquito was found, this time on April 10, in the vicinity of the Holy Cross Catholic Cemetery at Santa Cruz and Avy avenues in Menlo Park, San Mateo County.

The insect - known as Aedes aegypti - is a tiny black-and-white mosquito that bites during the day and is know to carry yellow fever, dengue fever, chikungunya and encephalitis viruses,

This species has been detected at 13 locations in 2014, the first time on Jan. 22, and all near the cemetery, officials say, according to local paper The Almanac. 

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The Aedes aegypti mosquito - which was eradicated from San Francisco in 1979 - has been detected once again. The tiny insect, which - unlike other mosquitoes - bites during the day, can carry yellow fever, dengue fever, chikungunya (a fever) and encephalitis viruses

This mosquito is not native to California, but has also been found in Fresno and Madera counties. There have been no reports of illness so far, and the viruses have not been detected in California, the statement says.

'Our goal is to eradicate this mosquito population,' says Robert Gay, the local district manager.

 

'We are doing everything to help ensure this mosquito does not become established in our communities.'

In 1979, district agents eradicated the Aedes aegypti from San Mateo County when it was discovered near San Francisco International Airport.

The Aedes aegypti lays its eggs in water in small containers such as pots, pet bowls, bird baths and bottles.

'It's important for residents to survey their yard and (areas) around their house to eliminate even the smallest amount of standing water,' officials say.

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The tiny insect has been detected at 13 locations near this cemetery in Menlo Park since January this year

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Closer view of an Aedes Aegypti mosquito (dengue feverr vector). Dangerously, its sting can be quite painless and often goes unnoticed

To reduce the chances of being bitten, the district recommends using insect repellants containing DEET, picaridin, oil of lemon eucalyptus or IR 3535; checking window and door screens for tight fits; eliminating any standing water from around the home; wearing long-sleeved shirts and long pants; and shielding children with mosquito nets over infant carriers, cribs and strollers.

In Brazil, a company has been hired to release counterforces of genetically-modified mosquitos to kill the Aedes aegypti, due to the spread of dengue fever.

The mosquitoes are all non-biting males that have been modified to carry two genes that makes them and their progeny dependent on the antibiotic tetracycline, the absence of which in the wild will prevent the next generation from reproducing.

Source

Yellow fever vaccination centre to come up in Aundh, Pune, India

PUNE: The Union government's yellow fever vaccination centre, which was supposed to come up in the city two years back, is yet to take off as authorities have now decided to shift the venue of the centre to Aundh Civil Hospital instead of B J Medical College.

The change of location is due to the technical issues related to the procurement of medical equipment. "Earlier, we had decided to set up the centre at B J Medical College attached to Sassoon Hospital, which is under the Maharashtra government's Directorate of Medical Education and Research (DMER). There were some technical issues in terms of procurement of medical paraphernalia. We have now decided to set up the centre at Aundh Civil Hospital which comes under the Maharashtra government's Directorate Public Health Department," said Vasant Gokak, senior regional director (regional office) of the Union ministry of health and family welfare.

"If everything goes as per our plans, the centre will become functional within a month," he said, adding that the Union government has also proposed to set up two more centres in Aurangabad and Nagpur.

Gokak said that the aim is to cater to the large number of people travelling to endemic countries in Africa and South America. Currently, they have to go to Mumbai to get the shot and obtain the mandatory yellow fever vaccination certificate, in the absence of which, they do not get the permission to travel.

Yellow fever is an acute viral haemorrhaegic disease transmitted by infected mosquitoes. 'Yellow' refers to jaundice that affects some patients. There is no cure for yellow fever. Treatment is symptomatic and is aimed at reducing the symptoms. "There will be a one-room facility at the government health centre. It will be manned by a medical officer and a nurse. It will offer vaccination only on fixed days and during fixed hours for those travelling to yellow-fever endemic countries," said a state health official.

Certain countries in South Africa and South America require travelers to get the yellow fever vaccination certificate. Also, people coming to India from these countries need a certificate stating that he or she is vaccinated otherwise they are quarantined at the airport hospitals and kept under observation for 10 days.

A yellow fever vaccination certificate is valid only if it conforms to the model certificate. The validity period of the international certificate is 10 years, beginning 10 days after vaccination.

Foreign nationals residing or who have passed through the yellow fever endemic countries during the preceding six days, are granted visas only afterproducing the vaccination certificate. After checking the vaccination certificate an entry read as 'Valid Yellow fever Vaccination Certificate Checked' is made in the passport of the passenger.

Fact sheet

Yellow fever is endemic in 33 countries in Africa and 11 countries in South America

The virus is transmitted in two ways - the sylvatic or forest cycle and the urban cycle

Transmission begins when vector mosquitoes feed on non-human primates infected with the virus. The infected mosquitoes then feed on humans

Once contracted, the virus incubates in the body for three to six days. The infection can occur in one or two phases. The first, 'acute', phase causes fever, muscle pain with backache, headache, shivers, loss of appetite, and nausea. In most patients symptoms disappear after three to four days

15% of the patients enter the second and more toxic phase within 24 hours of the initial remission. Along with high fever, the patient rapidly develops jaundice and complains of abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Once this happens, blood appears in the vomit and faeces. Kidney function deteriorates

(Source: World Health Organization)
Umesh Isalkar,TNN | Apr 13, 2014, 02.56 AM IST
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Personal experience of a traveler getting Yellow Fever vaccination done at Bangalore government center

This is an unsolicited feedback on our blog from a traveler who took the Yellow Fever Vaccination at the Government Center in Bangalore. The actual review is posted here on this blog post, but I have copied it here to improve the visibility of the same...

I wanted a yellow fever shot done in November and when I called the public health department on a Monday they did never answer until it was at least after 20 tries .the man who answered said that I could only get the vaccination done on Wednesday. When I got there on Wednesday at 9 AM he asked me to wait and that he would call me..while I was waiting I saw a travel agent go up to him and hand him about 4 passports and I also saw him pay the guy which he put in his drawer I cannot exactly be sure of how much.After a little longer I saw a couple hand him Rs 1000 -the guy opened his drawer and the couple put the money in there...I was totally disgusted when all this was happening.He finally asked me to go pay and get a receipt and I did.when I got to the lady who was in-charge of vaccinating she yelled at me for having missed a signature on my yellow fever book..maybe its just me.But,I had a very unhappy experience at Bangalore. 

Ks ChengappaFebruary 9, 2014 at 1:45 AM

CDC:Chikungunya in the Caribbean

Centers for Disease Control and Prevention: Travel Notices: April 10, 2014

In December 2013, the World Health Organization (WHO) reported local transmission of chikungunya in Saint Martin. Local transmission means that mosquitoes in the area have been infected with chikungunya and are spreading it to people. This is the first time that local transmission of chikungunya has been reported in the Americas.

Local transmission of chikungunya is now being reported in other countries in the Caribbean. As of April 4, 2014, the following Caribbean countries have reported cases of chikungunya:

• Anguilla
• British Virgin Islands
• Dominica
• Dominican Republic
• French Guiana
• Guadeloupe
• Martinique
• Saint Barthelemy
• Saint Kitts
• Saint Martin (French)
• Sint Maarten (Dutch)

CDC recommends that travelers to the Caribbean protect themselves from mosquito bites.

 

Source: CDC: Chikungunya in the Caribbean