We are NOT authorized by Govt of India for Yellow Fever Vaccination

Friday, April 7, 2017

CDC’s MMWR Examines Yellow Fever Outbreak In DRC, April 2017

CDC’s “Morbidity and Mortality Weekly Report”: Yellow Fever Outbreak — Kongo Central Province, Democratic Republic of the Congo, August 2016
John O. Otshudiema of the Epidemic Intelligence Service Program and the Meningitis and Vaccine Preventable Diseases Branch in the Division of Bacterial Diseases at the CDC’s National Center for Immunization and Respiratory Diseases and colleagues examine the yellow fever outbreak in the Democratic Republic of the Congo’s Kongo Central Province, including the steps taken to control the outbreak, as well as challenges faced (3/31).
Source

Friday, March 31, 2017

Yellow fever – Suriname, 28th March 2017. WHO

On 9 March 2017, the National Institute for Public Health and the Environment (RIVM) in the Netherlands reported a case of yellow fever to WHO. The patient is a Dutch adult female traveller who visited Suriname from the middle of February until early March 2017. She was not vaccinated against yellow fever.
The case was confirmed for yellow fever in the Netherlands by RT-PCR in two serum samples taken with an interval of three days at the Erasmus University Medical Center (Erasmus MC), Rotterdam. The presence of yellow fever virus was confirmed on 9 March 2017 by PCR and sequencing at Erasmus MC, and by PCR on a different target at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
While in Suriname, the patient spent nights in Paramaribo and visited places around Paramaribo, including the districts of Commewijne (Frederiksdorp and Peperpot) and Brokopondo (Brownsberg), the latter is considered to be the most probable place of infection. She experienced onset of symptoms (headache and high fever) on 28 February 2017 and was admitted to an intensive care unit (University Medical Center) in the Netherlands on 3 March 2017 with liver failure. The patient is currently in critical condition.
Suriname is considered an area at risk for yellow fever and requires a yellow fever vaccination certificate at entry for travellers over one year of age arriving from countries with risk of yellow fever, according to the WHO list of countries with risk of yellow fever transmission; WHO also recommends yellow fever vaccination to all travellers aged nine months and older. This is the first reported case of yellow fever in Suriname since 1972.

Public health response

This report of a yellow fever case in the Netherlands with travel history to Suriname has triggered further investigations. Following this event, health authorities in Suriname have implemented several measures to investigate and respond to a potential outbreak in their country, including:
  • Enhancing vaccination activity to increase vaccination coverage among residents. Suriname will continue with its national vaccination programme and will focus on the district of Brokopondo. A catch-up vaccination campaign is also being conducted to increase coverage in Brownsweg.
  • Enhancing epidemiologic and entomologic surveillance including strengthening laboratory capacity.
  • Implementing vector control activities in the district Brokopondo.
  • Carrying out a survey of dead monkeys in the suspected areas.
  • Conducting social mobilization to eliminate Aedes aegypti breeding sites (e.g. by covering water containers/ barrels).
  • Issuing a press release to alert the public.
  • Mapping of the suspect area of Brownsweg, as well as the Peperpot Resort.

WHO risk assessment

Yellow fever is an acute viral haemorrhagic disease that has the potential to spread rapidly and cause serious public health impact in unimmunized populations. Vaccination is the most important means of preventing the infection.
Suriname is a country with a risk of yellow fever transmission in endemic areas. Vaccination is recommended before travelling to Suriname for all travellers aged nine months and older. Suriname requires proof of vaccination against yellow fever for all travellers over one year of age.
Suriname introduced the yellow fever vaccination into the routine program for all children aged one years old in 2014.The estimate of national immunization coverage is 86% and only includes children aged one years old. The unvaccinated populations living in the endemic areas are at high risk of yellow fever infection.
The current report of a travel-associated case provides evidence to consider local transmission of yellow fever in the country. More investigations are also needed for animal health sectors.
In addition, Suriname shares borders with Brazil, which has been experiencing yellow fever outbreaks since January 2017 (the largest outbreak of yellow fever in the Americas in the past three decades).
Sequencing and comparison to cases from various other countries is still ongoing, but it is likely that the case is not related to the yellow fever outbreak in Brazil.
As South America is currently experiencing a cyclical increase in the number of cases in non-human primates and human cases, an increase in the number of cases in unvaccinated travellers returning from affected areas in South America is not unexpected. The risk of spread of the disease by non-immunized travellers from Suriname to the countries that have the vector for the transmission of the yellow fever virus is considered to be low but cannot be ruled out.
Currently, five countries in South America report yellow fever virus activity: Brazil, Bolivia, Peru, Colombia and Ecuador. This multi-country yellow fever virus activity might reflect current, wide-spread ecological conditions that favour elevated yellow fever virus transmissibility among wildlife and spill-over to humans. The sequencing analysis of currently circulating strains in Brazil, Bolivia, Colombia, Peru, Ecuador and Suriname should provide insight whether the human cases in these countries are epidemiologically linked or represent multiple, independent spill-over events without extensive ongoing community transmission.

WHO advice

Advice to travellers planning to visit areas at risk for yellow fever transmission in South America includes:
  • Vaccination against yellow fever at least 10 days prior to the travel. A single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease and a booster dose of the vaccine is not needed;
  • Travellers with contraindications for yellow fever vaccine (children below nine months, pregnant or breastfeeding women, people with severe hypersensitivity to egg antigens, and severe immunodeficiency) or over 60 years of age should consult their health professional for advice based on risk benefit analysis;
  • Observation of measures to avoid mosquito bites;
  • Awareness of symptoms and signs of yellow fever;
  • Promotion of health care seeking behaviour while travelling and upon return from an area at risk for yellow fever transmission, especially to a country where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present).
  • Seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission.
This case report illustrates the importance of yellow fever vaccination for travellers to countries with risk of yellow fever virus transmission, even for countries that have not reported cases for decades.
WHO, therefore, urges Members States to comply with the requirement for yellow fever vaccination for travellers to certain countries and the recommendation for all travellers to countries or areas with risk of yellow fever transmission (see ‘Yellow fever vaccination requirements and recommendations; malaria situation; and other vaccination requirements – List of countries, territories and areas’ in related links). Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission predominantly in areas where the competent vector is present. If there are medical grounds for not getting vaccinated, this must be certified by the appropriate authorities.
WHO does not recommend that any general travel or trade restriction be applied on Suriname based on the information available for this event.

Friday, March 10, 2017

United States at Risk for Yellow Fever From Brazil Outbreak, Medscape, March 2017

Yellow fever could become the 5th mosquito-borne virus to hit the United States in recent years, according to experts from the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland.
An on-going outbreak in rural areas of Brazil has so far not involved human-to-human transmission through Aedes aegyptimosquitoes but has been spread via nonhuman forest-dwelling primates, write Infectious Disease Fellow Catharine I. Paules, MD, and NIAID Director Anthony S. Fauci, MD, in an articlepublished online today in the New England Journal of Medicine.
However, the outbreak is near major urban areas, where yellow fever vaccine is not routinely given and might readily lead to urban human-to-human transmission.
The outbreak in the Brazilian states of Minas Gerais, Espirito Santo, and São Paulo has resulted in 234 confirmed infections and 80 confirmed deaths as of February 2017. "The high number of cases is out of proportion to the number reported in a typical year in these areas," write Dr Paules and Dr Fauci.
They also note that, as with Zika, arbovirus epidemics spread by A Aegypti can move rapidly through populations that lack immunity and can be readily spread by human travelers. Yellow fever outbreaks could occur in warmer regions of the continental United States where the mosquito is endemic as well as in some US territories (as occurred with zika in Puerto Rico following its emergence in Brazil). The arboviruses that cause dengue, West Nile, and chikungunya followed similar trajectories.
The authors note that the key to dealing with yellow fever outbreaks is to combine early identification of cases, mosquito control, and vaccination of at-risk populations. The live attenuated yellow fever vaccine still in use was developed in 1937 and provides lifetime immunity for up to 99% of recipients, but vaccine supplies have not always been adequate for dealing with sudden outbreaks.
For example, the December 2015 yellow fever outbreak in Angola and the Democratic Republic of Congo caused 961 confirmed cases of yellow fever and 137 deaths. Attempts to contain that outbreak exhausted the worldwide vaccine stockpile reserved for epidemic response, leading health authorities to decrease doses to as little as one fifth of the standard dose to conserve the dwindling vaccine supply.
Furthermore, although yellow fever claimed thousands of American lives in the eighteenth and nineteenth centuries, the disease was largely eliminated from the United States through mosquito control and better sanitation.
As most American physicians have never seen a case of yellow fever, Dr Paules and Dr Fauci provide clinical guidance on what to look for if the current outbreak leads to urban spread. As with zika virus, they recommend special attention to travelers returning from areas where there have been outbreaks. Initial diagnosis is based on clinical presentation, with later confirmation by specialized laboratory testing.
Incubation is 3 to 6 days, after which the patient may present with high fevers associated with bradycardia, leukopenia, and transaminase elevations, as well as persistent viremia.
This is typically followed by a period of remission, but within 24-48 hours up to 20% of patients progress to the intoxication stage, with high fevers, hemorrhage, severe hepatic dysfunction, jaundice, renal failure, cardiovascular abnormalities, central nervous system dysfunction, and shock. The case-fatality rate is 20% to 60% in these severely ill patients; there is no effective antiviral therapy.
"Yellow fever is the most severe arbovirus ever to circulate in the Americas, and although vaccination campaigns and vector-control efforts have eliminated it from many areas, sylvatic transmission cycles continue to occur in endemic tropical regions," the authors write.
Peter Hotez, MD, PhD, FASTMH, FAAP, dean of the National School of Tropical Medicine, professor of pediatrics and molecular & virology and microbiology, and head of the section of pediatric tropical medicine at Baylor College of Medicine in Houston, Texas, told Medscape Medical News, "Dr Paules and Dr Fauci are right to express concern about yellow fever, both in the Americas and in Angola and Democratic Republic of Congo last year.
"But it's not yellow fever alone. In the Western Hemisphere we have seen a significant and almost mysterious rise in arthropod-borne vector infections, including zika, chikungunya, dengue and yellow fever. We have also seen a parallel rise of some of these same diseases in Southern Hemisphere. In the Public Library of Science (PLoS) last year, I ascribed the rise of these vector borne infections to the 'Anthropocene' forces of climate change, human migrations, urbanization, and deforestation, as well as the shifting nature of global poverty, which I labelled blue marble health.' Yellow fever is an important part of this trend."
Dr Hotez is coeditor-in-chief of PLoS Neglected Tropical Diseases, and in 2013 warned in a blog post in that journal that US health officials should be more concerned about possible outbreaks of yellow fever in the Americas.
Dr Hotez urged at that time that yellow fever risk be evaluated in the major southern cities of the United States, including Houston, Miami, New Orleans, and Tampa. He explained that the A aegypti mosquito can be found in many areas of the southern United States. Other risk factors in those areas include high poverty rates, poor urban housing, and foci of standing water that provide potential breeding sites.
Dr Hotez also pointed out that although Max Theiler received the Nobel Prize for developing the yellow fever vaccine in 1951, almost nobody in the United States other than travelers to endemic areas gets vaccinated.
The authors and Dr Hotez have disclosed no relevant financial relationships.
NEJM. Published online March 8, 2017. Full text
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Friday, February 24, 2017

Yellow fever update: 33% of confirmed cases end in death, Brazil Feb 2017

The most recent update on the yellow fever outbreak in Brazil reveals additional confirmed cases and deaths since the last update a few days ago. According to the Brazil Ministry of Health, or Ministério da Saúde, as of Feb. 20, 1,286 suspected cases of yellow fever were reported to the Ministry of Health, of which 274 were confirmed.
Image/CDC
Image/CDC
To date, 92 confirmed yellow fever deaths have been reported, with the case fatality rate among confirmed cases stands at 33.6%.
Of the confirmed cases, 235 have been reported in Minas Gerais state, or 86 percent of the total cases. Seventy-nine of the confirmed fatalities occurred in the state.
As of Feb. 20, 2017,  883 epizootic diseases were reported to the Ministry of Health in non-human primates (PNH), of which 212 remain under investigation, 8 were discarded and 377 were confirmed for yellow fever.
http://outbreaknewstoday.com/yellow-fever-update-33-confirmed-cases-end-death-15774/

Friday, February 17, 2017

Going to Suriname? Get the Yellow fever vaccine- Feb 2017

Caribbean Airlines (CAL) is advising all citizens with intentions of travelling to Suriname to ensure they have had their yellow fever vaccine and documentation to support it.
In a press release, the national carrier said, "Caribbean Airlines has been advised that the Ministry of Health, Suriname will be conducting intensified checks on yellow fever immunization for travelers from yellow fever risk regions. These regions include but are not limited to: Trinidad and Tobago, Guyana and Venezuela."
Head of Corporate Communications, Dionne Ligoure stated: “To ensure an uninterrupted travel experience, Caribbean Airlines is recommending that all persons intending to travel, make certain that their vaccinations are up to date. Persons are advised to carry their International Immunization Card with proof of valid Yellow Fever and other vaccinations when travelling to Suriname.”
Customers are responsible for meeting all documentation and proof of citizenship requirements for travel. Failure to comply with these Ministry of Health requirements could result in inconvenience and additional expenses to be borne by the traveller.

Tuesday, February 7, 2017

Lychee fruit poisoning causing death in Up, Bihar. Ref: Shrivastava A, Kumar A, Thomas JD, et al: Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health. 2017; Online First.

Summary
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Background
Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur [Bihar], the country's largest litchi [lychee] cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

Methods
In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to 2 hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same 2 hospitals for a non-neurologic illness within 7 days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

Findings
Between 26 May and 17 Jul 2014, 390 patients meeting the case definition were admitted to the 2 referral hospitals in Muzaffarpur, of whom 122 (31 percent) died. On admission, 204 (62 percent) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9.6 [95 percent CI 3.6-24]) and absence of an evening meal (2.2 [1.2-4.3]) in the 24 hours preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7.8 [95 percent CI 3.3-18.8], without evening meal; OR 3.6 [1.1-11.1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66 percent] of 73 urine specimens from case-patients and none from 15 controls; 72 (90 percent) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12.4 microg/g to 152.0 microg/g and MCPG ranged from 44.9 microg/g to 220.0 microg/g.

Interpretation
Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

--
Communicated by:
Dr Irene Lai MBBS (Sydney) FFTM RCPS (Glasg)
Global Medical Director, Medical Information & Analysis
Level 3, 45 Clarence St, Sydney NSW 2000
Australia


[The etiologies of seasonal encephalitis (or encephalopathies) in northeastern India have not been well defined. Many have been attributed to Japanese encephalitis (JE). However, JE virus infections have been excluded in many cases, with the undiagnosed cases termed acute encephalitis syndrome (AES). Previous ProMED-mail posts have implicated Reye syndrome, consumption of lychees, and heat stroke, as well as JE virus infections, as responsible for AES (see ProMED-mail archive no. 20161111.4621162).

Dr Jacob John has asserted that many of these are hypoglycemic Reye syndrome cases. He noted that in the pre-monsoon period, particularly in May and June, outbreaks of Reye-like acute hypoglycemic encephalopathy occur in the north western region of Bihar state and that is also popularly, but unfortunately, called AES. Many doctors, the media, and the public consider these encephalopathy cases as encephalitis because of the term AES. This has been now clarified and in June 2014 children were treated by 10 per cent dextrose infusion and many lives were saved. Other etiologies have been proposed by clinicians. A published article in a pediatric journal proposed that some cases are due to heat stroke.

It has been proposed previously that consumption of lychees is responsible for some encephalitis cases. Encephalopathy and hypoglycemia have been associated with consumption of lychee fruit containing phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. 20150201.3132842). Several reports have associated AES with contaminated water, suggesting enterovirus etiology. A recent report indicates that the scrub typhus bacterium may be causing many encephalitis deaths in the nearby northeastern state of Assam.

The report above makes a convincing case for lychee consumption as the etiology of many of these cases in areas of lychee production in Bihar state. Public education will be essential to prevent these lychee intoxications. Japanese encephalitis virus is also endemic in this area, but is preventable by vaccination and should not be ignored.

ProMED thanks Dr Irene Lai for sending in this report, along with a press release from the US Embassy in India: US and Indian Governments identification of a cause of unexplained illness in Bihar state (https://in.usembassy.gov/u-s-indian-governments-identify-cause-unexplained-illness-bihar/).

Maps of India can be seen at http://www.mapsofindia.com/maps/india/india-political-map.htm and http://healthmap.org/promed/p/11360. - Mod.TY]

FAQ on Yellow Fever

Query : 
Good morning dr. Please my 9 months old baby took yellow fever and measles vaccines together yesterday and woke up this morning feeling so weak and he has been vomiting. Please what will i do. I gave him paracetamol that yesterday.

Ans:
Hi,
Continue giving paracetamol, and give some vomiting medicine as well.
If the child does not show improvement, meet your pediatrician,

Warm regards

Friday, February 3, 2017

Brazil confirms more yellow fever cases; over 100 infected, Feb 2017

Authorities in Brazil's Sao Paulo state say three more people have died from yellow fever, adding to an outbreak that has seen more than 100 cases.
The vast majority of cases are in the southeastern state of Minas Gerais, where authorities had confirmed 97 cases as of Friday. Of those, 40 died.
The Health Department of Sao Paulo on Monday said it has now confirmed six cases of the disease, four of whom became infected in Minas Gerais. All of the patients died. The state of Espirito Santo has also recorded one case.
Much of Brazil is considered at risk for yellow fever, but the country has not seen this large an outbreak since 2000. The World Health Organization has said it expects the mosquito-borne to spread to more states.

Wednesday, February 1, 2017

Yellow Fever in Brazil, CDC update Feb 2017

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

What is the current situation?

The Brazilian Ministry of Health has reported an ongoing outbreak of yellow fever starting in December 2016. The first cases were reported in the state of Minas Gerais, but cases have since been reported in the neighboring states of Espirito Santo and Sao Paulo. Cases have occurred mainly in rural areas, with most cases being reported from Minas Gerais state. Some cases have resulted in death. Health authorities in the affected states, with assistance from the Brazilian Ministry of Health, are conducting mass vaccination campaigns among unvaccinated residents of affected areas.
In response to this outbreak, health authorities have recently expanded the list of areas in which yellow fever vaccination is recommended for travelers. For a list of these municipalities and a map showing the existing and new yellow fever risk areas in Brazil, see the World Health Organization’s most recent update (scroll down on linked page for the list).
The Brazilian Ministry of Health maintains a list of all other municipalities in Brazil for which yellow fever vaccination continues to be recommended (not including recently added municipalities). It is located at http://portalsaude.saude.gov.br/images/pdf/2015/novembro/19/Lista-de-Municipios-ACRV-Febre-Amarela-Set-2015.pdf.
Anyone 9 months or older who travels to these areas should be vaccinated against yellow fever. People who have never been vaccinated against yellow fever should not travel to areas with ongoing outbreaks. CDC no longer recommends booster doses of yellow fever vaccine for most travelers. However, a booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 years ago and who will be in a higher-risk setting, including areas with ongoing outbreaks. Because of the ongoing outbreak, travelers to the Brazilian states of Minas Gerais, Espirito Santo, and parts of Bahia, Sao Paulo, and Rio de Janeiro states may consider getting a booster if their last yellow fever vaccination was more than 10 years ago. Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. For more information on booster shots, see “Clinician Information,” below.
Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever vaccine provider well in advance of travel.

What is yellow fever?

Yellow fever is a disease caused by a virus spread by mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

How can travelers protect themselves?

Get yellow fever vaccine:

  • Visit a yellow fever vaccination (travel) clinic and ask for a yellow fever vaccine.
    • You should receive this vaccine at least 10 days before your trip.
    • After receiving the vaccine, you will receive a signed and stamped International Certificate of Vaccination or Prophylaxis (ICVP, sometimes called the “yellow card”), which you must bring with you on your trip.
    • For most travelers, one dose of the vaccine lasts for a lifetime. Consult a travel medicine provider to see if additional doses of vaccine may be recommended for you based on specific risk factors.
    • In rare cases, the yellow fever vaccine can have serious and sometimes fatal side effects. People older than 60 years and people with weakened immune systems might be at higher risk of developing these side effects. Also, there are special concerns for pregnant and nursing women. Talk to your doctor about whether you should get the vaccine.

Prevent mosquito bites:

  • Cover exposed skin by wearing long-sleeved shirts and pants.
  • Use an EPA-registered insect repellent containing DEET, picaridin, oil of lemon eucalyptus (OLE), IR3535, or 2-undecanone (methyl nonyl ketone). Always use as directed.
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.
    • Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
    • Most repellents, including DEET, can be used on children older than 2 months.
    • Follow package directions when applying repellent on children. Avoid applying repellent to children’s hands, eyes, or mouth.
  • Use permethrin-treated (clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
    • Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
    • If treating items yourself, follow the product instructions carefully.
    • Do not use permethrin directly on skin.
  • Stay and sleep in screened or air conditioned rooms.
  • Use a bed net if the area where you are sleeping is exposed to the outdoors.

Clinician Information:

Additional Information:

Wednesday, January 25, 2017

WHO: Yellow fever- Brazil: Jan 2017

World Health Organization: Emergencies preparedness, response: January 2017

On 6 January 2017, the Brazil Ministry of Health (MoH) reported 12 suspected cases of yellow fever from six municipalities in the state of Minas Gerais.

WHO risk assessment

Yellow fever outbreak has previously been detected in Minas Gerais. The most recent outbreak occurred in 2002–2003, when 63 confirmed cases, including 23 deaths (CFR: 37%), were detected.

The current yellow fever outbreak is taking place in an area with relatively low vaccination coverage, which could favor the rapid spread of the disease. The concern is that transmission may extend to areas located in proximity of Minas Gerais, such as the state of Espírito Santo and the south of Bahia, which have favorable ecosystems for the transmission of the virus.

These areas were previously considered to be at low risk of transmission and, consequently, yellow fever vaccination was not recommended. The introduction of the virus in these areas could potentially trigger large epidemics of yellow fever.
There is also a risk that infected humans may travel to affected areas, within or outside of Brazil, where the Aedes mosquitoes are present and initiate local cycles of human-to-human transmission. Response efforts are further complicated by the fact that it is occurring in the context of concomitant outbreaks of Zika virus, chikungunya and dengue.

WHO advice

Yellow fever can easily be prevented through immunization provided that vaccination is administered at least 10 days before travel. WHO, therefore, urges Members States especially those where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present) to strengthen the control of immunisation status of travellers to all potentially endemic areas.

WHO does not recommend any restriction of travel and trade to Brazil based on the current information available.
 
 

Friday, January 13, 2017

Yellow fever vaccine linked to breast cancer risk reduction - jan 2017

Researchers at Italy’s University of Padova have claimed that the yellow fever vaccine could potentially reduce the risk of breast cancer.

They have suggested that administering the yellow fever vaccine to women aged between 40 and 54 could halve the risk of developing breast cancer.

During the study, the researchers analysed the medical records of over 12,000 women who had received the yellow fever vaccine. They found that in the 3,140 women aged 40 to 54, those who had received the vaccination more than two years ago were 54 per cent less likely to develop breast cancer than those who had received it within the previous two years.

They also found, however, that women who were vaccinated before the age of 40 or over the age of 54 did not see a significant reduction in breast cancer risk. They said this could be due to the fact women in these age groups typically develop more aggressive tumours that would not be stopped by the vaccine.

Responding to the study, UK research charity Breast Cancer Now senior research communications officer Dr Richard Berks said: “These findings are very intriguing, but a number of unanswered questions remain. Further studies are now needed to understand whether it is the yellow fever vaccine itself that is having this effect, or other factors, before this could be tested in people as a means to reduce breast cancer risk.

“With the number of people being diagnosed with breast cancer continuing to rise, we urgently need more research into breast cancer prevention to help improve the number of risk-reducing options available to women.”

He went on to add that women can help to reduce their risk of breast cancer by maintaining a healthy weight, reducing their alcohol intake and partaking in regular physical activity.ADNFCR-2094-ID-801830931-ADNFCR

Wednesday, January 11, 2017

First Chikungunya Vaccine Developed in USA

Researchers in the United States have developed a Chikungunya fever vaccine using insect-specific viruses which do not affect people. The vaccine is safe and effective. The findings were published in Nature Medicine. The vaccine produces a strong immune defence protecting mice in addition to nonhuman primates from exposure to the Chikungunya virus. University of Texas Medical Branch at Galveston, senior author, Scott Weaver ‘the vaccine offers efficient, safe and affordable protection against Chikungunya and builds the foundation for using viruses that only infect insects to develop vaccine against other insect-borne diseases.’ The Eliat virus was used as a vaccine platform as it has no impact on people and only on insects, and was found to be identical structurally to the chikungunya virus.

http://emedinexus.com/user/postdetail/355894 (needs free registration for doctors)

Friday, January 6, 2017

Prepare for a healthy holiday with this A-to-E guide

So your well-earned holiday is finally here. But before you pack your swim gear, magazines and camera, take a moment to think about your health.
Experiencing an illness in a foreign destination can be very challenging. Obviously it will reduce the quality of your trip, but it can also leave travellers with unexpected costs and exposed to a foreign medical system. On occasion, serious complications can follow.
More than nine million Australians travel internationally per year, with most trips undertaken by people between the ages of 25 and 55. The top ten most popular destinations for Australians are New Zealand, Indonesia, the USA, UK, Thailand, China, Singapore, Japan, Fiji and India.
A range of new health problems can be encountered during travel, and existing health problems can be exacerbated. Staying healthy is all about being informed, prepared and sensible.
Minimise your chances of experiencing these by following a simple ABCDE.

A: Allow time to prepare

Around popular holiday periods, it pays to allow plenty of time to book an appointment at a travel clinic, or a local medical clinic that offers travel vaccinations.
Some vaccinations have two or three doses and may need four weeks for the course to be completed. Examples include vaccines for Japanese encephalitis and rabies.
If travelling as a family, several visits may be required for preparing children for travel certain destinations.
Indonesia is a popular holiday destination for Australians. rueful/flickrCC BY
Keep in mind that your travel medicine practitioner may need detailed information about your exact itinerary, your past childhood vaccinations, your medical history and medications. If you have all this information readily available, you can get the most out of your travel consultation.
If you have an existing medical condition, get checked out to make sure it’s being managed as expected. For example, blood pressure medications may need to be adjusted if your blood pressure is either too high or too low.
Yellow fever immunisations and other live vaccines – those that contain active components – should be avoided if you are on medications that reduce your immunity, such as steroids like prednisolone. You may need alterations to immunosuppressive medications some weeks before you travel, or an official letter exempting you from a vaccine that is necessary for entry into certain countries (as is the case with yellow fever vaccine).

B: Behaviour - think about it

Holiday makers often seek to get out of their comfort zones. But it’s worth avoiding the temptation to completely let your hair down: behaviours you would never entertain in the home setting should be avoided in a foreign setting as well. You may also need to alter some of your daily living behaviours.
Traveller’s diarrhoea can largely be avoided by using bottled water in any setting that you consume water, including staying hydrated, brushing your teeth, washing fruit and salads, and making ice blocks and other drinks.
Eat food from venues that appear to adhere to good food hygiene standards – although this can be difficult to judge. Avoid hawker food or street food where items may have been left for long periods at temperatures where bacteria can multiply. When uncertain of hygiene standards, selecting packaged food is the safest choice.
Respiratory infections are common in travellers. If you find yourself in a crowded setting where someone appears unwell and is coughing, create a distance to reduce the risk of being infected. Alcohol-based hand gels are useful to maintain hand hygiene and may protect you from infection due to common colds and other viruses that linger on surfaces.
Smart packing is also important. You should travel with sunscreen and clothes that protect you from sun exposure, and repellent that has an active component to repel insects if travelling to an area where mosquitoes can transmit infections such as dengueZika and malaria.
Dengue is a virus transmitted by mosquitoes. echbirmingham/flickrCC BY
Avoid acquiring a sexually transmitted infection by using barrier protection (condoms) for sexual intercourse.

C: Check safety, and have a check up

Review travel warnings at a reputable website, such as SmartTraveller.
A general check up is advised to ensure your health is stable. Health conditions such as inflammatory bowel disease, diabetes or a lowered immune system may put you at greater risk of travellers’ diarrhoea. Cancer or recent operations can increase risk of developing a blood clot.
Check ups are also a good opportunity to ensure that your vaccinations are up-to-date (see below).

D: Drugs (medications) and vaccines are vital

Medications that can reduce the time or severity of travellers’ diarrhoea are recommended for almost any destination, but particularly when travelling to developing countries where food hygiene standards can be variable. Examples include antibiotics such as azithromycin that treat bacterial causes of diarrhoea, and drugs such as tinidazole to treat parasitic causes of diarrhoea.
Medications such as doxycycline or malarone that protect against being infected with malaria are recommended in some regions within Africa, Asia, South America and the Pacific.
Zika virus infection generally causes a mild illness or no symptoms at all. Pregnant female travellers are advised to avoid travel to a Zika endemic area. Couples planning a pregnancy in the near future should seek advice from a health professional if travelling to a Zika endemic country.
Sunburn can easily be prevented with appropriate clothing, hats and sunscreen. nicksie2008/flickrCC BY
If you’re travelling to destinations that are above 2500 metres (such Cusco in Peru), talk to your doctor about medications that help prevent or manage altitude sickness.
The normal schedule of vaccinations provided to Australians may not cover you for illnesses found in your holiday destination. Extra vaccinations are necessary for certain destinations.
For example, yellow fever is transmitted by mosquitoes and can cause anything from mild fevers to a severe illness involving multiple organs. Vaccination against yellow fever is required for entry into countries with known yellow fever transmission, and for returning back to Australia if visiting an area of known transmission.
Australians may consider vaccinations against the following diseases before travel to popular holiday destinations:
  • Hepatitis A
  • Hepatitis B
  • Influenza
  • Japanese encephalitis
  • Meningococcal disease
  • Rabies
  • Tuberculosis
  • Typhoid
  • Varicella (Chickenpox)
  • Yellow fever
  • Cholera
  • Measles
  • Polio
  • Tetanus
A full list of countries and recommended vaccinations has been compiled by the USA’s Centers for Disease Control and Prevention.
Even if you’re previously been vaccinated for some of these conditions, as time passes you may require boosters to strengthen your immunity.

E: Enjoy your trip!

Relax, you’ve earned a break. from www.shutterstock.com