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.
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.
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)
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/flickr, CC 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 dengue, Zika and malaria.
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/flickr, CC 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:
