Priest died after suffering 'very rare adverse reaction' to yellow fever vaccine

A priest died after suffering a very rare adverse reaction to the yellow fever vaccine, an inquest heard.

Fr Gerard Cusack (71), prior of the Holy Trinity Abbey, Kilnacrott in Ballyjamesduff, Co Cavan, died at Beaumont Hospital on March 18 last year, 11 days after he had been given the vaccine in advance of a trip to central Africa.

Dublin Coroner’s Court heard that there have been only 60 documented cases of death due to the vaccine worldwide since its introduction in the 1930s.

Fr Cusack was due to travel to Tanzania to inspect works on a church roof paid for through fundraising efforts.

His sister Marie Crossan said that he was generally in good health with no medical complaints.

He attended the Tropical Medical Bureau (TMB) clinic on Grafton Street on March 7 where he was initially seen by Dr William Yap and subsequently a member of the nursing staff.

Dr Graham Fry, medical director at the TMB, said that Fr Cusack reported no health issues, previous or at the time, on the medical questionnaire that the clinic requires patients to complete nor did he do so during his consultation with Dr Yap.

He was prescribed medication for his upcoming trip and given a number of vaccinations including yellow fever.

When he left the practice 20 to 30 minutes later, Fr Cusack appeared to be in good health, he said.

The court heard that Fr Cusack subsequently presented at Cavan General Hospital on March 15, complaining of feeling ill for one week.

His GP had prescribed an antibiotic but this had no effect.

His condition deteriorated rapidly over the following 36 hours and he was transferred to Beaumont Hospital where he died from multi-organ failure on March 18.

Professor Peter Conlon, consultant nephrologist at Beaumont, told the court that there is no treatment for yellow fever other than “supportive” measures and the disease is fatal in 20 per cent of cases.

The post-mortem confirmed the presence of yellow fever in the liver and that the strain of the disease was the same as the one administered to Fr Cusack in the vaccine.

The cause of death was acute liver and kidney failure due to an adverse reaction to the yellow fever vaccine.

Dr Fry said yellow fever is a “live vaccine” with a higher instance of side effects in people over 60.

As a result, a risk-benefit analysis must be done considering a number of factors including what parts of the country the person intends to visit, he said.

There are approximately 60 cases of deaths as a result of the vaccine in international travellers since it was introduced, he told the court.

The TMB treats 3,000 people annually with the vaccine and this is the first time they have seen an adverse reaction, he added. 

The inquest was adjourned to August 19 to hear direct evidence from Dr Yap.

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My son aged 12 years have Egg allergy. Can he get the Yellow Fever Vaccine?

Sir,

My son aged 12 years have Egg allergy. He generally gets 'Red Itchy spots'(chapaki) and sometime swelling on face after eating Boiled egg. 

Since he wish to Travel Africa and for that Yellow Fever Vaccination is required.

Please advice how to get Waive off Yellow fever vaccination based upon Egg allergy test and immigration clearance. Is the test done at your clinic?

Rgds

ANS: Here is what I would recommend.

Can he eat cakes/ bakery items containing eggs without any problems? If so the vaccine should not be a problem at all.

You can get blood tests done for confirming the egg allergy if needed. Assuming these are positive, they can help you clear immigration. If these are negative I believe that the Yellow Fever Vaccination can probably be administered in a hospital setting in this situation.

Regards

Dr Gupta

Will dengue fever threaten the World Cup? CNN

CNN) -- While following their favorite soccer teams in preparation for the 2014 World Cup, fans in Brazil may have glimpsed one of the largest public health campaigns ever organized by the country's Ministry of Health.

"Dengue Mata" or "Dengue Kills" is the key message being pushed in print materials and TV commercials. Brazilian health officials hope the campaign will encourage local citizens to clean up areas around their homes to reduce mosquito breeding grounds, and that doing so will reduce the risk of the mosquito-transmitted virus that causes dengue fever.

The 2014 World Cup host country has reported the most cases of dengue in South America over the past 30 years, including four deaths attributable to the disease in January and February.

Because there is no vaccine or specific treatment, prevention is paramount.

'Indescribable, crazy pain': Surviving dengue fever

Risks for U.S. travelers

"It's difficult for anyone to put any number on the level of risk," said Lt. Cmdr. Tyler Sharp, an epidemiologist at the Centers for Disease Control and Prevention's dengue branch in San Juan, Puerto Rico. "The important thing to remember is that all regions of Brazil every day, every week and every year have transmission (of dengue)."

Most dengue virus infections occur in and around homes, Sharp said, so tourists in air-conditioned hotels have a relatively low risk of infection. Travelers staying with friends and relatives in their homes are at a higher risk.

Could the virus make it back to U.S. soil? Sharp said it would be a rare event, but the virus could be spread from an infected traveler to any state with a mosquito presence.

Dengue fever is not unheard of in the United States. In 2013, 137 cases were reported in Florida. Of those cases, 114 involved a person who had traveled to a dengue endemic country (including Brazil) in the two weeks before onset, according to the Florida Department of Health.

U.S. hospitalizations for dengue fever tripled in seven years

Dengue symptoms include high fever, severe headaches, pain behind the eyes, muscle and joint pain, nausea, vomiting and swollen glands. It is potentially fatal because of fluid accumulation, respiratory distress, severe bleeding or organ impairment.

Individuals with diabetes, obesity, cardiovascular disease or asthma have a higher risk of developing a more severe illness if infected. People who are older or have had previous exposure to one of the four dengue viruses are also more at risk.

For protection, the CDC recommends using a bug repellent at dawn and dusk that includes either DEET, picaridin, oil of lemon eucalyptus or IR3535 as the active ingredient. Sunscreen should be applied first and insect-repellent second. Wearing long-sleeved shirts and pants and sleeping in screened or air-conditioned rooms are other strategies for avoiding infection.

Dengue at the World Cup

An analysis published in Lancet Infectious Diseases in May looked at the climate forecast for dengue fever during the 2014 World Cup. Researchers analyzed past behavior of the virus to determine high-risk areas, which include the cities of Recife, Fortaleza and Natal, where many countries, including the United States, have matches.

Even though three of the tournament cities pose a higher risk, according to the Brazilian Federal Government, the World Cup falls during a time of year that typically sees a 74% reduction in dengue fever cases across the country.

"The one thing in our favor is that it is winter in Brazil," Sharp said.

The risk of infection and outbreak are based on several factors, including the number of mosquitoes (based on climate and presence of standing water needed for breeding) and a susceptible population.

The Pan American Health Organization says inadequate sewage disposal and water supply issues in residential areas are part of the reason Brazil has a heightened dengue risk. Unplanned city growth in the country is also increasing the spread of the disease.

Thousands hit by Brazil outbreak of dengue

Brazil travelers should also protect themselves against hepatitis A and B, yellow fever, typhoid, meningitis, malaria, rabies and diarrhea, the CDC says.

5 ways to stay healthy while traveling abroad

Mosquito-borne virus chikungunya worries CDC

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The mozzie Darth Vader

The mosquito that hosts yellow fever, dengue and chikungunya, does an excellent job at spreading those diseases to us humans.

It's not at all hard to imagine that Aedes aegypti is the Darth Vader of mosquitoes, an evil little creature bent on the destruction of mankind and a serial violator of Geneva Convention rules about biological warfare.

Almost every time there’s an outbreak of a tropical disease – yellow fever, dengue, and now, chikungunya (in the United States) – Aedes aegypti turns out to be behind it.

During the Spanish-American War, Aedes aegypti inflicted more casualties on US troops with yellow fever infections than the Spanish army did with bullets and bayonets.

“That’s kind of an extremely anthropocentric view of the subject,” cautions Roger Nasci of the federal Centers for Disease Control and Prevention (CDC), an expert on insect-borne illnesses.

Translation: That’s thinking too much like a human being.

Aedes aegypti is just doing what mosquitoes do, and doing it rather well.

“Aedes aegypti is not the only mosquito that’s an important vector for disease,” Nasci explains.

“Other types of mosquitoes carry malaria and the West Nile virus.

“But it’s uniquely suited to spreading disease, because it likes living around people.”

Many of the 170 or so species of mosquitoes in the US prefer breeding environments that don’t necessarily bring them in close contact with humans.

They like to lay their eggs in swamps, or frequently flooded areas, or rainwater-filled crannies in rocks or trees.

“Aedes aegypti, however, is happy to use stuff that humans bring to urban areas: buckets, tires, storage devices for potable water, essentially anything that holds a small pool of water,” says Nasci.

“And, unlike a lot of mosquitoes, they’ll feed indoors quite readily.”

Add to that a work ethic that would be admirable if you saw it among, say, roofers or Department of Motor Vehicles (DMV) clerks.

“Unlike mosquitoes who are used to taking their blood meal in one sitting, then going on their way to lay eggs, Aedes aegypti is patient with interruptions,” Nasci said.

“It bites your ankle, gets some blood, you shoo it away, and it goes on to the next person and the next, until it’s full.”

Feeding on multiple targets, of course, makes Aedes aegypti a prolific spreader of disease.

So does the fact that, for reasons scientists don’t fully understand, its body is a hothouse for viruses.

“Some mosquitoes, you can feed them boatloads of virus, and nothing happens,” Nasci says. “The virus just dies.

“But Aedes aegypti is extremely susceptible to viruses. The virus prospers, and then it gets passed along to people the mosquito bites.”

Aedes aegypti, like many of the diseases it carries, is originally from Africa.

But it arrived in North America hundreds of years ago, with the slave trade, and has spread throughout the southern US.

About the only things that ever seem to make a dent in its numbers are other mosquitoes, particularly the Asian tiger mosquito, Aedes albopictus, which first turned up at a Jacksonville, Florida, tire dump in 1986.

Aedes albopictus and Aedes aegypti both mate with the speed and discrimination of South Beach clubbers at closing time, which means they often have one another’s babies – but, being a mixture of two species, their offspring are sterile.

You might sneer that that’s what they get for a lack of sexual decorum, but that would be anthropocentric. – The Miami Herald/MCT Information Services

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