Two British people DIE after receiving yellow fever vaccines - Apr 2019

• Two patients developed a complication called viscerotropic disease 
• Yellow fever is spread by mosquitoes mostly in Africa and the Americas
• Vaccines can cause illness in some people because they use live viruses 

By SAM BLANCHARD HEALTH REPORTER FOR MAILONLINE

PUBLISHED: 14:51 BST, 18 April 2019 | UPDATED: 01:27 BST, 19 April 2019

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Two people in the UK have died after being given a vaccine to protect against the potentially fatal yellow fever.

The tropical illness is spread by mosquitoes and found in Africa, South and Central America, and the Caribbean, so the jab is recommended for people travelling to those areas.

But in extremely rare cases – approximately one in a million – the vaccine can trigger viscerotropic disease, which can be deadly.

Both the unidentified victims were in categories of people who shouldn't always be given the vaccine – one was aged over 60 and the other had had their thymus gland removed.

Travellers should not be put off getting the vaccine, health chiefs said, and medics have been warned to check it's safe to give their patient the jab, which can cost around £60 on the NHS.

 Two patients in the UK have died after being given the yellow fever travel vaccine, which went on to cause a disease which can lead to multiple organ failure (stock image)

The UK's Medicines and Healthcare products Regulatory Agency (MHRA) revealed the cases in a report this week but could not say when the two people died.

Both of them died 'shortly' after receiving the vaccine because of yellow fever vaccine-associated viscerotropic disease (YEL-AVD). 

One of them was 67 years old – the life-saving jab is not recommended for people over the age of 60, according to the NHS. This person died 16 days after their injection. 

One of the UK's leading cancer scientists and a consultant at the Royal Marsden NHS trust in London, Professor Martin Gore, 67, died after having a yellow fever vaccine in January, The Guardian reported – but the MHRA would not confirm the identity of the patient. 

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The vaccine is also not recommended for people who have had surgery to remove their thymus gland, a gland in the chest which is part of the immune system.

The other victim, who was in their 40s, had had this operation and died just eight days after having the yellow fever jab.

The vaccine is known to give safe and effective life-saving protection from a deadly infection, and the MHRA said travellers should continue to get it because of the danger of yellow fever. 

An MHRA spokesperson said 'Yellow fever is serious and potentially fatal. 

'Protection against the disease is essential for anyone travelling to an area where it is known to exist, and vaccination is the best form of protection. 

'The risk of serious, life-threatening reactions is rare, at around 1 in 100,000 vaccinees.

CAN VACCINES MAKE YOU ILL?

Live vaccines, such as the one given to protect against yellow fever, work by injecting a weakened but still living form of the virus into the body.

The purpose of this is to train the body how to make the right antibodies to fight off the virus, so it can remember how to do so in future.

However, if someone's immune system is weakened – by cancer, pregnancy, HIV or age, for example – it may be unable to destroy even the weakened form of the virus.

If this happens, it's possible the injected virus can survive, take hold and cause the infection it was intended to prevent.   

If this happens the symptoms are usually milder than the real disease.

People who have had live vaccines may also be able to transmit an illness to someone with a weakened immune system, so should stay away from them after the jab. 

Live vaccines given in the UK include those for: rotavirus, MMR, flu (nasal only), shingles, chickenpox, tuberculosis, yellow fever and typhoid (oral only). They are all proven to be effective and side effects are rare.

Source: Vaccine Knowledge Project, University of Oxford 

'The potential risks associated with yellow fever vaccines must be balanced with the benefits in terms of protection from infection.

'Vaccine safety is of paramount importance and we continually monitor the safety of vaccines.'  

And the government body warned medics to thoroughly check all patients before giving it to them.   

In a report it said: 'When a person presents for yellow fever immunisation, it is important that healthcare professionals clearly discuss with them the individual risks and benefits of the vaccine based on their specific travel itinerary. 

'Sufficient time should be set aside to ensure that the person is immune competent and has no [reasons they shouldn't have] the vaccine, including a review of full medical history and any available medical records.'

YEL-AVD triggers a similar illness to yellow fever caught from a mosquito, which leaves patients with fevers, headaches, vomiting and muscle pain.

In severe cases it can progress to uncontrollable bleeding and lead to multiple organ failure and death.

While wild yellow fever has a death rate of around 50 per cent among patients with symptoms, YEL-AVD kills more than 60 per cent of patients, according to the US Centers for Disease Control and Prevention (CDC).

The vaccine can trigger yellow fever in people with particularly weak immune systems because it uses a live form of the virus.

A healthy body destroys the weakened virus and remembers how to do it, making the person immune, but if the body is too feeble to do this the virus can take hold and trigger illness.

Other people who may be too unprotected to have the yellow fever vaccine include pregnant women, HIV or cancer patients and babies under nine months old.

As many as one in three people may have side effects such as headache, soreness or mild fever after having the jab, but these should pass within a fortnight. 

The yellow fever vaccine, known as Stamaril, is given in a single injection and is not freely available on the NHS – it usually costs between £60 and £80.

Hancock believes government must do more on anti-vaccination myths

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WHAT IS YELLOW FEVER?

Yellow fever is a tropical viral disease usually spread by mosquito bites. 

The virus is most commonly found in sub-Saharan Africa, South and Central America, and the Caribbean.

It is believed to infect around 200,000 people each year and to kill 30,000 of them. Most of these cases – around 90 per cent – happen in Africa.

As many as 50 per cent of people who develop severe symptoms, which include fever, muscle pain and soreness, bleeding and vomiting, end up dying of the disease.

People die as a result of the disease causing multiple organ failure and potentially triggering shock.

There is no medicine which can cure yellow fever after someone is infected, but there is a very effective vaccine – which travellers to at risk areas can buy – which gives most people lifelong immunity from a single dose.

Source: Centers for Disease Control and Prevention

Source

Ebola Spread Concentrated in Congo, Not a Wider Emergency - WHO, April 2019

GENEVA/LONDON (Reuters) - An outbreak of Ebola in the Democratic Republic of Congo (DRC) that has killed more than 700 people and is continuing to spread does not constitute an international emergency, the World Health Organization said on Friday.

Declaring the epidemic a "public health emergency of international concern" would have signalled that greater resources and international coordination are needed.

The WHO's independent Emergency Committee, which analysed the latest data, said the disease was entrenched in several epicentres in the northeast and was being transmitted in health care settings.

It had not spread across borders to Uganda, Rwanda or South Sudan, but neighbouring countries should shore up their preparedness, the experts said.

"It was an almost unanimous vote that this would not constitute a PHEIC (public health emergency of international concern) because we are moderately optimistic that this outbreak can be brought into control - not immediately, but still within a foreseeable time," panel chairman Professor Robert Steffen told a news conference.

Dozens of new cases reported this week have been mainly in the epicentres of Butembe, Katwe and Vuhovi, said Mike Ryan, head of the WHO's health emergencies programme.

"It's quite a focused amplification of disease in a very specific geographic area," Ryan said.

"But the disease there has risen because of lack of access to that community, we've fallen behind in starting vaccination rings," he said, referring to attacks on health centres by armed groups in February that cut-off hotspot areas.

"Vaccine is proving to be a highly effective way of stopping this virus but if we can't vaccinate people we cannot protect them," he added, noting that nearly 100,000 people have been vaccinated.

Experts have declared four emergencies in the past decade: the H1N1 virus that caused an influenza pandemic (2009), a major Ebola outbreak in West Africa (2014), polio (2014) and Zika virus (2016).

Some experts expressed concern that the Emergency Committee was too narrowly interpreting WHO guidelines.

"This is a deeply concerning event, due to the pathogen itself, the total number of cases, the increase in cases just this week, and the difficulty of coordinating the response due to conflict - that needs to receive the appropriate level of attention," health experts Rebecca Katz and Alexandra Phelan of Georgetown University in Washington D.C. said in a statement.

The Ebola outbreak - by far the biggest Congo has seen, and the world's second largest in history - was declared by national authorities in August. It is concentrated in Congo's North Kivu and Ituri provinces.

It has already infected at least 1,206 people, of whom 764 have died - giving a death rate of 63 percent.

They include 20 new cases reported by the health ministry on Thursday, another one-day record after 18 on Wednesday. Two workers at the Butembo airport tested positive, it said.

Reuters Health Information © 2019 

Cite this: Ebola Spread Concentrated in Congo, Not a Wider Emergency - WHO - Medscape - Apr 12, 2019.

Source

Singapore tightens entry regulations to prevent yellow fever, June 2018

Singapore (VNA) – The Singaporean Ministry of Health is considering adjustments to the Infectious Disease Act’s articles, especially those on denied entry to the country to prevent yellow fever virus.

The Southeast Asian country has listed Congo, Ethiopia, Paraguay, Brazil, Argentina and Peru among 42 African and South American countries in the endemic areas of the yellow fever virus.

Accordingly, all passengers, comprising children from one year old, from those nations, or international tourists once residing and transiting through the 42 countries for more than 12 hours in the latest six days, have to show up proof of yellow fever vaccination, or else they will be denied entering the country.

The ministry said that although there are yet no reported cases of yellow fever in Singapore, any importation of the disease to the nation will make it soon become an epidemic there due to the presence of Aedes mosquito vector.

Yellow fever is a mosquito borne acute viral haemorrhagic disease caused by the yellow fever virus. It is transmitted by the bite of an infected Aedes aegypti mosquito.

 

The disease, which is popular in African and South American countries, is characterised by high fever, nausea and jaundice. It can become more serious, causing heart, liver and kidney problems along with bleeding. Up to 50 percent of people with more-severe form of the fever die.-VNA 

Source

A Global Guide For Leery Travelers - Goats and Soda by NPR

With its tropical beaches and a memorable national park, Venezuela was a popular destination for American tourists a decade ago. But years of political and economic turmoil have left its tourism industry in tatters.

Now there's an even more pressing reason to stay out of the country. The Centers for Disease Control and Prevention (CDC) last month issued a rare "Level 3" warning, urging Americans to avoid nonessential travel to Venezuela. The CDC notes that the country is "experiencing outbreaks of infectious diseases, and adequate health care is currently not available in most of the country." Cases of measles, diphtheria and malaria have been reported.

"Venezuela's totalitarian regime has made health very tenuous, with many risks, both infectious and noninfectious," says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

While skipping Venezuela this summer seems like a no-brainer, other health dangers lurk in both mainstream and off-the-beaten-track destinations. Here are some of those threats, along with advice on how to check your destination in advance and take the proper precautions.

Is my destination too dangerous?

How do you know if your destination is too hazardous for your health? Checking the CDC's Travel Health Notices and the World Health Organization's Disease Outbreak News database will give you an overview of the global health problems this summer.

For popular tourist destinations, these include:

Yellow fever and malaria in Brazil. There's a large, ongoing outbreak of yellow fever in multiple states of Brazil, according to the CDC. The agency recommends vaccinations at least 10 days before travel to affected areas and urges you take precautions to ward off mosquito bites. The malaria warning is confined to the town of Wenceslau Guimarães, in Brazil's Bahia state.

Malaria and listeriosis in South Africa. U.K. health authorities in March reported cases of malaria in residents who had returned from the Waterberg district municipality of Limpopo Province. Malaria is most common along South Africa's borders with Zimbabwe and Mozambique. Listeriosis, a bacterial infection, is contracted by eating contaminated foods. The CDC has warned travelers to avoid certain foods, such as soft cheese made from unpasteurized milk, to reduce their risk of infection.

Zika in the Caribbean. The mosquito-borne Zika virus remains a problem in tourist hot spots like Antigua and Barbuda, Aruba, the British Virgin Islands, St. Martin, St. Vincent and the Grenadines, and Turks and Caicos. The CDC has warned travelers to take steps to protect themselves from mosquito bites.

For travelers headed to remote places, whether for business or adventure, there are significant warnings to consider. These include an Ebola Virus Disease outbreak in the Democratic Republic of the Congo, a cholera outbreak in Cameroon, and a danger of Middle East respiratory syndrome coronavirus infection, or camel flu, in Saudi Arabia.

A decision to travel is 'complicated'

An Ebola outbreak is a reason "for sure" to cancel a trip, says Robert Salata, chairman of medicine and an infectious-disease expert at University Hospitals Cleveland Medical Center. But it's not the only reason. If a place you're planning to visit this summer is on the warning list for cholera, other hemorrhagic fevers or Zika, you should strongly consider adding it to your no-visit list, says Salata.

"Don't just pay attention to the warnings about disease outbreaks," Salata adds. "Review any notices related to ongoing violence or natural disasters." Those can exacerbate a health problem at your destination by making it more difficult to obtain care.

Travelers should also consider their own health and other individual concerns, says Dan Strickman, a medical entomologist and a senior project officer at the Bill & Melinda Gates Foundation. (The Gates Foundation is a funder of NPR and its global health team.)

"It's complicated," he says.

Take Zika, for example. The mosquito-borne virus, which can cause birth defects, could be a reason to reconsider your travel plans. But if you aren't of childbearing age, it might not be, says Strickman. A few preventative measures — such as using mosquito repellent and wearing clothing with mosquito-repellent qualities — can substantially reduce the risk of infection.

How to protect yourself — and your vacation

If you're traveling this summer, it's vital to have a big-picture understanding of health and safety, says Louis Weiss, a professor of pathology at Albert Einstein College of Medicine in New York. For a primer on the subject, he recommends a section of the CDC site devoted to such risks. "Research the health risks and requirements for travel," he advises.

Another good resource is the U.S. Department of State website. Earlier this year, it overhauled its advisories to more clearly warn travelers of various dangers. (Afghanistan, the Central African Republic, Iran, and Iraq, for instance, rate "do not travel" warnings.)

"Travelers leaving the country should be well aware of any travel advisories for their intended destination," says Justin Tysdal, the CEO of Seven Corners, a travel insurance company. That includes popular destinations like England, France and Greece, each of which has its own CDC measles warnings.

Travel insurance may also be a worth considering. But you have to pore over the fine print before you buy. Medical evacuation coverage on travel insurance can be limited, so you might consider additional coverage through a medical-transport and travel-security membership program such as Medjet. Airfare, activities, or excursions booked through and prepaid to a travel supplier would generally be protected, as long as a health warning isn't already in effect in the destination.

But experts warn that if a health warning has already been issued, insurance usually won't cover an evacuation or cancellation.

"You might consider a 'cancel for any reason' policy, which addresses those types of concerns," says Beth Godlin, president of Aon Affinity Travel Practice, a travel insurance company. Those policies are typically more expensive than standard, named-exclusion insurance policies and will refund only a percentage of your vacation costs.

But whatever kinds of precautions you take, say the travel specialists, don't procrastinate. Once you've bought the tickets, getting a refund may not be possible.

Christopher Elliott is the founder of Elliott Advocacy, a nonprofit organization that empowers consumers to solve their problems and helps those who can't. Email him with your questions at chris@elliott.org.