14 April 2008

Yellow fever in South America - Update

Argentina

In January 2008, 17 monkeys were found dead in Piñalito Park, San Pedro Department, Misiones Province, one of which was confirmed as being infected with yellow fever. As of 26 March 2008, five human cases have been confirmed, one of which was fatal. All human cases were reported in the province of Misiones, three in the department of Guaraní, one from San Pedro, and one from El Dorado. A vaccination campaign is underway, vector control measures are being applied, and active surveillance is ongoing for people coming from or residing in risk areas [1].

Brazil

As of 4 April 2008, 40 confirmed human cases of yellow fever were reported, 21 of which were fatal. Four suspected cases are also under investigation. The majority of cases (21) have been reported from Goiás state. Cases have also been reported in Distrito Federal, Mato Grosso do Sul, Mato Grosso, Pará and Paraná states. The first case was reported on 16 December 2007 and the last suspected case was reported 23 March 2008. Yellow fever outbreaks in monkeys have also been reported in Goiás, Distrito Federal, Mato Grosso do Sul, Mato Grosso, Minas Gerais, Paraná, Tocantins and São Paulo strates [2]. A vaccination campaign is underway in the affected areas.

Paraguay

In January and February 2008, five human cases of yellow fever were reported in Estanislao in the department of San Pedro. These were the first reported cases since 1974 [3]. As of 31 March 2008, 26 cases have been confirmed, eight of which were fatal. Fifteen of the cases were reported from the department of San Pedro, ten cases from Central Department and one case from Caaguazú Department [4]. As of 8 April 2008, the last case of yellow fever was reported on 15 March 2008 [5]. A vaccination campaign is underway and a team of scientists from the Pan American Health Organization are assisting with the outbreak investigation and providing laboratory support [4].

Peru

Between January and April 2008, two confirmed human cases of yellow fever have been reported, both of which were fatal. One case was from Aguaruna "Nueva Esperanza" community in the Nueva District in the Amazonas Department and the other was from the Picota district of San Martin Department. Four suspected cases have also been reported [6].

Recommendations for travellers

Yellow fever is a serious viral disease in the tropical regions of the Americas and sub-Saharan Africa. In South America, the virus is transmitted via the bite of Aedes spp. (urban transmission from human to human) or Haemogogus spp. (jungle transmission from monkey to human) mosquitoes. These mosquitoes feed predominantly during daylight hours. Travellers should take mosquito bite avoidance measures.

In January and February 2008, NaTHNaC revised its yellow fever vaccination recommendations for travellers to Argentina, Brazil and Paraguay [7-9]. These recommendations remain current and can be found on the relevant NaTHNaC Country Information pages. The yellow fever vaccination recommendations for travellers to Peru have not changed.

There are specific contraindications and adverse events associated with yellow fever vaccine. A careful risk assessment should be made before administration and specialist advice sought as appropriate.

Health care professionals are reminded that all yellow fever vaccinations given after 15 December 2007 should be documented in the International Certificate of Vaccination or Prophylaxis (ICVP).

References

1. Pan American Health Organization. Yellow fever in Argentina, Emerging and Re-emerging Infectious Diseases, Regions of the Americas, 31 March 2008. Accessed 10 April 2008. Available at: http://www.paho.org/English/AD/DPC/CD/eid-eer-2008-03-31.htm 

2. Ministry of Health of Brazil. Situação da Febre Amarela Silvestre no Brasil, 2007 e 2008, 4 April 2008. Accessed 10 April 2008. Available at: http://portal.saude.gov.br/portal/arquivos/pdf/boletim_svs_febre_

amarela_040408.pdf [In Portuguese].

3. National Travel Health Network and Centre. Yellow fever in Paraguay, Clinical Update, 8 February 2008. Accessed 10 April 2008. Available at: http://www.nathnac.org/pro/clinical_updates/yf_080208.htm

4. Centers for Disease Control and Prevention (US). Yellow fever in Paraguay – updated, Outbreak Notice, 4 April 2008. Accessed 10 April 2008. Available at: http://wwwn.cdc.gov/travel/contentYellowFeverParaguay.aspx

5. Ministry of Health of Paraguay. Prevención y Control del Dengue y la Fiebre Amarilla “Estamos registrando mayor conciencia de la ciudadania”, 8 April 2008. Accessed 10 April 2008. Available at: http://www.mspbs.gov.py/ver_noticia.php?id=433 [In Spanish].

6. Anon, 2008. Tendencia Y Situacion Epidemiologica. Bol. Epidemiol (Lima), 17 (11) pp14. Accessed 10 April 2008. Available at: http://www.oge.sld.pe/Boletin_sem/2008/SE11/se11-01.pdf [In Spanish].

7. National Travel Health Network and Centre. Yellow fever in South America – Changes to vaccination recommendations for travellers to Argentina, 29 February 2008. Accessed 10 April 2008. Available at: https://www.nathnac.org/pro/clinical_updates/yf_290208.htm

8. National Travel Health Network and Centre. Yellow fever in Brazil, 17 January 2008. Accessed 10 April 2008. Available at: http://www.nathnac.org/pro/clinical_updates/yf_170108.htm

9. National Travel Health Network and Centre. Yellow fever in Argentina, Brazil and Paraguay: Changes to yellow fever vaccination recommendations for Paraguay, 22 February 2008. Accessed 10 April 2008. Available at: http://www.nathnac.org/pro/clinical_updates/yf_220207.htm