The Centers for Disease Control and Prevention (CDC) has issued an elevated risk travel alert for the country of Brazil as they are currently experiencing an outbreak of yellow fever.
As if the Zika virus did not result in enough damage in Brazil this past year, residents are now being plagued with an additional mosquito-borne virus “of mass destruction:” yellow fever.
Brazil has been experiencing an ongoing outbreak of yellow fever since December 2016, and in January 2017, the World Health Organization (WHO) issued an official warning of a potential outbreak of the disease. On February 1, 2017, the Centers for Disease Control and Prevention (CDC) issued a Level 2 travel Alert on travel for the country, which calls on individuals to, “Practice Enhanced Precautions.”
According to the CDC, “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.” Although most cases of this deadly infection have occurred in rural areas, the disease is continuing to spread into more urban locations. As a result of recent yellow fever-associated deaths and the continued spread of the disease, a mass vaccination campaign is underway, which will target unvaccinated individuals in the areas that are most affected.
According to the CDC, individuals 9 months of age and older who are living in, or traveling to, an area of endemic yellow fever should be vaccinated against the infection. In addition, those travelers who received the yellow fever vaccination 10 or more years ago, “and who will be in a higher-risk setting, including areas with ongoing outbreaks,” should receive a booster dose of the vaccine. The CDC recommends that individuals check with “a yellow fever vaccine provider to determine if they should be vaccinated.” Although the current recommendation is to receive the yellow fever vaccine at least 10 days prior to the trip, travelers should bear in mind that there is currently a shortage of the yellow fever vaccine and so if they are planning to visit a country with endemic yellow fever, they should contact the vaccine provider, “well in advance of travel.”
It is also important to note that some individuals can have serious reactions to the yellow fever vaccine. Individuals who are over 60 years of age, those with weakened immune systems, and pregnant and nursing mothers are at highest risk of reactions to the vaccine, and therefore, should contact their health care provider prior to being vaccinated so as to assess the risk.
Symptoms of yellow fever, which may take between 3 and 6 days to develop, “include fever, chills, headache, backache, and muscle aches,” although, it is important to note that most infected individuals will experience only mild illness or no symptoms at all. “About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death,” according to the CDC.
Once infected, the treatment options focus on treating the symptoms, as currently, no specific treatment exists. Hospitalization is recommended for those who are infected so that supportive care (pain relievers to reduce aches and fever, rest, and fluids), can be administered and the patient can be closely monitored. Individuals who do exhibit symptoms, or who only exhibit mild symptoms tend to recover completely, while those who have more serious forms of the illness may take months to fully recover. Twenty to 50% of those that develop serious forms of the disease will die.
The CDC has compiled a list of municipalities in which a yellow fever vaccine is recommended to travelers. A map of these municipalities and a current list of high-risk areas is available on the CDC and WHO’s websites. In addition, a list of these areas is also available via the Brazilian Ministry of Health.