21 May 2008

Yellow fever in South America – changes in recommendations for Argentina and Ecuador

Argentina

On 29 February 2008, NaTHNaC revised its recommendations for yellow fever vaccination for travellers to Argentina based on Ministry of Health recommendations [1]. These recommendations have been further revised and the areas for which yellow fever vaccination is recommended have been clarified and extended.

As of 21 May 2008, yellow fever vaccination should be given to those 9 months of age and older travelling to the northern and north-eastern forested regions of Argentina, and all areas bordering Paraguay and Brazil. These areas include:

• All departments of Misiones and Formosa provinces
• Department of Bermejo in Chaco province
• Departments of Berón de Astrada, Capital, General Alvear, General Paz, Ituzaingó, Itatí, Paso de los Libres, San Cosme, San Martín, San Miguel and Santo Tomé in Corrientes province
• Departments of Ledesma, San Pedro, Santa Bárbara and Valle Grande in Jujuy province
• Departments of Anta, General José de San Martín, Oran and Rivadavia in Salta province.

The US Centers for Disease Control and Prevention (CDC) have produced a map of Argentina reflecting the revised recommendations for yellow fever vaccination.

The NaTHNaC Country Information Page for Argentina has been updated to reflect these changes.

Ecuador

In March 2008, the Ministry of Health of Ecuador recommended yellow fever vaccination for several provinces within the Amazon basin [2]. Based on this information NaTHNaC has revised its recommendations for Ecuador and extended the areas for which yellow fever vaccination is recommended.

As of 21 May 2008, yellow fever vaccination should be given to those 9 months of age and older travelling to the following provinces in the Amazon basin:

• Morono-Santiago
• Napo
• Orellana
• Pastaza
• Sucumbíos
• Zamora-Chinchipe.

Vaccination is also recommended for all other areas to the east of the Andes Mountains. This does not include the cities of Quito and Guayaquil or the Galapágos islands.

The US Centers for Disease Control and Prevention (CDC) have produced a map of Ecuador reflecting the revised recommendations for yellow fever vaccination.

The NaTHNaC Country Information Page for Ecuador has been updated to reflect these changes.

Advice 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) or Haemogogus spp. (jungle transmission) mosquitoes. These mosquitoes feed predominantly during daylight hours. Travellers should take mosquito bite avoidance measures.

Since January 2008, human cases of yellow fever have been reported from Argentina, Brazil, Paraguay and Peru [3]. Travellers should review the Country Information Pages for specific recommendations.

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. Travellers who are vaccinated should make sure they carry their International Certificate of Vaccination or Prophylaxis in the event that documentation of vaccination is requested.

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. NaTHNaC Clinical Update. Yellow fever in South America – changes to vaccination recommendations for travellers to Argentina. 29 February 2008. [Accessed 21 May 2008]. Available at http://www.nathnac.org/pro/clinical_updates/yf_290208.htm

2. World Health Organization. Yellow fever vaccination requirements and recommendations. In International and Travel Health, 2008. [Accessed 21 May 2008]. Available at http://www.who.int/ith/countries/ecu/en/

3. NaTHNaC. Yellow fever in South America – update. 14 April 2008. [Accessed 21 May 2008]. Available at http://www.nathnac.org/pro/clinical_updates/yf_140408.htm