Health Professionals

Clinical Updates

22 February 2008

Yellow fever in Argentina, Brazil and Paraguay: Changes to yellow fever vaccination recommendations for Paraguay

Argentina

In January 2008, 17 monkeys were found dead in Piñalito Park, San Pedro Department, Misiones Province. On 4 February 2008 yellow fever was confirmed in one of these monkeys. A vaccination campaign is underway for people living in or travelling to the affected areas. There have been no human cases reported [1].

Brazil

As of 18 February 2008, 31 confirmed cases of yellow fever in humans including 16 deaths have been reported from the states of Distrito Federal, Goiás, Mato Grosso and Mato Grosso do Sol. An additional three suspected cases are currently under investigation and yellow fever has been ruled out in 23 previously suspected cases. The first confirmed case was reported on 16 December 2007 and the last suspected case was reported on 25 January 2008 [2]. A vaccination campaign is underway in the affected areas.

Paraguay

Between 15 January and 20 February 2008, seven confirmed cases of jungle yellow fever in humans were reported from the San Pedro Department, in the east central region of Paraguay [3]. Five of the cases originated from the area of Estanislao and had participated in hunting activities [4]. These were the first reported human cases of yellow fever in Paraguay since 1974 [5, 6]. A cluster of four suspected cases has also been reported in San Lorenzo municipality in Central Department, 20km from the capital, Asunción. These cases are clinically compatible with yellow fever and final confirmation is pending [3].

The Ministry of Health, in cooperation with the Pan American Health Organization, has initiated enhanced surveillance of cases of fever and jaundice, vector control and vaccination in the affected areas to prevent serious public health consequences of the spread of yellow fever in urban areas.

Revised recommendations for travellers

Yellow fever is a serious viral disease affecting monkeys and humans 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.

The current outbreaks of yellow fever in Brazil and Paraguay have resulted in changes to travel advice (see below). The outbreak of yellow fever in monkeys in Argentina is in an area where vaccine is already recommended and therefore recommendations for travellers have not changed.

Paraguay

Following consultation with the Centers for Disease Control and Prevention in the United States (CDC) [7], the recommendations for Paraguay have been revised since the last posting of 8 February 2008 [4]. Yellow fever vaccine should be given to all travellers over 9 months of age visiting Paraguay. This recommendation will be reviewed as further information is forthcoming about the situation in Paraguay.

Brazil

On 17 January 2008, NaTHNaC revised its yellow fever vaccine recommendations for travellers to Brazil [8] and these recommendations remain current. The CDC have produced an updated map showing the areas of Brazil where there is a risk of yellow fever transmission.

Specific advice regarding recommendations for vaccination and certificate requirements for Argentina, Brazil and Paraguay can be found in the NaTHNaC Country Information Pages.

Yellow fever vaccination

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 YF vaccinations given after 15 December 2007 should be documented in the International Certificate of Vaccination or Prophylaxis (ICVP).

References

1. Pan American Health Organization. Jungle Yellow Fever in Brazil, Paraguay and Argentina, Emerging and Re-emerging infectious diseases, Regions of the Americas, 11 February 2008. Accessed 18 February 2008. Available at: http://www.paho.org/English/AD/DPC/CD/eid-eer-2008-02-11.htm

2. Ministry of Health, Brazil. Situação da Febre Amarela Silvestre no Brasil, 2007 e 2008, 20 February 2008. Accessed 21 February 2008. Available at: http://portal.saude.gov.br/portal/arquivos/pdf/boletimfa_200208.p

df

3. World Health Organization. Yellow fever in Paraguay, 20 february 2008. Accessed 21 February 2008. Available at: http://www.who.int/csr/don/2008_02_20a/en/index.html  

4. National Travel Health Network and Centre. Yellow fever in Paraguay, 8 February 2008. Accessed 18 February 2008. Available at: http://www.nathnac.org/pro/clinical_updates/yf_080208.htm

5. World Health Organization. Yellow fever reported cases 1980 – 2005, 22 December 2006. Accessed 18 February 2008. On-line resource available at: http://www.who.int/immunization_monitoring/en/globalsummary/

timeseries/tsincidenceyel.htm

6. World Health Organization. WHO report on Global Surveillance of Epidemic-prone infectious diseases, 2000. Accessed 18 February 2008. Available at: http://whqlibdoc.who.int/hq/2000/WHO_CDS_CSR_ISR_2000.1

.pdf

7. Centers for Disease Control and Prevention, United States. Yellow fever in Paraguay, 21 February 2008. Accessed 22 February 2008. Available at: http://wwwn.cdc.gov/travel/contentYellowFeverParaguay.aspx

8. National Travel Health Network and Centre. Yellow fever in Brazil, 17 January 2008. Accessed 18 February 2008. Available at: http://www.nathnac.org/pro/clinical_updates/yf_170108.htm

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