Brazil tries to contain yellow fever outbreak

This story was published in Arab News on Feb. 2, 2017:

By Rasheed Abou-Alsamh

Special to Arab News

BRASILIA: Brazil is trying to contain an outbreak of yellow fever that has already claimed 46 lives, by vaccinating inhabitants of high-risk areas.

There have been 568 suspected cases of yellow fever so far this year, with 430 still being investigated, 107 confirmed cases and 31 discarded ones, according to the Health Ministry.
The outbreak is centered in rural areas of southeast Minas Gerais state, and the bordering areas of the states of Bahia and Espirito Santo.

“Apparently the state governments involved were rather slow in vaccinating everyone, but as soon as the outbreak happened they started to quickly vaccinate the population at risk,” Dirceu Bartolomeu Greco, an infection specialist and professor at the School of Medicine of the Federal University of Minas Gerais in Belo Horizonte, told Arab News.

“I think we may have reached the peak of the current outbreak. This serves as a very important reminder that the preventive part of this is perhaps the most important. I think this outbreak will be controlled.”

There is no known cure for yellow fever, so getting vaccinated is the best way to prevent contracting the disease.

It is a viral infection that causes fever, headache, chills, back pain, fatigue, loss of appetite, muscle pain, nausea and vomiting. In advanced stages it attacks the liver, causing the victim’s skin to turn yellow.

Brazil has been battling the disease since the mid-1800s. It originated in Africa and was brought to South America by slaves.

The Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro has been leading the fight against yellow fever in Brazil since its establishment in 1900, and today produces millions of doses of yellow fever vaccine for Brazil and various countries in Africa.

The Health Ministry reinforced its strategic stock of vaccine with an additional 11.5 million doses. It has already sent out an extra 5.4 million doses to five states: 2.9 million to Minas Gerais, 1.05 million to Espirito Santo, 400,000 to Bahia, 350,000 to Rio de Janeiro and 700,000 to Sao Paulo.

The problem is that many people living in urban areas have rushed to public health posts to be vaccinated for free, causing temporary shortages of the vaccine in some cities.
In Luziania, Goias, just 57 kilometers from the capital Brasilia, a suspected yellow fever death led to a rush on vaccination centers, causing a 30 percent increase in the number of people seeking vaccination, O Globo newspaper reported.

The federal government sent an extra 100,000 doses to Goias. The state government of Goias said 94 percent of its population is already vaccinated against the disease. The strain of yellow fever prevalent in Brazil is spread by mosquitoes living in rural areas, where monkeys are the common carriers of the virus.

The government recommends that Brazilians living in 19 states, mostly in the mid-west and north of the country, take the vaccine.

New scientific studies have shown that a single yellow fever vaccination could possibly protect a person their whole life.

“The advantage of the vaccine is that studies are showing that you’ll probably only need one dose to protect yourself for life,” said Greco.

Studies have shown that a single vaccination has protected some patients for up to 30 years. Current practice recommends that people living in or traveling to high-risk areas be vaccinated every 10 years.

Rapid expansion of the population into rural areas has added to the severity of yellow fever outbreaks, said Greco: “Brazil hasn’t had an urban outbreak of yellow fever since 1942, but we need to keep an eye on this push into rural areas and keep up our prevention campaigns.”

The virus is transmitted in Brazil by mosquitoes in rural, heavily wooded areas, not by the Aedes aegypti mosquitos of urban areas that have already spread dengue fever and the Zika virus. This year’s outbreak of yellow fever has been the largest in Brazil’s history, Folha de Sao Paulo newspaper reported.

In 2000 there were 85 cases and 40 deaths, in 2008 there were 46 cases and 27 deaths, and in 2009 there were 47 cases and 17 deaths.

Getting vaccinated against swine flu in Brasilia

I HAD wanted to be vaccinated against swine flu for quite a while, so I was excited when the Brazilian government announced earlier this year that it was going to start a vaccination campaign for free this autumn. (Remember that Brazil is in the Southern Hemisphere, so we’re going into winter here, when the outbreak of flu is at its highest point.)

My happiness was short-lived when the Ministry of Health announced the categories of people who could get the vaccine for free at government health centers: Persons above 60 years of age with chronic health problems; pregnant women, and young people between 20 and 29 years of age. The government said that if there were any vaccines left after that, then everyone else would also be vaccinated. After the severe shortages of the H1N1 vaccine that Brazil experienced last year, I was not going to hold my breath for any leftover vaccine.

“Why don’t you just go to a private clinic?” my partner Thiago said one day when I complained to him that I didn’t fit into any of the categories that the government was vaccinating. “I’m sure you can get it done at Sabin,” he added.

So a few days ago I called Sabin and sure enough they did have the H1N1 vaccine. But at a cost: R$140, or around $80. I thought that was an okay, if a little expensive, price to pay to avoid the horridness of having swine flu and perhaps not surviving it. No appointment was needed, the helpful woman told me on the phone. “We even work through lunch,” she said.

Yesterday I drove to Sabin Vacinas and paid the fee for both the H1N1 vaccine and the first of three shots for hepatitis A+B. The nurse assured me that it was okay to take both on the same day, one in each arm, as they were made from dead viruses.

“Look, this one is made in Holland and the other one is made in Belgium,” the nurse said showing me the packaging of the vaccines and pointing out the manufacturing and expiration dates of both. “You get protection from swine flu plus the seasonal flu,” she added.

“Are you good at giving injections?” I asked warily with a nervous laugh, having had terrible experiences with clumsy nurses in the past, who would poke around looking for a vein while trying to extract my blood.

“Yes of course,” she replied with a big smile. “Don’t worry, only the hepatitis shot will burn a little.”

She gave me the H1N1 shot first in my right arm. I didn’t feel a thing. In fact I thought she had not even given it to me. The hepatitis one in my left arm burnt a little, but just for a moment.

“Your arm will be sore for a while,” she said. “But you should be fine.”

Getting up from the chair and walking to the receptionist’s desk I suddenly felt woozy like I was going to faint. I immediately sat down and put my head down between my knees.

“Keep your head up!” a kind woman doctor told me. “Do you feel like fainting? If so, keep your head up.”

She brought me water with sugar, a very Brazilian remedy for anyone feeling faint or upset, followed by coffee and a few pão de queijo (cheese breads).

“Breath deeply in and out,” she said. “You know, men are always weaker than women when it comes to needles and injections. They’re always the ones that faint.”

“Oh my! You look very pale,” said the receptionist looking at me.

“Let me take your blood pressure,” said the doctor.

After listening to my blood circulating she announced: “Your pressure is quite low. Just sit here a little and wait for it to improve.”

After chatting with them for around 15 minutes, and the doctor taking my pressure once more to make sure that it was rising to normal levels again, I bid farewell and walked to my car to drive home.

Both arms are still a little sore, which made it a little uncomfortable to sleep last night, since I’m a side sleeper, but hey, I feel safer now that I’ve been vaccinated against swine flu. Now I just need to get two more shots against hepatitis A+B. I just hope I don’t nearly faint again!

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