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.

Braces aren’t just for teenagers


By Rasheed Abou-Alsamh

For years many people neglected taking care of their teeth, which of course resulted in decay, cavities, and the inevitable extractions that would leave the person toothless and having to use a denture to fill in the gaps of the missing teeth.

It is said that Queen Elizabeth’s teeth turned black in the 1600s from decay because of her predilection for Moroccan sugar, since they probably did not realize that excessive consumption of sugar and lack of dental hygiene meant that their teeth were doomed. Of course things are now rather different. Widespread fluoridation of drinking water begun in the 1960s, as well as the use of fluoride toothpaste, have helped dramatically decrease tooth decay in both children and adults.

But our continued collective sweet tooth, with our love of fizzy drinks, candy and cookies, all loaded with tons of sugar, means that we will not put dentists out of business any time soon!

I have had reasonably good teeth for most of my life, albeit with my share of cavities and later on root canals on teeth that could not be saved by a simple filling. Until I reached my 40s I did not go see a dentist regularly once a year, or even every six months, as recommended by dental professionals. Like most people, I brushed my teeth twice a day, and rinsed my mouth after eating or drinking something particularly sweet. But then the problems started in my mid-40s. I started to need more and more root canals, and now in my 50s my teeth seem to be breaking more easily than ever.

In an attempt to save the remaining real teeth that I still possess, I now brush my teeth after each meal and floss once a day. Even so, I have been forced to get three implants after my dentist told me that the infection in the root was too far gone to save the tooth.

On one of my recent visits to my dentist I asked about the possibility of getting braces, as one of my front teeth was being pushed out, and my bottom front teeth were slightly crooked. It seems that as we get older our teeth start moving, and become crooked.

“Yes, of course you can have braces. I think you’d only need to wear them for nine months,” he told me.

I thought a lot about the possibility of having braces and researched online the experiences of other adults who had done the same. The results were positive, so I decided to take the plunge. This week I went in to my orthodontist and he and his assistant placed the braces on my teeth.

“Your teeth are going to start hurting in about four hours from now, so take a pain killer,” my orthodontist warned me at the end of the procedure. But my teeth did not hurt that night, thank goodness.

Having braces is not easy. You must watch carefully what you eat, not biting into anything hard such as apples and nuts. Anything that can get caught in the metal of the brackets should be avoided such as popcorn, caramels and other chewy candy and chewing gum. The other problem is that after eating a meal, some food remains trapped in one’s braces, which means a careful brushing afterwards, not just washing your moth out with water, is needed to get rid of the debris.

In the US there has been a recent boom in adults wearing braces. According to a Wall Street Journal article, 1.2 million American adults received orthodontic treatment in 2012 according to the American Association of Orthodontists, up 39 percent from 1996. The article even mentions an 87 year old man who recently had his braces removed at the end of his treatment.

It does feel a bit strange having all of those small metal brackets stuck on my teeth. My braces have given me a slight lisp, but nothing I can easily correct when talking. Now all I have to do is endure the jokes thrown at me by relatives and friends. My American cousin Tom called me “metal mouth” when he saw a picture of my braces that I posted online. A friend quipped “sweet 16!” Of course I protested and said that I had never needed braces when I was teenager, but need them now in my middle age. Braces nowadays, I told him, are for adults too.



Brazil struggles with Zika outbreak

Brazilian soldiers empty bottles filled with water in a person's backyard to not allow mosquitoes a breeding place.

Brazilian soldiers empty bottles filled with water in a person’s backyard to not allow mosquitoes a breeding place.

By Rasheed Abou-Alsamh

Brazil is reeling from an unprecedented outbreak of the Zika virus, which in the worst cases affects the fetuses of pregnant woman, causing malformation of the babies’ brains.

The virus is spread by the Aedes aegypti mosquito and the first case here was only recorded in 2014. It is believed that the virus was imported into Brazil by a traveler or athlete from the Pacific islands during the World Cup.

There are already 3,718 cases of suspected microcephaly in Brazilian babies, which means that their heads measure only 32 centimeters or less at birth. The majority of reported cases have been in Northeastern Brazil, the hottest and poorest region of the country. This has caused the US government to warn pregnant American women from traveling to Brazil, and has worried some Brazilians that if the outbreak is not handled quickly it could scare off some of the hundreds of thousands of foreign tourists expected to arrive for the Rio de Janeiro Olympic Games in August.

But what is the Brazilian government to do? Brazil is a tropical country with a lot of heat and rain. The poorest Brazilians live in shacks in slums that have many places where garbage accumulates as well as pools of water and sewage, perfect breeding grounds for mosquitoes. As one American expert rather gloatingly noted recently, the Zika virus is not going to spread like fire in the US because most Americans have air-conditioning and screens on the windows in their homes that keep the mosquitos out. Poor Brazilians do not have that luxury.

So the Brazilian government has done as it always has: Launched a public relations campaign through ads on television, radio and newspapers, telling the population to fight the breeding grounds of mosquitoes by making sure they do not have pools of water lurking around their homes in old containers, under potted plants and in any junk they may have accumulated in their backyards. But this is the continuation of a long-term campaign in its battle against the equally mosquito-borne pestilence of dengue fever. Municipal officials and occasionally army troops are annually deployed across cities and towns in Brazil, going door-to-door to inspect homes for mosquito-breeding locations. If they do find stagnant water pools, they try to drain them, and if that is not possible they pour insecticide into the water to kill the larvae of the mosquitoes.

But, meanwhile, the numbers of Brazilians infected with dengue and Zika keep skyrocketing. According to the Ministry of Health, the number of dengue cases in the first 20 days of this year jumped 48 percent, reaching 73,000 cases. In 2015, there were an eye-popping 1.6 million cases of dengue in Brazil. In dengue fever, the symptoms are high fever and acute pain in the eyes and joints of patients. In the case of Zika infection, the victim also gets red blotches on their skin across his/her body. There is also a more dangerous version of dengue fever that apart from causing all of the aforementioned symptoms causes internal bleeding.

The Brazilian government has now said its priority is to help with the work being done to develop a vaccine for the Zika virus. They hope to have human trials for a vaccine 18 months from now.

The scary aspect of the Zika virus is that when a pregnant woman catches it in her first three months of pregnancy, she most times passes it on to her fetus. Unfortunately, tests can only detect whether a fetus has been infected with the virus from the 24th week of gestation and onward. Which means that a fetus will already be six months old when the Zika virus can be detected. That causes many complications in that it makes it harder for a woman to have an abortion at that late stage in the pregnancy. Brazil has been battling with this, since being a Catholic nation abortion is strictly banned except if the mother was raped or could die if she brought the pregnancy to gestation.

A Supreme Court justice said recently he believed that women with fetuses affected by the Zika virus should be allowed to have abortions, since these babies will most likely be born with malformed brains. But no one seems to be pushing this aspect of dealing with the crisis. As one Brazilian commentator quipped: “Rich Brazilian women are not affected too much by the restrictions because they can afford to pay the $1,800 to have an illegal abortion in a private clinic, while poor women who cannot afford that remain resigned to their fate.”

The panic that this has generated here in Brazil has caused many well-to-do pregnant women to move to Miami in the US for the duration of their pregnancies, returning to Brazil only after their babies are born. Poor women obviously do not have that option. So the Brazilian government should step up efforts to control the mosquito population in Brazil, while work is being done on a vaccine for Zika and dengue too. Fumigating areas with too many mosquitoes, encouraging Brazilians not to throw their trash everywhere, and handing out free insect-repellent in poorer areas would go a long way in controlling the ever growing number of dengue and Zika victims.

This column was printed in Arab News on Feb. 14, 2016:

Do more before Ebola reaches tipping point

US Marines get their temperatures taken after landing in Liberia on October 9, 2014, to help set-up more blood screening centers in the fight against the Ebola virus. (Getty Images)

US Marines get their temperatures taken after landing in Liberia on October 9, 2014, to help set-up more blood screening centers in the fight against the Ebola virus. (Getty Images)

This is my Arab News column published on October 12, 2014:

By Rasheed Abou-Alsamh

Watching a BBC report this week on a desperate family in Liberia that had a male member ill with the Ebola virus, driving from one emergency medical center to another, only to be turned away from them all, was heart-wrenching.

They were confused and in the tropical heat looked dazed and angry, a woman frantically fanning the sick man who looked too weak and feverish to walk, let alone stand up, as he sat slumped in the front passenger seat. The reporter bravely gave the family rubber gloves to use, the most she could do in such extreme conditions, where in a tiny and impoverished nation such as Liberia, this deadly virus has completely overwhelmed the public health system. The sick man died shortly thereafter.

With more than 4,000 deaths now from the Ebola virus, and more than 8,000 people in West Africa infected with it, according to the World Health Organization, we have an epidemic on our hands. And if more is not done quickly, such as more experimental drugs to treat Ebola victims, and vaccines invented to prevent infection, then we will soon have a global pandemic. For sure the Ebola virus is not that easily transmitted, but it is also not that difficult to become contaminated with it if you come into contact with the bodily fluids of infected patients, as we have seen with the various nurses and aid workers, who have come down with the disease. And the mortality rates are extremely high: 70 percent of Ebola patients in West Africa are dying from it, Robert Murphy, a professor of medicine at Northwestern University in Chicago, told USA Today.

Which brings us to how the disease is being fought, how patients are being treated or not, and why finding a cure still doesn’t seem to be a high priority for major pharmaceutical companies. The first three Americans exposed to the virus in West Africa were all flown home to the United States where they received the best medical treatment in the world, including the experimental drugs ZMapp and TKM-Ebola. They also received blood transfusions from Ebola survivors, in the hope that their antibodies would strengthen their immune system against the virus. All three survived and have recovered well.

Compare their treatment to that of the 42-year-old Liberian Thomas Eric Duncan who just died this week of the Ebola virus in a Dallas hospital. He was not offered ZMapp or TKM-Ebola. According to the Atlanta Blackstar news site, contradictory reasons were given for why Duncan did not get the drugs. Tom Frieden, the director of the Centers for Disease Control and Prevention, said that doctors treating Duncan feared the drug might worsen his condition. Dr. Anthony Fauci of the National Institutes of Health claimed that supplies of ZMapp were exhausted, and that it would take six to eight weeks before new supplies would be ready. Duncan was given brincidofovir, an experimental antiviral drug, more than one week after he was admitted to hospital, according to USA Today. Obviously, that was not enough to save his life. He was not offered blood transfusions or any other experimental drugs according to the paper.

The good news, if you can even call it that, is that the WHO has fast-tracked the development of experimental vaccines against Ebola, agreeing to skip the usual randomized controlled tests in which some participants get the vaccine and others a placebo. The WHO said that it was ethical to give Ebola patients untested vaccines, although the risks and benefits should be strictly evaluated and the results shared. Several experimental vaccines are being tested in Africa, and hopefully will be able to save lives once they are produced and used on larger scales.

The US government has already sent 400 US military personnel to Liberia to set-up blood screening centers that process blood samples from Ebola patients. The US House of Representatives has now approved a further $700 million in funding to deploy a further 4,000 American troops to West Africa to help in the fight against Ebola. Cuba too has sent 165 doctors to Sierra Leone and will send a further 296 doctors to Liberia and Guinea.

Big pharmaceutical companies are not beating down anyone’s door to develop Ebola vaccines or treatment drugs because so far the majority of the victims have been poor Africans, who could never afford to buy expensive medicines that these manufacturers would want to push them to do in order to recoup their research and development costs in bringing these Ebola drugs quickly to the market. But this is a global emergency and all governments involved — African, Western, and Asian — should get together and pool their resources to fast-track the development of an Ebola vaccine. They could do so by using government laboratories or in some sort of government-private sector partnership where they offered private pharmaceutical firms tax incentives to develop these drugs quickly and cheaply.

All of our lives are in danger if not enough is done now, and Ebola is allowed to become to a global scourge. We cannot continue to be complacent, as our future depends on it.


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