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Tuesday, November 28, 2017

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Friday, November 24, 2017

Yellow fever – Brazil Disease outbreak news 24 November 2017, WHO

Between July and mid-October 2017, a total of 71 suspected yellow fever cases were reported in São Paulo State, Brazil. Of these, two were confirmed, six are under investigation, and 63 were ruled out. The two confirmed cases (one of which was fatal) were reported from Itatiba from 17 September through 7 October 2017.
From July to early November, 580 epizootics in non-human primates (NHPs) were reported in São Paulo State, with an increase in the number of cases reported from 10 September 2017. Of these, 120 were confirmed for yellow fever, 233 are under investigation, 74 were classified as undetermined, and 153 were ruled out. The highest number of epizootics was registered in the health surveillance area of Campinas, where epizootic episodes were reported for the first time in the municipalities of Campo Limpo Paulista (in the week ending 23 September 2017), Atibaia (in the week ending 30 September 2017), and Jarinu (in the week ending 14 October 2017). Epizootics in NHPs were also recently reported in large parks located within the urban area of São Paulo City (in the week ending 14 October 2017).

Public health response

The detection of two confirmed yellow fever human cases and epizootics in the state of São Paulo, as well as confirmed yellow fever epizootics in the urban area of São Paulo City, prompted national authorities to begin vaccination campaigns in areas previously considered not at risk for yellow fever transmission. In addition, state and municipality health authorities are strengthening health care services and carrying out risk communication activities.

WHO risk assessment

These are the first human cases of yellow fever that have been reported in Brazil since June 2017. These cases, alongside the occurrence of epizootics in the urban area of São Paulo City and in municipalities that were previously considered not at risk for yellow fever, are a public health concern. Although Brazilian health authorities have swiftly implemented a series of public health measures in response to this event, including mass vaccination campaigns, it may take some time to reach optimal coverage in these areas given the large number of susceptible individuals. Currently, the number of unvaccinated people in São Paulo City remains high at around 10 million. If yellow fever transmission continues to spread to areas that were previously considered not at risk for yellow fever, ensuring the availability of vaccine and implementing control measures would pose significant challenges.
To date, there has been no evidence of transmission by Aedes aegypti in relation to this outbreak in Brazil which began in 2016. Although entomological studies conducted in selected municipalities of São Paulo revealed low levels of Ae. aegypti and Aedes albopictus infestation (pupa index range: 0% – 3.1%), the risk of sustained arbovirus transmission is ever present.
The risk of spread at the regional level is considered to be low given the high vaccination coverage in neighbouring countries; however, the detection of a human case of yellow fever in Oiapoque, the border river between French Guiana and Brazil in August 2017 by French health authorities indicates that the risk of regional spread exists. The risk at the global level is considered to be low and limited only to unvaccinated travellers returning from affected areas. Travelers who return home while infected with yellow fever virus may increase the risk of establishing local cycles of yellow fever transmission in areas where the competent vector is present.
WHO continues to monitor the epidemiological situation and assess the risk according to the latest available information.

WHO advice

Advice to travellers planning to visit areas at risk for yellow fever transmission in Brazil includes receiving yellow fever vaccine at least 10 days prior to traveling, following measures to avoid mosquito bites, and being aware of yellow fever symptoms and signs. WHO continues to promote health seeking behaviour when travelers are in and when they have returned from an area at risk for yellow fever transmission.
As per Annex 7 of the International Health Regulations (2005), a single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease. Booster doses of yellow fever vaccine are not needed. If, on medical grounds, a traveler cannot be vaccinated against yellow fever, this must be certified by the relevant authorities as per Annex 6 and Annex 7 of the International Health Regulations (2005).
The WHO Secretariat does not recommend any restrictions on travel or trade with/to Brazil according to the information currently available for this event.

Friday, November 10, 2017

Ongoing surveillance and vaccination are key to prevent yellow fever outbreak in humans

November 6, 2017
A combination of continuous monitoring of mosquitoes and non-human primate deaths, along with laboratory tests and increased vaccination, is crucial to prevent human cases of yellow fever in places where the virus is transmitted. Findings from a brief research report are published in Annals of Internal Medicine.
Yellow fever is a virus found in South America and Africa that is transmitted by . Transmission typically occurs in wild animals, but occasionally spills over to humans entering forest regions. Still, urban transmission is rare, mainly due to vaccination. Recently, concerns about reemergence of urban yellow fever have grown because of the reappearance and rapid spread of A aegypti (a type of mosquito that may carry yellow fever) in the urban environment. Further, immunization coverage for yellow fever is insufficient because it is usually administered to high-risk populations.
Researchers from the Instituto Goncalo Moniz studied the 2017 epizootic outbreak (outbreak within animals) of yellow fever in Salvador, Brazil to determine the risk for human disease. The researchers studied the temporal and spatial distribution of the yellow fever virus outbreak affecting non-human primates (small monkeys) in Salvador, by geocoding the places where the monkeys were found dead. They also collected mosquitoes at such places to investigate potential vectors. The authors found that cases of yellow fever in  in densely urbanized areas posed a considerable risk for disease resurgence in humans because of the high prevalence of the A aegypti and A albopictus mosquitoes. Salvador has long been an epicenter of dengue transmission and more recently of Zika and chikungunya viruses, all with A aegypti as the main vector.
The authors conclude that surveillance and increased vaccination, even among those not considered at high risk for infection, could help to prevent human cases of  in Brazil.

Wednesday, November 1, 2017

Yellow fever virus found in semen of Brazilian patient

SHOW CITATION
October 27, 2017
Researchers in Brazil recently detected yellow fever virus RNA in urine and semen samples from a convalescent patient in Brazil.
Yellow fever is normally detected in blood, but urine has been used to confirm yellow fever infection in humans, researchers from two universities and a research institute in São Paulo noted in their reportBut yellow fever was not among the 27 viruses previously identified to persist in semen.
The researchers said their findings “suggest that semen can be a useful clinical material for diagnosis of yellow fever and indicate the need for testing urine and semen samples from patients with advanced disease.”
“Such testing could improve diagnostics, reduce false-negative results and strengthen the reliability of epidemiologic data during ongoing and future outbreaks,” they wrote in Emerging Infectious Diseases.
A recent yellow fever outbreak in Brazil was fueled by cases among monkeys in the Amazon basin and other tropical forests in Brazil, rather than person-to-person transmission involving mosquitoes. Following a large vaccination campaign, Brazil declared an end to the outbreak in September.
According to the researchers, there were 792 confirmed cases and 274 deaths in the Brazilian outbreak as of July 10. Their report summarized the case of a man aged 65 years from São Paulo who was not vaccinated against yellow fever.
According to the researchers, the man had traveled to the southeastern Brazilian state of Minas Gerais on Dec. 28, not long after the first cases of yellow fever were detected there. About a week later, he traveled to a rural area north of São Paulo. Three days after that, on Jan. 6, he began experiencing symptoms of infection, including fever, chills, body pain and nausea, according to the researchers.
More severe symptoms developed, and the man was admitted to several different hospitals over the next few weeks, according to the report. On Jan. 16, he was admitted to a reference hospital for infectious diseases in São Paulo. Serum samples taken there were negative for yellow fever, but a urine sample obtained 10 days after symptom onset was positive for the virus, the researchers reported.
Urine and semen samples taken on Jan. 27 also were positive for yellow fever virus by qRT-PCR. The researchers tested the urine sample to evaluate infectivity and isolated the virus in cell culture, confirming virus integrity. They confirmed infectivity after a second virus passage. The researchers did not mention testing the semen sample for viable virus. – by Gerard Gallagher
DisclosuresThe authors report no relevant financial disclosures.

PERSPECTIVE

Photo of Thomas Yuill
PERSPECTIVE
The detection of yellow fever virus in urine and semen when it is undetectable in blood suggests an additional approach to making a yellow fever diagnosis. Viable virus in urine and evidence of virus in semen raises a question about the risk for sexual transmission. It also raises the question about possible effects that yellow fever virus infection might have on male fertility as it does with infection by the related Zika virus. These results are from a single case. Considerably more cases need to be studied to determine how frequently yellow fever virus is shed in urine and semen and for low long before any firm conclusions can be drawn.
Thomas M. Yuill, PhD
ProMED virus diseases moderator
Professor emeritus, department of pathobiological sciences and department of forest and wildlife ecology
University of Wisconsin-Madison
Disclosure: Yuill reports no relevant financial disclosures.

Saturday, October 21, 2017

WHO supports the immunization of 874 000 people against yellow fever in Nigeria, Oct 2017

 The Government of Nigeria has launched a campaign to immunize 873 837 people against yellow fever in the states of Kwara and Kogi.
The ten-day campaign began on Friday, 13 October 2017, and mobilizes more than 200 health workers and volunteers. It targets residents aged 9 months to 45 years old.
“This campaign aims to ensure that people living in high-risk areas are protected from yellow fever, and to prevent the disease from spreading to other parts of the country,” said Dr. Wondimagegnehu Alemu, WHO Nigeria Representative.
WHO has been working with health authorities on its implementation in nine local government areas in Kwara State and two in Kogi State.
Nigeria has requested support from the International Coordination Group (ICG) on vaccine provision for yellow fever. A global stockpile of 6 million doses of the yellow fever vaccine is available for countries to access, with the support of Gavi, the Vaccine Alliance.
WHO and health partners have been supporting the Government’s response to the outbreak since the first case of yellow fever was confirmed in Oke Owa Community, Ifelodun Local Government Area of Kwara state on 12 September.
WHO has deployed experts to Nigeria to support surveillance and investigation, lab testing, public health measures, and engagement with at-risk communities. An Emergency Operations Centre has been activated in the area to coordinate the response.
The last yellow fever outbreak in Nigeria was reported in 2002, with 20 cases and 11 deaths.

For further information, please contact:

Fadéla Chaib
Communications Officer
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

Friday, October 6, 2017

Dengue and yellow fever: two Kenyan cities at high risk, Oct 2017

study published in PLOS One last month (17 August) shows that poor urban planning in Kenya could aid the re-emergence of dengue and yellow fever, transmitted through mosquitoes: Aedes aegypti and Aedes bromeliae.

Dengue, a viral disease spread by day-biting mosquitoes, “is the fastest spreading vector-borne viral disease” and has reached more than 100 countries, according to the WHO. Patients with the non-severe form of dengue develop high fever, flu-like symptoms and stomach pain, the severe form could result in the death of 20 per cent of patients with the disease. Meanwhile, yellow fever, a viral disease spread by infected mosquitoes could kill about 50 per cent of those infected with its severe form within seven to ten  days, says WHO.

“Our study is helping to identify areas where the vector is present in high abundance that can sustain transmission of the virus.”

Rosemary Sang, Kenya Medical Research Institute


The study was conducted in the outskirts of three Kenyan cities — Nairobi and Kisumu, which have no known history of dengue outbreak and Mombasa, which is prone to dengue outbreak — from October 2014 to June 2016 during the wet and dry seasons.
Researchers from Kenya-based International Centre of Insect Physiology and Ecology (icipe) and South Africa’s University of Pretoria measured the abundance of the mosquitoes Ae. aegypti and Ae. bromeliae.

According to the study, 7,424 Ae. aegypti and 335 Ae. bromeliae were collected from all sites, made up of 100 houses for each city and season.

Ae. aegypti remains the only known dengue vector in Kenya with sufficient abundance in the major cities to sustain transmission,” the authors note. “It is highly abundant and the risk values are indicative of high risk of dengue transmission in Kilifi and Kisumu.”

Rosemary Sang, a co-author of the study and a consultant scientist at the icipe, tells SciDev.Net that dengue outbreak in Kenya has only occurred in few specific locations in the coast and that the research team “wanted to establish the risk of spread of outbreaks to other areas”.

Sang, a principal research scientist at the Arbovirology Unit, Kenya Medical Research Institute, adds that more experiments are underway to determine if these vectors can transmit the viruses.

“Our study is helping to identify areas where the vector is present in high abundance that can sustain transmission of the virus should the disease get imported through infected travellers from outbreak countries or regions,” explains Sang, adding that this will be important for early warning and implementation of preventive measures.

Omu Anzala, a professor of medical microbiology at the University of Nairobi, lauds the study for increasing knowledge and understanding of newly emerging pathogens. “Being able to understand and predict whether there is impending epidemic is very important,” Anzala tells SciDev.Net. “We should be doing this regularly, looking at indicators of early warning so that we are better prepared [during disease outbreak].”

Anzala encourages research uptake by policy makers to enable them act quickly on outcomes of studies on emerging disease outbreaks.   
 
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.
Source

Over 6000 receive free yellow fever vaccination in Uganda, Oct 2017

By Ritah Kemigisa:
Over 6000 people have been immunized in the three day free yellow fever campaign  organized by the National Medical Stores and the ministry of health that ends today to reward tax payers.
Speaking to Kfm at Kololo independence grounds on the last day of the URA tax payers appreciation week, the NMS General Manager Moses Kamabare says by the end of today more than 10,000 people are expected to be immunized and issued with yellow fever cards.
Kamabare says due to the overwhelming turn up of people the ministry of health together with NMS have decided to add more five days for the free services adding that come next week the services shall still be offered to the people at Kololo independence grounds.
Kamabare adds that as a government policy only people with national identification cards are allowed to access the free services.
According to the Ministry of Health and Civil Aviation Authority, all passengers traveling in and out of Entebbe International Airport are supposed to present proof of immunization against the disease inform of certificates or cards.

Experts Alarmed by Yellow Fever Cases in Asia, Oct 2017

Eleven cases of yellow fever (YF) brought to China in 2016 were quickly contained but set off fear that the disease might gain a foothold in Asia, where 1.8 billion unvaccinated people could be at risk.
The introduction, by workers returning to China from Angola, highlight the dire straits epidemiologists face in trying to contain a disease with limited vaccine supplies. Shortages of YF vaccine developed because of outbreaks and the need for mass vaccinations in Angola and Brazil. By July 24, 2017, stocks of the only YF vaccine approved in the United States had been depleted, and supplies are not expected to become available for routine civilian use again until mid-2018.
Daniel R. Lucey, MD, MPH, and Halsie Donaldson, MS, both from the Division of Infectious Diseases, Georgetown University Medical, Washington, DC, write that the new risk for YF in Asia means that "the global vaccine stockpile must contain more than the projected 1.38 billion doses needed to eliminate existing YF epidemics by 2026." They published their findings online September 25 in Annals of Internal Medicine. The authors also explain that the 80-year-old, egg-based method currently used to manufacture YF vaccine cannot be scaled up quickly enough to stop urban epidemics.
"Thus, new YF vaccines based on cell culture and DNA technologies should be developed now, rather than in the mid to long term cited in the [World Health Organization's] Global Strategy to Eliminate Yellow fever Epidemics," the authors write.
Peter Hotez, MD, PhD, dean of the National School of Tropical Medicine, professor of Pediatrics and Molecular & Virology and Microbiology, and head of Pediatric Tropical Medicine at Baylor College of Medicine, Houston, Texas, agreed that new methods for producing YF vaccine are urgently needed, even without the potential for YF outbreaks in Asia.
"With regard to Asia, it remains somewhat of a mystery as to why YF has not spread there, as has Japanese encephalitis. Some have speculated that circulating dengue and [Japanese encephalitis] strains may provide some cross-protective herd immunity, but we really don't know the answer," Dr Hotez told Medscape Medical News. "But there are 3 million Chinese working in Africa now, through their belts-and-road initiative, and there is a theoretical threat to Asia. Moreover, we can be sufficiently concerned about YF in the western hemisphere and Africa alone to raise the issue of YF vaccine shortage."
Dr Hotez said that Dr Lucy and Donaldson are right to be concerned about the potential for YF outbreaks in both Africa and the Americas, as well as the possibility of YF vaccine shortages. "In the western hemisphere, we have seen during the last few years the rise of dengue, Zika, chikungunya, and other arboviruses transmitted by Aedes aegypti, so the threat of YF is very real. This is due to shifts in poverty and climate change. The risk to other areas, including the United States, has been further heightened by increased population density in urban areas, making transmission more likely, and by the widespread presence of mosquitoes able to transmit the virus," he said.
However, Dr Hotez also echoed the comment by Seth Berkley, MD, chief executive from Global Alliance for Vaccines and Immunization, that emergency vaccine stockpiles should be the last line of defense against YF, after better mosquito control, routine YF immunization, and preemptive vaccination campaigns. According to Dr Berkley, emergency YF vaccine stockpiles are essential, but "if we have to call upon them, we have in some way already failed. They should be our last line of defense."
Dr Berkley notes that the current global emergency stockpile of YF vaccine is about 6 million doses, a supply that could be quickly exhausted if Rio (population 12 million) and one other major city had YF outbreaks.
Meanwhile, shortages in the United States are already limiting the availability of YF travel vaccinations, which are required for travelers to enter some countries.
Dr Hotez told Medscape Medical News that part of the problem is the demand for YF vaccine has not been high until recently. "There is not always a high market incentive for vaccine manufacturers to make vaccines for pandemic threats, which is why the new organization [Coalition for Epidemic Preparedness Innovations] has been established," he said.
In the United States, YF vaccination is not routinely recommended except for patients traveling to an endemic area. Containing a potential outbreak is likely to be complicated by the fact that few US physicians have ever seen a case of YF, which causes a self-limited fever in 85% of patients but black vomit; bleeding from nose, mouth, and eyes; jaundice; and renal damage in the other 15%, half of whom die from the infection.
The authors and Dr Hotez have disclosed no relevant financial relationships.
Ann Intern Med. Published online September 26, 2017. Abstract
Source (nneds free registration)

Friday, September 29, 2017

Yellow Fever Vaccine Shortages in the United States and Abroad: A Critical Issue, Annals of Internal Medicine, Sept 2017

Yellow fever (YF) virus, a flavivirus that infects the liver, causes a self-limited febrile syndrome in 85% of patients. In the other 15%, however, it causes jaundice, bleeding, and renal damage, and half of these patients die. No antiviral therapy exists. In urban settings, YF virus is transmitted between humans by Aedes aegypti mosquitoes, as are Zika, dengue, and other viruses. Outside urban settings, in the jungle or forest (“sylvatic cycle”), YF transmission occurs between monkeys and from monkeys to humans via non-Aedes mosquitoes (1).

The United States had YF epidemics in the 18th and 19th centuries. In the 20th century, epidemics occurred in sub-Saharan Africa, Latin America, and the Caribbean. The first cases in Asia were reported in 2016, when 11 workers returned home to China after having been infected in Angola (1).

How Nigeria is tackling spread of yellow fever? Sept 2017

The Federal Government on Tuesday expressed its readiness to contain further spread of yellow fever in the country.
The Chief Executive Officer, Nigeria Centre for Disease Control, NCDC, Chikwe Ihekweazu, said this in a statement he issued in Abuja.
He also said that the government would also limit the impact of the killer ailment.
Mr. Ihekweazu said that following the case of yellow fever in Kwara State, laboratory diagnosis was carried out at the Lagos University Teaching Hospital and confirmed at the Institute Pasteur, Dakar, Senegal.
He said that a multi-agency Incident Management System has been constituted at the NCDC to ensure a rapid and coordinated response.
”In response to the case, and in line with WHO guidelines, a vaccination campaign is being planned to begin in the affected and surrounding Local Government Areas on 30th September to prevent further spread.
”Communication activities are being intensified to enlighten health care workers and the general public,’’ he said.
He also said that an Emergency Operations Centre is being activated in the state to ensure a coordinated and efficient response at the state level.
The NCDC boss described yellow fever as an acute viral haemorrhagic disease transmitted by infected Aedes mosquitoes.
He listed the symptoms to include fever, headache, jaundice (yellowness of the eyes), muscle pain, nausea, vomiting and fatigue.
According to him, some infected people may not experience any of these symptoms, while in some the symptoms might be mild.
He added that in severe cases, jaundice and bleeding may occur from the mouth, nose, eyes or stomach.
Ihekweazu said that vaccination against the disease remained the most important measure in preventing Yellow Fever.
He said the Yellow Fever vaccine had been part of the childhood immunisation schedule in Nigeria.
”Other methods of prevention include using insect repellents, sleeping under a long-lasting insecticide treated nets, living in net screened accommodation, ensuring proper sanitation and getting rid of stagnant water or breeding places for mosquitoes.
”Although there is no specific medicine to treat the disease, intensive supportive care can be provided, most patients would recover with appropriate care when they present early enough,” he said.
He, therefore, advised health care workers to practice standard precautions while handling patients or body fluids at all times and to be familiar with the case definition and maintain a high index of suspicion.
Mr. Ihekweazu advised Nigerians to remain calm, avoid self-medication and report to the nearest health facility if feeling unwell or if they notice any of the above symptoms in anyone around.

Tuesday, September 26, 2017

Mosquitoes carrying deadly diseases could invade 75% of America, warns US government, Sept 2017

Mosquitoes capable of spreading serious and potentially deadly diseases such as Zika, dengue and yellow fever could invade about three-quarters of mainland United States, the US Centres for Disease Control and Prevention have warned.
The CDC, a US federal agency, has previously warned that climate change could affect human health in many ways including increasing the number of “disease carriers such as mosquitoes and ticks”.
In a paper published in the Journal of Medical Entomology, it revealed maps showing areas where the habitat was suitable for two particular species of mosquito, Aedes aegypti or Aedes albopictus to survive.
mosquitomap.jpg
Mosquitoes could start spreading deadly diseases across a huge swathe of the US (CDC)
A study found 71 per cent of counties in the 48 contiguous states were suitable for aegypti and 75 per cent could support albopictus.
The paper said the dengue, chikungunya and Zika viruses in particular represented a “growing public health threat in parts of the United States where they are established”.
“We anticipate that Aedes aegypti and albopictus will be found more commonly in counties classified as suitable,” it said.
“Counties predicted suitable with 90 per cent sensitivity should therefore be a top priority for expanded mosquito surveillance efforts while still keeping in mind that Aedes aegypti and albopictus may be introduced, via accidental transport of eggs or immatures, and potentially proliferate during the warmest part of the year.”
Dr Rebecca Eisen, a research biologist with the CDC, said the maps showed the CDC’s “best estimate” of the insects potential range.
“In other words, these maps show areas where CDC predicts Aedes aegypti and albopictus mosquitoes could survive and reproduce if introduced to an area during the months when mosquitoes are locally active,” she said.
However the experts stressed the maps did not show where mosquitos were currently or the place where there was a risk of virus transmission. 
Temperature was a key factor.
If there was just one day in winter when the temperature exceeded 10 degrees Celsius (50F), the chances that the area would be suitable for mosquitoes increased.
Consistently cold temperatures, however, reduced the chances that the insects’ eggs would survive the winter, particularly for aegypti, Dr Eisen said.
Rainfall had a significant influence on albopictus as it relies more on water courses filled by rainwater to lay its eggs than aegypti.
Dr Eisen said the maps would help monitor for signs the mosquitoes.
“Surveillance efforts can be focused in counties where Aedes aegypti and albopictus could survive and reproduce if introduced to an area during the months when mosquitoes are locally active or at least survive during summer months if introduced,” Dr Eisen said. 
“Additionally, the maps can help healthcare providers and the public understand where these types of mosquitoes could be found so that they can take steps to protect against mosquito bites and possible infection."

Nigerian govt confirms new yellow fever case, Sept 2017

A case of Yellow Fever has been confirmed in Oke Owa in Ifelodun Local Government Area of Kwara State, says the Federal Ministry of Health.
In a press statement released on Monday, the ministry said the case was confirmed in a young girl from the community after a laboratory diagnosis at the Lagos University Teaching Hospital at the Institut Pasteur, Dakar, Senegal on the September 12.
Following the confirmation of the case, the Minister of Health, Isaac Adewole, said the State Epidemiology Team has begun investigation into the affected area and neighbouring communities.
“A joint team from the Nigeria Centre for Disease Control, National Primary Health Care Development Agency and the World Health Organisation Country Office has been deployed to support the State in carrying out a detailed investigation and risk analysis,” he said
Mr. Adewole added that an Outbreak Control Team had also been constituted to ensure rapid and coordinated decision-making.
He assured the public that all the agencies of the Federal Ministry of Health and their partners would work together to support the government of Kwara to respond in order to prevent spread.
Yellow fever is an acute viral haemorrhagic disease transmitted by infected aedes mosquitoes.
The disease is preventable, the most important measure to in prevention being vaccination against the disease.
A single dose of Yellow Fever vaccine is part of Nigeria’s routine immunisation schedule given to children at nine months and the dose is sufficient to confer sustained protection of up to 10 years.
It is meant to be given free at all primary healthcare centres and other children immunisation point .
According to fact sheets on the disease from the World Health Organization, yellow fever virus is endemic in tropical areas of Africa and Central and South America.
The international health agency said a small proportion of patients who contract the virus develop severe symptoms and approximately half of them die within seven to 10 days.
But since the launch of the Yellow Fever Initiative in 2006, significant progress has been made in combatting the disease in West Africa and more than 105 million people have been vaccinated in mass campaigns.
There is currently no specific anti-viral drug for yellow fever.
Mr. Adewole said a vaccination campaign is already being planned in the affected area in Kwara State to prevent spread.
Symptoms of the disease include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue.
Some infected people may, however, not experience any of these symptoms. In severe cases, bleeding may occur from the mouth, nose, eyes or stomach.
Other methods of prevention include using insect repellent, sleeping under a long-lasting insecticide treated net, ensuring proper sanitation and getting rid of stagnant water or breeding space for mosquitoes.
Mr. Adewole advised health care workers to practise universal care precautions while handling patients at all times and also urged to be alert and maintain a high index of suspicion.

Wednesday, September 13, 2017

H7N9 Avian Flu Continues to Spread, Worsen in China, Medscape Sept 2017

The latest epidemic of Asian lineage avian influenza A (Asian H7N9) in China infected almost as many patients as the four previous outbreaks combined and gave rise to a variant less susceptible to available treatments and vaccines, researchers report in an article  published in the September 8 issue of the Morbidity and Mortality Weekly Report.
The fifth annual epidemic, which occurred from October 1, 2016, through July 31, 2017, included 759 patients and 281 deaths (37%). The cumulative mortality for all five Asian H7N9 outbreaks since February 2013 is 39% (605 of 1557 patients).
"Although human infections with Asian H7N9 viruses from poultry are rare and no efficient or sustained human-to-human transmission has been detected, when human infections do occur, they are associated with severe illness and high mortality," write James C. Kile, DVM, from the Influenza Division at the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and colleagues. "Continued vigilance is important to identify changes in the virus that might have epidemiologic implications, such as increased transmission from poultry to humans or transmission between humans."
The fifth outbreak involved all but three of 33 provinces, regions, and municipalities in China. All infected patients had either lived in or traveled to these areas, and most (90%) infections were associated with poultry exposure, especially at live bird markets.
The authors note, however, that the increase in infections was the result of wider geographic spread and higher prevalence of Asian H7N9 viruses among poultry, not increased poultry-to-human or human-to-human transmission.
Notably, during the fifth epidemic, some Asian H7N9 strains acquired mutations that turned them from low-pathogenic to high-pathogenic strains. Twenty-seven patients were infected with high-pathogenic avian influenza strains that had acquired mutations.
Sequencing data from 166 viral isolates collected during the fifth epidemic uncovered genetic markers of resistance to amantadine and rimantadine. In addition, researchers found significant changes in surface proteins among some of the high-pathogenic avian influenza strains, making them less similar to previous candidate vaccine viruses.
These factors contributed to the CDC's decision to classify Asian H7N9 as the virus with the highest potential pandemic risk among all viruses evaluated using the Influenza Risk Assessment Tool.
The government of China is trying to minimize Asian H7N9 spread by promoting large-scale farming and centralized slaughtering, improving poultry product handling, and routinely closing, cleaning, and disinfecting live poultry markets and enhancing surveillance for influenza-like illness.
The authors write, "CDC has partnered with China CDC, and other China government organizations, United Nations organizations, and surrounding countries to enhance surveillance and laboratory capacity to detect and respond to Asian H7N9 in animals and humans."
One coauthor holds two US patents for influenza vaccines. The other authors have disclosed no relevant financial relationships.
Morb Mortal Wkly Rep. 2017;66:928-932. Full text  

Saturday, September 9, 2017

Yellow Fever Vaccine Shortage Affects Arkansas Travelers, Sept 2017

FAYETTEVILLE, Ark. -- - Yellow fever is a viral disease transmitted by infected mosquitos. 
 
The depletion of the US-made vaccine means an alternative vaccine,manufactured in France, will have to be imported. 
 
"We are down to our last few right now so we will have to refer students and faculty who are in need of the vaccine to other clinics who do stock the current yellow fever vaccine that is there," Executive Director, Pat Walker Health Center Mary Alice Serafini.  
 
The disease impacts people in almost 50 countries, including South America and Africa. 
 
Health officials say if you're told to get the vaccine before visiting a certain country, do it. 
 
"Not only is the person at risk for yellow fever once they are there, but it is possible that they could be infected and bring it back," Medical Director for Immunizations, Arkansas Dept. of Health Dr. Jennifer Dillaha said. "Although we do not have yellow fever currently the united states, we have had serious yellow fever epidemics in history."
 
The shortage is so widespread, the only clinic with the vaccine in the state is in Little Rock. 
 
"Any travel clinic is equipped and trained on these types of things and make recommendations for the kind of health risks people will encounter and how they should overcome the health risks," Dr. Dillaha said. 
 
Travelers in Northwest Arkansas include study abroad students from the university. 
 
"We send a lot of students to Central and South America and Africa," Assistant Director, Office of Study Abroad at The University of Arkansas Brian Poepsel said. "Those students are going to have to work a little bit harder to obtain it. "