Brazil's Yellow Fever Crisis
Since 2016 countries across South America have recorded their highest rates of yellow fever cases in recent decades. According to the regional arm of the World Health Organization (WHO) - the Pan-American Health Organization (PAHO) - between January 2016 and the end of 2017, seven countries in South America suffered potential yellow fever outbreaks which affected both humans and animals – the latter commonly addressed as epizootic cases.
Brazil was by far the most affected country and the only nation to record monthly cases. Between the end of 2016 and mid-2017, more than 260 deaths were attributed to yellow fever infections. Since June, the spread of the disease has been largely contained through massive vaccination campaigns carried out across rural regions and metropolitan areas of major state capitals. Hundreds of thousands of people camp overnight at local public health centres to receive the vaccination, even if they only receive a fractional dose, which WHO says grants full immunization for at least 12 months (a single full dose is enough for an individual’s lifetime). The most severely affected states are all located in Brazil’s south-east; Sao Paulo, Minas Gerais, Rio de Janeiro and Espirito Santo were all put on alert as the number of cases significantly increased. According to the Brazilian Institute of Geography and Statistics (IBGE), more than 40 percent of the country’s population or around 86 million people live in south-eastern Brazil. From those, more than 65 million are inhabitants in Sao Paulo and Minas Gerais.
In Sao Paulo state authorities have ordered the suspension of services to major state parks surrounding the Sao Paulo metropolitan area after monkeys infected with the disease were found dead. Dozens of cases were recorded in the town of Mairipora, including a Dutch national who was diagnosed with yellow fever shortly after he returned to the Netherlands. WHO said that the individual had stayed in the town and was not vaccinated. Yellow fever cases across Brazil are mostly confined to rural areas, which are often referred to as sylvatic yellow fever. Since 1942 no cases of urban yellow fever were reported in Brazil. However, in January, precautionary measures were implemented in Sao Paulo after a howler monkey – allouatta – was found dead at the city’s zoo. The incident prompted local authorities to extend the vaccination campaign, which now includes areas previously untouched. Meanwhile, in Minas Gerais a six-month state of emergency has been declared after more than 20 people were confirmed dead since December. The measure includes areas in the south-eastern region known as Zona da Mata, the Central Region, and even the metropolitan area of the state capital Belo Horizonte.
International organisations and governments have already issued travel advisories to travellers heading to Brazil. Due to the current outbreak, the WHO has temporarily extended its previous advisory map to include areas across south-eastern Brazil. The WHO recommends yellow fever vaccinations for travellers to most Brazilian states with some exclusions, such as coastal areas and some states in the north-east. The UK Foreign Commonwealth Office (FCO) and the US Centers for Disease Control and Prevention (CDC) have both issued advisories to travellers heading to Brazil, which include the entire states of Sao Paulo, Rio de Janeiro and Espirito Santo. These warnings have been met with scepticism from federal health authorities, who have subtly downgraded international bodies’ concerns and have only recommended caution for travel to rural and deep jungle areas. The warnings come as Brazil is expected to receive millions of visitors during February for the carnival celebrations, which are highly popular in major cities such as Rio de Janeiro, Sao Paulo, Salvador and Recife.
Yellow fever is a mosquito-borne disease which is predominant in South America, Sub-Saharan Africa and parts of Central America and the Caribbean. Symptoms may include high fever, headache, muscle and joints pain and loss of appetite, while in the most severe cases may also cause bleeding from the mouth and nose, vomiting, abdominal pain and dark urine. The most effective way to avoid contracting the disease is through vaccination at least 10 days before travelling to your destination - at least 30 days before for maximum effect. Yellow fever is mainly spread through mosquito bites, so the use of strong insect repellents is highly recommended when travelling to areas of risk. The virus may take up to six days to manifest and in the event that symptoms appear, medical assistance should be urgently sought, even if the traveller has already returned to their home country.