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HEALTH-BRAZIL: Yellow Fever – Epidemic or False Alarm?

Fabiana Frayssinet

RIO DE JANEIRO, Jan 14 2008 (IPS) - The Brazilian Health Ministry is fighting a war on two fronts. It is taking measures to prevent an outbreak of sylvatic (or jungle) yellow fever while countering speculation in the press about an imminent epidemic of the disease. There have been no cases of urban yellow fever in the country since 1942.

In all, 24 cases of yellow fever have been reported to the ministry since December. Two have been confirmed by laboratory tests, and five have been ruled out, leaving 17 suspected cases, according to the Health Ministry.

In the first two weeks of 2008, three patients have died. One of the victims was confirmed to have contracted yellow fever, and the others are suspected to have died of the illness on the basis of clinical assessments that have not yet been confirmed by laboratory tests, which take several days.

“There is exaggerated alarm, because we have only had rare sporadic cases,” Valdineia Veloso, the head of the Evandro Chagas Research Institute, part of the Oswaldo Cruz Foundation (FioCruz), said in an interview with IPS.

Veloso, a specialist in infectious diseases, is one of the official spokespersons charged with denying stories about an outbreak of yellow fever.

Yellow fever is a haemorrhagic viral disease transmitted by Aedes aegypti mosquitoes, the same species of insect that transmits dengue fever. It is present in 18 out of the 27 Brazilian states – in the north, west-centre and south – according to the Health Ministry.

But Veloso stressed that this is not an urban variety of the virus, like the one that caused the epidemic prior to 1942, but a sylvatic strain, confined to jungles and forests and mainly infecting monkeys.

“We are not experiencing an outbreak of urban yellow fever. What we have are suspected cases of sylvatic yellow fever in persons who travelled to at-risk areas and may have become infected with the disease,” the expert said.

Even if it were confirmed that these are cases of yellow fever, “which occur sporadically in Brazil,” what really matters is ascertaining whether these infections were contracted in urban areas, according to Veloso.

She said that in the case of all three fatalities, “there was a history of having visited jungle areas where sylvatic yellow fever is an established risk.”

One of the deceased patients was Graco Abubakir, a computer technologist from Brasilia, who had travelled to Pirenópolis, a historic city in the central state of Goiás, which has forested areas.

Another was Almir Rodrigues da Cunha, a member of the business community who died in Maringá, a city in the southern state of Paraná, after spending the New Year holidays with his family in Novas Caldas, another city in Goiás.

The third victim was Salvador Pérez, a Spaniard, who died on Sunday in Goiania, the capital of Goiás. He too had travelled to the interior of Goiás before falling ill.

“This tale that urban yellow fever is back is a lie. I personally guarantee that there is no possibility of urban yellow fever anywhere in the country,” Health Minister José Gomes Temporao said last week.

“The situation is absolutely under control. There is no danger of an epidemic,” he told a press conference. He repeated this message in a television appearance Sunday.

The minister made his statements last week after his ministry issued an international alert through the Foreign Ministry and Tourism Ministry, recommending that foreigners be vaccinated against yellow fever before visiting this country.

At the same time as he was trying to calm the population, Temporao announced that two million additional doses of yellow fever vaccine were being distributed. Production of the vaccine is being doubled.

According to Veloso, this is a “routine” measure, taken whenever there is a suspected case of yellow fever. The vaccine is part of the regular immunisation schedule for Brazilians over the age of nine who live in at-risk areas, she said.

The vaccines are produced by FioCruz, which was already increasing output because vaccination in risk areas has been expanding since 1998, Veloso said.

Brazil also exports the vaccine to other countries.

Temporao said that people who are planning to visit at-risk areas should be vaccinated at least 10 days in advance, so that the body has time to build up antibodies against the virus.

Immunity lasts 10 years, and the vaccine is available at all health centres, although because of the scare, there are temporary shortages in some places.

“What’s happening is an over-reaction,” the minister said. “People are caught up in a frenzied rush to be vaccinated. There is no reason to panic. People who have already been vaccinated and are still immune are lining up unnecessarily to be revaccinated,” he said. There are long lines at health posts around the country.

According to Health Ministry statistics, there were 349 cases of sylvatic yellow fever between 1996 and 2007, with 161 deaths. Brazil’s total population is over 188 million.

Last year six people were infected, two in the state of Amazonas, two in Goiás, one in Roraima and the other in Pará, in the northwest, centre and north of the country, respectively. Five of them died. Yellow fever has a high mortality rate in serious cases, Veloso said.

The present alert follows an earlier warning by health authorities in December, when wild monkeys were found dead near urban areas in Goiás and the Federal District surrounding the capital, Brasilia.

Between Dec. 29, 2007 and Jan. 12, health personnel vaccinated 892,982 people in the Federal District, which has an estimated total population of 2.4 million. Vaccine coverage was over 90 percent before the alert, according to the Health Ministry, indicating that a large number of people were presenting for revaccination.

The disease is caused by the yellow fever virus, which attacks the liver and other organs, and is fatal in approximately 50 percent of toxic cases. Treatment is limited to supportive measures.

Veloso said that the symptoms – which are easily confused with those of dengue, malaria or other acute febrile illnesses – include muscular pain, debility, nausea, vomiting and, in serious cases, haemorrhages.