Minas Gerais declares yellow fever ‘state of emergency’

The government of Minas Gerais state in southeastern Brazil decreed Saturday a public health emergency situation in three regional state for six months because of yellow fever. The measure covers the regional health units of the municipalities of Belo Horizonte, Itabira and Ponte Nova – 94 cities in total, according to a Jornal do Brazil report (computer translated).

The decree signed by governor Fernando Pimentel authorizes the adoption of administrative measures necessary to contain the outbreak, especially the public acquisition of supplies and materials. In addition, the measure ensures the contracting of services necessary to attend to the emergency situation.

With the second period of epidemiological monitoring of cases of yellow fever in Minas Gerais, from July last year to the beginning of this year, 22 cases of the disease were confirmed in the state. According to the State Department of Health, of these, 15 resulted in death. During this period, 40 suspected cases were ruled out, and 46 cases were investigated in 24 municipalities.

Related: Yellow fever vaccine recommended for travelers to São Paulo; Netherlands report imported case

Currently, the accumulated vaccine coverage of yellow fever in the state of Minas Gerais is around 82%. According to an epidemiological report released on Wednesday , it is estimated that there are just over 3 million people who have not yet been vaccinated, especially in the age group of 15 to 59 years, which was also the most affected by the epidemic of wild yellow fever occurred in 2017.</s>BRASILIA – Brazil’s south-eastern state of Minas Gerais declared a public health emergency on Saturday following an outbreak of yellow fever in nearly 100 cities over the last several months.

Yellow fever is a disease caused by a virus that is transmitted to humans by mosquitoes.

The decree allows the government to hire health workers without a bidding process, and buy emergency materials. The emergency will be in place for six months.

At least 15 people have died of yellow fever in the state since December, according to the BBC. Since July 2017, 35 cases have been confirmed in Brazil and 20 have died, health ministry data showed.

In Minas Gerais alone, 475 cases were confirmed between January and June 2017, and 162 people died.

A mass vaccination program is under way in three southern states of the country. The World Health Organization has said that the Sao Paulo state is also at risk and has advised travellers to get vaccinated. Minas Gerais is the hardest hit state.</s>SAO PAULO — The government of Brazil’s southeastern state of Minas Gerais has decreed a state of emergency for its public health system due to an outbreak of yellow fever in 94 of its 853 cities.

The decree was published Saturday in the state’s official gazette and allows the government to contract health providers without going through a bidding process.

Since July 2017, 35 cases of yellow fever have been confirmed in Brazil and 20 people have died, according to the latest figures from the health ministry.

The World Health Organization said earlier this week that all of Sao Paulo state is also at risk for yellow fever and recommended that international visitors to be vaccinated.</s>Brazilians lined up for hours to get yellow fever vaccinations, alarmed by the increase in the number of fatal cases of infection and a warning from the World Health Organisation (WHO) to tourists visiting parts of the country.

In Belo Horizonte, a city in the south-eastern state of Minas Gerais, people had to wait up to seven hours for a shot because health centres were not prepared for the surge in demand, a state spokesman said.

People were being turned away at some health centres in Minas Gerais and in the southeastern state Sao Paulo because vaccines and syringes had run out, Brazilian media reported.

The WHO said last week that Sao Paulo state, which includes South America's largest city, Sao Paulo, should be considered at risk for yellow fever and recommended foreign travellers get vaccinated before visiting.

But Brazil's Health Ministry said the recommendation, coming weeks before Carnival, an event for which thousands of tourists descend on Brazil, would not cause it to change its advisory that only travellers going to rural areas be vaccinated.

All known cases of infection were in rural areas. - REUTERS

Research carried out in part by a "robot scientist" with artificial intelligence (AI) has found that a common ingredient of toothpaste could be developed to fight strains of malaria.

In a study in the journal Scientific Reports, scientists from Britain's Cambridge University said the ingredient, triclosan, showed the potential to interrupt infections at two critical stages - in the liver and blood.

After being transferred into a host via a mosquito bite, malaria parasites work their way into the liver. They then move into red blood cells, multiply and spread, causing potentially life-threatening complications.

Scientists have known that triclosan can halt malaria parasites' growth at the blood stage by inhibiting the action of an enzyme known as enoyl reductase. In toothpaste, this helps prevent build-up of plaque bacteria.

In this latest work, scientists found that triclosan also inhibits a different enzyme of the parasite, called dihydrofolate reductase (DHFR).

This enzyme is the target of the antimalarial pyrimethamine - a drug to which the parasites are increasingly developing resistance. The Cambridge team's work showed that triclosan was able to target and act on DHFR even in drug-resistant parasites. - REUTERS

Depression and anxiety afflict Americans concerned with the fate of the environment, showed a study of the mental health effects of climate change.

Most hard-hit are women and people with low incomes who worry about the planet's long-term health, said the study published this week in the journal Global Environmental Change.

"Climate change is a persistent global stressor," said Sabrina Helm, lead author of the paper and professor of family and consumer sciences at the University of Arizona.

The study involved 342 online surveys of respondents whose views broadly reflect the wider US population, researchers said. - REUTERS</s>Two people died in the Brazilian state of Sao Paulo from negative reactions to yellow fever vaccinations at a time when thousands of people are jamming into medical centers to be immunized, in view of the big increase in deaths from the disease, officials announced Friday.

As Municipal Health Secretary Wilson Pollara stated on the G1 online news site, the victims were two people with "low immunity," a woman age 76 and a man whose identity has not yet been revealed.

The vaccine is currently recommended for those between the ages of nine months and 59 years. People older than that need a medical exam to find out the state of their immunological system and to see if they have a high risk of being contaminated by the disease or not.

Dr.Expedito Luna, an epidemiologist and professor with the Tropical Medicine Institute at the University of Sao Paulo, said on G1 that since the year 2000 it has been identified in Brazil and other places in the world that a small proportion of those who are vaccinated could develop a serious case of the yellow fever itself.

"In the study of those rare cases with adverse reactions, it turned out to be common among those over age 60, with diseases of the thymus and autoimmune system, which led to a greater restriction of administering the vaccine in those cases," the doctor said.

Specialists categorize two types of yellow fever, which are differentiated by the infecting mosquito: one is the "wild" kind transmitted by the Haemagogus and the Sabethes species, which mainly attack the macaque - and the "urban" type, which transmits the Aedes aegypti, also the vector of dengue, zika and chikungunya.

For several years, however, not one case of yellow fever caused by the urban type has been recorded.

Southeast Brazil, chiefly the states of Minas Gerais, Sao Paulo and Rio de Janeiro, for several weeks have seen an outbreak of this infectious viral disease that is transmitted by mosquito bites and has caused at least 15 deaths.</s>The Nigeria Centre for Disease Control (NCDC), recently confirmed that nine persons died of yellow fever outbreak in Kwara, Nasarawa, Kano, Niger, Kebbi, Kogi and Zamfara States.In its situation report on yellow fever in the country released for the first epidemiological week in 2018, NCDC said the ailment has so far been confirmed in 12 local government areas across seven states.

Described as an acute systemic illness, the disease is usually caused by a virus called flavivirus. In severe cases, the viral infection causes a high fever bleeding into the skin, and necrosis death of cells in the kidney and liver. The damage done to the liver from the virus result in a severe condition of the patient, which makes the skin yellow.Health experts say it has no cure, although antiviral medications may be tried. Non-aspirin pain relievers, rest, and rehydration with fluids also decrease the discomfort.

Yellow fever can be prevented by vaccination. It is recommended for people travelling to or living in tropical areas, where yellow fever occurs. And because it is a live vaccine, it should not be given to infants or people with immune-system impairment.The experts also advised parents to always take their children, especially newborn babies, to primary health care within nine months for routine immunisation programme, as this would help to reduce yellow fever outbreak in the country.

On October 23, 1969, the Virus Research Laboratory of the University of Ibadan was notified that cases of suspected yellow fever had occurred in Jos, Plateau State. The diagnosis was confirmed by virus isolation and the existence of a widespread outbreak in Plateau and adjacent areas was established. This was the first recognised epidemic of yellow fever in Nigeria since1953. Between September and the end of December 1969, an estimated total of 252 patients with the ailment were hospitalised.

Dr. Ezekiel Sofela Oridota, a Senior lecturer and Consultant, Public Health Physician, Epidemiology and Biostatistics Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos and Lagos University Teaching Hospital (LUTH), Lagos, said signs and symptoms of yellow fever not different from those of malaria, as the patient would experience vomiting, tiredness, losts of appetite, back pains and headache.

He said: “Within three to six days of coming down with yellow fever, the patient begins to have the first set of signs and symptoms. In some people, it would result in aggressive symptoms for a day and then stop, which is referred to as self-limited, while others may not have any symptom at all. Some people would graduate to more serious ailments, which is when such other organs as the liver and kidney would be involved, especially the liver because this is where yellowness of the eyes begins to appear. At this stage, almost half of such patients would die, because this is where the organs begin to bleed.”

Oridota explained that yellow fever has a vaccine, which is extremely effective and is life-long. “This is where government needs to do more to create awareness,” he said. “The media also needs to be involved in this campaign in order to enlighten the people. Many people do not want to report disease outbreak in their communities, because they do not want their community to be labelled with such. But such stance will not help in eradicating disease outbreaks in the country. An immunised population is better than one not immunised, as routine immunisation is very effective.

“The disease itself does not have antiviral drugs that can be used to arrest it, but what we do is supportive treatments. This means treating the symptoms. For instance, if the patient is having pains and headache, we try to manage those problems, so that he/she can stay alive.” He reiterated the need for environmental sanitation and hygiene, which should be taken seriously, not during yellow fever outbreak, but on a daily basis.

“For instance, the Ebola Virus, lassa fever, and cholera outbreaks all have to do with personal hygiene and environmental sanitation. The aedes mosquito is the vector through which people contract yellow fever. So, it is advisable that people clean their environment and maintain personal hygiene by cleaning gutters and clearing stagnant water and bushes around homes.

“When people in the rural area fall ill, they tend to manage the sickness with self-medication, and before it is presented to health workers, it might be too late. Therefore, there is the need to see a doctor within two days of having any sickness. We should also strengthen our surveillance. For instance, once there is disease outbreak in Lagos, the response is faster than in other states. We need to work on information people have about their health. Some of the disease outbreaks we had was as a result of poverty and ignorance. There are many social problems that result in the outbreak of diseases. So, there is need for increased surveillance.”

Ebunoluwa Aderonke Adejuyigbe, a professor of paediatrics and former Dean of the Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, said yellow fever is an acute viral haemorrhagic disease transmitted by aedes and hemagogues mosquitoes, which are infected by the causative agent.

She explained that the causative agent is an arbovirus from the Flavivirus family. The aedes mosquito that transmits it also transmits Zika and Dengue viruses. It breeds in tree holes and water in the forests, where it bites humans and non-human primates. It is also found in uncovered water reservoirs in communities and urban areas.

She said: “However, immunisation protects exposed humans, while unimmunised individuals come down with the disease. Unimmunised tourists, forest workers, farmers and campers bitten and infected in the forests and jungles become sources of transmission, when they return to their towns , cities and villages.

“Infants and children are at higher risk than adults. A case of mother to child transmission has also been reported. There is also a potential risk of transmission through blood transfusion and needlestick injuries, especially during epidemics. Signs and symptoms of yellow fever infection in most people are clinically inapparent, presenting with fever alone or with headache.

“For people who develop symptomatic illness, the incubation period is typically three to six days. The first phase of the illness presents as a nonspecific influenza-like syndrome, with sudden onset of fever, chills, headache, backache, myalgia, prostration, nausea, and vomiting which resolve in most patients.

“However, 15 percent of these patients enter a more serious or toxic form of the disease, characterised by jaundice, bleeding, and eventually shock and multisystem organ failure 48 hours after the initial improvement. The bleeding in these patients manifests as hematemesis, melena, metrorrhagia, hematuria, petechiae, ecchymoses, epistaxis, and oozing blood from the gingiva and needle-puncture sites. The case-fatality ratio for severe cases with when the kidney or liver is affected is 20 per cent to 50 per cent.”

She explained that treatment is mainly supportive and involves prompt treatment of symptoms as they manifest. For instance, if the bleeding becomes severe, the patient can be given blood transfusion, and if there is kidney failure, dialysis can be done.

“The most effective prevention strategy is immunisation, which is free, safe and provides life-long immunity,” she said. “It is given as part of routine childhood immunisation and to travellers from low-risk countries. It is also given to large populations, when they are affected by yellow fever epidemic as mass vaccination.

“Another prevention modality is the control of mosquitoes population by draining collections of water, where mosquitoes breed in neighbourhoods, applying larvicides to kill young mosquito larva, application of insecticide in homes, personal prevention from mosquito bites by wearing long clothing that cover the ankles and wrists and usage of insecticide treated nets. The final prevention is emergency preparedness by effective surveillance of yellow fever outbreaks and prompt response by mass vaccination campaigns and treatment of infected patients.”

Adejuyigbe said government’s efforts are key to prevention, by ensuring sustenance of routine infant immunisation, as epidemics would not occur, if over 80 per cent of the population is immunised. She said: “Effective disease surveillance and availability of confirmatory diagnostic laboratories, instead of having to send samples to Dakar, Senegal for confirmation is necessary. Prompt response to outbreaks by conducting mass vaccination campaigns and treating infected individuals is also crucial.

“Educational campaigns during outbreaks are important, so that infected individuals can quickly identify the symptoms and present at a health facility. Improving healthworkers’ skills during outbreaks in disease identification and management by brief refresher trainings is vital.“My advice to the public is to take advantage of government efforts at immunisation of infants and adults, as well as ensure immunisation, when travelling to countries with previous outbreaks.

“People should deprive mosquitoes of breeding spots in the neighbourhoods by emptying cans, containers, water puddles and spraying larvicides into those that cannot be drained.“There is also personal prevention from mosquito bites by applying mosquito repellent creams and wearing long covering clothings, especially in the evenings and when on camping trips, as well as prompt presentation to health facilities, when having suggestive symptoms.”

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This post was syndicated from The Guardian Nigeria Newspaper – Nigeria and World News. Click here to read the full text on the original website.
The state government of Minas Gerais, Brazil, declares a health emergency in three areas, Belo Horizonte, Itabira and Ponte Nova, over an outbreak of yellow fever.