Published Date: 1999-05-07 23:50:00
Subject: PRO/AH/EDR> Yellow fever - Bolivia (Santa Cruz) (09): urban
Archive Number: 19990507.0754
YELLOW FEVER - BOLIVIA (SANTA CRUZ): URBAN
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See Also
Yellow fever - Bolivia (Santa Cruz): RFI 990210211317Yellow fever - Bolivia (Santa Cruz) (08) 990326203530
Yellow fever - Brazil (Mato Grosso & Para) 990326203619
Yellow fever threat to Asia 990311215901
Date: Fri, 7 May 1999 15:35:17 -0400
From: "Robertson, George" <GRobertson@bioreliance.com>
Source: Reuters Health, Fri 7 May 1999 [edited
The Lancet 1999;353:1558-1562
Yellow fever outbreak requires urgent response
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Urban yellow fever, eradicated in the Americas since 1954, has
reappeared among residents of Santa Cruz, Bolivia, and urgently
requires a mass immunization campaign, according to investigators.
Writing in the 8 May 199 issue of The Lancet, Professor Patrick Van der
Stuyft of the Institute of Tropical Medicine in Antwerp, Belgium, and his
colleagues confirmed that six residents of the Bolivian city had
contracted yellow fever, and five had died.
In urban areas, yellow fever is transmitted from person to person by a
common mosquito, _Aedes aegypti_. These mosquitoes were largely
eliminated during the middle of the century. But in the 1970s, a
relaxation of eradication programs gradually led to a re-infestation.
In contrast, in rural and jungle areas, yellow fever is transmitted from
monkeys to human beings by a different mosquito called
_Haemagogus_. The jungle form is only partially controlled by
vaccination of rural residents and provides a source of infection to
urban centers infested with _Aedes aegypti_.
The researchers note that a rural outbreak in early 1999 included
98 cases, and 21 deaths.
The infection causes bleeding from the gums, the intestines and the
kidneys. The liver is also affected, causing the jaundice that gives
yellow fever its name. The disease is fatal in approximately 20% of
victims.
Due to financial problems, Bolivia has had difficulty in purchasing
yellow fever vaccines. "Despite the risk ...and international calls by the
health authorities for vaccine donation, the planned campaign of mass
yellow-fever vaccination in Santa Cruz city has not yet been possible,''
write Stuyft and colleagues. Between January 1998 and April 1999, less
than 150 000 doses of vaccine were dispensed in the urban area. The
researchers believe there is a need for at least 600 000 doses.
"The potential for a large urban yellow-fever outbreak in Santa Cruz
remains beyond doubt. The vector...is present in abundance, immunity
in the population is low, and journeys to nearby endemic areas are
frequent,'' conclude the investigators. ''A catch-up mass immunisation
campaign of all the urban residents of Santa Cruz de la Sierra, should
be started urgently.''
--
ProMED-mail
<promed@usa.healthnet.org>
[This is NOT the way the world should be told about a grave threat to
public health -- through a publication in a medical journal that has taken
at least a week to appear. The International Health Regulations require
that all countries report even a single suspect case of yellow fever to the
World Health Organization *immediately*, followed as soon as possible
by confirmation. But we have seen nothing on the WHO or PAHO
websites.
Meanwhile, precious time has been lost. Santa Cruz is a major road
transportation hub with regular passenger traffic to Brazil & Peru.
Dozens of infected people could be arriving in those countries daily.
Some of them could be on planes to Asia before they fall ill -- see final
ref. above - Mod.JW
..............................................jw
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