What is Yellow Fever?

Yellow Fever Update July 2017

The World Health Organization has revised countries requiring Yellow Fever Vaccinations. Travelers going to or coming from Zambia, Tanzania, Eritrea, Somalia, Sao Tome and Principe as well as Rwanda will no longer be required to produce a yellow fever vaccination certificate when in South Africa as these countries have been included on the World Health Organization (WHO) list of countries with low potential for exposure to yellow fever.

During the 136th session of the WHO Executive Board meeting, a review of countries with risk of yellow fever transmission and countries requiring yellow fever vaccination was conducted and based on the recommendations of the meeting; all travelers arriving into South Africa from these countries will NOT be required to produce proof of vaccination against Yellow Fever. This provision is with immediate effect.

In line with the International Health Regulations, 2005 South Africa requires a valid yellow fever certificate from all citizens and non citizens over one year of age (citizens over 60  years of age require a waiver certificate) if they are:

·         Travelling from a yellow fever risk country; or

·         Have been in transit exceeding 12 hours, through the airport of a country with risk of yellow fever transmission.

Definition of a valid Yellow Fever vaccination certificate:

Vaccine should be approved by the WHO and administered at least 10 days before departure to South Africa at a Yellow Fever approved vaccination centre. The vaccine offers protection 10 days after administration and provides lifetime immunity.

List of countries for which a Yellow Fever vaccination certificate is required for entry into South Africa:

AFRICA

CENTRAL AND SOUTH AMERICA

 Angola  Guinea  Argentina
 Benin  Guinea-Bissau  Bolivia
 Burkina Faso  Kenya  Brazil
 Burundi  Liberia  Colombia
 Cameroon  Mali  Ecuador
 Central African Republic  Mauritania  French Guyana
 Chad  Niger  Guyana
 Congo  Nigeria  Panama
 Cote d’lvoire  Senegal  Paraguay
 Democratic Republic of the Congo  Sierra Leone  Peru
 Equatorial Guinea  Southern Sudan  Suriname
 Ethiopia  Sudan  Trinidad and Tobago
 Gabon  Togo  Venezuela
 Gambia  Uganda
 Ghana

For a PDF of Countries with risk of yellow fever transmission and countries requiring yellow fever vaccination click HERE

What is Yellow Fever - Yellow Fever Map for Africa
Yellow Fever Map for Africa

 

What is Yellow Fever?
Yellow Fever Map for South America

 

What is Yellow Fever?

Yellow fever virus is found in tropical and subtropical areas in South America and Africa. The virus is transmitted to people by the bite of an infected mosquito. The mosquito responsible for spreading Yellow Fever is from the Aedes and Haemogogus species.

Once contracted, the yellow fever virus incubates in the body for 3 to 6 days. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days.

A small percentage of patients, however, enter a second, more toxic phase within 24 hours of recovering from initial symptoms. High fever returns and several body systems are affected, usually the liver and the kidneys. In this phase people are likely to develop jaundice (yellowing of the skin and eyes, hence the name ‘yellow fever’), dark urine and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Half of the patients who enter the toxic phase die within 7 – 10 days.

Yellow fever is difficult to diagnose, especially during the early stages. More severe disease can be confused with severe malaria, leptospirosis, viral hepatitis (especially fulminant forms), other haemorrhagic fevers, infection with other flaviviruses (e.g. dengue haemorrhagic fever), and poisoning. It is imperative to visit Travel doc – Travel Clinic should you experience any of these symptoms when returning from a yellow fever area.

How to Prevent Yellow Fever?

  1. Use insect repellent.
  2. Wear proper clothing to reduce mosquito bites.
  3. Be aware of peak mosquito hours: peak biting times for many mosquito species is dusk to dawn. However, one of the mosquitoes that transmits yellow fever virus, feeds during the daytime.
  4. Yellow fever vaccine is recommended for people aged ≥9 months who are traveling to or living in areas with risk for YFV transmission in South America and Africa. In addition, some countries require proof of yellow fever vaccination for entry.

Do you need a Yellow Fever vaccination? Call Travel Doc 011 440 5325 or 011 440 5326 or 082 457 0176

Yellow Fever in Summary

  1. Yellow fever can be deadly
  2. When travelling to certain countries from South Africa, Yellow Fever Vaccination is required
  3. Yellow fever vaccination is safe and affordable (Travel Doc charges R687 per vaccine)
  4. It provides effective immunity against the disease in the range of 80 to 100 % of those vaccinated after 10 days and  99%  immunity after 30 days
  5. A single dose provides life-long protection against yellow fever disease
  6. A booster dose is not needed
  7. Vaccine can be offered to individuals with asymptomatic HIV infection with CD4+  counts 22 cells/mm3 or higher requiring vaccination
  8. For pregnant and lactating woman travelling to areas with yellow fever transmission, vaccination is recommended when travel cannot be postponed or avoided.
  9. The following people are usually excluded from yellow fever vaccination, however a waiver certificate from Travel Doc is required:
  • Immunocompromised individuals
  • Thymus disorders
  • Symptomatic HIV
  • Malignant neoplasms under treatment
  • Those that have received or are receiving immunosuppressive treatments
  • Recent transplants
  • Current or recent radiation therapy
  • People with sever allergies to egg and their derivatives
  • People over 60 years of age

Our Services

  • Is your company sending employees to a country that requires Yellow Fever vaccination? We will come to you and administer the vaccination to your employees.
  • Are you travelling to a country that requires Yellow Fever vaccination as a group? We will come to you and administer the vaccinations in the comfort of your home/ office.
  • Are you travelling to a country that requires Yellow Fever vaccination come to us or we will come to you.
  • Are you at the airport and just realised that you need the Yellow Fever vaccination in order to board your flight? Call us and we will come to you.

Call us now: 011 440 5325 or 011 440 5326 or 082 457 0176

Updated 26 June 2017

With thanks to The South African National Travel Health Network

CHOLERA, DIARRHEA AND DYSENTERY UPDATE

The death toll continues to rise in Yemen, where a cholera outbreak has been spreading for months, according to the WHO. There have been 275 987 suspected cholera cases and 1634 deaths from the illness between 27 Apr and 5 Jul 2017, the WHO said in a statement on Wed 5 Jul 2017.

“If you get caught early in the morning with this and you don’t get treated by the end of the day, then you really have a problem,” WHO spokesman Christian Lindmeier said. “A weak elderly person could really be dead by the end of the day.” The WHO said in a statement last week, “we are now facing the worst cholera outbreak in the world.”

Areas with Cholera

The following countries have areas with cholera. However, it’s important to remember that most cholera is spread in limited outbreaks, and travelers are rarely at risk.

  • Africa: Benin, Burundi, Cameroon, Central African Republic, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Nigeria, Somalia, South Sudan, Tanzania, Uganda, Zambia
  • Asia: Afghanistan, Bangladesh, India, Iraq, Malaysia, Myanmar, Thailand, Yemen
  • Americas: Dominican Republic, Haiti

What is the cause of Cholera?

Cholera is caused by ingestion of _Vibrio cholera_ bacteria, which are spread through water or food that is contaminated with faeces. Up to 80 percent of people with cholera don’t have symptoms, but they are still capable of spreading it. Those who do show symptoms have a sudden onset of watery diarrhoea, which can lead to death by severe dehydration. About 14.5 million people in Yemen don’t have access to clean water and sanitation, according to the WHO. All but 2 of the nation’s governorates have been hit by the outbreak.

The WHO has partnered with the United Nations Children’s Fund and local health authorities to deliver medication and aid to combat the ongoing outbreak, including the establishment of 45 diarrhoea treatment centers and 236 oral rehydration therapy corners. Lindmeier said it is essential for people who are infected to rehydrate immediately. “The biggest challenge is reaching people,” he said. “This is great. This is a major effort and a huge logistical effort, but people need to know that they can get there. People need to know that they can find these places.”

Efforts have been complicated by Yemen’s civil war, which has left more than 18.8 million people in need of humanitarian assistance, according to the WHO. Many of the country’s trained medical personnel have fled or been killed as the conflict intensified over the past 2 years, said Juliette Touma, UNICEF’s regional chief of communications for the Middle East and North Africa.

Touma travelled to Yemen in early June 2017 to see what work was being done and said she was impressed by the dedication of health workers however, she couldn’t help but think about all the people who still needed relief. “What I kept thinking about was all of these children who couldn’t actually make it to medical care because they live in the remote parts of Yemen and the rural areas where there are no facilities, or those who couldn’t afford to pay,” Touma said.

How to prevent Cholera?

Since the outbreak began, campaigns and community volunteers across the country have been trying to spread the message of how to prevent cholera, she said, including how to clean water, to wash food before eating it and to take general hygienic measures. But Touma said there is a lot more to be done. “As long as we have more reports and suspected cases of cholera, and as long as the number of suspected cases increases — and it has been increasing by the day — we can’t unfortunately say there has been progress,” Touma said. “There is a cure for cholera, we can cure it, and that is very much dependent on getting in essential supplies, but we need to get more. We need to get more dedicated personnel.”

The Advisory Committee on Immunization Practices (ACIP) recommends CVD 103-HgR vaccine for adult travelers (age 18–64 years) to an area of active cholera transmission. An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1 and includes areas with cholera activity within the last year that are prone to recurrence of cholera epidemics; it does not include areas where rare sporadic cases have been reported.

The risk for cholera is very low for people visiting areas with epidemic cholera when simple precautions are observed.

All people (visitors or residents) in areas where cholera is occurring or has occurred should observe the following recommendations:

How is Cholera treated?

Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die.

Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as receiving rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

Treating a dehydrated child

Oral rehydration solution (ORS) is available in health centres, pharmacies, markets and shops.

If ORS is unavailable give the child a drink made with 6 level teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 litre of clean water.

Be very careful to mix the correct amounts. Too much sugar can make the diarrhoea worse. Too much salt can be extremely harmful to the child.

Making the mixture a little too diluted (with more than 1 litre of clean water) is not harmful.

Encourage the child to drink as much as possible.

A child under the age of 2 years needs at least 1/4 to 1/2 of a large (250-millilitre) cup of the ORS drink after each watery stool.

A child aged 2 years or older needs at least 1/2 to 1 whole large (250-millilitre) cup of the ORS drink after each watery stool.

How much ORS should be given?

  • Babies and toddlers: 0.5 liter of ORS drink every 24 hours
  • Children (2 to 9 years old): 1 liter of ORS drink every 24 hours
  • Children (more than 10 years old) and adults: 3 liters of ORS drink every 24 hours

Communicated by: ProMED-mail