Minas Gerais Declares State of Emergency as Brazilian Yellow Fever Outbreak Rages On

On Saturday, January 20, the Minas Gerais government declared a “public health emergency situation” in the southeastern Brazilian state that lies directly between the equally hard-hit states of Bahia, Rio de Janeiro, and São Paulo. According to Jornal do Brasil coverage of the decree, signed by governor Fernando Pimentel, the declaration allows for the adoption of administrative measures needed to obtain the necessary supplies, materials, and services to contain the outbreak. The municipalities of Belo Horizonte, Itabira, and Ponte Nova are included in the decree, which encompasses 94 cities.

A total of 22 cases of yellow fever have been confirmed in Minas Gerais since July 2017 and 15 of those individuals have died.

Like its neighboring states of Bahia, Rio de Janeiro, and São Paulo, Minas Gerais has adopted a mass fractional vaccination campaign, set to begin on January 25. The fractional vaccination campaign consists of providing individuals with a half-dose of the vaccine which is said to confer immunity for up to 8 years, as opposed to the full-dose which confers lifetime immunity.

The current vaccine coverage rate in the state is about 82%; however, according to the Jornal do Brasil, approximately 3 million individuals have yet to be vaccinated. Most of these individuals fall in the 15 to 59 age range.

For clinicians in the United States who have patients looking to travel to Brazil in the near future, the Centers for Disease Control and Prevention recommends vaccinations for those who are traveling to:

• All of Espirito Santo State.
• All of Rio de Janeiro State, including the city of Rio de Janeiro.
• All of São Paulo State, including the entire city of São Paulo.
• A number of cities in Bahia State.

Although getting the yellow fever vaccine is the best way to protect against infection, supplies of Sanofi’s YF-Vax, the only yellow fever vaccine licensed in the United States, are expected to remain depleted until mid-2018. An alternative vaccine, Stamaril, is available; however, it is only available at select sites throughout the United States and therefore, those who are interested in the alternative yellow fever vaccine should check with their health care provider.

Yellow fever is a mosquito-borne virus that causes fever, headache, jaundice, muscle pain, nausea, vomiting, and fatigue. According to the WHO, “a small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days.” About 200,000 cases of infection occur around the world each year and about 30,000 of those infected will die.