By Dr Gurp Sidhu, Medical Director, Intana Global
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The advisory comes after a recent escalation in cases of yellow fever, a viral infection transmitted by mosquitoes which can be fatal.
Although no urban outbreaks are being reported as of yet, there have been multiple reports of cases in southern Brazilian states thought to be originated from Minas Gerais, raising the potentially alarming prospect of a widespread transmission of the virus in urban areas.
Yellow fever has long been present in Brazil but the numbers of people affected by the virus has accelerated in recent months since the outbreak in January this year and it has now spread to areas where the risk of getting infected was considered to be extremely low previously.
Brazilian health authorities are taking action to tackle the outbreak, including mass vaccination campaigns and vector control activities, but efforts have been hampered by the simultaneous outbreaks of Chikungunya, Dengue and Zika — so travellers to the country are facing additional threats.
With the rapidly evolving situation and expanded areas of risks, Intana Global is urging companies who need to send their staff to Brazil to take sufficient measures and precautions to ensure the health and travel safety of their employees as well as to evaluate the changing risk level with the support of their assistance companies. Employers should include a specific employee risk assessment prior to travel, and provide their travellers with access to advice before, during and after their trip, to ensure their health and wellbeing.
Since yellow fever has been present in Brazil for a very long time, there is a real danger that people could overlook the threat.
Most people infected with yellow fever virus have no or only mild illness. Among those who do develop flu-like symptoms within a typical incubation period of 3-6 days, around 15-25% of them can progress to develop a more severe form of the disease and the mortality rate is high among this group.
With the rapid spread of the virus in recent months, businesses and leisure travellers alike need to reappraise the risk as a very real health threat and take adequate precautions prior to their trip and during their stay in the country.
Top key facts:
- As of 29th March 2017, a total of 1,589 cases (496 confirmed) have been reported across largely jungle and rural areas — but there is concern that the virus could spread into urban centres which will pose an increased threat to business and leisure travellers alike.
- Vaccinations are recommended for those visiting affected areas and should be administered at least 10 days before travel.
- However, due to specific undesirable effects associated with the vaccination, the inoculation is not suitable for all travellers and is not recommended for those who travel outside of affected areas. An individual risk assessment with a healthcare professional specialised in travel health is therefore recommended 6-8 weeks prior to travel.
- Travellers should wear loose-fitting clothes with long trousers and long sleeves.
- Travellers should sleep under an intact mosquito net if not in air-conditioned accommodation. Nets should be impregnated with a contact insecticide (such as permethrin).
- Scrupulous insect bite avoidance measures should be adhered to during day and night hours, especially in view of the simultaneous outbreaks of Chikungunya, Dengue and Zika.
- Use insect repellents such as N, N-diethylmetatoluamide (DEET) based repellents as they tend to be the most effective. DEET is available in several concentrations with 20% offering 1-3 hour protection. Higher concentrations can provide longer-lasting protection. Insect repellents should be applied regularly.
- Travellers who experience any fever or flu-like illness after returning home from Brazil should seek immediate medical advice and inform their doctor about their visit to South America.
- Travellers over nine months of age arriving in Brazil from Angola and the Democratic Republic of Congo (DRC) are required to present a yellow fever vaccination certificate.
Intana Global advises travellers that there is a difference between the requirement for a yellow fever vaccination certificate and the need for a yellow fever vaccination itself. The former simply proves a person is vaccinated and enables travellers arriving from Angola and the DRC to get through border controls, while the latter gives one protection against the disease and is recommended for all those travelling to affected areas.
The current situation is a rapidly changing one — and employers who send travelling staff to Brazil in particular should be monitoring the situation closely under their Duty of Care obligations.
Since the outbreak, Panama and Nicaragua have changed their guidance on yellow fever vaccination certification required to enter their countries. More countries may follow and amend their entry requirements at short notice. Travellers are advised to regularly check these requirements at least two weeks prior to their trips.