Wednesday, April 23, 2008

Yellow Fever in Brazil

Suspected of having yellow fever dies:

In Goiania since the last day 2, John Baptist Gonçalves, 31, died yesterday of the bankruptcy of multiple organs. Laudo vai confirm whether rural worker was contaminated by the disease, as authorities suspect. Two weeks ago, were found in Missouri and the Federal District, dead monkeys infected with fever. In the DF, 200 thousand people have already been vaccinated, very close to the goal of 240 thousand, equivalent to 10% of the population. Yesterday, the Ministry of Health requested that all state governments to send doses of the vaccine to Missouri, where the goal is immunisation 15% of the residents.

Death suspected
Ploughman goiano admitted with symptoms of the disease suffer from multiple organ failure. Authorities hope to have the state official report on the case yet this week. In the DF, vaccination continues tomorrow

Erika Klingl
The team of Mail

He died in Goiania the rural worker of 31 years, the first suspected of contamination by yellow fever since the secretaries of Health of Goias and the Federal District gave the alert against the disease. The concern about contamination by yellow fever came when 53 monkeys were found dead in two units of the Federation. He made of multiple organ failure, cardiac arrest, after the worsening of renal and liver which had led to the Hospital of Tropical Diseases (HDT), in the capital goiana, on the last day 2.
In Goiania, and medical authorities give as virtually certain that the cause of death of the farmer, occurred the night of Friday, is linked to contamination by yellow fever. The official confirmation, however, will come only with the disclosure of the first report, which should occur by the end of this week. All indications lead to the clinical diagnosis of the disease. The starting with the origin of John the Baptist. Morador of Aparecida de Goiania, he was working in the rural area of Uruaçu, considered a local government area of yellow fever endemic wild. There and in other 38 municipalities there were goianos record in 2007 of cases of animal diseases: death of monkeys by suspected yellow fever wild. In three of the 41 monkeys found dead, was identified the presence of the virus.
What further strengthens the argument that John the Baptist was with the disease was her clinical picture. According to the State Secretariat of Health in early December, he sought the medical service of Uruaçu with fever, abdominal pain, bleeding and signs of renal excretion disorder - common symptoms of yellow fever, but also to other viruses such as rubella, hantavirus and dengue. Last week the framework of farmer worsened dramatically. "When there is failure of the kidneys and liver, as occurred with this patient, the range of possibilities of disease reduces a lot. In this case, cut off most viruses and worked with yellow fever, a dengue haemorrhagic or fulminant hepatitis," argues Aminadad Rodrigues, director of the Epidemiology Department of the Secretary of Health of Goiania.
He died at 21h20 on Friday and burial was planned to occur last night. Carlos de Souza, one of those responsible for the Office of Verification of Death of the state, explains that, after death, samples of blood and offal of the farmer were collected. "The first report was made from the collection of blood when he was admitted to HDT. Now, a more complete examination vai confirm the cause of death," he says. The result of the initial report should leave in five days and the second in three months.
The news of the contamination and death of the farmer led rush to put the health of Goiás "The Ministry of Health urged all states to send their doses of vaccine against yellow fever," says the Secretary of Health of Missouri, Cairo de Freitas. He explains that in addition to release 1.5 million doses of vaccine, the federal government has increased the percentage of residents to be immunized in the state, from 10% to 15%, which represents 803 thousand people. So far, 734 thousand were already v acinadas.
"We are on track and kill the farmer will not change our strategy," explains the Secretary of Health of the DF, Jose Geraldo Maciel. "Of the 240 thousand people who were part of our goal of vaccination - the equivalent of 10% of the population - 200 thousand already vacinaram in the first days of intensification of the campaign. All of immunization in a few days", said Maciel.
In the federal capital, the alert was given by the discovery of two dead monkeys in Mineral Water, which resulted in the closure of the park by yet undetermined time. Jose Geraldo Maciel expects to receive tomorrow or after an answer from the Ministry of Health on the reopening of Mineral Water. The bodies of 10 other monkeys were found in various regions of the DF.
The Secretary of Health explained that all those who took the vaccine in the last 10 years need to be immunized. This weekend, the posts of health of the DF have not worked. Vaccination can be made from Monday to Friday, between 8 am and 17h.
When there is failure of the kidneys and liver, as occurred with this patient, the range of possibilities for diseases reduces much
Aminadad Rodrigues, director of the Epidemiology Department of the Secretary of Health of Goiania

Soon, vaccination against rubella

The risk of resurgence of yellow fever in the Federal District has changed the routine of brasilienses. In addition to closing for an indefinite period of the National Park - main option for leisure holidays - the population has had to face long queues in clinics to take the vaccine against the disease. There is no record of any case in the federal capital and the health authorities are keen to stress that the measures taken are merely precautionary in nature. But if the yellow fever is still only a threat to public health from Brasilia, other diseases are increasing among brasilienses and still are victims in the city. Last year, increased the number of cases of hantavirus, dengue and rubella. Dobrou also the number of deaths from meningitis.
After the mobilization against yellow fever, the Department of Health vai launch this year of a campaign of vaccination against rubella. The cases of the disease recorded in the city jumped from five in 2006 to 350 in 2007, according to data published by the Secretariat of Surveillance in Health In smaller proportions, the hantavirus has 10 victims last year - number 42% higher than the seven cases treated in 2006.
While the mobilisation against rubella is not launched, the concern focuses on the fight against yellow fever. The offensive against the disease began on December 28, when the Department of Health recommended that all brasilienses take the vaccine against yellow fever virus. The same day, the GDF determined the closing of the National Park, where two monkeys were found dead. Preliminary examinations did not indicate the presence of the virus, but we must await a rebuttal. Other 10 monkeys were found dead elsewhere in Brasilia. Tomorrow, the Ministry of Health decides whether the opening of the Mineral Water will be allowed to visitors who present a card showing the vaccination of immunization against disease.
The form of the disease that still exists in Brazil is the wild yellow fever, when the infection occurs in the rural area. "But if someone infected by the circular urban area, where it still remains the Aedes aegypti mosquito, there is a high risk of resurgence of urban yellow fever, which would be disastrous. Hence, the risk of new cases is absolutely worrying", highlights the infectologista . In the Federal District, there are no cases of yellow fever wild since 2000, when the farmer Rodrigo da Silva, 21, died in the Rural Center Rajadinha in Planaltina.

Word of specialist:

An evil serious and highly lethal

Carlos Gropen

Press of known viruses such as hepatitis C and the dreaded ebola virus, yellow fever is caused by a virus belonging to the family Flaviviridae, sent by the same vector of dengue, Aedes aegypti mosquito. It is, however, a more severe disease with considerable fatality in a significant portion of infected patients.
The infection begins with the bite of a mosquito that contains the virus, followed by a period of latency and incubation, which lasts three to six days, where there are no symptoms. Then appear fever, malaise, muscle pain mainly on the back, lack of appetite, nausea and vomiting. These first signs are called nonspecific, as occurs in many other diseases, viróticas or not.
Most patients moves to decrease the intensity of symptoms and the cure. However, a considerable portion of ill - about 15% - develops the more severe form of the disease, whose possibility of death is 50%. The symptoms of toxic phase is called jaundice (yellowing eyes and face), abdominal pain, vomiting, bleeding in the mouth, eyes and stomach. Often moves towards severe renal insufficiency with the possibility of complete stop of the functioning of the kidneys.
Unfortunately, there is no specific treatment for yellow fever. He is suportivo, with moisturizing and attempt to correct the consequences of the disease, sometimes even being required dialysis, or do the work of kidney patients through a machine. Some viruses have been tested, with no results yet completely consistent. The vaccine is a good form of prevention and should be used according to criteria established by the Ministry of Health
The most worrying is the vector, the transmitter, which is exactly the same as that of dengue. This means that, once started an epidemic of yellow fever, infrastructure and logistics needed already in place, inherited the dengue and all public policies in health, which still falls short of ideal.

Carlos Gropen is a doctor and consultant in the area of Health and Medicine

Three diseases worrying

In addition to combat the threat of yellow fever, the Secretary of Health of the DF tries to prevent the advancement of rubella, the emergence of new cases of meningitis and the spread of the dengue mosquito

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