Brazilian FAQ: “Yellow Jack Has Not Come Back”

https://i0.wp.com/www.who.int/csr/disease/yellowfev/yellowfevercover.jpg
Yellow fever, sylvatic, intermediate and urban. The Wikipedia article on the topic does not note this differentiation into types. Neither does the Brazilian news media. No one seems to be addressing the topic of “intermediate” yellow fever. Source: WHO-OMS.

Não há risco de epidemia de febre amarela, diz ministro da Saúde (G1/Globo): A pending announcement by the minister of health, that “there is no risk of a yellow fever epidemic,” is the top story on Globo and in the Estadão today. On which see also

The health ministry has put up a FAQ on the issue. It is a little wordy, and ought to be written in an “inverted pyramid” style that addresses the biggest question first: How do I know whether I should get vaccinated or not? This is the 26th question on the FAQ sheet:

Nesta época do ano, muitos brasilienses ainda estão viajando e ainda não retornaram para o trabalho e para o início do ano letivo em Brasília. Dado o período de imunização ser de dez dias após a vacinação, estas pessoas devem se vacinar nas cidades em que se encontram, antes de voltarem a Brasília? É fácil conseguir a vacina em outros estados?

At this time of year, many Brazilians are still traveling and have not yet returned to work or the beginning of the school year in Brasília. Given that the period of immunization begins ten days after vaccination, should these persons get vaccinated in the cities where they find themselves, before returning to Brasília? Is it easy to find vaccine in other states?

Se estiverem em área silvestre consideradas de risco,devem tomar a vacina e as precauções necessárias para evitar a doença.

If they were in a wilderness area considered to be at risk, they should take the vaccine and the steps needed to avoid the disease.

Which does not answer all the questions frequently asked under this heading.

A Spanish gentleman farmer died in Brasília after returning from a trip to, I think it was, Mato Grosso for the holidays.

Some monkeys were initially said to have died of the disease near the nation’s capital, but not some of those reports did not pan out, I think I heard. Or maybe not.

File under “contamination fears, moral panics that exploit, possible” and “official information, how to garble or not garble.”

Recommendation: Among the Five Ws of this story, “where” is the one that is coming through the murkiest on this end of the gazillion-jigawatt megaphone.

Government flacks are not hammering this point hard enough, and the local news media cannot be bothered to pick up the slack when flacks lose track.

O ministro da Saúde, José Gomes Temporão, faz pronunciamento à nação neste domingo (13), em cadeia de rádio e TV, por volta de 20h, para, segundo ele próprio, “tranquilizar” a população brasileira sobre o risco de epidemia de febre amarela no país.

Health minister Temporão will address the nation at around 8pm this Sunday on TV and radio to, as he says, “put the Brazilian population’s mind at ease” about the risk of a yellow fever epidemic.

He gave a press conference to the same effect on January 9.

That press release seemed very well written, but I think it could have hit the main point harder: Should I get vaccinated or not? How do I decide? This technical note from January 11 (PDF) gives a wealth of detail bearing on the issue, but needs to be provided with a “for dummies” version.

The Oswaldo Cruz foundation — I read a great little book by physician and novelist Moacyr Scliar, whose A Majestade do Xingu also deals with the subject, fictionally, on the pioneering immunologist and tropical disease specialist, — has released 2 million doses of the vaccine.

“Não existe risco de epidemia”, informará o ministro da Saúde. Temporão lembrará que, apesar da existência de 24 notificações pelas secretarias de Saúde, sendo dois casos confirmados e outros três descartados, o Brasil não tem casos de febre amarela desde 1942.

“There is no risk of an epidemic,” Temporão will tell the nation. He will remind Brazilians that, despite the existence of 24 notifications from state health secretaries, with two cases confirmed and another three ruled out, Brazil has not had cases of yellow fever since 1942.

Of urban yellow fever, is what they mean.

It has registered 349 cases of selvatic yellow fever — which is spread by another type of mosquito, one that normally bite monkeys — in the last 12 years.

“Os casos registrados de lá para cá foram todos de febre amarela silvestre, ou seja, de pessoas que contraíram a doença nas florestas”, dirá ele no pronunciamento.” [sic]

“The cases registered since then have all been cases of sylvatic yellow fever, that is, case of people who contracted the disease in the rainforests,” he will say in his speech.

Segundo o ministro da Saúde, os casos “suspeitos” estão localizados e “restritos” a áreas onde algumas pessoas não vacinadas entraram em florestas e matas nas últimas semanas.

According to the health minister, the “suspected” cases are localized in and “restricted to” areas where unvaccinated persons have entered the rainforests and jungles in recent weeks.

Why “in quotes”?

“O Ministério da Saúde tomou todas as medidas preventivas para evitar que casos da doença aparecessem antes mesmo da confirmação do caso sob investigação”, informa o ministro.

“The health ministry had taken all precautionary measures to avoid having cases appear, even before the confirmation of the case under investigation,” he informs.

Some monkeys died. They activated their standard Plan “Follow Up on Funky Monkey Deaths.”

The image “https://i2.wp.com/i113.photobucket.com/albums/n216/cbrayton/Stuff/where.png” cannot be displayed, because it contains errors.
A picture is worth a thousand words: Unnatural monkey die-offs that triggered monkey autopsies this year and last. Green: animal epidemics recorded; blue: animal epidemics confirmed by laboratory; red: animal epidemics and cases of sylvatic YF; brown: cases of sylvatic YF. How did São Paulo, Bahia and Santa Catarina get on the
O Globo list if they have registered no monkey plagues? Source: Brazilian Ministry of Health Technical Note, January 11, 2008.

Ele recomenda ainda à população que só procure os postos de saúde quem morar, ou for visitar, as chamadas “áreas de risco” e somente quem nunca se vacinou – ou se foi vacinado antes de 1999.

He also recommends that the population only seek out health clinics if they live in, or have visited, the so-called “risk areas,” and only those who have never been vaccinated — or were vaccinated before 1999.

And what are those risk areas?

I am having a hard time finding that out, precisely.

The clinics at the airport and bus station here in São Paulo were jam-packed with people seking vaccination the other day, the TV news showed us.

But it seems as though eco-tourists who have not got the shot are the main target audience here.

If you are going to tromp around the monkey-infested jungles, where the Onça Caetano lurks, get the damn shot.

But then we were already pretty clear on that.

Urban yellow fever is spread by the same mosquito — Aedes egyptii, right? –that spreads dengue, which is currently a problem running into the dozen or so cases in some urban areas — the vast majority of them off-the-grid (shantytown) communities, naturally — and the object of a concerted public education campaign this rainy season.

“Mas, lembre-se, tomando a vacina, você estará totalmente protegido após dez dias”, explicou Temporão. O ministro finalizará dizendo que as autoridades estão preparadas para atender a quem realmente precisa da vacina.

“But remember, taking the vaccine, you will be totally protected after ten days,” Temporão explained. He will finish by saying that authorities are prepared to attend those who really need the vaccine.

O Globo reported the other day that the public health secretary declared “risk zones” in 18 Brazilian states.

O Ministério da Saúde ampliou a recomendação de vacinação contra a febre amarela no Brasil. Além de Goiás e Distrito Federal, onde macacos morreram supostamente infectados pela doença, a Vigilância Sanitária pediu nesta segunda-feira que se vacinem também os moradores e visitantes de todos os estados das regiões Norte e Centro-Oeste, Maranhão, Minas Gerais, regiões oeste de Piauí, São Paulo, Paraná e Santa Catarina, e o sul da Bahia e do Espírito Santo.

The federal health ministry widened its recommendations for vaccination against yellow fever in Brazil. Besides Goiás and the Federal District, where monkeys died, supposedly after being infected with the disease, the public health system asked on Monday that residents of and visitors to the Northern and Midwest regions, Maranhão, Minas Gerais, eastern Piauí, São Paulo, Paraná, and Santa Catarina, and the southern parts of Bahia and Espírito Santo, be vaccinated.

Supposedly? Supposed by whom?

The Brasília dead monkey, from a national park, once tested, turned out not to have yellow fever.

The image “https://i2.wp.com/i113.photobucket.com/albums/n216/cbrayton/Stuff/sylvaticrisk.png” cannot be displayed, because it contains errors.
The coast and the monkey jungle zone: Sylvatic YF risk, 2005. Key: green=endemic; red=transitional; yellow=potential; blue=unaffected. The bulk of the population lives in the blue zone.

Let me say again that I am still a little confused about this issue, after reading both the press and the health ministry FAQs.

We live in São Paulo. We still understand we have no urgent need to be vaccinated, though I plan to do it during my next check-up because we would like to visit Belem and Manaus this year.

Should I get vaccinated if I live in or visit any part of those states, or just the wilderness areas? The O Globo report makes it sound like the former, don’t you think?

My wife was in Minas recently, but not in a rainforest area, and has not heard from any responsible adults that the area is considered a risk zone.

De acordo com dados dos últimos 12 anos apresentados pelo Ministério da Saúde, foram notificados no período 349 casos, que levaram à morte de 161 pessoas.

349 cases of selvatic yellow jack, leading to 161 deaths, in the last 12 years.

The Folha de S. Paulo quotes the health secretary of Goiás as saying that 8 out of 10 people running to the health clinics for vaccinations don’t need it because their vaccination is already up to date.

TV news showed a small town in Minas mounting protests because, when a resident who visited the mato recently got what may be a case, the city was hit with a rumor that it was a festering hotbed of horrible, horrible disease. Hotel bookings declined drastically, the boob tube reported.

You cannot get the disease from other humans or primates, just from getting bit by the mosquito that spreads the virus. Brazil vaccinates 1.4 million a month against the disease and produces 2.4 million doses, according to a ministry factoid.

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