“Brazilian Yellow Jack is Back”: Cyclical or Apocalyptic?

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Yellow fever cases reported, Brazil, 1980-2006. Source: WHO. Chart by NMM-Tabajara Boring Infographics Labs. I am not sure whether 2005 and 2006 represent zero cases or simply a lack of data. A definite zero is reported for 2001. Click to zoom.

How bad is this year’s bump in sylvatic yellow fever cases in Brazil? How shocking? How afraid should we be?

An 8th confirmed death from the disease has been announced, and a ninth awaits confirmation. O Globo reports 12 confirmed cases so far. The Ministry of Health reports 31 cases of people getting sick from overdosing on the vaccine.

News coverage here in Brazil focuses on the rise in the number of cases over the same period last year, but is the rise from one year to the next itself anomalous?

I was listening to an interview with a monkey scientist the other, for example — I cannot remember where, but it was not on one of the main news channels — who said that the disease tends to ebb and flow among monkey populations because of breeding patterns.

The more monkeys that get sick, the greater the risk to humans. Monkey survivors of previous monkey die-offs acquire immunity, so the disease tends to ebb until those survivor monkeys breed, producing non-immune junior monkeys.

Something like that. The guy was saying outbreaks tend to be cyclical for that reason.

Is that true? Have there been previous notable bumps in the disease? And how did the press cover them at the time?

I do not have time to thoroughly research that question, but someone probably should.

And I did find this in the archives of the Terra Brasil news portal, for example, from 2001: Mortes por febre-amarela cresceram 116% em 2000.

O número de mortes por febre amarela no Brasil aumentou 116% no ano 2000 em relação a 1999. Segundo estatísticas da Fundação Nacional de Saúde (Funasa), foram registrados 39 óbitos no ano passado, contra 18 mortes em 1999. A Funasa alerta que todos os brasileiros que viajam para a Amazônia e o Centro-Oeste devem se vacinar pelo menos uma vez a cada dez anos, período de validade da vacina.

The number of deaths from yellow fever in Brazil grew 116% in 2000 in relation to 1999. According to statistics from the National Health Foundation (Funasa), 39 deaths were registered last year compare with 18 in 1999. Funasa warns that all Brazilian who travel to Amazônia and the Mid-West should vaccinate themselves at least once every ten years, the effective life of the vaccine.

I would make that 117%, rounding up in the usual way from 116.666%.

Most deaths tend coincide with the rainy season, from January to March.

Yellow fever cases accelerated in those two years, according to data cited by epidemiology blogger Paulo Latufo (a physician with a Harvard post-doc). These are cases, not deaths:

Anos Brasil Bolívia Colômbia Equador Peru Venezuela
1970-79 182 310 270 19 391 0
1980-89 286 373 72 11 887 0
1990-99 263 221 14 37 1045 14
2000-1 118 8 3 1 18 0

WHO reported an estimated 30,000 deaths from the disease in the 44 at-risk nations worldwide in 2002, but fewer than 600 confirmed cases reported. Which remind us that reporting is not necessarily incidence. If a corpse rots in the forest and no one autopsies it, has it really died?

Os dados demonstram que a febre amarela vem se manifestando em sua forma mais fulminante. O número de pessoas que contraíram a doença cresceu apenas 12%, apesar do crescimento de 116% no número de óbitos, o que demonstra o maior índice de mortalidade. De 75 casos em 1999, subiu para 84 o número de pessoas infectadas no ano passado. Quando se manifesta de maneira mais fulminante, a doença pode matar em poucos dias, comprometendo o funcionamento dos rins e do fígado, e provocando hemorragias.

The data [Terra continues] show that yellow fever is manifesting itself in its more severe form of late. The number of cases grew only 12%, even as deaths rose 116%, a much higher mortality rate. From 75 reported cases in 1999, the number grew to 84 last year [2000.]

If that is the number Funasa gave Terra at the time, then WHO must have gotten its numbers from elsewhere, because its statistics on reported cases register a decline in the number of cases, from 76 to 73, during that period.

When manifesting itself in a more severe form, the disease can kill in a matter of days, compromising renal and liver function and provoking hemorrhages.

Além da Amazônia e do Centro-Oeste, a Funasa informou que as pessoas que viajam para o Maranhão também devem tomar a vacina. A vacina é também indicada para quem faz turismo ecológico em matas e florestas do país. Sua aplicação deve ser de no mínimo 10 dias antes da viagem, para que tenha efeito. A doença é transmitida pela picada de mosquitos Haemagogus e Sabethes, que vivem em matas. Não há mecanismos para controle da doença nas matas, o habitat natural do vírus amarílico.

Besides Amazônia and the Mid-West, Funasa says that people travelling to Maranhão (North) should get the vaccine, as should eco-tourists visiting forests and jungles.

Ten days before traveling. Transmitted by two types of mosquitos, which cannot be controlled without treating their natural habitat as though it were a plantation of Bolivian marching powder raw materials targeted by the black helicopters of Plan Colombia.

These sorts of public health statistics are not super easy to research on Brazilian government Web sites, by the way.

I have yet to see anyone compiling statistics on number of cases versus number of deaths from the disease.

The press just covers the fear and death.

You should see the numbers for Nigeria, though.

Where available. Running into the thousands of cases a year for a while there, then the numbers are simply no longer reported to WHO, apparently.

I plan to look for more comments from Dr. Latufo, of the USP teaching hospital, author of a textbook on practical epidemiology — who also takes the local press to task for failing to cover the masscare of 7 persons in the Bad Boy bar in the Zona Norte the other day.

An all too frequent occurence in that part of the city.

Lead poisoning still seems to be the deadliest tropical disease around, far and away, no contest.

Houve o assassinato do coronel da PM seguido pela chacina de sete pessoas. Qual foi o impacto na imprensa de opinião? O Estadão transformou em manchete, muito bom. Mas, a Folha deu destaque menor e, os comentaristas de jornal e blogue ignoraram o assunto. Enquanto discutir o senador Lobinho, xingar-se mutuamente em blogues ou tentar influir nas eleições americanas for mais importante do que o ocorrido em São Paulo, nós estaremos condenados a manter o nível atual dos indicadores de violência. O declínio em São Paulo pode estancar ou se acelerar, depende de nós. Aguardo os jornais de amanhã e as semanais. Volto a comentar na segunda-feira. Aposto que não haverá repercussão.

There was the assassination of the PM colonel followed by the massacre of 7 persons. What was the impact in the opinion-forming press? The Estado de S. Paulo made it a top headline, which was good. The Folha gave it minor play, however, and its commentators and blog ignored the item. As long as bickering over [the minister of mines and energy], cussing one another on their blogs, or trying to influence the American elections is more important than what happens in this city, we are condemned to see no reduction in the current level of violence. I am waiting to see the morning papers tomorrow, and the weeklies. I will comment again on Monday. But I bet you there will be no coverage.

I bet you Dr. Latufo is right.

It’s funny, but for all its defects, the Estado really does seem to me to have adopted a much stronger community focus than its rival. If you want to read about the kinds of policy issues that the Gotham Gazette covers so well in New York, for example, you are better off buying the Estadão. And its articles on the yellow fever meme stood out from the competition in being framed in a less sensationalist way.
In general, however, if Globo TV personality Luciano Huck has a gun waved in his face and his Rolex stolen at a stop signal a moral crusade is launched. Tanker trunks of ink are spilled.

The 45,000 people who have guns actually used on them, to lethal effect, every year, get less ink combined than the Brazilian ex-Mouseketeer’s latest bad hair day.

It’s enough to give you headache, nausea, and massive failure of the bodily organs that regulate your desire to consume Brazilian mass-market infotainment.

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