CDC: Yellow fever kills four Brazil travelers; vaccination urged

The CDC is recommending that people who are not vaccinated against yellow fever avoid certain areas of Brazil after 10 people who visited the country became infected, four of whom died. Eight of the infected travelers, including the four who died, had visited a popular tourist destination off the Rio de Janeiro coast.

The cases came amid an ongoing, multistate yellow fever outbreak in the country that began in December 2016. Health officials have warned that stockpiles of the vaccine for the virus are limited. The CDC is recommending that all individuals who plan to travel to affected areas of Brazil be vaccinated.

“In the last 2 years or so, Brazil’s yellow fever outbreak has expanded significantly and moved closer to popular tourist destinations near the coast and in major urban areas like Rio de Janeiro and São Paulo,” Marty Cetron, MD, director of the CDC’s Division of Global Migration and Quarantine, said during a press conference.

Cetron, who was also one of the authors of an MMWR report on the outbreak, said the agency has updated its recommendations for travelers.

“The most important new recommendation is that travelers should not go to yellow fever hotspots in Brazil unless they are vaccinated,” he said.

Of the 10 infected travelers, two came from Argentina and three from Chile, the CDC said. The other five were from Europe and included men from the Netherlands, Romania, Switzerland and Germany, and a woman from France. The European travelers ranged in age from 34 years to 46 years. None of the 10 travelers had been vaccinated against yellow fever, the CDC said. The Swiss and German visitors, along with two of the Chileans, died from their illness.

The four who died had all visited Ilha Grande, a forested island off the coast of Rio de Janeiro whose natural beauty and outdoor allure draw tourists.

“This number of travelers getting yellow fever from visiting the same general area, and around the same time, is highly unusual,” Cetron said, naming Ilha Grande a hotspot for yellow fever.

According to the Brazil Ministry of Health, 920 confirmed cases of yellow fever, resulting in 300 deaths, were reported in the country between July 2017 and March 13, 2018. Most cases occurred in January and February, the ministry said.

Yellow fever cases during that period were reported in five Brazilian states, with all except six cases reported in Minas Gerais, São Paulo and Rio de Janeiro states.

The CDC recommends all eligible people aged 9 months or older be vaccinated before traveling to certain areas of Brazil. Travelers should be vaccinated at least 10 days ahead of time and may consider receiving a booster if it has been 10 years or more since they were vaccinated, the agency said.

The FDA-approved vaccine, VF-Vax (Sanofi Pasteur) is out of stock in the United States, but another — Stamaril (Sanofi Pasteur) — is available on a limited basis. Cetron said only about 250 U.S. clinics have the vaccine, as opposed to the usual 4,500 clinics. Demand may be high for the vaccine, he warned, and travelers should plan ahead.

A list of clinics that provide Stamaril can be found on this CDC web page. – by Joe Green

References:

Gossner CM, et al. Euro Surveill. 2018;doi:10.2807/1560-7917.ES.2018.23.11.18-00106.

Hamer DH, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6711e1.

Disclosures: The authors report no relevant financial disclosures.