Yellow fever cases have occurred throughout southern Brazil, mainly in the states of Rio Grande do Sul and São Paolo. Yellow fever occurs in sub-Saharan Africa and tropical South America and is spread to people through the bite of infected mosquitoes. Symptoms can include sudden onset of fever, chills, headache, backache, nausea, and vomiting.
From December 2008 through April 2009, the state of Rio Grande do Sul, on the southern tip of Brazil, reported 20 confirmed human cases of yellow fever infection. Nine of these people died. This is the first time since 1966 that human yellow fever cases have been reported in Rio Grande do Sul. In response to the situation, the Brazilian Ministry of Health has added a number of municipalities to the yellow fever risk area, which now includes the state’s capital city of Porto Alegre.
From February through April 2009, the state of São Paolo in Southern Brazil reported 28 confirmed human cases of yellow fever, including 11 deaths. These cases occurred in municipalities that lie outside the reported yellow fever risk area. In response, the Brazilian Ministry of Health has added a number of municipalities to the yellow fever risk area for São Paolo.
Yellow Fever Risk Areas in Brazil
Currently, Brazil recommends yellow fever vaccination for travelers to the following states:
All areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, Tocantins, and designated areas of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. Vaccination is also recommended for travelers visiting Iguassu Falls.
Vaccination is NOT recommended for travel to the following coastal cities: Rio de Janeiro, São Paulo, Salvador, Recife, and Fortaleza.
Recommendations for US Travelers
Brazil currently does not require yellow fever vaccination for entrance into the country. However, travelers are strongly urged to get the yellow fever vaccine before traveling to an area of Brazil with risk of yellow fever transmission.
Since yellow fever is spread by the bite of an infected mosquito, travelers are also reminded to take steps to prevent mosquito bites:
* When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. Always apply sunscreen before insect repellent.
o Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), oil of lemon eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
o In general, repellents protect longer against mosquito bites when they have a higher concentration (%) of the active ingredient. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often just 1-2 hours.
o The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children over 2 months old.
o Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
* Wear loose, long-sleeved shirts and long pants when outdoors.
* Spray clothing with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: Don’t use permethrin on skin.)
