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Yellow fever vaccine

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I am curious to know what people think, did, will do about the yellow fever vaccine. My ID specialist suggested me to avoid the vaccination until I was staying in Rio and São Paulo City centres. (I had to get the vaccine from the day I begun to go to BH, PA and other minor Brazilian cities). 

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I got the vaccination last Fall (non-fractionated) prior to travel to Minas Gerais. A significant proportion of new infections in SP state have occurred within 15 kms of SP city; a significant proportion in RJ state occurred in Teresopolis area, within 100 kms of RdeJ city. Not a bad idea to get inoculated, as high density pop areas are hot zones if and when YF is introduced. Having had 2 subtypes of dengue, I have a great deal of respect for Aedes Aegypti buggers. Currently, the odds of exposure remain low but can be deadly. 

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Guest mrb43

I just returned from Brasil - Rio, BH, Brasilia and Sao Paulo.

They were recommending that you get the vaccine as yellow fever was starting to appear in the cities.

I went to a private clinic and for $50 USD - vaccinated.

I later learned that it takes 10 days to become effective.

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59 minutes ago, mrb43 said:

I just returned from Brasil - Rio, BH, Brasilia and Sao Paulo.

They were recommending that you get the vaccine as yellow fever was starting to appear in the cities.

I went to a private clinic and for $50 USD - vaccinated.

I later learned that it takes 10 days to become effective.

Haha well unless you got bitten on your last day, you would already have huge symptoms. 

Anyway there's no case yet of YF in big cities (talking just about rj and SP) . SP did have 8 cases, but it is a huge city and all were from the North of it. (poorer, huge green areas and parks with monkeys). 

This is because I was told, it's quite difficult for the virus to begin its urban cycle; (luckily) until now, all the cases came from bites from the silvestres ones. SP and RJ are doing quite a lot to prevent a urban diffusion of YF, and possibly since the huge vaccination campaign (even if the coverage is still low) , they should be OK. 

US CDC says that vaccination is recommended for the whole RJ and SP states. 

WHO recommends it for the whole SP state... RJ city is safe. 

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I must be less cynical. I think the message is that there have recently been hundreds of YF cases clustered in a relatively small area of Brazil, considering the immensity of the country. 10% of these have died, some of them foreign travellers. The country has been trying to arrange large-scale vaccination. Vaccination is the lowest common denominator for individual prevention and to ward off an urban outbreak, because urban spread of YF mimics the transmission patterns of Zika, Chikungunya, and dengue ... human to human via mosquito.

There are enough red flags to suggest that many of the preliminary conditions for the first major urban outbreak in 90 years have been reached. Vaccination as prevention is one person at a time. It is two-pronged in that it protects you and you cannot be the source of another's exposure. Simple math, N of 1, multiply by a lot, factor in our good fortune in terms of access compared to inhabitants of the African continent. 

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11 hours ago, mrb43 said:

I just returned from Brasil - Rio, BH, Brasilia and Sao Paulo.

They were recommending that you get the vaccine as yellow fever was starting to appear in the cities.

I went to a private clinic and for $50 USD - vaccinated.

I later learned that it takes 10 days to become effective.

Where did you get this vaccine for $50 USD.  A quick Google search in San Francisco area yields $150 minimum.

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The yellow fever vaccine that is typically used in the US is out of stock at least until the end of this year, and the FDA has provide provisional/temporary approval for the vaccine that is normally used in Europe to be supplied in the US. But this means that it is available only in a few FDA-approved locations, and it is costly. I think I paid $160. https://wwwnc.cdc.gov/travel/news-announcements/yellow-fever-vaccine-access

I had to drive approximately 40 miles to find a place that had it in stock. You can search for all of the approved providers here: https://wwwnc.cdc.gov/travel/page/search-for-stamaril-clinics

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Correction: I indicated a10% mortality rate ... in fact, over 1,500 cases in Brasil since July 2016, 30% death rate. 

I also did not know that YF vaccination in 14 interior states was already a longstanding routine procedure.

The gov't plans to administer 70 million doses over the next 12 months, from perimeter n/e thru to s/e and south, so they must have a huge supply chain. 

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I got the yellow fever vaccine when I decided to make a trip to Porto Alegre. I say it cant hurt and there may be other places you will travel to other than brazil in the globe and need it. I will say while I had my documentation with me of the vaccine I was never asked for it.

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Everyone is not a good candidate for the yellow fever vaccine, as it contains a live organism being introduced into the body. Patients with weak or compromised immune system are often advised by their physicians to forego the vaccine due to risks. If you fit into one of these categories, you should probably talk to your primary care physician before getting the vaccine:

“Because certain people have an increased risk of developing a serious adverse event if vaccinated with yellow fever vaccine, vaccine is not recommended (i.e., contraindicated) for people with:

  • Allergy to a vaccine component
  • Age <6 months
  • Symptomatic HIV infection or CD4+ T-lymphocytes <200/mm3 (<15% of total in children aged <6 years)
  • Thymus disorder associated with abnormal immune function
  • Primary immunodeficiencies
  • Malignant neoplasms
  • Transplantation
  • Immunosuppressive and immunomodulatory therapies

Some people may have an increased risk of an adverse event, but they may benefit from receiving the vaccine. Talk to your healthcare provider if you have any of the following:

  • Age 6 to 8 months
  • Age ≥60 years
  • Asymptomatic HIV infection and CD4+ T-lymphocytes 200 to 499/mm(15-24% of total in children aged <6 years)
  • Pregnancy
  • Breastfeeding”

https://www.cdc.gov/yellowfever/vaccine/index.html

 

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12 minutes ago, Lucky said:

My doctor this morning told me that people coming to Brazil from the US do not need the yellow fever vaccine. Is he right?

He does want me to do malaria prevention.

It is recommended by the cdc, but not considered mandatory. 

If you go to the countryside, get it if you can. There are many cases of infection, it is not a near-zero risk.

There are yet no confirmed case of people catching it while only staying in the big metropolises of Southern Brasil, so you should be fine in Rio and SP. also the cooler south, like the state of RS, is not affected at all.

Brasilia and BH are right in the middle of the affected zones, though  

 

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What the hell... Vaccination for malaria? 

Change your doctor (unless you're going to the Amazon). 

Yellow fever in Brazil has been overhyped because of the potential risks of a urban cycle of the disease (which did not and will probably never happen since the mass vaccination campaigns) ... Around 1000 cases (about half were lethal) out of a population of 207 million people. 

Not saying that it's worth to risk to get it but until you stay in developed areas in big cities there's no need to do it. 

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I just returned from Brazil two days ago.  I didn't get the vaccine in Brazil since I was too busy there.  And I was afraid the vaccine may seriously weaken my body while I was drinking, partying and sexing most of the days there.  Perhaps I should set aside a whole week for vaccine recovery time on my next trip.

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10 minutes ago, Walker said:

I just returned from Brazil two days ago.  I didn't get the vaccine in Brazil since I was too busy there.  And I was afraid the vaccine may seriously weaken my body while I was drinking, partying and sexing most of the days there.  Perhaps I should set aside a whole week for vaccine recovery time on my next trip.

The vaccine takes 2 weeks to become effective so you need to schedule it before you go. 

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According to the Bulletin of the Department of Health of Rio de Janeiro State, through 4 June 2018, there have been 262 cases of yellow fever reported in the State of Rio de Janeiro, with 84 deaths. This bulletin reports cases and deaths by city within the State of RJ. While I don't see any reports of communities within the city limits of Rio de Janeiro, and certainly not in the Zona Sul and Centro, where many of us tend to travel, there have been communities that are pretty close to Rio, e.g., the old imperial city of Petrópolis and in towns on the tourist route, e.g., the beautiful coastal town of Paraty.

When I was visiting in Rio in December 2017 and January and February 2018, there was a massive public health program to encourage all people to obtain the YF vaccine. Because supplies were low, and in order to immunize as many people as possible, many states and communities in Brazil decided to offer a "fractionated" YF vaccine, i.e., containing one-quarter of the normal YF vaccine dose. Be advised that, if you get a dose of the fractionated vaccine, protection is expected to last only 7 years. Now, however, public health officials say that the full dosage YF vaccine protection is lifelong.

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My main concern with the yellow fever vaccine is that it’s a live vaccine. Within the past 5 years, 7 people have contracted yellow fever from the vaccine and died.  It is one factor to consider when balancing benefits/risks.

https://www.webmd.com/drug-medication/news/20010713/deaths-tied-to-yellow-fever-vaccine

 

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13 hours ago, sanddunes said:

My main concern with the yellow fever vaccine is that it’s a live vaccine. Within the past 5 years, 7 people have contracted yellow fever from the vaccine and died.  It is one factor to consider when balancing benefits/risks.

https://www.webmd.com/drug-medication/news/20010713/deaths-tied-to-yellow-fever-vaccine

 

That article is dated July 2001. So, the 5 year period in the article is from July 1996 to July 2001 — 17 years ago. And if was 6 out of 7 people that received the vaccine and contracted yellow fever that died — not all 7 (not that much more comforting, but facts should matter).

What’s more statistically important is that the number who contracted yellow fever and died after receiving the vaccine is very low compared to the total number who have received the vaccine. And as mentioned, most likely those people were young, elderly or immunocompromized.

"If you are traveling in an area of ongoing transmission, such as Western Africa or the Amazon, your risk of getting yellow fever unprotected by vaccine is many times higher than your risk of [having problems] from the vaccine," says Cetron.”

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