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Brazil-Health Advice for Travelers to the 2016 Summer Olympic and Paralympic Games
The World Health organization has released health advice for travelers to the 2016 Summer Olympic and Paralympic Games in Rio deJaniero. These recommendations include several pertinent to zoonotic diseases, meaning those capable of being transmitted from animals to humans. In most instances, the vector of transmission is the mosquito.
The Olympic and Paralympic Games will take place from August 5 to August 16, and from September 7 to September 18 respectively. In addition to Rio deJaniero, five additional cities will be hosting matches of the Olympic football tournament - Belo Horizonte, Brasilia, Manaus, Salvador, and São Paulo.
The following recommendations are intended to advise national health authorities and health care providers about practices and measures for travelers visiting Brazil.
Before departure, travelers should be advised about health risks in the areas they plan to visit and related preventive practices and measures to minimize the probability of acquiring diseases and of having accidents.
Travelers to Brazil should consult the travel advice issued by their national authorities.
Personal protective measures
Although the risk of mosquito borne disease is lower during winter, travelers should still take personal protective measures to prevent mosquito bites. These include:
- Whenever possible, wearing clothes (preferably light-colored) that cover as much of the body as possible during the day;
- Using repellents that contain DEET (diethyltoluamide), or IR 3535, or icaridin andare applied to exposed skin or to clothing and used in strict accordance with the label instructions, especially regarding the duration of protection and timing of re-application. If repellents and sunscreen are used together, sunscreen should be applied first and the repellent thereafter;
- Choosing sanitary accommodations with piped water and physical barriers such as proper window and door screens to prevent mosquitoes from entering rooms;
- Avoiding areas in cities and towns with no piped water and poor sanitation, which constitute ideal breeding grounds for mosquitoes.
Arboviruses transmitted by Aedes mosquitoes
In addition to yellow feve, mosquito-borne diseases transmitted by Aedes species mosquitoes include chikungunya, and dengue and Zika virus disease.
Dengue and chikungunya
Detailed information about dengue and chikungunya is available on the websites of Brazil’s Ministry of Health, and at www.who.int. There is no vaccination for chikungunya. Dengue vaccination is not recommended for travelers.
Zika virus disease
Zika virus infection usually causes a mild disease, and many cases of Zika virus infection are asymptomatic. However, following an outbreak of Zika virus in Brazil in 2015 and its subsequent spread in the Americas, an unusual increase in serious neurological disorders was seen in the off-springs of pregnant women who had been infected, including cases of microcephaly and congenital neurological malformations. Cases of Guillain-Barré Syndrome (GBS), a rare but serious form of muscle weakness, were observed among adults. Based on a growing body of research, there is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome. Zika virus is primarily spread by mosquitoes, though sexual transmission has increasingly been documented.
On the basis of current knowledge about Zika virus disease and its complications, the following is recommended to national health authorities and health care practitioners:
- To provide travelers to areas of ongoing Zika virus transmission, including Brazil, with up-to-date advice on appropriate measures to reduce the risk of becoming infected, including by preventing mosquito bites and practicing safe sex (e.g. use condoms correctly and consistently); and on the potential consequences and complications of infection, especially for women who are pregnant or planning a pregnancy; non-barrier forms of birth control will not protect against sexual transmission of Zika virus infection;
- To advise pregnant women not to travel to areas of ongoing Zika virus outbreaks, including Brazil;
- To advise women who inadvertently become pregnant or discover they are pregnant in or shortly after returning from Brazil, and/or other areas with ongoing Zika virus transmission, to contact their health care providers;
- To advise pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks to ensure safe sexual practices or abstain from sex for the duration of their pregnancy;
- To advise travelers to practice safe sex or abstain from sex during their stay in Brazil, and/or other areas with ongoing Zika virus transmission, and for at least eight weeks after their return. If men experience symptoms of Zika virus disease, they should adopt safer sex practices or abstain from sex for at least six months;
- To advise travelers returning from Brazil, and/or other areas with ongoing Zika virus transmission, not to donate blood for at least four weeks after departure from the area;
- To advise health care practitioners to be on alert for Zika virus disease in travelers returning from Brazil and/or other areas with ongoing Zika virus transmission;
- National authorities should provide health care practitioners with clear guidance on how to refer travelers with suspected Zika virus infection for suitable clinical management and testing where appropriate.
Malaria (transmitted by Anopheles mosquito)
The risk of malaria transmission is negligible or non-existent except in the administrative region of Amazonas, corresponding to the Northern states of Brazil. This includes the city of Manaus which is hosting some of the Olympic football matches.
Plasmodium falciparum infections account for approximately 15% of malaria cases in Brazil. In malaria-affected areas, in addition to mosquito bite prevention (including use of repellents and sleeping under an insecticide treated mosquito net), chemoprophylaxis with atovaquone–proguanil, or doxycycline, or mefloquine should be considered and selected according to reported side-effects and contraindications. Alternatively, for travel to rural areas with low risk of malaria infection, mosquito bite prevention can be combined with stand-by emergency treatment (SBET).
Based on the risk assessment by Brazilian health authorities, the national guidelines do not include recommendations on malaria chemoprophylaxis. Therefore, the access to these drugs while in Brazil will be limited and antimalarial drugs should be purchased before travelling. Travelers who become ill with a fever while traveling in a malaria-risk area within Brazil should seek immediate medical attention (see list of websites below for diagnostic and treatment health centers). Travelers who become ill with a fever for up to one year after their travel should inform their health care practitioners about their travel history. There is no vaccination recommended for malaria.
WHO declares end of Ebola outbreak in Liberia
Liberia, 9 June 2016 – Today the World Health Organization (WHO) declares the end of the most recent outbreak of Ebola virus disease in Liberia. This announcement comes 42 days (two 21-day incubation cycles of the virus) after the last confirmed Ebola patient in Liberia tested negative for the disease for the second time. Liberia now enters a 90-day period of heightened surveillance to ensure that any new cases are identified quickly and contained before spreading.
Liberia first declared the end of Ebola human-to-human transmission on 9th May 2015, but the virus has re-emerged three times in the country since then. The most recent cases were a woman who had exposure to the virus in Guinea and travelled to Monrovia in Liberia, and her two children who subsequently became infected.
“WHO commends Liberia’s government and people on their effective response to this recent re-emergence of Ebola,” says Dr Alex Gasasira, WHO Representative in Liberia. “WHO will continue to support Liberia in its effort to prevent, detect and respond to suspected cases.”
This date marks the fourth time since the start of the epidemic 2 years ago that Liberia has reported zero cases for at least 42 days. Sierra Leone declared the end of Ebola human-to-human transmission on 17 March 2016 and Guinea on 1 June 2016 following the last flare ups.
WHO cautions that the 3 countries must remain vigilant for new infections. The risk of additional outbreaks from exposure to infected body fluids of survivors remains.
Source: World Health Organization
End of Ebola outbreak declared in Guinea
Brazzaville, 1 June 2016 - Today the World Health Organization (WHO) declares the end of Ebola virus transmission in the Republic of Guinea. Forty-two days have passed since the last person confirmed to have Ebola virus disease tested negative for the second time. Guinea now enters a 90-day period of heightened surveillance to ensure that any new cases are identified quickly before they can spread to other people.
“WHO commends the Government of Guinea and its people on ending this Ebola outbreak,” says Dr Abou Bekr Gaye, acting WHO Representative in Guinea. “We must continue to be vigilant to ensure that we rapidly detect and stop any new cases that may occur.”
In the latest outbreak, 7 confirmed and 3 probable cases of Ebola virus disease were reported between 17 March and 6 April in Guinea. In addition, 3 confirmed cases were reported between 1 and 5 April in a woman and her two children who had travelled from Macenta, Guinea, to Monrovia, Liberia.
The source of infection in this latest outbreak is likely to have been due to exposure to infected body fluid from an Ebola survivor. The risk of additional outbreaks from exposure to infected body fluids of survivors remains.
Source: World Health Organization
WHO sets up strategic response plan for Zika
WHO/PAHO and partners have set out their strategic response to Zika, placing a greater focus on preventing and managing medical complications caused by Zika virus infection. To date, $122.1 million is necessary to effectively implement the Zika Strategic Response Plan through December 2017.
The revised Zika Strategic Response Plan includes a greater focus on preventing and managing medical complications caused by Zika virus infection and expanding health systems’ capacities for that purpose. Risk communication targeting pregnant women, their partners, households and communities will be central to prevention efforts to ensure they have the information they need to protect themselves.
“Much has been learned about Zika virus infection,” said Dr. Margaret Chan, WHO Director-General. “The response now requires a unique and integrated strategy that places support for women and girls of child-bearing age at its core.”
Other elements include integrated vector management, sexual and reproductive health counselling as well as health education and care within the social and legal contexts of each country where Zika virus is being transmitted.
The plan highlights several specific characteristics of the Zika outbreak that require a collaborative, global response and support. These include:
- the potential for further international spread of Zika virus given the wide distribution of Aedes mosquitoes that are capable of transmitting Zika virus,
- the lack of population immunity in areas where Zika virus is circulating for the first time and which allows the disease to spread quickly,
- the absence of vaccines, specific treatments and rapid diagnostic tests, and
- inequalities in access to sanitation, information and health services in affected areas.
Source: World Health Organization
The 2014 Ebola epidemic in West Africa is the first in history. The first case was reported in Guinea in March 2014, and the disease spread in the neighboring countries of Liberia and Sierra Leone. Over the span of a year, the Ebola epidemic has caused more than ten times as many cases of Ebola than the combined total of all those reported in previous Ebola outbreaks. As the outbreak became more widespread, travel-associated cases appeared in Nigeria, Mali, Senegal, and even countries outside Africa, including the United States.
Zika: Controlling mosquitoes at home
May 6, 2016
Here’s what you can do to control mosquitoes outside your home:
- Install or repair and use window and door screens. Do not leave doors propped open.
- Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like tires, buckets, planters, toys, pools, birdbaths, flowerpot saucers, or trash containers. Mosquitoes lay eggs near water.
- Tightly cover water storage containers (buckets, cisterns, rain barrels) so that mosquitoes cannot get inside to lay eggs.
- For containers without lids, use wire mesh with holes smaller than an adult mosquito.
- Use larvicides to treat large containers of water that will not be used for drinking and cannot be covered or dumped out.
- Use an outdoor flying insect spray where mosquitoes rest. Mosquitoes rest in dark, humid areas like under patio furniture, or under the carport or garage. When using insecticides, always follow label instructions.
- If you have a septic tank,repair cracks or gaps. Cover open vent or plumbing pipes. Use wire mesh with holes smaller than an adult mosquito.
Here’s what you can do to control mosquitoes inside your home:
- Keep windows and doors shut and use air conditioning when possible.
- Keep mosquitoes from laying eggs inside your home. Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like vases and flowerpot saucers.
- Kill mosquitoes inside your home. Use an indoor flying insect fogger* or indoor insect spray* to kill mosquitoes and treat areas where they rest. These products work immediately, but may need to be reapplied. Always follow label directions. Only using insecticide will not keep your home free of mosquitoes.
Mosquitoes rest in dark, humid places like under the sink, in closets, under furniture, or in the laundry room.
Use an indoor fogger* or indoor insect spray* to reach and treat areas were mosquitos rest inside the home.
|Active Ingredient||Brand name examples**||How long it works|
|Indoor flying insect spray||ß-Cyfluthrin, Imidacloprid||Home Pest Insect Killer, Raid, Ortho, HotShot, EcoLogic||7-10 days|
|Indoor flying insect fogger||Tetramethrin, Cypermethrin||Hot Shot, Raid, Real Kill, Spectracide||Up to 6 weeks|
|**Insecticide brand names are provided for your information only. CDC and the U.S. Department of Health and Human Services cannot recommend or endorse any name brand products|
Facing up to the New Avian Flu Virus H7N8
January 26, 2016
The killing of 400,000 birds in Indiana this month has focused attention on the 2016 Avian Flu Virus H7N8. Last year different strains of the avian flu virus (the H5Nx viruses) led to the killing of 48 million birds throughout the Midwest, sending egg prices soring. The impact of this new H7N8 virus is not yet clear.
Professor Juergen A. Richt, Regents Distinguished Professor at Kansas State University and Director of the Department of Homeland Security Center of Excellence for Emerging and Zoonotic Animal Diseases, wrote for the Genetic Expert News Service (at: GENeS) that: "Since low pathogenic H7N8 influenza viruses were found in poultry flocks in the area of the initial outbreak, it is possible that a low pathogenic H7N8 was introduced from wild birds into poultry flocks which subsequently mutated into a highly pathogenic avian influenza virus (HPAIV) during replication in turkeys. The limited information from USDA supports this possibility."
This virus has not yet spread to humans and is unlikely to do so, but the threat to poultry is serious.
200,000 birds euthanized in Indiana: What we know about the new avian flu virus
January 19, 2016
Last week USDA confirmed discovery of a highly pathogenic H7N8 avian flu virus in a turkey flock in Indiana. Subsequently, eight more turkey flocks tested positive for H7N8 but were found to have a low pathogenic variant of the virus. While the virus genome is being analyzed, 200,000 infected birds, both turkeys and chickens, are being euthanized in efforts to stamp out the outbreak before it reaches the proportions seen in the 2015 epidemic when over 48 million birds were killed.
Read More at GENeS