The World Health Organization announced Tuesday that it now considers
all of Sao Paulo state at risk for yellow fever, recommending that all
international visitors to the state be vaccinated.
That puts the
megacity of Sao Paulo on the list. But Brazil's Health Ministry said in a
statement that it was not changing its own, recently updated map of
at-risk areas, which includes only certain parts of the state and city.
The ministry said that the WHO's more-cautious recommendation for
foreigners was made in light of the fact that it is impossible to know
where visitors might travel once they arrive in Sao Paulo state.
Antonio Nardi, a senior official at the ministry, later told reporters it was the result of an "excess of concern."
announcement comes as an outbreak is gathering steam in Brazil during
the Southern Hemisphere summer rainy season and just weeks ahead of
Carnival, a major draw for foreign tourists. Nardi noted that most
Carnival activities happen in cities, not in the forested areas that are
of most concern, and so visitors should be safe.
Since July 2017,
35 cases of yellow fever have been confirmed in Brazil, 20 of them in
Sao Paulo state and three in Rio de Janeiro state, according to Health
Ministry data released Tuesday. In all, 20 people have died. Yellow
fever is spread by the same mosquito that transmits other tropical
diseases, including Zika.
Much of Brazil is considered at risk for
the virus, but a corridor along the coast was long largely considered
safe. Last year, however, Brazil saw an unusually large outbreak of the
disease, including in areas not previously thought to be at risk. More
than 770 people were infected, and more than 250 died. In response, the
WHO began expanding its map of areas of transmission, including adding
all of Rio de Janeiro state.
Brazil rushed to vaccinate millions
of people in a massive campaign last year, and it is continuing those
efforts this year. Just last week, the Health Ministry announced that a
new campaign would vaccinate nearly 20 million people in dozens of
cities in Sao Paulo, Rio de Janeiro and Bahia states. Sao Paulo health
authorities announced Tuesday they would start vaccinations a few days
early and said the campaign would vaccinate about half of the state's
population by the end of next month.
Most of those people will
receive a fractional dose of the vaccine — a strategy the WHO recommends
to contain ongoing outbreaks that threaten to outrun vaccine supplies.
declined to say how many doses Brazil has in its strategic stocks, but
he said the country has "sufficient vaccine to vaccinate the entire
Brazilian population if necessary." Brazil is a major producer of yellow
fever vaccines, but last year it requested 3.5 million doses from
international emergency stockpiles.
Brazilian authorities say
studies have shown that a fractional dose is effective for at least
eight years, though a WHO factsheet only goes as far as saying it is
effective for at least a year "and likely longer." A full dose is
generally considered effective for life.
Even before the WHO
announcement, Brazilian media were reporting long lines at health
centers in Sao Paulo and Rio de Janeiro on Tuesday morning.
should have already vaccinated the whole population of this country,"
said Roberta Tonelli Ferreira, 61-year-old who visited a health center
in Sao Paulo on Tuesday with her granddaughter Valentina, who is 2.
"They wait until a person dies, to have who knows how many deaths, for
the public to be frightened to start vaccinating."
There is no
known treatment for yellow fever, and vaccination campaigns are
considered crucial to containing outbreaks. Symptoms of the disease
include fever, muscle pain, and nausea; some patients also experience
abdominal pain, kidney problems and the jaundice from which the disease
gets its name.