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Brazil

General

 Brazil is the largest country in South America and extends from the Atlantic Ocean to the Caribbean to the depths of the Amazon basin. The climate varies throughout the country but generally it experiences a humid

tropical climate.

Safety & Security

The level of crime in many of the main urban centres is certainly rising and tourists need to be aware of the risks involved in travelling particularly in the evening hours. It is wise to use an official taxi for any journeys after dark. It is sensible not to flaunt any personal wealth and to use the hotel safety boxes for any valuables and your travel documents. The amount of crime against tourists tends to be greater in areas surrounding hotels, discotheques, bars, nightclubs and other similar establishments that cater to visitors, especially at dusk and during the evening hours. There are frequent reports of theft on city buses and such transportation should be avoided. A number of the main cities have established specialised tourist police units to patrol areas frequented by tourists. Rio de Janeiro, Sao Paulo and Brasilia all continue to experience a high incidence of crime.

Road Safety

Throughout this huge country the state of the roads varies greatly. In many regions the roads are dirt tracks and assistance would be hard to obtain for those travelling off from the main tourists routes. Bag snatching from traffic lights occurs in the main cities. If considering hiring a car make certain that your travel insurance is sufficient.

Jet Lag

After your flight you will experience a degree of jet lag. Travelling from Europe this will be less than when you travel home but nevertheless it will still cause your body to complain for 24 to 48 hours. Try to have a more relaxing time for the first few days (and also after returning home if possible!). Be careful not to fall asleep by the pool and then awaken with sunburn which could ruin your time abroad.

Medical Facilities

In any country of this size the level of medical care will vary greatly. This is particular true out side the main tourist resorts. English speaking doctors should be available but the level of hospital care can be worrisome. Make certain you carry sufficient supplies of any medication you may require for your entire holiday. Essential drugs (asthma, diabetes, epilepsy etc) should be divided for security.

Sun Exposure and Dehydration

The hot humid tropical climate often leads to quite significant problems for the Irish traveller. Make sure you cover your head when out in the sunlight and drink plenty of fluids to replenish that lost through perspiration. Replace the salt you loose by eating crisps etc orby putting salt on your meal (providing there is no contraindication).

Visiting the Iguassu Falls

These huge waterfalls border Argentina, Brazil and Paraguay. There is only minimal risk of malaria and so malaria prophylaxis is not generally recommended. Also, Yellow fever is not transmitted in this area but mosquitoes can abound. Sensible insect bite precautions should be followed at all times.

Food & Water

Many tourists who visit Brazil stay in the main resorts along the southern coast. The food and water preparation in the hotels is normally excellent but eating food from street vendors is generally unwise. Shell fish (bivalve oysters, mussels, clams etc) are unwise even in a five star hotel. Check the water from the cold water tap in your room. If you can’t easily smell chlorine (swimming pool style) don’t use it even for brushing your teeth. If travelling around the country (Caribbean coast or into the Amazon regions) take significantly more care.

Rabies 

This viral disease occurs throughout Brazil and it is usually transmitted through the bite from an infected warm-blooded animal (eg dogs, cats & monkeys). Any contact should be avoided but if it occurs treat it very seriously and seek competent medical attention immediately after you wash out the area and apply an antiseptic.

Malaria

The risk of malaria is significant all year throughout the Amazon regions. There is insignificant risk for those staying along the coast up as far as Fortaleza and for those remaining in this region prophylaxis is not usually recommended. The risk in the region of Brasilia is also thought to be minimal though this is an area which has unusually experience an outbreak of Yellow Fever recently, and so the situation will require review.

Mosquito Borne Diseases  Apart from malaria the other two main diseases transmitted by mosquitoes which cause problems in Brazil are Dengue Fever (mainly along Caribbean Coast but has been reported much further south) and Yellow Fever (mainly in the Amazon Basin but thought to be spreading to other regions). Avoidance techniques are important at all times throughout the day. Swimming **************************************** Most of the main tourist swimming pools will be well maintained and the smell of chlorine will be evident. If sea swimming is on your agenda make sure you go where there are plenty of others and never swim alone. Look for warning signs and pay attention to local advice. Be very careful of local currents which can be dangerous. Vaccinations **************************************** The Brazilian Embassy is advising all travellers to Brazil to have vaccination cover against Yellow Fever. Also for your personal protection it is wise to consider some further vaccines. Generally we would recommend the following vaccination cover; * Yellow Fever (mosquito borne) * Tetanus (childhood booster) * Typhoid (food & water borne) * Hepatitis A (food & water borne) For those travelling more extensively or staying in the country for longer periods we would usually suggest that further vaccines are considered including Hepatitis B, Meningitis and Rabies. Summary **************************************** Many travellers to Brazil will remain perfectly healthy and well providing they follow some sensible precautions. Further information is available from either of our centres regarding any recent disease outbreaks.

Travel News Headlines WORLD NEWS

Date: Wed, 10 Apr 2019 18:49:48 +0200

Rio de Janeiro, April 10, 2019 (AFP) - Residents of a hillside Rio de Janeiro favela risk finding hungry caimans at their front door after the city was hit hard by heavy flooding caused by torrential rain.   The cold-blooded creatures -- smaller relatives of alligators -- belong to
a resident of the Rolas favela in western Rio, and escaped on Tuesday when a wall holding them in burst when struck by a flash flood.

An animal control team has been mobilized to re-capture the reptiles, the Rio environmental services office told AFP.   How many were on the loose? Officials did not say.   The team faces a risky task: not only must they be wary of the aggressive animals, but they must navigate streets knee-deep in water or slick with mud, dodging uprooted trees and loose power lines like the one that electrocuted a man to death near where the caimans escaped from.   They also face more mundane dangers, such as being shot, knifed, mugged or kidnapped in the high-crime favela.

As of Wednesday the team had been unable to enter the favela "due to the strong presence of drug traffickers," city officials said.   "I saw the wall collapse and two people have already seen caimans at their front door," a local resident wrote on social media.   The unusually heavy rain, which began late Monday and continued into Tuesday, has killed at least 10 people, officials said.   The rain triggered flash flooding that turned some streets into raging rivers, uprooting trees and sweeping away vehicles.   Heavy runoff from neighbouring hills gushed through some apartment buildings and shops, leaving behind mud and debris.
Date: Sat 6 Apr 2019
Source: Globo.com [in Portuguese, machine trans. edited]

In the Northern Region of Rio Grande do Sul, the death of cattle has worried producers. At least 50 animals have died this year [2019] on 15 properties with signs of rabies. [This appears to be a large outbreak and needs some serious support from the local and state governments. - ProMED Mod.TG]

In the town of Soledade, Adriano Borges Knopf lost 4 animals in less than 15 days. "We started to suspect it was not a normal thing. We noticed the animals lost their legs [weakness in legs] and did not get up any more," said the farmer.

A sample [from the animal necropsy, and the laboratory] report found Adrian's cattle had herbivore rabies, a disease caused by a virus transmitted by bats. [Cattle are herbivores, and consequently in some areas it is called herbivore rabies, but this virus could equally affect people, or dogs or horses. - ProMED Mod.TG]

Four other cattle belonging to the producer Luiz Carlos dos Santos also died because of the problem. "It's their milk we live on. We were even planning to improve this year [2019]," he lamented about the losses in production.

The challenge now is to control the transmission of the disease affecting these cattle. Most of the animals that died were attended by the veterinarian Bolivar Camargo, who is part of a cooperative in the region. "There are people who had 10 lactating cows and ended up losing 7, so their profitability ends, right?" he pointed out.

Last week, a bat was found near one of the affected properties. Technicians from the State Department of Agriculture are doing a survey to try to identify the source of these infections.  In addition to injury, producers are also concerned about the transmission of rabies to humans. The disease, however, is not transmitted by the consumption of milk or meat.  "They [the people] should be vaccinated if they have a very high risk, if they have suffered a bite from an animal, or had very intimate contact with an animal showing clinical signs of rabies," explained veterinarian Isadora Correa.

She added: "[The vaccine] is not available to the entire population, nor would it be the case, because the risk of transmission of herbivore rabies from a bovine to a human being is fairly low."
======================
[Most likely, the bats responsible for transmitting the rabies virus are vampire bats. While these bats can and do move around, deforestation seems to upset them, causing them to move to areas where there previously has not been a problem.

Vampire bats are distributed in tropical areas of the western hemisphere from Argentina to Mexico and have been responsible for transmitting rabies virus, most frequently to cattle and equine animals, and, infrequently, to humans [by bite]. Of the 3 vampire bat species, _Desmodus rotundus_ is by far the most common rabies virus transmitter.

There are 2 options for rabies control in these situations:
vaccination of animals upon which the vampire bats feed, or reduction of the vampire bat populations, or perhaps a 3rd option would be a combination of the 2 approaches. Eliminating vampire bat hosts is the fastest and most effective approach when vampire bat-transmitted rabies appears in an area. In areas where repeated vampire bat-transmitted rabies occurs, control of these bats has been employed in some countries. Controlling vampire bats by eliminating their roosts is extremely difficult because these roosts can be hard to find. Effective vampire bat control has been accomplished by capturing bats in mist nets when they come to feed on livestock and applying anticoagulant jelly (warfarin and similar products), which they and their roost-mates ingest on grooming.

As animals can be vaccinated, it would prudent to do so immediately, as there is approximately 2 weeks from vaccination of the cattle until they are capable of mounting an immune response. In addition to vaccination, the suggestion of netting the bats and using anticoagulant jelly is perhaps equally as important. So, employing additional methods instead of only one method, would be the most prudent approach to a more rapid control of this disease from these bats.

The loss of these animals to these families is huge, and this is a large outbreak needing immediate containment. Perhaps the government could send out some vaccine and additional people to help vaccinate animals and to net and coat the bats with anticoagulant jelly. Coating the bats means handling the bats, minimally, and gloves should be worn. Likewise, any bite or scratch should receive immediate medical attention and post exposure prophylaxis rabies vaccine for the individual(s) affected.

References
----------
1. Brass DA. Rabies in bats: natural history and public health implications. Ridgefield CN: Livia Press, 1994. 335 pp.
2. Greenhall AM: Feeding behavior. In: AM Greenhall and U Schmidt, editors. Natural history of vampire bats. Boca Raton, FL: CRC Press, 1988. 111:31. - Mod.TG

HealthMap/ProMED map available at:
Rio Grande do Sul, Brazil: <http://healthmap.org/promed/p/3419>]
Friday 5th April 2019
http://www.hpsc.ie/a-z/vectorborne/yellowfever

Brazil is currently in the seasonal period for yellow fever, which occurs between December and May. The expansion of the historical area of YF transmission to areas previously considered risk-free led to two prior waves of transmission one during the 2016-2017 seasonal period, with 778 human cases, including 262 deaths, and another during the 2017-2018 seasonal period, with 1,376 human cases, including 483 deaths.  Human cases reported so far during the current 2018-2019 period, (July 2018 to March 2019) in in São Paolo State, as well as the confirmation of a human case and epizootics due to yellow fever in the states  of Paraná, and Santa Catarina mark the beginning of what could be a third wave and a progression of the outbreak towards the Southeast and South regions of the country.

From December 2018 through March 2019, 75 confirmed human cases, including 17 deaths, have been reported in the states of São Paulo (62 cases), Paraná (12 cases), and Santa Catarina (1 case). Among these confirmed cases, 88% are male, the median age is 43 years, and 71% are rural workers. Between 1 July 2018 and 18 March 2019, 33 confirmed epizootics were reported, in five federal entities: São Paulo (20), Rio de Janeiro (8), Minas Gerais (1), Mato Grosso (2), and Parana (2). In the last 4 weeks epizootics have been confirmed in São Paulo and Parana states.

Given the gradual geographical expansion of the epizootic wave that Brazil has faced during the last two seasonal periods, the country has had to adjust its immunization policies for yellow fever. The number of areas with recommended vaccination has increased from 3,526 municipalities in 2010 to 4,469 municipalities in 2018.

In line with the World Health Organization guidelines, Brazil has adopted a single dose vaccination scheme for yellow fever since April 2017. The use of fractional doses to respond to outbreaks and the risk of urbanization of yellow fever, especially in large cities, was also adopted. This strategy was implemented in 77 municipalities with the greatest risk for yellow fever in the states of São Paulo (54 municipalities), Rio de Janeiro (15 municipalities), and Bahía (8 municipalities). As of epidemiological week (EW) 39 of 2018 (23-29 September), preliminary results of the mass vaccination campaign against yellow fever indicate that 13.2 million people were vaccinated. With respect to the accumulated doses and doses administered during the campaign, a total of 13.3 million people in São Paulo, 6.5 million people in Rio de Janeiro, and 1.85 million in Bahía states were vaccinated, which represent vaccination coverage of 53.62%, 55.60% and 55.03%, respectively.

WHO risk assessment

Further transmission is expected in the coming months based on seasonal patterns. Recent human cases of YF during the current seasonal cycle have been reported in São Paulo, Paraná, and Santa Catarina states in Southeast Brazil.

The preliminary results of the vaccination coverages in municipalities from Paraná, Rio Grande do Sul, São Paulo, and Santa Catarina states suggests a high proportion of persons remaining at-risk and the necessity to intensify risk communications among high-risk groups.

The geographical distribution of human cases and epizootics from the current and previous two seasonal cycles suggests southward movement of the virus, which presents further risk to the states of Paraná, Rio Grande do Sul, and Santa Catarina. Furthermore, these areas have ecosystems favourable for yellow fever transmission and borders with other countries such as Argentina, Paraguay, and Uruguay.

During the previous season cycle, human yellow fever cases were reported among travellers, though to date, most imported cases have been reported in countries where the vector are absent (or absent during winter). These reports illustrate the importance of maintaining high levels of awareness, especially for international travellers from areas with favourable ecosystems for yellow fever transmission.

To date, yellow fever transmission by Aedes aegypti has not been documented. More recently, an investigation conducted by the Evandro Chagas Institute reported by the Brazil Ministry of Health revealed the detection of yellow fever virus in Aedes albopictusmosquitoes captured in rural areas of 2 municipalities in Minas Gerais (Ituêta and Alvarenga) in 2017. The significance of this finding requires further investigation. The last documented outbreak of urban yellow fever in Brazil was recorded in 1942. The sylvatic yellow fever virus is transmitted to monkeys by forest dwelling mosquitoes such as Haemagogus and Sabethes spp. Humans who are exposed to these mosquitoes can become infected if they are not vaccinated. In entomological studies conducted during the 2016-2017 outbreak in some of the affected states, isolated Haemagogus mosquitoes were found to be positive for yellow fever, indicating predominantly sylvatic transmission.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information. Currently, based on available information, WHO assesses the overall risk as High at the national level, Moderate at the regional level, and Low at the global level.

WHO advice

On 25 January 2019, PAHO/WHO alerted Member States about the beginning of the seasonal period for yellow fever and therefore, the highest risk of transmission to unvaccinated humans. Thus, PAHO/WHO advises Member States with areas at-risk for yellow fever to continue efforts to immunize the at-risk populations and to take the necessary actions to keep travelers informed and vaccinated prior to traveling to areas where yellow fever vaccination is recommended.

WHO recommends vaccination of international travelers above 9 months of age going to Brazil. The updated areas at-risk for yellow fever transmission and the related recommendations for vaccination of international travelers were updated by WHO on 3 May 2018; the map of revised areas at risk and yellow fever vaccination recommendations is available on the WHO ITH website:http://www.who.int/ith/en/

Yellow fever can easily be prevented through immunization, provided that vaccination is administered at least 10 days before travel. A single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease: a booster dose of the vaccine is not needed and cannot be required of international travelers as a condition of entry. The vaccine has been used for many decades and is safe and affordable.

Resources

·         Information on the YF situation in Brazil and other countries in the Americas is published regularly on the PAHO/WHO website. Available at: www.paho.org/epialerts
·         Information on the yellow fever situation in Brazil is available on the Brazil Ministry of Health website. Available athttp://bit.ly/2Eqlccu
·         Information on the yellow fever situation in Sao Paulo State. Available at: https://bit.ly/2qZVisQ
·         Information on the yellow fever situation in Paraná State. Available at: https://bit.ly/2QKDSc7
·         Information on the yellow fever situation in Santa Catarina State. Available at: http://www.dive.sc.gov.br/

 
Further Information:

The WHO Risk Assessment is as follows:
Serious Public Health impact: Yes

Yellow fever (YF) is an acute viral disease transmitted by mosquitoes infected with the yellow fever virus with a high case-fatality rate among patients presenting with the toxic phase of the disease.  In 2018 Brazil launched mass YF vaccination campaigns and preliminary results of the campaigns indicate 64.2% of vaccination coverage in São Paulo, 55.6% in Rio de Janeiro and 51.7%, in Bahia states [1]. Suboptimal vaccine coverage implies that herd immunity is not reached and that a high proportion of persons remain at-risk.

Unusual or unexpected: Yes

Human cases of yellow fever during the current seasonal cycle have been reported in the states of São Paulo, Paraná and Santa Catarina in Southeast Brazil, with probable sites of infection in municipalities which had no confirmed epizootics or human cases due to yellow fever in the previous 2 seasonal cycles. In the state of Paraná there had been no reported human cases since 2015 and in the state of Santa Catarina none since 1966.

International disease spread: Yes
The geographical distribution of human cases and epizootics from the current and previous two seasonal cycles suggest southward movement of the virus where there are ecosystems favorable for yellow fever transmission and an area bordering other countries (Argentina, Paraguay, and Uruguay). However, so far, no YF human cases have been reported outside Brazil, in link with the current outbreak.
Interference with international travel or trade: No 
WHO does not recommend any restrictions on travel and/or trade for Brazil based on available information on this event.
Actions requested: For information only, please circulate to all relevant staff
 
Additional documents included: None
 
Further sources of information:
·         PAHO/WHO yellow fever fact sheet: http://www.who.int/mediacentre/factsheets/fs100/en/   
·         WHO yellow fever Health Topics: http://www.who.int/topics/yellow_fever/en/   
·         WHO list of countries with vaccination requirements and recommendations for international travelers:http://www.who.int/ith/ith-country-list.pdf
·         WHO yellow fever risk mapping and recommended vaccination for travelers: http://www.who.int/ith/yellow-fever-risk-mapping/state_request/en/
·         WHO International Travel and Health website: http://www.who.int/ith/en/WHO strategy for yellow fever epidemic preparedness and response: http://www.who.int/topics/yellow_fever/en/
Date: Sun 30 Mar 2019
Source: Tribuna do Norte [in Portuguese trans. ProMED Mod.TY, edited]

Infectious disease physicians in the state health network of the Rio Grande do Sul Federal University UFRN) did not confirm that the disease, having symptoms similar to chikungunya [virus infection], observed this past week in 140 residents of 2 neighborhoods of Tirol and Petropolis in Natal [state] is in fact chikungunya. Blood tests done on Sat 23 Mar 2019 on samples from 6 individuals detected the presence of that virus, but the specialist physicians do not discard other hypotheses. Occurrence of this number of cases in less than one month is considered an outbreak.

Investigations were done on 73 cases in order to identify whether there is a mutation of that virus or a new virus in circulation in Natal. "The fact of a confirmation of chikungunya [virus infection] in some of the cases does not close the case [outbreak]," stated Kleber Luz, an infectious disease physician at the Federal University of Rio Grande do Norte.

In a meeting of infectious disease physicians convened for studies in order to identify the virus [responsible for the cases], 4 hypotheses were presented:
- 1st that this could be an arbovirus called "Ross River" that is present in Australia,
- 2nd an arbovirus call Barmah Forest, also in Australia,
- 3rd Mayaro virus present in other states of Brazil since 2016,
- Last, it could be a modification [mutant] of chikungunya [virus] caused by the circulation of another virus [another type of chikungunya virus? - ProMED Mod.TY]
All are transmitted by the _Aedes aegypti_ mosquito [not correct. See comment below. - ProMED Mod.TY].

The profile of the ill individuals:
The majority are women with a median age of 58 years. No children were identified with the disease. The majority are residents and workers in the Tirol neighborhood, a locality in which the numbers of _Aedes aegypti_ mosquitoes increased according to the municipal surveillance team. The most frequent symptoms are pain in the joints, fever and rash.

It is the unusual nature of the symptoms that impede the diagnosis as chikungunya [virus infection], Zika [virus infection] or dengue. For example: the majority of the patients examined present with arthralgia, sores in the mouth and fever, which are common in chikungunya cases, but also have a rash which is common in Zika cases, but with strong itching; a symptom that the new patients have is itching, but not to the point of troubling them as in Zika [virus infections].

The symptoms of the new cases are less intense than the known diseases and appear more rapidly. Most of the patients feel pain in the soles of their feet on the 1st day [of illness]; when this pain happens in known chikungunya cases, generally it appears during the 2nd week.

"A patient told me, 'Doctor, when I decelerate (step on the clutch) of the car, it hurts a lot.' This pain of the soles of the feet only appears at the end of [chikungunya] disease," said Kleber.

This difference does not mean that this could be a new virus. During the meeting, the infectious disease physician Andre Prudente called attention to the "spectrum" of symptoms that arboviruses produce. "The big problems with arbovirus diseases is that the spectrum of symptoms is very wide. Some patients have intense pain, and others do not. And this can be with the same disease [virus]," he explained.

"Some symptoms seem to be a milder chikungunya," a caveat offered by infectious disease physician Kleber Luz. He accredits this to the hypothesis of a modified virus but will not discard the others [hypotheses] until the end of the investigation. "That is to say, laboratory tests, and until then, we will continue to work with all the hypotheses. I believe that it is chikungunya, but not only that."

The specialists discussed the progress of the studies.

Hypotheses raised up to now:
- A modified chikungunya or other virus is circulating or present in the people.
This hypothesis takes into consideration that the chikungunya virus could have had a modification from another [chikungunya] virus in circulation. This could explain why patients had chikungunya [virus] present in their blood but with symptoms different from the disease.

Ross River arbovirus, for its similarity of symptoms
Transmitted by _Aedes aegypti_, Ross River [virus] causes joint pains,rash, but unlike the symptoms identified in Natal, the rash appears just 10 days after illness. [In Australia, the recognized vectors for Ross River virus are _Aedes vigilax_, _Ae. camptorhynchus_, and _Culex. annulirostris_. _Aedes aegypti_ is not considered a significant vector. - ProMED Mod.TY]

Barmah Forest arbovirus is also present in Australia
Barmah Forest virus also causes similar symptoms, mainly a red rash. They are similar to those of Ross River [virus infections] but the symptoms last longer. Another similarity is that Barmah [Forest virus] is found in possums. According to some of the physicians present in the meeting, there are species of possums in Dunas Park near Tirol, a place most related to the cases. [The recognized vectors of Barmah Forest virus in Australia are: _Ochlerotatus vigilax_, _Culex annulirostris_, _Aedes (Oc.) camptorhynchus_, _Ae. normanensis_, and _Coquillettidia spp._. _Aedes notoscriptus_ is considered an additional potential vector (see ProMED-mail archive Barmah Forest virus - Australia: (TS) http://promedmail.org/post/20190309.6359062). _Aedes aegypti_ is not considered a significant vector of this virus. - ProMED Mod.TY]

Mayaro arbovirus, present in Brazil but never identified in Ro Grande do Norte Cases of Mayaro, an arbovirus similar to those in Natal, are related to Goiania. The symptoms are similar and [the virus occurs] near cities with forests [as is the case with Goiania and wetlands; in Natal Dunas Park) which is a common factor.

[Mayaro virus was 1st isolated by Charles Anderson and his colleagues during the 1950s from humans with febrile illnesses in Trinidad. Mayaro virus has since been identified in the Amazon and other tropical regions (Trinidad, Suriname, French Guyana, Brazil, Peru, Bolivia, and Venezuela) and more recently in Haiti. In South America, it has been shown mostly to be transmitted by _Haemogogus_ mosquitoes. However, the urban mosquito _Aedes aegypti_ has now been also shown to be an experimental vector of the virus and was recovered from this mosquito captured in Mato Grosso state.

[There follows a summary of the observations, discussion and points covered in the above text. - ProMED Mod.TY]
======================
[Occurrence of Ross River or Barma Forest viruses in Natal state, Brazil, is very unlikely. Mayaro virus is a much more likely possibility. The laboratory tests that were done identified chikungunya virus (CHIKV), but apparently, differences in the clinical picture caused the infectious-disease physicians to doubt that diagnosis or instead postulate a variant of that virus that causes milder disease. The type of test that was done that detected the virus (or RNA?) in the blood of affected patients is not specified. There is no mention of whether mosquitoes, especially _Aedes aegypti_, were collected in the area where the cases occurred and were tested for the presence of viruses. Until further laboratory tests are completed, the only laboratory-based evidence points to CHIKV infections. ProMED would appreciate receiving additional information as it becomes available. - ProMED Mod.TY]

[Regarding unidentified febrile disease in Rio Grande do Norte, 23 of 34 samples examined suggested CHIKV infection (there is no information about if the tests performed were serological and/or biomolecular tests). On 25 Mar [2019], it was informed by local public health authorities that there is the circulation of all DENV serotypes, ZIKAV, and CHIKV. The director of the Natal Health Surveillance Department said, "I do not consider that [the disease] is any mystery. We have 6 types of arboviruses circulating in the [Tirol] municipality: dengue types 1, 2, 3, and 4; Zika virus; and chikungunya [virus]." ([in Portuguese]).

Despite the lack of more qualified clinical, epidemiological, and laboratorial clues, it should be considered that the current circulating arboviruses are the most probable agent of this apparent cluster. - ProMED Mod.RNA]

[HealthMap/ProMED-mail map:
Date: Thu 21 Mar 2019 17:55 BRT
Source: Bem Parana [in Portuguese trans. ProMED Mod. TY, edited]

The weekly epidemiological bulletin released on [Thu 21 Mar 2019] by the State Department of Health reports that the number of cases of yellow fever rose in Parana. Last week [week of 11 Mar 2019] there were 8 confirmed cases and now there are 12 in the updated bulletin, corresponding to the period from 1 Jul 2018 to 20 Mar 2019.

According to the Secretary of State for Health, Beto Preto, the 22 regional health centers of Parana are involved with the intensification of vaccination. "We reaffirm the guidance that being immunized is the only way to protect against the disease. Everyone aged 9 months to 59 years should receive the vaccine," he said.

He adds that the Health Department is actively pursuing people who have not yet been immunized and live in areas of difficult access, as well as reinforcing guidelines on the importance of vaccination at community events. He also promoted the training of teams for vaccination at the Hospital do Trabalhador, in Curitiba, and in the 3rd Health Regional of Ponta Grossa.

The 12 confirmed cases of the disease are in Antonina, Morretes, Adrianopolis, Campina Grande do Sul, Curitiba, Piraquara, and Sao Jose dos Pinhais. Of the patients, (92%) are males, with a mean age of 36 years; 3 of them are rural workers. There is one confirmed yellow fever death in Parana in the 1st week of March [6 Mar 2019], with residence and probable place of infection in the municipality of Morretes.

The municipalities with the highest incidence of notifications are Paranagua (55), Curitiba (33), and Sao Jose dos Pinhais (30). The Capital reported 8 more notifications than the bulletin of the previous week and Sao Jose dos Pinhais 7 new cases. In total, there are 224 notifications and 61 cases under investigation, in addition to the 12 confirmations.

Monkeys: the State Department of Health also intensifies disease surveillance and death of monkeys, and reaffirms that they do not transmit the virus. On the contrary, they provide an alert for the circulation of the virus, since in the regions where these infected animals appear, the transmitting mosquito is present.

This week's newsletter [week of 18 Mar 2019] shows 4 confirmed epizootics [monkey cases] and 12 under investigation and 2 new areas recorded occurrences: Paranagua and Sao Jose dos Pinhais. The municipalities of Antonina and Morretes had already reported the disease in monkeys.

Vaccine: in the period from 1 Jan to 19 Mar 2019, around 445,000 doses of the yellow fever vaccine were applied throughout Parana in the population aged 9 months to 59 years.
=====================
[Parana state is within the endemic area for yellow fever virus. The occurrence of monkey cases of yellow fever suggest that the human cases reported above were acquired from spill over of the sylvan (forest) transmission cycle and not from urban human-_Aedes aegypti_-human transmission cycle. Vaccination is urgent to prevent the urban cycle from being initiated and to protect the lives of humans living in or visiting areas where the sylvan cases are occurring. - ProMED Mod.TY]

[Maps of Brazil:
More ...

World Travel News Headlines

Date: Tue, 23 Apr 2019 13:01:09 +0200
By Ron LOPEZ

Porac, Philippines, April 23, 2019 (AFP) - Philippine rescuers raced Tuesday to reach some two dozen people still feared buried under a building near Manila that collapsed a day earlier in a deadly earthquake, as a powerful second tremor hit the nation.   The US Geological Survey put the second quake -- on the central island of Samar -- at 6.4 magnitude, stronger than the one that wrought significant damage Monday near the capital in the north.

The latest quake sent terrified locals fleeing into the streets, with images on social media showing cracked roads, crumbling church walls and shattered glass.   "No one started crying, but of course some panicked because it was really strong," said Rey Estrobo, a supervisor at a hotel in Borongan town, near the epicentre.   At the same time, the toll in Monday's quake rose to 16, with most of the fatalities in the worst-hit northern province of Pampanga, national disaster officials said.   More than 100 others were injured by falling rubble on Monday, including in Manila, according to police.

However, initial reports indicated relatively minor destruction in Samar given the strength of Tuesday's quake, which could be down to differences in ground composition.   "The damage is more pronounced if the houses and buildings are built on a foundation of soft soil," seismologist Myla Advincula told AFP, referring to Pampanga's soft sediment. "It enhances the shaking effect."

Scores of rescuers in the northern town of Porac spent Tuesday using cranes and jackhammers to peel back the pancaked concrete structure of a four-storey market building where the Red Cross said 24 people were unaccounted for.   "Every minute, every second is critical in this rescue," Cris Palcis, a volunteer rescue dog handler, told AFP. "Time is short for the people under the rubble so we have to be quick."

Pampanga Governor Lilia Pineda told journalists that rescuers could still hear at least one person trapped beneath the rubble, but the digging was proceeding delicately to avoid accidentally crushing the survivor.   Rogelio Pacelo was shopping with his wife and child when the market building collapsed around them, but they incredibly made it out almost without a scratch.   "I thought this only happens in movies. I thought that was the end of the world, it's our end," he told journalists. "I looked for a way out."   The quake also damaged several centuries-old churches which were crowded with worshippers in recent days as the majority-Catholic Philippines marked the Easter holiday.

- 'Ring of Fire' -
Father Roland Moraleja, who is based in Porac, said the 18th-century belfry of the Saint Catherine of Alexandria church collapsed in the quake.   "It was the only part left from the old church," he told AFP. "The historical value is now gone, but we are hopeful that it will rise again."   High-rise buildings in the capital swayed after the tremor struck Monday evening, leaving some with large cracks in their walls.

Thousands of travellers were stranded after aviation authorities shut down the secondary Clark Airport, which is located on the site of the former US military installation that lies about an hour's drive north of the capital.   It was still closed on Tuesday as officials assessed the heavy damage to the terminal building and some cracking on the air traffic control tower.

The quake was centred on the town of Castillejos, about 100 kilometres (62 miles) northwest of Manila, local geologists said.   Seismologists put Monday's tremor at 6.3 initially, but subsequently downgraded it to a 6.1 magnitude.   The Philippines is in the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from quake-prone Japan through Southeast Asia and across the Pacific basin.
Date: Tue, 23 Apr 2019 10:08:27 +0200

Johannesburg, April 23, 2019 (AFP) - At least five people died early Tuesday in South Africa's coastal city of Durban after torrential rains triggered mudslides that crushed homes, emergency services said.   Among those killed were a six-month-old baby, a child of about 10 and two adults.   "Torrential rains damaged peoples houses (and) there were mudslides," Garrith Jamieson, spokesman for Rescue Care, told AFP.

"I can confirm five (deaths) but there are many more casualties," he said, adding there were unconfirmed reports of "multiple" deaths in other parts of the KwaZulu-Natal province.   Victims were either crushed to death by the mudslides or drowned in flood waters.   It was not immediately clear how many people were missing, but search and rescue operations continued on Tuesday.

Downpours have caused flooding in the southern and eastern parts of the country.   The military has been dispatched to help in rescue and evacuation efforts in some of the affected areas.   The South African Weather Services warned that more heavy rain was expected until Wednesday which could lead to more flooding and pose a threat to low-lying bridges and roads.
Date: Tue, 23 Apr 2019 06:03:52 +0200

Colombo, April 23, 2019 (AFP) - The toll from a string of deadly suicide bomb attacks in Sri Lanka has risen to 310, with several people dying of their injuries overnight, a police spokesman said Tuesday.   Around 500 people were wounded in the blasts, Ruwan Gunasekera said in a statement.   He added that 40 people were now under arrest in connection with the attacks, which Sri Lanka's government has blamed on a previously little-known local Islamist group, National Thowheeth Jama'ath.
Date: Mon, 22 Apr 2019 06:22:23 +0200

Melbourne, April 22, 2019 (AFP) - A father and son lifesaving team drowned while trying to save a tourist swept out to sea near one of Australia's most famous sights off the south coast, officials said Monday.   Ross Powell, 71, and his son Andrew, 32, died on Sunday after their lifesaving boat overturned in the surf during the rescue of a 30-year-old man near the Twelve Apostles, a set of 12 limestone stacks off the Victoria state coast.

The tourist, whose nationality or name has not been released, had been wading at the mouth of a river when he got into trouble.   He was winched from the water alongside a third lifesaver from the boat, who was seriously injured, by a rescue helicopter and taken to hospital, Victoria Police said. The bodies of the Campbells were found in the water shortly after.   The tragedy has rocked the small tourist town of Port Campbell where the two men came from, with Prime Minister Scott Morrison leading the tributes.   "Surf lifesavers are selfless & brave. We thank them all for their service & extend our deepest sympathies to Ross & Andrew's family & friends," Morrison tweeted Monday.

Surf Lifesaving Victoria president Paul James hailed the pair as heroes, and said the conditions had been rough and "not the place to be swimming".   "It's just terrible, it's heart-breaking," he told reporters in an emotional press conference of the death of the dairy farmers and experienced volunteer lifesavers.   "I understand the boat was operating in a two-metre (6.5 feet) swell, so a very high swell, and we know that it is very treacherous down there... These brave people, these heroes, have gone out to try and help."   Amber Griffiths, the partner of Andrew Campbell and who local media reported was pregnant with their second child, wrote about her heartbreak on Facebook.   "Today we lost two of the most beautiful people to ever exist -- always putting others first," she wrote.   "The love of my life, light of my life, father of my baby girl. My heart is broken. I miss you Andrew Powell."

Australia's beaches are among the island continent's biggest tourist drawcards, but can have strong rips and tides. Swimmers are advised to keep between areas bounded by flags and patrolled by lifesavers.   The area where the tourist was rescued is near high cliffs and said to have wild and treacherous seas.   The Twelve Apostles are giant rock stacks of varying heights in the Southern Ocean which began forming 20 million years ago when erosion gradually began whittling away the limestone cliffs of Port Campbell.
Date: Mon, 22 Apr 2019 01:55:28 +0200

Montreal, April 21, 2019 (AFP) - Flooding in eastern Canada forced the evacuation of more than 1,500 people while over 600 troops have been deployed in response, authorities said Sunday.   Warming weather over the Easter weekend has brought spring floods due to heavy rains and snowmelt from Ontario to southern Quebec and New Brunswick.

Authorities, who initially feared a repeat of catastrophic 2017 floods in Quebec, the worst in half a century, appeared more confident about the situation on Sunday.   "We are optimistic about the coming days," civil security spokesman Eric Houde told AFP.   "There will be significant floods but overall not at the level of 2017, except in certain areas like Lake St Pierre," a widening of the St Lawrence River in Quebec, he added.   "The big difference from 2017 is the level of preparation of municipalities and citizens."

Over the past several days, towns have mobilized volunteers and distributed hundreds of thousands of sandbags to erect barriers or protect houses in threatened areas.   The areas most affected were around Ottawa, and Beauce, a region south of Quebec City where nearly 800 people were evacuated. More than 1,200 homes had been affected by the flooding in Quebec by late Sunday.

The provincial governments of Quebec and New Brunswick asked for reinforcements from the military.    About 200 soldiers had deployed in Quebec by late Saturday, and 400 others near Ottawa, in Laval north of Montreal and in Trois-Rivieres between Montreal and Quebec City.   About 120 additional soldiers stood at the ready to be mobilized in New Brunswick.   On Saturday, the flooding claimed its first victim in the municipality of Pontiac, west of Ottawa: a man in his seventies who did not see that a bridge had been washed away, and plunged his car into the stream below.
Date: Mon, 22 Apr 2019 01:08:11 +0200

Montreal, April 21, 2019 (AFP) - The bodies of three world-renowned professional mountaineers -- two Austrians and an American -- were found Sunday after they went missing during an avalanche on a western Canadian summit, the national parks agency said.   American Jess Roskelley, 36, and Hansjorg Auer, 35, and David Lama, 28, of Austria went missing late Tuesday at Banff National Park. Authorities launched an aerial search the next day.   The three men were attempting to climb the east face of Howse Pass, an isolated and highly difficult route.

They were part of a team of experienced athletes sponsored by American outdoor equipment firm The North Face.   "Parks Canada extends our sincere condolences to their families, friends and loved ones," the agency said in a statement.   "We would also like to acknowledge the impact that this has had on the tight-knit, local and international climbing communities. Our thoughts are with families, friends and all those who have been affected by this tragic incident."

Roskelley was the son of John Roskelley, who was also considered one of the best mountaineers of his own generation.   Father and son had climbed Mount Everest together in 2003. At the time, the younger Roskelley was only 20 years old, and became the youngest mountaineer to climb the planet's highest mountain above sea level.   Auer and Lama, from Tyrol in Austria, were also considered among the best mountaineers of the times.
Date: Sun, 21 Apr 2019 23:36:53 +0200

Kano, Nigeria, April 21, 2019 (AFP) - Two people including a British aid worker have been shot dead and four tourists abducted in an attack by armed gunmen on a holiday resort in north-western Nigeria, police said on Sunday.   Police and aid agency Mercy Corps named the dead woman as Faye Mooney.   "Faye was a dedicated and passionate communications and learning specialist", Chief executive Neal Keny-Guyer said in a statement posted on social media, adding that colleagues were "utterly heartbroken".   Mooney had "worked with Mercy Corps for almost two years, devoting her time to making a difference in Nigeria", Keny-Guyer added.

Gunmen stormed the Kajuru Castle resort, 60 kilometres (40 miles) southeast of Kaduna City at 11.40 pm (2240 GMT) on Friday, Kaduna state police spokesman Yakubu Sabo told reporters.   The Briton "was gunned down from the hill by the kidnappers who tried to gain entrance into the castle but failed", Sabo said.   "They took away about five other locals but one person escaped," he said.   A Nigerian man believed by local residents in Kajuru to be Mooney's partner was also killed in the attack on the resort where a group of 13 tourists had arrived from Lagos, southwest Nigeria the police spokesman said.   In Kaduna and the wider northwest region, kidnapping for ransom has become an increasingly rampant, particularly on the road to the capital, Abuja, where armed attacks have thrived.

Kidnapping in Nigeria's oil-rich south, has long been a security challenge, where wealthy locals and expatriate workers are often abducted.   Yet the problem has escalated in northern areas too, like Kaduna where criminal gangs made up of former cattle rustlers have been pushed into kidnapping after military crackdowns on cattle theft.   Kajuru is also flash point in the deadly conflict over increasingly limited land resources in Africa's most populous country, between herders and farmers, predominantly across central and northern Nigeria.    The conflict has increasingly taken on ethnic and religious dimensions in the region, with the Fulani Muslim herders in conflict with Christian Adara farmers in Kajuru.

Tourists are rarely affected by the herder-farmer violence and Kajuru Castle resort has attracted many foreign and local visitors.   Yet police have struggled to thwart kidnappers in the region. The latest attack comes in a resort in northern Nigeria, particularly popular amongst foreign and well-to-do local tourists.   In January four western tourists -- two Americans and two Canadians -- were also abducted in Kaduna by gunmen in an ambush in which two of their police escorts were killed.   Earlier in April, recently re-elected President Muhammadu Buhari, ordered his most senior security chiefs to curb kidnapping in the region.
Date: Sun, 21 Apr 2019 09:55:31 +0200

Lilongwe, Malawi, April 21, 2019 (AFP) - Three people died after a landslide hit a village in the Rumphi district in northern Malawi, with at least five still missing Sunday and many others injured and hospitalised.   Rumphi police spokesperson Tupeliwe Kabwilo told AFP that incessant rains in the area led to the landslide early Saturday which washed away an entire village nestled between Mphompha Hills and Lake Malawi.   Among the dead are two boys aged 12 and 15 and a 35-year-old woman, according to police.   The missing persons, who are feared dead, include a one-year-old boy, two other boys aged six and 10 as well as two women aged 35 and 46.

A Rumphi district council official who was at the scene of the disaster told AFP that the affected area was inaccessible by road and it would be impossible to mount a rescue operation.   "Huge boulders rolled from the mountain and these are the ones that cause the biggest damage and if the missing victims are buried under these rocks, then we will need an excavator to move them." said council official Wakisa Mtete.    "But there is no access by road to the area so this is an impossible task. The boulders are so big that moving them by hand is not possible," Mtete said.    He added that it was also possible for some of the missing bodies to have been washed into the lake, in which case the bodies would resurface within the next two days.

Disaster management officer Alufeyo Mhango told AFP that government ministries were preparing to step in to transport heavy duty excavation equipment over the lake as soon as the weather cleared.   "We have been informed by government ministries that we should get ready to transport the equipment. But this will depend on whether we get a large boat for that and on whether the hailstorm stops because there could be a recurrence of the landslide," he said.   According to Mhango, Police officers, soldiers and emergency personnel are on site attending to the disaster.
Date: Sat, 20 Apr 2019 15:21:54 +0200

Butembo, DR Congo, April 20, 2019 (AFP) - The DR Congo army fought off an attack on a hospital by a rebel group, killing one militiaman, police said Saturday, in the latest assault on medical staff trying to rein in an Ebola outbreak in the east of the country.   Armed rebels from the Mai-Mai militia attacked Katwa hospital near the city of Butembo at around 3.40 am (0140 GMT), officers told AFP.   "We have resisted and repelled the attack even though these 'Mai-Mai' had a PKM machine gun," said Butembo police chief Colonel Paul Ngoma.   He said one rebel was killed and four captured.   The attack came a day after a WHO doctor, Richard Valery Mouzoko Kiboung, was shot dead in an assault by armed militiamen on Butembo University Hospital, according to the World Health Organization.   The WHO said the epidemiologist had been deployed to help combat Ebola in the region.

The attacks are the latest in a string of assaults on teams grappling with a near nine-month-old Ebola outbreak that has claimed almost 850 lives.   UN Secretary General Antonio Guterres on Friday condemned the Butembo University Hospital attack and called on Congolese authorities to bring the perpetrators to justice.   DR Congo declared its tenth outbreak of Ebola last August, in north-eastern North Kivu province, before the virus spread into the neighbouring Ituri region.   Local organisations have said the number of Ebola deaths is rising.    An updated toll by the health ministry, issued on Wednesday, said there had been 843 deaths since August.

WHO data from April 9 put the number of confirmed or probable cases at 1,186, of which 751 had been fatal.   The outbreak is the second deadliest on record, after the epidemic that struck West Africa in 2014-16, which killed more than 11,300 people.    Efforts to roll back the highly contagious haemorrhagic fever in DRC have been hampered by fighting but also by resistance within communities to preventative measures, care facilities and safe burials.    On March 9, an attack on a treatment centre at Butembo left a policeman dead and a health worker wounded. It was the third attack on that centre.   On February 24, a treatment centre in Katwa was set ablaze.
Date: Fri, 19 Apr 2019 16:36:32 +0200

Khokha, Yemen, April 19, 2019 (AFP) - Oxfam has warned that war-torn Yemen risks a "massive resurgence" of cholera, with around 195,000 suspected cases of the disease recorded so far this year.   "Fears that the world's worst cholera outbreak could be set for a massive resurgence are growing," the relief organisation said Thursday.   It said aid agencies were struggling to reach suspected cases.

In a statement, Oxfam pointed to "fighting and restraints on access, including checkpoints and permit requirements imposed by the warring parties", and warned the coming rainy season was likely to accelerate the spread of the disease.   The water-borne bacterial infection has claimed more than 3,000 lives in Yemen since the outbreak began in 2016, according to Oxfam.

At a medical centre for the displaced in the government-held western town of Khokha, Qassem Suleiman had brought his son Alaa for tests after a serious case of diarrhoea.   Doctor Wadah al-Tiri told AFP that several patients had been transferred to Aden while others had been treated at the Khokha centre.   He said a tent was to be set up for suspected cases.

The doctor said Yemen badly needed international aid to combat the epidemic.   The UN's humanitarian coordination office OCHA said last month that children under the age of five make up nearly a third of this year's cases.   The spike, which comes two years after Yemen suffered its worst cholera outbreak, was concentrated in six governorates including in the Red Sea port of Hodeida and Sanaa province, both combat zones, it said.

Yemen's conflict, which pits Iran-linked rebels against a regional pro-government alliance led by Saudi Arabia, has left some 10,000 people dead since 2015 and pushed millions to the brink of famine.   Aid groups say the actual death toll could be five times as high.    The war has created the perfect environment for cholera to thrive, as civilians across the country lack access to clean water and health care.