Brynn Barineau

Tag: Yellow Fever

  • Dengue, Zika, Chikungunya, & Yellow Fever

    Dengue, Zika, Chikungunya, & Yellow Fever

    This is public enemy #1!
    Aedes aegypti. Know it and squish it!

    There are over 3,000 species of mosquitoes. A fact I think proves there’s no benevolent deity.

    This post is a run down of the basic info on the common mosquito born diseases in Brazil: dengue, zika, chikungunya, and yellow fever. It’s essential information if you’re visiting.

    Because the mosquitoes are winning.

    Last year in the wake of zika and the microcephaly epidemic in Brazil, the federal government mobilized troops to patrol for standing water basically declaring war against mosquitoes. The yellow fever outbreak this year is evidence of how well that went in the long term.

    So here’s everything you didn’t want to need to know about mosquito born illnesses in Brazil.

    DENGUE: Let’s start with dengue because it kills the most people every year. I know zika is the Kim Kardashian of the bunch, hogging all the media attention, but dengue is most likely to put you in the hospital. There were roughly 1.5 million registered cases of dengue in Brazil last year and of those 629 died. The severity depends on which of the four strains of the virus you get. The worst causes hemorrhaging, but most people just get incapacitating joint pain and high fever.

    Dengue is usually transmitted through the bite of an infected mosquito, but it can be passed from mother to fetus. The disease is asymptomatic in 40-80% of cases. The incubation ranges from 3 to 14 days.

    Symptoms

    • Sudden high fever
    • Severe headache
    • Severe joint pain
    • Moderate joint pain
    • Severe pain behind the eyes (basically your body will hurt a lot)
    • A skin rash that appears post fever
    • Fatigue
    • Nausea
    • Itching

    The Severe Case Symptoms (everything above plus…)

    • Bleeding from the nose and gums
    • Abdominal pain
    • Vomiting
    • Hypotension
    • Dizziness
    • Breathing difficulty

    In rare cases, sometimes after a second infection, a person can develop dengue hemorrhagic fever which leads to shock and death in 24 hours. Yeah, dengue totally sucks.

    There’s no vaccine. There’s no drug treatment. The only thing to do with dengue is treat the symptoms and be sure not use any aspirin because it increases the risk of hemorrhaging.

    Yeah, they’re all cute and cuddly until one drops dead of yellow fever.

    ZIKA: If you’ve been to Brazil in the last year and sneezed, you might have had zika. Or maybe you didn’t sneeze. You still might have had zika. Most cases are asymptomatic, about 80%.

    Of the most common mosquito borne diseases, zika results in the fewest hospital cases. In 2016 there were 214,193 cases of Zika in Brazil and 3 deaths. The global panic over zika is because of it’s link to microcephaly, a condition that babies develop in utero which prevents the brain and skull from developing normally.

    And let’s be clear. There IS scientific consensus that the zika virus is one of the causes of microcephaly. I believe in the CDC, WHO, and peer reviewed scientific journals. Conspiracy theorists can save themselves time and not bother commenting about genetically altered mosquitos. I will just delete them.

    The fact the disease is asymptomatic in the majority of cases makes it particularly scary for women who are or may become pregnant. It’s possible to have zika and never know until the baby develops complications. Even if you develop symptoms, they’re usually mild.

    Symptoms

    • low grade fever
    • headache
    • skin rash starting on the face and spreading over the body
    • red eyes
    • itching
    • fatigue
    • sore joints

    Less Common Symptoms

    • Muscle pain
    • Swelling
    • Sore throat
    • Vomiting or diarrhea
    • Swelling

    So now pregnant women all over Brazil can worry that their swollen legs and exhaustion is actually zika. Because there wasn’t enough for expectant parents to worry about. Fucking mosquitos.

    There’s no vaccine.

    CHIKUNGUNYA: Unlike zika and dengue, if you get chikungunya, you’ll know. 70% of cases develop symptoms. At least you don’t have to wonder whether or not you need a doctor.

    Last year there were 265,554 cases of chikungunya resulting in 159 deaths, so worse than zika but not as prevalent as dengue.

    Symptoms

    • Sudden onset of high fever
    • Severe joint pain mostly in feet, ankles, hands, wrists

    About the joint pain, almost every case has it and in rare cases it becomes chronic.

    Less Common Symptoms

    • Intense back pain
    • Headache
    • Muscle pain
    • Vomiting
    • Conjunctivitis
    • Fatigue
    • Photophobia
    • Sore throat

    Basically everything hurts like hell.

    Like the others, there’s no vaccine for chikungunya and no treatment beyond treating the symptoms.

    CDC’s risk area for yellow fever in South America

    YELLOW FEVER: The CDC’s website has a map of areas where yellow fever vaccines are recommended. The risk area for Brazil extends just up to the border of our state. So far this year 31 people have died from yellow fever in Esparto Santo. Dear CDC, you need to update your map.

    Yellow fever is typically passed via an infected monkey to mosquito to human, so areas without dense forests were considered safe. The incubation period is 3 to 6 days but most cases are asymptomatic.

    Symptoms

    • Sudden high fever
    • Severe headache
    • Back pain
    • Muscle pain
    • Nausea & vomiting
    • Fatigue
    • Weakness

    After a brief remission, 15% of cases will develop a severe form of the disease.

    Symptoms of Severe Form

    • High fever
    • Jaundice (hence the name)
    • Bleeding
    • Shock
    • Organ Failure

    Of cases that turn severe 20-50% die.

    We got our yellow fever vaccines!

    But good news! There’s a vaccine! Two doses taken ten years apart provide lifetime immunity. Yay science! If you’re thinking about visiting Brazil this year, double check to see if your hotel is located within one of the new expanded risk area. Be sure to use a Brazilian site. Remember, the CDC’s map is out of date.

    Vaccines are being developed for the other three. Several companies will have zika vaccines ready for clinical trials by the end of the year. Late stage clinical trials of dengue vaccines are already underway, and researchers have reported success with initial clinical trials for chikungunya vaccines. Unfortunately, we’re still years away from these vaccines being available to the public.

    In the meantime, don’t cancel your vacation. Just be prepared. Get a yellow fever vaccine. Pack repellent. Sleep with your windows closed and fan on. And for god’s sake, if you see a mosquito, kill it!

  • Getting Our Yellow Fever Vaccines

    Getting Our Yellow Fever Vaccines

    This is public enemy #1!
    Aedes aegypti. It carries dengue, zika, & chikungunya.

    Mosquito born viruses did not cross my mind when considering what my daily life would be like in Brazil, but it turns out that repellent is right up there with sunscreen as a daily necessity.

    I certainly never lost sleep over a mosquito in the U.S., but here in Brazil, more than once we’ve turned the lights on in the middle of the night at the whine of a mosquito. Some people might think mosquito hunting at 2am is overreacting, but my husband has had dengue. The steely-eyed commitment with which he stalks every mosquito in our home makes me think the experience has stayed with him.

    Public health officials in Brazil take mosquitoes seriously too. They’ve been battling dengue for decades. Chikungunya and Zika became common place in the last few years, and this year, Espirito Santo and its neighbor, Minas Gerais, are combating the spread of yellow fever. My family and I got our yellow fever vaccines last week, and it was an impressive operation.

    If you know the monkey might have yellow fever, is it still as cute?

    Vaccine distribution is one public service Brazil has mastered. At the end of February, the city government confirmed a monkey found dead in Vitoria in January had died from yellow fever. This one dead monkey kicked public health services into Defcon 5. The city closed 11 parks in the metro area. The federal government sent 1 million more doses of yellow fever vaccine to Espirito Santo. Public Health posts’ hours and days of operation were expanded. Churches have been converted to vaccination centers. Firefighters and nurses from public hospitals have been enlisted to distribute and administer the vaccines. This past Saturday 98,904 people were vaccinated in the metro area bringing the total vaccinated to over 800,000 in a little over two weeks.

    This is public health at it’s most efficient and most militarized. I know from personal experience. We were assigned a specific vaccination center and time when my husband reserved our vaccines online. When we got to the church, we had to present IDs for everyone, including my daughter, before we could enter the building where people waited in rows of white plastic chairs. We’d been assigned numbers at the entrance, and in what has to be one of the shortest waits in the history of line waiting in Brazil, a woman in a white lab coat, clipboard in hand, called our numbers, and we entered the heart of the operation.

    Along one wall was a row of nurses and firefighters taking down people’s names, ID numbers, and stamping vaccine cards. Firefighters are militarized in Brazil, and their khaki green uniforms with ranks sewn on their shirts made the whole scene feel like something out of Contagion. Along the adjacent wall, was another group readying vaccines before passing them in a ceaseless stream to the one woman who administered vaccines. Needle in. Needle out. Hands off the old needle. Accepts freshly opened vaccine. Needle in. Needle out.

    It wasn’t frantic, but it was efficient. People were moved around the room and back out the door with a lack of pleasantries I have never witnessed in Brazil.

    We survived!

    My daughter did not like it. She’d been totally chill about it until we got inside the vaccination room. The tension and focus that permeated the air had her clinging to her dad and begging to go. And these people were not waiting for her to calm down. I don’t blame them. They’re trying to vaccinate a few million people. My husband and I went first, trying to teach by example. It had no effect. She just got more hysterical with every second, so my husband held her in his arms. I held her arm straight, and the vaccine lady jabbed the needle in.

    For the rest of the day, my daughter showed off the tiny, nearly invisible red dot left behind like the scars of a near-death shark attack.

    As of Friday, there were 20 confirmed yellow fever deaths in our state. That’s 20 deaths out of 80 confirmed cases. The math is simple. That’s a 25% fatality rate. In neighboring Minas Gerais, there have been 109 deaths out 288 confirmed cases. I’m getting my calculator…37.8%. Wow, I hadn’t realized until writing this how bad this outbreak is.

    So if you’re planning on visiting Brazil anytime soon, I’d check if you’re ecolodge is smack in the middle of a high risk zone, and then I’d pack lots and lots of repellent regardless.