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Off to Brazil for the FIFA World Cup in June? Heading to Africa in coming months?

Don’t leave it too late to get the required yellow fever vaccination, says Travelvax Australia.
The reason we suggest you be immunised sooner rather than later is because manufacturing problems have meant the vaccine is in short supply in much of the world.
As a result, the vaccine’s manufacturer, Sanofi Pasteur has placed limits on the number of doses travel medicine clinics and other licensed providers in North America and Europe can obtain.
Travellers in Canada, the USA, and the UK planning to visit sub-Saharan Africa or South America in the current northern winter and autumn have been warned of the shortage and advised to have the vaccine soon in case supplies become even tighter. 

 Australia not affected by shortage – for now

Travelvax stresses that, at this stage, supplies of the vaccine, sold in Australia under the brand name Stamaril, have not been affected here.
However, we are concerned that the situation might change.
“With two months before the situation is expected to return to normal, the global shortage may put pressure on supplies in Australia,” Dr Eddy Bajrovic, Medical Director of Travelvax Australia, said.
“The sensible thing is to have the vaccine soon in case a shortage occurs here.”
Australia’s list of yellow fever-declared destinations includes 43 countries in sub-Saharan Africa and most countries of South America – including Brazil. 

No cure for sometimes-fatal yellow fever

Yellow fever is an acute viral haemorrhagic disease. In Africa it is transmitted mainly by the bite of infected female Aedes aegypti mosquitoes, and by Haemagogus mosquitoes in South America.
There is no cure for the disease and it can be fatal. About 30,000 people die each year.
Initial symptoms typically include sudden fever, chills, severe headache, back pain, general body aches, nausea and vomiting, fatigue, and weakness.
While most victims recover, around 15% of patients will have a brief period without symptoms before developing a more severe form of disease. Approximately 20% of those who go on to develop this ‘toxic’ phase of yellow fever will die.

“Show me your yellow fever certificate, please…”

Australians visiting yellow fever-endemic countries may be required to show proof that they have been vaccinated against the disease by producing a signed and stamped WHO-approved International Certificate of Vaccination at any or all of the following times: (1) on arrival, (2) when they return to Australia, or (3) if they travel on to other countries within 6 days of having visited a yellow fever-infected country.
To be valid, the vaccine must be administered by a medical centre or vaccination clinic which is licensed to administer the vaccine 10 days before arrival in a yellow fever-endemic country.
The customs officials of some countries are more rigorous about enforcing the myriad of regulations surrounding yellow fever vaccination than others. To protect their own populations, some governments insist that travellers who cannot produce a yellow fever certificate be vaccinated on arrival or be refused entry.
For instance, to keep yellow fever out of South Africa, its government has taken a strict ‘no proof, no entry’ stance. Although yellow fever is not present in South Africa, it does have the mosquitoes that transmit the disease and border officials insist that all travellers transiting South Africa en route from the endemic countries to the north, or from South America, must produce a valid vaccination certificate.
Failure to do so has resulted in scores of travellers being refused entry to South Africa. The policy saw a diplomatic row erupt in March, 2012 when South Africa deported 125 Nigerians over suspicions that their yellow fever certificates were fakes.

Why we need to protect Australia

“South Africa is not popular with some of its neighbours for its tough stance,” Dr Bajrovic said.
“But, the introduction of yellow fever would be a public health disaster for any country.”.
“Aedes aegypti mosquitoes spread dengue fever in North Queensland and two outbreaks in Cairns and Port Douglas have seen more than 126 people infected already this year.
“Most of Australia’s 1816 dengue cases last year were imported by travellers, so the risk of yellow fever being introduced to Australia in this way isn’t fanciful. While yellow fever is not as common among travellers as dengue, it results in more serious illness and has a significantly higher death rate.”

Where yellow fever occurs in Brazil

Soccer fans heading to Brazil for the World Cup should check their itinerary to gauge their risk of infection.
Yellow fever occurs in the following areas: the entire states of Acre, Amapa, Amazonas, Distrito Federal (including the capital city of Brasilia), Goias, Maranhao, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Para, Rondonia, Roraima, and Tocantins.
It can also be found in designated areas of the following states: Bahia, Parana, Piaui, Rio Grande do Sul, Santa Catarina, and Sao Paulo.
Vaccination is also recommended for travellers visiting Iguazu Falls.
But, the vaccine is not recommended for travellers whose itineraries are limited to areas not listed above – including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador, and Sao Paulo.
Ideally, go through your itinerary with a yellow fever-licensed doctor to ensure you get the right advice.

Some travellers can get vaccine exemption

Yellow fever is a safe, highly protective, live-virus vaccine. (Other live-virus vaccines that may be recommended for travel should be given on the same day as the yellow fever vaccine, or separated by a month.)
However, the yellow fever vaccine is not recommended for:
- Infants under 9 months.
- People with a severe allergy to eggs (i.e. those with anaphylactic hypersensitivity).
- Anyone who is immunosuppressed or with a weakened immune system.
- Those who have thymus disease (including myasthenia gravis, thymoma, DiGeorge Syndrome) or have had their thymus removed.
- Pregnant women and those breast feeding – unless there is a likelihood of exposure to the disease.
These people can be exempted from vaccination, but must carry with them a detailed exemption letter.
The letter also should be printed on the clinic’s letterhead, signed by a doctor licensed to administer the vaccine, and include the official stamp. Exemption letters are valid only for the period of travel, which should be stipulated.
Adults over 60, especially those who have not had the vaccine previously, have a slightly higher risk of side effects than younger adults and children. For those over 60, the risk of an adverse events increases with age.
However, travellers over 60 aren’t routinely exempted from vaccination.

Your next YF vaccine could be your last

Ironically, anyone who has the yellow fever vaccine for travel to South America or Africa this year will most likely never have to have another.
Last year, after reviewing data from 80 years of yellow fever vaccination, the WHO’s immunisation experts determined that a single dose of the vaccine provides life-long immunity and travellers no longer require boosters every 10 years. At this stage no country has officially adopted this recommendation, so 10 yearly boosters remain.
The announcement doesn’t mean those who have never been immunised against yellow fever can avoid having the vaccine for the first time if visiting an endemic area: the disease will continue to be a travel risk in destinations where it occurs.
However, their first dose is likely to be their last.

Read more about yellow fever and travel tips on preventing mosquito bites, including the use of an effective insect repellent. The CDC’s yellow fever FAQs also has good advice for travellers.

The yellow fever vaccine, a certificate of vaccination, or an exemption letter, are available through Travelvax Australia’s nationwide network of travel clinics. For obligation-free advice on the potential health risks for overseas travel, call Travelvax Australia’s travel health advisory service (1300 360 164 – toll free from landlines).