Yellow fever - Articles - Zimbio

You Need To Get A Yellow Fever Vaccination If...

Sun, 6 Oct 2008 14:29:00 GMT

posted by winnerdk

By DON WINNER for Panama-Guide.com - As usual, any time the Panamanian government changes the rules there's a significant degree of misunderstanding, miscommunication, and generally a degree of chaos reigns for awhile until everyone settles down into the new reality. The way the Panamanian Ministry of Health (MINSA) went about letting everyone know about these new requirements didn't help very much, either. The MINSA simply issued two notifications, one in June and another in August 2008, but those went out primarily to airlines and travel agents. MINSA left it up to private industry to get the word out, and (of course, go figure) that plan didn't work very well. In any case, now the Panamanian government has extended the implementation date for the Yellow Fever shot requirement until 1 November 2008, and everyone is asking themselves the same question - "Do I Need To Get This Shot?" In this article I will try to answer that question once and for all. (more)

Hey! How'd That Get In There? Well, just wanted to take a time out for some urban slang. The term "Yellow Fever" is also used to describe guys who are hot for Asian chicks. And, since this is Panama Guide and we like to cover all of the really important issues, I just couldn't let the opportunity to post another picture of a girl in a bikini slip by. I mean, it's an issue related to world health, right? And the vaccination for this kind of "Yellow Fever"? That's called having a Colombian girlfriend. Grin, or die.

An Update From The Shot Clinic: A friend who was going to try to get the shot this morning in Los Rios just called to let me know that they are starting to get their act together over there. Now, they are handing out 250 tickets starting at about 7:30 in the morning and they were gone by 9:00 am. He arrived at 10:00 am so he was turned away. Once you have your ticket they will call your number, do some paperwork, you get your shot and go away with the shot record. The cost is $5.00 bucks. Also, the Ministry of Health has opened up another location starting today over behind the old US embassy where they will be giving shots. I did the math - doing 250 shots per day with a population of 3.3 million - the entire population of Panama will be vaccinated in 361 years. Good.

Increasing Publicity: This new requirement from the Panamanian government is not going to go away, and every day there are more articles coming out in the local media about this issue. We're still early in October and it's probably going to hit "crunch time" again as we get closer to 1 November 2008 and the enforcement of the requirement.

Protect Yourself: First of all, consider this. There is enough of a threat of Yellow Fever in the world to make this an issue of concern for everyone. There is a belt which runs generally around the world at the equator through South American and Africa where Yellow Fever is still a serious problem. If you travel to any area where there is even a remote possibility of contracting Yellow Fever, getting the disease just might kill you. Here in Panama it's possible to get the Yellow Fever vaccination for a $5.00 dollar fee. So, my general advice to everyone is to "just get the damn shot." People who have been responding to these articles about the recent changes in the Panamanian government's requirements for this vaccination have seemed to be focusing completely on the requirements and regulations, and apparently forgetting that Yellow Fever is a potentially lethal disease. So, whether or not a government is going to make you get vaccinated, you might want to simply make that decision for yourself. I've been vaccinated against Yellow Fever continuously since 1980 with updates every ten years.

Who Should Not Receive Yellow Fever Vaccine: According to the Centers for Disease Control, Yellow fever vaccine generally has few side effects; fewer than 20% of those receiving the vaccine develop mild headache, muscle pain, or other minor symptoms 5 to 10 days after vaccination. Severe reactions to the vaccine have been reported but are extremely rare. There are four groups of people who should not receive the vaccine unless the risk of yellow fever disease exceeds the risk associated with the vaccine.

Yellow fever vaccine should never be given to infants under 6 months of age. In most cases, vaccination should be deferred until the child is at least 9 months of age.
Yellow fever vaccine is not recommended for pregnant women.
Persons who are allergic to eggs should not receive the vaccine because it is prepared in eggs. Notify your doctor prior to vaccination if you think that you may be allergic to the vaccine or to egg products.
Persons with an immunosuppressed condition associated with AIDS or HIV infection, or those whose immune system has been altered by diseases such as leukemia and lymphoma, or by drugs and radiation should not receive the vaccine. People with asymptomatic HIV infection may be vaccinated if exposure to yellow fever cannot be avoided. Persons who have had thymus disease or thymus removal should not be vaccinated.

Get A Note From The Doctor: If you have one of these conditions, your doctor will be able to help you decide whether you should be vaccinated, delay your travel, or obtain a waiver. The physician should help you weigh the risks of exposure and contracting the disease against the risks of immunization, and consider alternative means of protection.

Not Required If Coming From the US or Canada: The most important thing to know is that if you are only coming in to Panama from the United States or Canada then you will not require the shot in order to enter Panama. There are other issues, of course, such as earlier visits to other countries and things like through-travel. Hold on a sec'...

**BIG FAT WARNING NOTE** Head's up, friendly traveler, the goal of this article is to continue to clarify the Yellow Fever vaccination issue, and to not add to the confusion. But, with that having been said, there are several issues and angles that are apparently not being considered in the implementation of these new policies on the part of the Panamanian government. I'm going to bring these potential stumbling blocks to light now for your consideration in order to maybe allow you to avoid some pain later. Fer' instance...

Earlier Travel: One of the potential sticking points in this whole mess is the issue of earlier travel. There is a possibility that you might not be allowed to enter Panama if you are not currently vaccinated against Yellow Fever and if you have ever traveled to one of the 43 countries the World Health Organization lists as areas where Yellow Fever is transmitted. For example let's say that sometime in the past you've been to Ecuador, and your entry and exit is stamped into your passport, then it's possible Panama might require you to be vaccinated against Yellow Fever in order to enter the country, even though your country of origin for this trip is the United States. Logically speaking, you could have contracted Yellow Fever a long time ago, making you an active carrier of the virus. To date the focus for this requirement on the part of the Panamanian government has been on current travel only as in, where are you going or coming from, today, for this trip. I have not seen a word talking about travel or trips you might have made five years ago, but I'll bet a jelly doughnut this angle will become part of the mix before too long.

Hey! Aren't We Already Here? Here's another one for you that I have not seen thus far in the discussions about the Yellow Fever vaccination requirements being laid on by the government of Panama. Since Panama is on the WHO list of countries where Yellow Fever is transmitted, and since the Panamanian requirement is based on that list, then (if logic follows) all Panamanians should be vaccinated against Yellow Fever, right? I mean, traveling into or out of Panama is a kind of moot point when we're already living here in the middle of a country where Yellow Fever is transmitted according the the World Health Organization, right? (Please refer to the earlier disclaimer about not wanting to cause more confusion. If you find yourself more confused than you were before you started reading this article, you might want to sit down, get a cup of coffee, and scratch your head a couple of times. That feeling will pass, trust me.) In fact there has not been a case of Yellow Fever documented in Panama since 1974, and the primary motivation of the Panamanian government behind implementing these changes is to assist in the prevention of the return of Yellow Fever to Panama. So, let's remain focused here people...

Ten Day Incubation Period: You can not get the Yellow Fever shot today and expect to travel tomorrow. The shot requires a ten-day period to incubate in the body of the recipient in order to begin to confer a degree of protection against the Yellow Fever virus. And, when you show up in Panama (or at the check-in counter) you will have to show your vaccination card reflecting the date you received your shot. If that was less than ten days ago then, if they actually begin to enforce this regulation like they say they are going to, then you will be turned away from Panama until you've "cooked" at least ten days. Don't expect to be able to do this one at the last minute.

Delegated Enforcement: The government of Panama is putting the requirement to check vaccination and immunization requirements on the airlines. They will be asking for your shot records and if you want to travel and you are required to have the shot (and you don't) then the airlines will not let you get on the plane. The reason for this is that when travelers arrive in Panama they will be screened again, and any traveler who is not properly vaccinated will be returned to their country of origin at the expense of the airline. Did you catch that last part? The airlines are not going to suck up the cost of flying your ass back to where ever you came from so they will make sure you have the shot before they let you get on the plane. No shot, no fly. Be ready for that.

Emergency Travel: This shot requirement might cause some serious problems in the event of emergency travel requirements say, for whatever reason, you have to fly to Argentina right now! If you're not vaccinated then you won't be able to go.

Yellow Fever Transmission Countries: For the remainder of this article I will be referring to "Yellow Fever Transmission Countries" as defined by the World Health Organization. The government of Panama is using this list, published and updated by the World Health Organization, as the standard for their new regulation. For the record there are 43 countries on that list and they are as follows:

American Continent:
- Argentina
- Bolivia
- Brazil
- Colombia
- Ecuador
- French Guiana
- Guyana
- Panama
- Paraguay
- Peru
- Trinidad and Tobago
- Suriname
- Venezuela
African Continent
- Angola
- Benin
- Burkina Faso
- Burundi
- Cameroon
- Central African Republic
- Congo
- Côte DIvoire
- Equatorial Guinea
- Ethiopia
- Gabon
- Gambia
- Ghana
- Guinea
- Guinea Bissau
- Liberia
- Mali
- Mauritania
- Niger
- Nigeria
- Rwanda
- Republic of Congo
- Sao Tome and Principe
- Senegal
- Sierra Leone
- Somalia
- Sudan
- Togo
- Uganda
- United Republic of Tanzania

Three Part Panamanian Requirement: In reality this new regulation issued by the Government of Panama requires travelers to be vaccinated against Yellow Fever if they fall into one of three categories:

Those Entering Panama From One Of These Countries: First of all, you will require the vaccination if you intend to enter Panama from any of the 43 countries on the WHO list. Pretty simple - if you don't have the shot you can't come into Panama as of 1 November 2008.
Those Traveling To One Of These Countries: Part Deux of this new requirement is for anyone traveling from Panama to any of the 43 countries on the WHO list to have the Yellow Fever vaccination before they will be allowed to depart. I mean, I guess you could make the argument that you intend to depart and never return, but I don't think it will matter. They will make you have the shot before they let you BOARD an airplane to fly from here to here. This requirement applies to both Panamanian nationals and foreigners.
Countries Requiring Yellow Fever Vaccination For Travelers Coming From Countries With Risk Of Yellow Fever Transmission: And here's the kicker - while there are only 43 countries on the WHO list that are identified as having a risk of Yellow Fever transmission, there are a whole lot more countries who require vaccination for anyone who is traveling to one of those countries from one of the 43 countries on the WHO list. And, Panama is on the WHO list, and therefore having a current vaccination against Yellow Fever is a requirement for anyone wishing to travel from here to one of those countries. You can click on the following link to see a listing of countries requiring Yellow Fever vaccinations for travelers coming from countries at risk of transmission.

What Is Yellow Fever? Yellow fever is a viral infection transmitted by mosquitoes in tropical regions. It has a mortality rate of almost 50%. The following is from Yellow fever and was written by Dr Charlie Easmon, specialist adviser in travel medicine:

What is yellow fever? Yellow fever is a serious viral infection, transmitted by mosquitoes in tropical regions. It has both an urban cycle and a jungle cycle that relies on monkeys as carriers ('sylvatic cycle'). In mild cases the symptoms are similar to influenza, but serious cases develop a high temperature and may have a series of after effects, such as internal bleeding, kidney failure and meningitis. A classic feature of yellow fever is hepatitis, which is the reason for the yellow colouring of the skin (jaundice) and the name of the disease. Yellow fever can cause sudden epidemics, with a mortality rate of almost 50 per cent. Although a safe, efficient vaccine has been available for the last 60 years, epidemics still occur, constituting a health risk in tropical regions. The disease is covered by the International Quarantine Regulations, which are taken very seriously by authorities everywhere. Therefore, the vaccine has to be administered by a specially authorised doctor. In the UK you can only obtain the yellow fever vaccination from a designated Yellow Fever Clinic.
What causes yellow fever? Yellow fever virus belongs to the Flaviviridae family, other members of which cause dengue fever and Japanese encephalitis. The virus is introduced into the bloodstream via the saliva of the mosquito as it bites. The virus can then be transported around the body and reproduce itself in a variety of the body's cells, usually the liver, kidneys and blood vessels. In serious cases, these cells may become damaged themselves. In addition, the cells of the immune system are affected and release large quantities of signalling substances. These substances are the cause of the normal disease symptoms, such as muscular pain and fever, which are also observed in influenza.
How is yellow fever passed on? The virus is transmitted among humans by a couple of species of mosquito, including Aedes egyptii, which can also transmit dengue fever. It is an unexplained fact that despite the presence of the Aedes mosquito in Asia, yellow fever is limited to Africa and South America. In its original jungle cycle, the mosquito sucks the blood of an infected monkey. The mosquito develops a permanent infection, in which the virus accumulates in its salivary glands. Then the mosquito bites another monkey, which then also becomes infected with the virus. A person travelling through the jungle may also become infected by an infected mosquito. When this person returns to urban areas, a new cycle begins. Urban cycles start when an infected traveller returns from the jungle. A mosquito bites the traveller, who then becomes infected and passes the virus on to other people, and either an epidemic breaks out, or an endemic situation is perpetuated.
Where does yellow fever occur and how many people are affected? The virus is permanently prevalent, with a more or less constant number of sufferers (ie it is endemic) in several tropical regions of Africa and on the continent of America. In addition, there is an increasing number of epidemics, in which a large number of people suddenly develop yellow fever. Every year about 200,000 cases of yellow fever are recorded, and 30,000 of these die, but the figures are underestimated because of poor record-keeping. In total, yellow fever occurs in 33 countries and 468 million people are at risk of catching the disease. As yet there is no yellow fever in Asia, but it is feared that the high level of international travel could introduce the virus by means of infected people. Mosquitoes do live here, and they could potentially transmit the disease and create a new reservoir. Consequently, the countries of Asia have very strict quarantine regulations, which apply if you arrive without a valid vaccination certificate travelling from areas in Africa and Latin America, where yellow fever occurs.
What are the symptoms of the disease? The incubation period from infection to developing yellow fever is 3 to 16 days. Mortality ranges from 5 per cent to 40 per cent. Some people do not develop a serious form of the disease. They may have no symptoms at all or just a mild influenza-like illness. In the actual full-blown disease there is:
- high fever
- generalised symptoms like violent headache, muscular pain, upset stomach and loss of fluid.
- The fever dies down after three to four days and the general condition improves. However, in about 15 per cent of cases the fever returns within 24 hours and a dangerous situation develops.
- The danger signals
- Various systems in the body are affected during this phase. Anaemia (lack of red blood cells) develops as well as liver inflammation, hepatitis and jaundice.
- The kidneys are also affected and bleeding from the mouth, nose and stomach may occur, which leads to blood in vomit and faeces.
- The majority of patients who experience bleeding die in a short space of time.
What can you do yourself? There is a vaccine, which is very effective against yellow fever. It protects you from 10 days after the vaccination, which is administered in a single injection. Current advice is to have it repeated every 10 years. It is recommended for all areas where the disease occurs.
Requirement for yellow fever vaccination: In some countries where there are mosquitoes that could transmit the virus, actual documentation is required, stating that you have been vaccinated against yellow fever before you can obtain permission to enter the country. This can be provided by a stamp in the yellow international vaccination card issued by a WHO recognised vaccination centre. To be on the safe side, it has been agreed internationally that the vaccination provides protection for 10 years. After that you have to be vaccinated again, even though the first vaccination may still be effective for a little while longer.
Preventing mosquito bites: Apart from vaccination, prevention of mosquito bites is the best way of avoiding yellow fever. However, because the disease is so dangerous, taking a chance and going without vaccination is absolutely not recommended. In many poor countries where for one reason or another vaccination is not available, bite avoidance may be the only method of protecting the local population.
How is the disease diagnosed? The disease may be difficult to distinguish from other illnesses, especially in the early stages. To confirm any suspicions from the case history and information on the patient's journeys abroad, the doctor has to take a blood sample. In the laboratory, specific yellow fever virus antibodies can be detected in the blood.
What treatment is there for yellow fever? There are no medicines that are effective against this virus. Serious cases of yellow fever always need hospital treatment. As there are no products that combat the virus itself, the doctor can only treat the symptoms. If there is a lack of fluid in the body, leading to disturbances in the electrolyte balance, this can be remedied by administration of fluids by intravenous drip. In mild cases, the pain may be relieved with simple painkillers. High temperatures can be treated by cooling the patient and giving them appropriate medicines to lower the temperature, such as aspirin (eg Disprin) or ibuprofen (eg Nurofen). Paracetamol (eg Panadol) is probably best avoided if there is already evidence of liver damage.

I Hope This Helps: My battle cry in this gaggle remains "just get the damn shot." It's clearly the easiest way to avoid a potential cluster in the future, and getting the shot might prevent your contracting the disease. While admittedly your chances of contracting Yellow Fever in Panama are remote, the reason why it's hard to catch Yellow Fever is because people have been vaccinated. Want to know who's not getting the shot? People who live in conditions of extreme poverty who either can't afford to get the shot themselves, or who live in countries with poor governments who can't get the shot for them. You, on the other hand, probably don't have an excuse. Again, just get the damn shot. Expect more rather than less on this issue in the weeks to come.

More Clarification on the Yellow Fever Vaccination

Thu, 3 Oct 2008 19:59:23 GMT

posted by winnerdk

By DON WINNER for Panama-Guide.com - The government of Panama is going to begin to require that passengers traveling either to or from one of the 42 countries listed by the World Health Organization (WHO) as being areas were Yellow Fever is being transmitted have a valid and current Yellow Fever vaccination effective on 1 November 2008. To make things perfectly clear, this does not include passengers traveling either to or from the United States or Canada. If you're coming into Panama from the US and flying straight in with no stops or layovers, then you do not need the shot. You might want to get one anyway just to protect your own health, but there has not been a case of Yellow Fever reported in Panama since 1974. This new more stringent set of requirements is a response on the part of Panama to attempt to prevent the return of Yellow Fever to the country from other areas of the world where it is more prevalent. (more)

Get It Here For $5 Bucks: One guy came up on the Americans in Panama Yahoo! email group and reported that he just got his shot in the United States and that he paid $395 for the privilege. If you're going to be coming to Panama and you want to get the shot, just hang onto your money and get it while you are here. The shots are being administered by the Ministry of Health for $5 bucks a pop. You might have to wait a while and go through a bit of a paperwork gaggle (as usual for anything having to do with any government) but in the end you will get your shot for basically free.

Colombia, Peru, Ecuador...: All of the countries in the Northern part of South America are on the WHO list of 42 countries, so if you have any plans to travel either to or from those countries through Panama then you had better get the shot. The rest of the countries are all in Central Africa, so sweat it if you've been to Gabon lately. Here's the maps (again): (Source)

Just Get The Damn Shot: My battle cry with regards to this whole Yellow Fever mess is becoming "just get the damn shot." I mean, it costs $5 bucks and it's good for ten years so why not? Whatever. In any case you've been property informed so my work here is done. Now that I've been protected, off to wrestle with those frisky monkeys...

Yellow Fever Vaccination - It's A Real Requirement

Fri, 27 Sep 2008 18:04:47 GMT

posted by winnerdk

By DON WINNER for Panama-Guide.com - It now begins to appear that in fact Panama will required Yellow Fever vaccinations for anyone entering the country. Of course there are exceptions for the very young or for those who the shot is not recommended for medical reasons, but those people are going to have to show basically a note from their doctor excusing them from the requirement. After I sent out a quick query this morning I started to receive additional information from several sources. It seems that the Panamanian Ministry of Health (MINSA) issued a notification 089-DE/0091-DGS/MS stating that they will begin to enforce the requirement on Wednesday, 1 October 2008. (more)

People Are Already Going To Be Screwed: This requirement takes effect on 1 October 2008, in four days. The shot takes ten days to take effect. So, if you don't already have the shot and you're holding tickets, you might not be allowed to travel. You can expect a significant degree of confusion to reign until standard procedures are established.

In Colombia: This came from Noticias RCN in Colombia:

Panama will begin to demand a Yellow Fever vaccination certificate from travelers.
The measure adopted by the Republic of Panama governmental, airport and sea port authorities, and health authorities will take effect on Wednesday, 1 October 2008.
According to an official press release presented by Panamanian authorities, all travelers coming (into Panama) from countries where there is a risk of Yellow Fever transmission, according to the list published by the World Health Organization, who wish to enter the country must be properly vaccinated against this disease.
The press release adds that "should any passenger arrive in the country without such accreditation, they will be returned to the country where they came from by the airline that carried them here."
The vaccine can be applied free of charge in airports and ground terminals in Colombia. The shot is good for ten years, but it will have to be applied at least ten days before arriving in Panama.

Mostly To Protect Panama: The governmental authorities in Panama are taking these measures to reduce the likelihood of someone who has been infected in their home country of bringing the disease here. From the looks of things travelers from the United States and Canada are not going be needing the Yellow Fever shot to visit Panama. However, I took a look at the World Health Organization's website about Yellow Fever, and if you go to Costa Rica then they might require you to have the shot in order to come back in. Take a look at the following two graphics:

Selective Requirement: So, according to the press release, all travelers coming (into Panama) from countries where there is a risk of Yellow Fever transmission, according to the list published by the World Health Organization, who wish to enter the country must be properly vaccinated against this disease. Anyone wanted to enter Panama from any of the countries shaded in blue above will probably have to be vaccinated.

The Onus is On the Airlines: Panama has apparently made it clear that if the airlines allow a passenger to board a plane and fly to Panama who has not been property vaccinated, then that passenger will be returned to their country of origin at the expense of the carrier. Much of the material that's being forwarded to me is coming in the form of press releases and announcements from airlines who are trying to get the word out to their passengers. The airlines will probably begin to screen passengers at the ticket counter and if you don't have the shot then you can't get on the plane.

Ten Day Incubation Period: Also, you can't just get the shot at the airport and be on your merry way. The shot has to have been administered at least ten days prior to your arrival in Panama or you will be denied entry to Panama.

To Get Your Shot Here: Go to the "International Immunization Center" in the Metropolitan Regional Health Center located in Corozal on the road leading to the Miraflores locks in the old IDAAN building. Due to the anticipated increase in demand for the shot they have increased their operating hours and will now be open Monday through Friday from 7:30 am to 12:00 noon, and then from 1:00 pm to 3:00 pm. The cost for the shot is $5.00 bucks. Phone numbers are 512-6600 and 512-6666.

A Requirement To Leave: The MINSA document also requires anyone who is leaving Panama and flying to a country that is on the list will also require a vaccination. So, if you want to fly to Costa Rica or Colombia or Peru then you will need the shot (or they might not let you travel.)

From Avianca: This was sent out by Avianca on this same subject. It's in Spanish and I'm not going to translate it but you can feel free to do so if the spirit moves 'ya. It basically says the same thing as this article just with more detail:

Panamá, 22 de Septiembre de 2008
Para:

Getting Low On Yellow Fever Vaccine in David?

Wed, 16 Oct 2008 14:01:00 GMT

posted by winnerdk

By DON WINNER for Panama-Guide.com - Posted to the Americans in Panama email forum this morning: "Went to the hospital in David to get my yellow fever shot. When we went to the desk, they informed us they were getting low on the vaccine and were only providing it to people with a ticket to the country you are traveling that requires an inoculation. This occurred on Monday 13 October. Their hours of operation for the yellow fever shots are MWF from 8 to 3 pm. peace, Joe" Heads up. I suspect they will get back to giving the shot to everyone once more vaccine comes in. You might want to call in to check before making the trip down there. Does anyone have the phone number for the location in David?

More on Yellow Fever Vaccination Procedures

Tue, 8 Oct 2008 14:40:25 GMT

posted by winnerdk

By DON WINNER for Panama-Guide.com - This came in from George, who posted it as a comment to an earlier article, but I wanted to push it up front for people to see: "FYI, I lost my vaccination certificate. If you were vaccinated at Los Rios, you can get a replacement certificate by telling them when you were vaccinated, they look it up, you pay five bucks and get a new one. Also, at the Av Chile site I was told that the line is 150 people long when they open and that it would be best to wait until after the fiestas patrias, if you can." Thanks for the update, George.