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

Monday, October 06 2008 @ 09:29 AM COT

Contributed by: Don Winner

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 D’Ivoire
  • 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.

Copyright 2008 by Don Winner for Panama-Guide.com. Go ahead and use whatever you like as long as you credit the source. Salud.

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