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Collaborative Course on Infectious Diseases January 2008. LECTURE #9 Pre-departure Lecture: Araçatuba and Jequitinhonha. Jessé Alves and T a nia Chaves [email protected] [email protected] Harvard School of Public Health

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Collaborative Course on Infectious Diseases

January 2008

LECTURE #9

Pre-departure Lecture: Araçatuba and Jequitinhonha

Jessé Alves and Tania Chaves

[email protected]

[email protected]

Harvard School of Public Health

Faculdade de Ciências Médicas da Santa Casa de São Paulo

Brazil Studies Program, DRCLAS, Harvard University


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Objectives

  • Assess the most prevalent health risks based on local epidemiology

  • Provide information about health and disease prevention based on travel medicine practices


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Basic travel medicine evaluation

  • Who

    • Health history, previous immunization, allergy

  • Where

    • Detailed information about itinerary, accommodation

  • When

    • Amount of time prior to departure, season, duration of trip

  • Why

    • Reasons for travel (vacation, work, study)


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Vaccines

  • Required

    • Yellow fever

  • Routine

    • Updating missed doses and boosters

  • Recommended

    • Variable according to the trip and previous medical history (Hepatitis A, Typhoid fever, MMR, Rabies and Hepatitis B)


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Other pre-travel recommendations

  • Protection against vector-borne diseases

    • Repellents

  • Risk from food and water (drinking and recreational activities)

    • How to eat and drink safely

      • Boiling, chemical disinfection, filters

    • Possible infections related to wading or swimming.


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Southeast

  • Largest regional population (72,412,411)*

  • Most industrialized

  • São Paulo state is leader in health, social and educational development

  • Contrasts between different states and regions

* 2000 census


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Yellow fever shot. Why?

  • High morbidity and mortality

  • Recent changes in epidemiology

  • Epizootic transmission outside endemic area

  • Both Araçatuba and Jequitinhonha inside transition zone of transmission

  • Allow for the possibility of additional, unplanned travel


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Yellow Fever

Epidemiological status in Brazil, 2001

Endemic area

12 states

Population:29,327,171

Transition area

7 states

Population: 17,892,237

YF-Free area

8 states

Population: 117,896,554

Source: FUNASA; adapted from Vasconcelos and cols., 2001


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Human Yellow Fever areas

Minas Gerais 2001 / 2002 / 2003

Primate occurrence - 2002

Serro

Sabinópolis

Santa Vitória

Alvorada de Minas

Pitangui

Leandro-Ferreira

Municipalities with cases of FA 2001/2003

Municipalities with cases of FA 2001/2003 and epizootic transmission

Municipalities with cases of FA 2001/2003

Itaúna

Municipalities with cases of FA 2001/2003 and epizootic transmission

Divinópolis

Municipalities with cases of FA 2001/2003

Source: FUNASA

Area of epizootic transmission and yellow fever



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Yellow fever - Brazil, 1990 - 2007*

Endemic area

Transition area

Safe area

Potencial risk area

* Initial data

Source: SVS/MS



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Yellow Fever – epizootic transmission and human

Cases, Brazil 1999 - 2006

Source: SVS/MS


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Leishmaniasis

  • Transmitted by insects

  • Cutaneous and visceral diseases

  • Most cases reported in the North

  • Predominantly rural transmission

  • Urban cases in the Southeast and Northeast





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Wild reservoir

Rattus rattus

Nectomys squamipes

Bolomys lasiurus



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Visceral Leishmaniasis

Deadliness of visceral leishmaniasis in Brazil, 1994 to 2004

Source: SVS/MS


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Schistosomiasis

  • Aquired through contact with fresh water

  • Still prevalent in Minas Gerais, Bahia and other NE states

  • Cause of acute and chronic disease and complications like portal hypertension syndrome


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Endemic Areas of Schistosomiasis in Minas Gerais

Concentrated Areas of Schistosomiasis in Minas Gerais

Source: SVS/DVE/SES/MG




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Fresh water exposure 2004

Women in Jequitinhonha river


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Chagas disease 2004

  • Vector-borne disease

  • High prevalence in Bahia, Minas Gerais, São Paulo, Goiás

  • Presently, low incidence among children and young adults

  • Changes in the epidemiology (food borne transmission)


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Year 2004

# Municipalities

Sample Size

Positive Samples

% Prevalence

Chagas disease sero-prevalence among students in Minas Gerais

Source: CCZ/DVE/SE/SES-MG


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State 2004

Municipality

Cases

Deaths

Death rate

Transmission

Transmitted by

Acute Chagas disease, food acquired, 2007


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Snakes, spiders, etc. 2004

  • Accidents are rare among travelers

  • Most cases are reported in farm land

  • Pay attention while walking in the country


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# accidents 2004

%

Snake bites, by type


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Coefficient of annual occurance of snake incidents per 100,000 inhabitants, by region of Minas Gerais State, 2001 to 2005

Source: CCZ/DVE/SE/SES-MG


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Per 100,000 inhabitants 100,000 inhabitants, by region of Minas Gerais State, 2001 to 2005

* Partial data subject to change

Coefficient of annual occurance of poisonous animal incidents per 100,000 inhabitants, Minas Gerais state, 1986 to 2004*

Source: CCZ/DVE/SE/SES-MG


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Incidence of snake bites in São Paulo state 100,000 inhabitants, by region of Minas Gerais State, 2001 to 2005

Source: CVE


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Natural foci of plague 100,000 inhabitants, by region of Minas Gerais State, 2001 to 2005


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Human plague in Brazil, 1980 to 2005 100,000 inhabitants, by region of Minas Gerais State, 2001 to 2005

Source: CDTV/CGDT/DEVEP/SVS/MS


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