Destination Brazil: Araatuba and Jequitinhonha

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Collaborative Course on Infectious
Diseases January 2008
LECTURE 9 Pre-departure Lecture Araçatuba and
Jequitinhonha
Jessé Alves and Tania Chaves jesse.alves_at_fleury.c
om.br tania.chaves_at_uol.com.br
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 Population29,327,171
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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Municipality of Jequitinhonha
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Yellow fever - Brazil, 1990 - 2007
Initial data
Source SVS/MS
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Araçatuba region
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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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Cases of cutaneous leishmaniasis 2003 - 2004
Source SVS/DESP
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Cutaneous leishmaniasis in Minas Gerais, 2006
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Cutaneous leishmaniasis in Minas Gerais, 2002 to
2006
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Wild reservoir
Rattus rattus
Nectomys squamipes
Bolomys lasiurus
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Visceral leishmaniasis in Minas Gerais, 2001 to
2006
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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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Deaths caused by Schistosomiasis in Minas Gerais,
1996 to 2004
Source DATASUS/MS
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Hospital admittances due to Schistosomiasis, 1994
to 2005
Source DATASUS/MS
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Fresh water exposure
Women in Jequitinhonha river
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Chagas disease

• 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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Chagas disease sero-prevalence among students in
Minas Gerais
Source CCZ/DVE/SE/SES-MG
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Acute Chagas disease, food acquired, 2007
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Snakes, spiders, etc.

• Accidents are rare among travelers
• Most cases are reported in farm land
• Pay attention while walking in the country

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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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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
Source CVE
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Natural foci of plague
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Human plague in Brazil, 1980 to 2005
Source CDTV/CGDT/DEVEP/SVS/MS
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