Yellow Fever in Paraguay – Updated
This information is current as of April 04, 2008
The Paraguay Ministry of Health (MOH) has reported to the World Health Organization (WHO) the first cases of yellow fever disease identified in Paraguay in more than 30 years. As of March 31, 2008, a total of 26 confirmed cases (including 8 deaths) of yellow fever in humans have been reported by the Paraguay MOH. These cases have been reported from the following departments: 15 cases in San Pedro Department, in the east central region of Paraguay; 10 cases in Central Department, near the capital city, Asuncion; and one case in Caaguazú Department, an area east of Asuncion. A team of scientists from the Pan American Health Organization (PAHO) has been sent to Paraguay to help investigate this outbreak and provide laboratory support. The Paraguay MOH has strengthened public health containment measures, with implementation of yellow fever vaccination for people living in or traveling to the affected areas. The information and recommendations in this notice are considered interim and will be updated as further information becomes available.
Although some rural, forested areas of Paraguay are known risk areas for yellow fever, the above reports suggest the presence of yellow fever in other areas of Paraguay, including possible transmission in urbanized areas. Investigations are taking place to determine if urban transmission is truly occurring. The cases in San Pedro are most likely jungle yellow fever, which occurs when mosquitoes transmit the virus from monkeys to humans. However, when the virus is introduced into urban areas it can be transmitted by mosquitoes from one human to another. This form of transmission is known as urban yellow fever and can spread rapidly through susceptible populations where mosquito vectors are abundant.
Until further notice, CDC is temporarily expanding its yellow fever vaccination recommendation for Paraguay (below) to protect travelers’ health.
Recommendations for Travelers
On the basis of these case reports and the vaccination campaign taking place among the local population, travelers are strongly advised to follow the expanded CDC Guidelines.
Until further notice, yellow fever vaccination is now recommended for all travelers older than 9 months who are going to all areas of Paraguay.
- The complications from yellow fever vaccine are greater for certain groups of people, such as those younger than 9 months or older than 60 years, pregnant women, and those whose immune systems are compromised. For more information about these and other yellow fever vaccine precautions and contraindications, please see the Prevention information in the Yellow Fever section of CDC Health Information for International Travel 2008. These travelers (or their parents) should discuss the risks and benefits of vaccination for travel to Paraguay with their physicians.
Since yellow fever is spread by the bite of an infected mosquito, travelers are also reminded to:
- Use insect repellent on exposed skin surfaces when outdoors, particularly during the day.
- Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended for adults. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication.
- Repellents containing picaridin are available in the United States in formulations of up to 15% concentration, which require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the United States.
- For additional information regarding the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
- Wear long-sleeved shirts and long pants when outdoors. Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don’t use permethrin on skin.)
The CDC has yellow fever immunization centers in Kansas listed on their website: