Ebola vaccine study results printed: 100% protection in Ebola challenged rhesus macaques

Yesterday, GeoVax Labs, Corporation. announced the publication of their manuscript titled “A Single-Dose of Modified Vaccinia Ankara Expressing Ebola Virus Like Particles Protects Nonhuman Primates from Lethal Ebola Virus Challenge” in the peer-reviewed open access journal Scientific Reports naturally Research, which shows that just one intramuscular (IM) dose of GeoVax’s Ebola vaccine (GEO-EM01) provided 100% protection in rhesus macaques challenged having a lethal dose of Ebola virus (EBOV).

Produced by the National Institute of Allergy and Infectious Diseases (NIAID), under a very-high magnification, this digitally-colorized scanning electron micrograph (SEM) depicts a single filamentous Ebola virus particle that had budded from the surface of a VERO cell of the African green monkey kidney epithelial cell line.Created through the National Institute of Allergy and Infectious Illnesses (NIAID), within very-high magnification, this digitally-colorized checking electron micrograph (SEM) depicts just one filamentous Ebola virus particle which had budded in the the surface of a VERO cell from the African eco-friendly monkey kidney epithelial cell line.

GEO-EM01 is dependant on their novel Modified Vaccinia Ankara (MVA) Virus-Like Particle (VLP) platform, which generates noninfectious VLPs within the individual being vaccinated. VLPs mimic an all natural infection, triggering your body to make a robust and sturdy immune response with antibodies and T cells.

This is actually the first are convinced that a replication-deficient MVA vector can confer full protection against a lethal EBOV challenge following a single-dose vaccination in macaques.

Within this study, GEO-EM01 was administered as whether single IM inoculation (prime) or as two IM inoculations in a four-week interval (prime-boost) to categories of four rhesus macaques each. A control group received the MVA vector without Ebola virus protein inserts. Four days after inoculation, creatures in most three groups were uncovered to some lethal dose of Ebola virus. Three from the four unvaccinated creatures died within 12 days, while all the vaccinated creatures survived. Researchers at Rocky Mountain Laboratories, area of the National Institute of Allergy and Infectious Illnesses (NIAID), collaborated within the study.

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GEO-EM01 is a element of a tetravalent hemorrhagic fever virus vaccine being produced by GeoVax. Another vaccine components are suitable for protection against Sudan virus (SUDV), Marburg virus (MARV), and Lassa virus (LASV). These vaccines are envisioned as either individual monovalent vaccines in epidemic situations or combined like a tetravalent vaccine for that protection from the countless individuals who reside in at-risk areas, travelers, military personnel, healthcare workers, yet others.

Farshad Guirakhoo, PhD, GeoVax’s Chief Scientific Officer, commented, “GEO-EM01 uses GeoVax’s proven MVA-VLP vaccine platform that’s been proven safe and also to induce durable antibody and T-cell responses in multiple human numerous studies for GeoVax’s prophylactic Aids vaccine. Utilizing the same platform, we’ve proven our Zika vaccine (GEO-ZM02) and our Lassa Fever vaccine (GEO-LM01) to supply single-dose 100% protection in rodents against intracranial challenge. This research is exclusive since the immune response caused following a single dose from the vaccine not just provided full protection against a lethal challenge, but additionally eliminated nature type Ebola challenge virus in the animal’s bloodstream. No live virus might be retrieved anytime point from the vaccinated creatures when compared to controls, which in fact had greater than 100,000 live Ebola infections per ml of bloodstream.”

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10 Most Significant Infectious Disease Tales of 2017: Outbreak News Today

I haven’t done a annual “Top 10” listing of the main infectious disease news tales since 2013 which is the very first on this web site.

The amount of important and newsworthy occasions of 2017 are plenty of and also to narrow it lower to 10 is really a challenge.

Some might have different tips on what constitutes the very best 10 and my list is dependant on covering infectious disease news since 2009.

The Very Best 10 Infectious Disease and Outbreak News tales of 2013

Anyway, here it is…

10. Getting ever nearer to eradication

Smallpox is the foremost and only human infectious disease to become eradicated. Thanks to some campaign of universal vaccination the final naturally sourced situation of smallpox is at October 1977 in Somalia. 2 yrs later the planet Health Organization (WHO) certified it as being eradicated. It was sanctioned through the World Health Set up (WHA) on May 1980.

Guinea worm Image/Video Screen ShotGuinea earthworm
Image/Video Screen Shot

There’s two other infectious illnesses which are getting so nearer to this massive achievement and also the finish is within sight–polio and guinea earthworm disease.

Polio cases have decreased by over 99% since 1988, from your believed 350,000 cases then, to 37 reported cases in 2016. In 2017, time (of WPV-1 cases) has dropped to 19 (7 in Pakistan and 12 in Afghanistan) through 12 ,. 19 because of vaccinations.

Guinea Earthworm Disease is with an equally miraculous track because it will get nearer to eradication. In 1986, there have been an believed 3.5 million cases in 21 countries in Africa and Asia. Today, time continues to be reduced by greater than 99.99 %.

Through March. 31, 26 cases happen to be reported from two countries (Chad- 14 and Ethiopia- 12). No vaccine or treatment are available for Guinea earthworm infection in humans. Rather, the traditional disease has been easily wiped out mainly through community-based interventions to teach and alter behavior, for example teaching individuals to filter all consuming water and stopping contamination by continuing to keep patients from entering ponds.

Image/geralt via pixabayImage/geralt via pixabay

9. Measles in Europe

This vaccine avoidable disease has truly raised it’s ugly mind in Europe beginning at the end of 2016 and thru all 2017.

Some 14,000 cases happen to be reported around the continent with Romania, Italia and Germany to be the most affected. Some 87 percent of individuals infected were unvaccinated.

LISTEN: Anti-vaccine arguments rebutted

8. Lyme disease developments

There is some important developments concerning the most typical vector-borne disease in america in 2017.

There’s been more political will to consider this tick borne disease as evidence this month through the first meeting of the Tick-Borne Disease Working Group.

Additionally, Valneva was granted FDA Fast Track designation for his or her Lyme disease vaccine candidate and important research was printed that found that the Lyme bacteria, Borrelia burgdorferi survive a 28-day span of antibiotics when treated several weeks after infection. Additionally, the research also measured the antibody immune reaction to the bacteria both pre- and publish- treatment, because this is how current diagnostics typically evaluate Lyme disease in humans.

It was just part of the happenings in the realm of Lyme disease.

LISTEN: Lyme disease: New information on Borrelia burgdorferi persistence

7. The Dengvaxia debacle

Because the announcement at the end of 2015 of Mexico approving the dengue vaccine, Dengvaxia by Sanofi Pasteur, about a dozen or even more countries approved the “milestone” vaccine.

The Philippines, the very first Asian country to approve the vaccine, folded it in pressure in 2016. From that point until lately, some 730,000 children were vaccinated.

Then came the announcement from Sanofi Pasteur on November. 29 that revealed that there’s an elevated chance of severe dengue and hospitalization many years after vaccination among individuals all age ranges who was not uncovered to dengue just before vaccination.

This motivated the Philippines to place the dengue vaccination program on hold. Since that time there’s been an activity Pressure produced and far putting the blame at who’s to blame.

meningitis epidemicsAfrican meningitis Belt/CDC

6. African meningitis belt

A large number of meningococcal meningitis C cases were reported within the African meningitis belt with Nigeria, Niger, Burkina Faso and Mali seeing a number of these cases. Nigeria saw greater than 1100 fatalities.

Just a week ago, the planet Health Organization cautioned of the approaching Men C epidemic in 2018 however, in addition, vaccine shortages happen to be noted.

5. Hepatitis A

Outbreaks in Europe and also the US happen to be reported among men who have relations with men (MSM) and destitute people. Vaccine shortages happen to be reported within this situation also.

4. Running from antibiotics

A WHO report in September shook people up a little with a few reality of the real crisis looming. The report,  Antibacterial agents in clinical development – an research into the antibacterial clinical development pipeline, including tuberculosis  showed a significant insufficient new antibiotics under development to combat the growing threat of antimicrobial resistance.

Officials observe that the majority of the drugs presently within the clinical pipeline are modifications of existing classes of antibiotics and therefore are only short-term solutions. The report found very couple of potential treatments for individuals antibiotic-resistant infections recognized by WHO as posing the finest threat to health, including drug-resistant t . b which kills around 250 000 people every year.

The report identifies 51 new antibiotics and biologicals in clinical development to deal with priority antibiotic-resistant pathogens however, only 8 are classed by WHO as innovative treatments which will increase the value of the present antibiotic treatment arsenal.

Image/CIAImage/CIA

3. Venezuela

Venezuela is within turmoil regardless of what position your perception. Infectious illnesses is a position.

In 2016, Venezuela saw probably the most malaria cases since 1971 and that 30 percent more children died before their first birthday and 64 percent more women died while pregnant or within 42 days following childbirth in 2016 when compared with 2015.

In 2017, we had a significant uptick in measles and also the very harmful vaccine avoidable disease, diphtheria.

Situations are not searching good and that i don’t expect much great news in 2018.

2. Madgascar plague

Plague in Madagascar isn’t unusual and countless cases, mainly bubonic plague is reported yearly.

However, an unparalleled outbreak of plague in Madagascar, which began on 1 August 2017 led to some 2,500 cases and most 200 deaths.

Nearly eight from 10 cases were the greater harmful and person-to-person transmissible pneumonic, or lung plague.

At the begining of December, WHO reported the outbreak have been contained.

LISTEN: Pandemic versus epidemic: What’s the main difference and how come it matter?

1. The Yemen crisis

Many years of war, Saudi-brought airstrikes and blockades has brought to some huge humanitarian crisis in Yemen, the poorest country in the centre East.

Since Apr. 27, 1,013,260 cholera cases happen to be reported, including 2233 deaths. The outbreak has rapidly surpassed Haiti because the greatest since modern records started in 1949.

Diphtheria has witnessed an upsurge using more than 300 cases and 35 deaths being reported previously three several weeks.

Based on the 2018 Humanitarian Needs Overview, 16.4 million individuals 215 districts across Yemen lack sufficient use of healthcare – 9.3 million who have been in acute need. This presents an extreme increase of 79.3% since late 2014.

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South Australia: Salmonella cases associated with Gawler loaves of bread

Medical officials on South Australia are reporting 17 confirmed Salmonella cases associated with sandwiches, wraps, rolls and focaccias purchased in Gawler South Loaves of bread previously two days, prompting them help remind the general public of the importance of safe food handling practices.

Salmonella bacteria (red)/National Institute of Allergy and Infectious Diseases (NIAID)Salmonella bacteria (red)/National Institute of Allergy and Infectious Illnesses (NIAID)

“Of these confirmed cases, three patients happen to be so seriously ill they have to be hospitalised,” SA Health’s Director of Public Health Dr Kevin Buckett stated.

“This is especially concerning because salmonella makes people very sick and, like the majority of installments of food borne illness, is avoidable through good hygiene and safe food handling practices.

“Food companies and individuals cooking in your home need to comprehend how important food safety factors are, especially at the moment of the year when it’s busy and also the weather conditions are warm.

“We urge food handlers to follow along with these four fundamental food safety tips: prepare food completely clean hands and surfaces that touch food chill cooked food rapidly and it awesome until eaten and separate raw and uncooked food from cooked and prepared-to-eat products.

“Gawler South Loaves of bread is cooperating with SA Health insurance and is ongoing to trade. Nevertheless it has stopped serving several sandwich-type products that contains chicken along with other fillings. SA Health, with the local council and also the business, is investigating its food practices and can continue inspections of the sites.”

Salmonella infection usually is a result of ingestion from the bacteria from contaminated food, water or hands. Eggs, meat and chicken are particularly high-risk foods.

People may feel signs and symptoms of salmonella infection between 12 and 72 hrs after exposure and signs and symptoms may last for three to 7 days.

Signs and symptoms include fever, diarrhoea, vomiting, headaches, stomach cramps and appetite loss. Anybody who develops these signs and symptoms is suggested to determine their physician, particularly youthful children, seniors and women that are pregnant who’re most in danger when they contract food poisoning.

It’s particularly important that for those who have these signs and symptoms, you don’t prepare or handle food.

There has been 1414 salmonella cases reported up to now this season, when compared with 1561 for the entire of this past year.

Hepatitis A: Cases up nearly 1000 percent in São Paulo

An episode of hepatitis A struck the town of São Paulo, South america in 2017 and the amount of cases reported through November is definitely an astounding 11 occasions the amount of cases in 2016, based on an r7.com report (computer converted).

Officials in São Paulo have seen 656 hepatitis A cases, including two deaths within the first 11 several weeks of the season, this compares with only 60 reported this past year, for any nearly 1000 percent increase year-to-year.

The rise in hepatitis A within the condition capital is principally associated with the homosexual population, based on the Municipal Health Secretary of São Paulo— “Most cases are men that have relations with men that haven’t been vaccinated and who are inclined to hepatitis. Most likely in this particular community, people grew to become infected and also the disease spread.”

 Hepatitis A is manifested here as icterus, or jaundice of the conjunctivae and facial skin/CDCHepatitis A is manifested because icterus, or jaundice from the conjunctivae and skinOrCenter for disease control

45% from the cases were transmitted through unprotected sex, 11% were because of ingestion of contaminated food or food as well as in the rest of the 44% the origin of transmission is unknown.

However, the good thing is it seems that cases are actually decreasing. The Brazilian Society of Infectious Diseases believes the occurrences shouldn’t rise in 2018.

Hepatitis A is really a virus that induce a liver infection. Signs and symptoms may last a couple of days to many several weeks. Herpes isn’t fatal and many people develop lifetime immunity following infection. Hepatitis A could be serious however, specifically for seniors and individuals with chronic liver disease. Of these individuals, there’s a larger chance of hospitalization and dying.

Most those who are infected recover completely. Unlike hepatitis B and C, hepatitis A doesn’t become chronic hepatitis or cirrhosis (scarring from the liver) and dying from hepatitis A infection is rare.

Signs and symptoms can start 15 to 50 days after becoming infected. It’s also easy to be infected and have no signs and symptoms. For symptomatic individuals, the seriousness of signs and symptoms can vary from mild to severe.

Signs and symptoms of hepatitis A include jaundice (yellowing of your skin and eyes), fever, fatigue, appetite loss, nausea, vomiting, abdominal discomfort, dark urine, and lightweight-colored stools.  Signs and symptoms usually appear over numerous days and last under two several weeks.  However, many people could be ill as lengthy as six several weeks.

Although there’s no specific treatment, you will find types of prevention, like the vaccine. The immunization has been created available totally free since 2014 by SUS (Sistema Único de Saúde) for kids as much as five years old. Groups in danger – individuals with immunosuppressive illnesses, for example hepatitis B and C, and Aids carriers – will also be titled towards the vaccine.

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Zika virus: A ongoing public health insurance and research challenge

Since 2016, when Zika was declared through the World Health Organization like a public health emergency of worldwide concern, herpes is becoming established in additional than 80 countries, infected huge numbers of people, and left many babies with birth defects (with each other known as hereditary Zika syndrome).

An Aedes aegypti mosquito prepares to bite a human. Image/USDAAn Aedes aegypti bug prepares to bite an individual.
Image/USDA

Although scientists make progress within their knowledge of herpes and it is bug carrier, and therefore are going after treatments along with a preventive vaccine, it might be premature to consider the Zika pandemic has become in check and won’t reemerge, possibly more strongly, say leaders in the National Institute of Allergy and Infectious Illnesses (NIAID), area of the National Institutes of Health. The Journal of Infectious Diseases published online December 16 a unique supplement of articles analyzing current scientific understanding concerning the Zika virus and also the key research questions that remain. The supplement was backed and edited by NIAID featuring several articles compiled by NIAID scientists.

The journal’s opening article was compiled by NIAID director Anthony S. Fauci, M.D., and senior consultant David Morens, M.D. It notes a few of the critical scientific queries about Zika that deserve further exploration, including: whether certain viral mutations happened to facilitate its geographical spread if different species of Aedes nasty flying bugs can handle transmitting Zika and just what that could mean for future transmission what’s apparently unique to Zika when compared with various other well-known flaviviruses, for example dengue, that may explain why it may cause hereditary infections, nerve conditions and encephalitis, transmit sexually and persist for lengthy amounts of time in multiple areas of the body and whether preexisting immunity with other related flaviviruses may impact Zika exposure and infection.

A few of the severe manifestations and complications connected with Zika disease include fetal loss, microcephaly along with other birth defects, and the opportunity of delayed physical and mental effects among infected babies born in apparent a healthy body. These 4 elements represent a “profound medical tragedy” and societal challenge that will need decades of monetary, medical and support, Drs. Fauci and Morens write. They observe that the rubella epidemic from the 1960s, when thousands of babies were born with hereditary rubella syndrome within the U . s . States, can offer important training learned which may be directly relevant to Zika research. The Zika pandemic will probably function as a roadmap for addressing future emerging infectious disease challenges, the authors conclude.

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E. coli strikes Marine Corps Recruit Depot North Park, hundreds sickened

An episode of STEC- Shiga Contaminant-Producing Escherichia coli (E. coli) has hit the Marine Corps Recruit Depot (MCRD), North Park where some 5500 recruits are presently in training.

On March 31, MCRD North Park reported 302 Marine recruits were impacted by the diarrheal disease.

E. coli/National Institute of Allergy and Infectious Diseases (NIAID)E. coli/National Institute of Allergy and Infectious Illnesses (NIAID)

Within an update on November. 1, Marine officials stated roughly 214 recruits at both MCRD North Park and also the command’s field training facilities at Edson Range, Camp Pendleton, Calif., are symptomatic of E.coli exposure with diarrheal illness by November. 1.

From the 214 recruits receiving care, 26 are new cases one of the greater than 5500 recruits in training. Twelve recruits are accepted for an off-base hospital as the remainder are now being looked after aboard the bottom.

“The command’s full effort is centered on taking care of individuals recruits who’re affected, making certain we limit any spread from the illness, and identifying the origin from the infection,” stated Brig. Gen. William Jurney, commanding general, MCRD North Park and also the Western Recruiting Region.

Actions come to acquire some solutions concerning the outbreak include:

Samples and examples happen to be forwarded for testing towards the US Army Public Health Command located aboard Fort Mike Houston, Dallas, Texas, where they’ll be tested and processed through the Food Analysis and Diagnostic Lab to look for the reason for the condition.

Preventative Medicine Units at Naval Clinic North Park and Naval Hospital Camp Pendleton still inspect all messing facilities for cleanliness, food storage, and handling procedures.

Food menu alterations happen to be adopted for infected personnel to higher facilitate maintaining diet and recovery.

E. coli is transmitted when you eat contaminated food or water by connection with fecal matter from infected persons or creatures. Individual to individual spread of bacteria can be done and could exist in family settings, daycare centers and nursing facilities.

Signs and characteristic of E. coli 0157 infection or STEC include severe abdominal cramps and loose and bloody diarrhea. Signs and symptoms occur typically 3-five days after swallowing the germ. A lot of people become infected but don’t develop signs and symptoms. People don’t develop immunity to E. coli.

Global warming may accelerate infectious disease outbreaks: Colorado researchers

Apart from inflicting devastating disasters on frequently vulnerable communities, global warming may also spur outbreaks of infectious illnesses like Zika , malaria and dengue fever, according to a different study by researchers in the College of Colorado Anschutz Medical Campus.

“Climate change presents complex and wide-reaching threats to human health,” stated Cecilia Sorensen, MD, lead author from the study and also the Living Closer Foundation Fellow in Climate and Health Policy at CU Anschutz. “It can amplify and unmask environmental and socio-political weaknesses while increasing the chance of adverse health outcomes in socially vulnerable regions.”

Aedes aegypti/CDCAedes aegypti/CDC

When disasters strike such places, she stated, the weather conditions could make the general public health crisis considerably worse.

They stated these vulnerabilities can occur anywhere. After Hurricane Katrina hit New Orleans, installments of West Earth disease bending the following year. Global warming in Africa seems to become growing installments of malaria. And also the recent destruction in Houston, Florida and Puerto Rico because of hurricanes may usher in additional infectious illnesses within the years ahead.

The research focused particularly on the magnitude 7.7 earthquake that struck seaside Ecuador in April 2016, coinciding by having an extremely strong El Niño event. El Niños are connected with heavy rain fall and warmer air temperatures. They’re also associated with outbreaks of dengue fever.

Sorensen, a clinical instructor in emergency medicine at CU Anschutz, is at Ecuador together with her co-authors dealing with the Walking Palms Global Initiative. These were operating a mobile health clinic following the disaster.

“We were seeing many of these viral signs and symptoms within the wake from the quake,” she stated. “We observed an enormous spike in Zika cases when the earthquake happened. Before this, there have been only a number of Zika cases within the whole country.” Actually, they found the amount of Zika cases had elevated 12-fold within the quake zone.

Zika virus is transmitted by mosquitos. Signs and symptoms are often mild however the infection may cause major abnormalities as well as dying inside a unborn child.

Warmer temperatures and elevated rain fall in the El Niño, plus a devastated infrastructure as well as an increase of individuals into bigger metropolitan areas, likely caused the spike in Zika cases, Sorensen stated.

“We saw a lot of people impacted by the earthquake which were sleeping outdoors with no shelter from nasty flying bugs, therefore we were worrying the region’s altering climate could facilitate multiplication of illnesses,” she stated. “Natural disasters can produce a niche for emerging illnesses to be released and affect more and more people.Inches

Sorensen’s team reviewed the present research around the outcomes of short-term climate changes and disease transmission. They applied individuals findings to describe the function from the earthquake and El Niño within the Zika outbreak.

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They suggest El Niño produced ideal conditions for Zika-transporting mosquitos to reproduce making more copies from the Zika virus. The hotter temperatures and elevated rain fall from El Niño have formerly been connected having a greater probability of dengue outbreaks. Warmer temperatures may also accelerate viral replication in nasty flying bugs and influence mosquitos’ development and breeding habits.

Simultaneously, the El Niño event introduced warmer ocean-surface temperatures, that have been proven to correlate with outbreaks of bug-transmitted illnesses. Estimates from remote sensing data in seaside Ecuador reveal that ocean-surface temperatures were greater than average from 2014-2016.

They also believes a rise in water scarcity following the earthquake not directly benefited bug development. The quake broken municipal water systems, forcing individuals to store water in open containers outdoors their houses. These offered to supplement habitats for bug larvae.

The brand new findings could be utilised by governments to recognize and safeguard vulnerable communities before disasters happen, Sorensen stated.

“One idea would be to develop disease mixers may use existing climate models to calculate where these vectors can have up because of climate variability,” she stated. “Applying these new models to areas which have pre-existing social vulnerabilities could identify susceptible regions, allowing us to direct healthcare sources there in advance.Inches

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Puerto Rico crisis: Do you know the infectious disease risks publish-Hurricane Maria

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On Sept 20, Hurricane Maria pulverized Puerto Rico, the worst hit the area had since 1928. Use of consuming water continues to be restored to 45% of Puerto Rico — but over fifty percent from the U.S. territory of three.4 million continues to be not having.  

Reports of some disease outbreaks happen to be printed, including false reports of cholera.

Do you know the infectious disease risks we’ll be seeing in Puerto Rico within the near and also the distant future publish Hurricane Maria?

Joining me to provide us his ideas is Michael Osterholm PhD, Dr Osterholm may be the director of CIDRAP in the College of Minnesota.

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Puerto Rico/CIAPuerto Rico/CIA

Infectious disease collides with changing climate.

May 24, 2017

São João Pequeno, Brazil – Two years of drought had been hard on Valdemar Braun and his three grown sons. They lived in the hilly, picturesque Brazilian village of São João Pequeno, and when the rains quit, the coffee would not grow. The farmers were forced to sell some of their cows.

Then at last the showers returned, and 2017 dawned full of promise for the plantations.

Valdemar had given each son two alqueires of land (almost 11 acres). In mid-January, one son helped another clear out forest to plant more coffee.

Mark Hoffman / Milwaukee Journal Sentinel

Virlei Braun is shown with his wife, Franciele Casagrande Strehlow, in their wedding photo on display at his parent’s home in São João Pequeno, Brazil. Braun was a 30-year-old father of a toddler son when he died of yellow fever.

OUTBREAK

Mark Hoffman / Milwaukee Journal Sentinel

Virlei Braun is shown with his wife, Franciele Casagrande Strehlow, in their wedding photo on display at his parent’s home in São João Pequeno, Brazil. Braun was a 30-year-old father of a toddler son when he died of yellow fever.

The portion of forest belonged to Edson Braun, who had recently divorced. He wanted to transfer the land to his ex-wife so that she could provide for their daughters. His brother, Virlei, agreed to help.

Virlei, 30, with pale blue eyes and a handsome face, had his own family to provide for: a wife and toddler son. On the day he went to help his brother, Virlei had already worked on the farm for 14 days straight. Never in his life had he been to a doctor for a health problem. 

That day in the forest, relatives believe, a mosquito bit Virlei.

In just 10 days, he would die, doctors desperately trying to lower his fever by packing his abdomen in ice, his mother crying out, “God, don’t take my son. Don’t take my son.”

“Go back home and help raise my child,” Virlei told her. “I’ve already put myself in the hands of God.”

***

Brazil, hit hard by the Zika virus in 2015 and 2016, is once again in the throes of a devastating mosquito-borne disease.

The illness that killed Virlei and at least 263 other Brazilians so far is yellow fever, a virus that can cause victims to vomit blood, suffer liver damage, and even descend into organ failure and coma. In some of Brazil’s forests, the virus recurs every six or seven years. 

The current outbreak is the nation’s worst on record; yellow fever deaths in the first four months of 2017 already exceeded all those from 1989 through 2008.

At the epicenter of this epidemic is a group of states that had just recovered from their worst droughts in 80 years. This intersection of drought and disease raises a complex and troubling question for scientists:

Is our changing climate contributing to flare-ups of infectious diseases?

“Yes, this is a factor that is present in our modeling,” says Márcia Chame, a researcher who has been examining the outbreak for the Oswaldo Cruz Foundation in Rio de Janeiro.

But climate alone cannot account for Brazil’s latest bout with yellow fever, according to Chame, coordinator of the foundation’s biodiversity research unit.

Other contributors include the clearing of forests for farms and plantations, an activity that brings humans into areas thick with mosquitoes; the grinding rural poverty that makes insect repellent a luxury for many villagers; and the reluctance of many Brazilians to receive the yellow fever vaccine. 

Still, it is clear that the recent climate in the areas most affected by yellow fever — severe drought followed by rainfall — benefits the forest mosquitoes. Their eggs can survive dry weather in a state of suspended animation “for years and years,” according to Michael T. Osterholm, co-author of the new book, “Deadliest Enemy: Our War Against Killer Germs.” 

When rains do come, they unleash several years’ worth of mosquito offspring. Whether the current outbreak is linked to climate change “is unclear,” Osterholm cautions. “It wouldn’t surprise me, but I don’t think we can say that.”

So far, yellow fever has been confined to rural, wooded areas, mostly in four states on Brazil’s eastern flank: Minas Gerais, Espírito Santo, São Paulo and Rio de Janeiro. But the virus has already spread much farther than in previous outbreaks, raising an unsettling possibility.

Yellow fever

Virus found mostly in Central and South America and Africa.

Transmission

Mosquito bite.

Geographic Regions

World Health Organization says the disease is endemic in 34 countries in Africa and 13 in Central and South America.

Symptoms

Three phases of symptoms. Some feel as if they have a cold — headache, fever, body weakness, lack of appetite. Those who progress to the second phase often find the fever stops around Day 6, followed by stomach pain in the area of the liver and yellowing of the eyes. Those in the most severe phase vomit blood, display dark-colored urine and yellowing skin and often require dialysis.

Cases and Death

Worldwide in 2013:

Between 84,000 and 170,000 severe cases

29,000 to 60,000 deaths

In the U.S.

Yellow fever is extremely rare.

Treatment

No antiviral drug. Doctors treat dehydration and kidney and liver failure.

Source: World Health Organization; Virus images: Centers for Disease Control and Prevention

Yellow fever

Virus found mostly in Central and South America and Africa.

Transmission

Mosquito bite.

Geographic Regions

World Health Organization says the disease is endemic in 34 countries in Africa and 13 in Central and South America.

Symptoms

Three phases of symptoms. Some feel as if they have a cold — headache, fever, body weakness, lack of appetite. Those who progress to the second phase often find the fever stops around Day 6, followed by stomach pain in the area of the liver and yellowing of the eyes. Those in the most severe phase vomit blood, display dark-colored urine and yellowing skin and often require dialysis.

Cases and Death

Worldwide in 2013:

Between 84,000 and 170,000 severe cases

29,000 to 60,000 deaths

In the U.S.

Yellow fever is extremely rare.

Treatment

No antiviral drug. Doctors treat dehydration and kidney and liver failure.

Source: World Health Organization; Virus images: Centers for Disease Control and Prevention

“If this thing takes off in the urban areas of Brazil, we’re in big trouble,” says Osterholm, who serves as director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Large cities, with their high densities of people and mosquitoes, can fuel an outbreak, just as dry tinder feeds a forest fire.

In late April, Brazilian authorities announced that the latest victim to die had lived just 35 miles from the city of Rio de Janeiro, population 6.3 million.

Experts say it is unlikely the U.S. will see a comparable outbreak of yellow fever, in part because air conditioning and window screens are commonplace, allowing us to keep mosquitoes out of our homes in hot weather. Still, any cases — even those brought here by travelers — could prove unnerving, especially since the currently-approved vaccine is in short supply.

Sanofi Pasteur, the sole manufacturer and supplier of the yellow fever vaccine to the U.S., is experiencing production delays as it moves to a new facility. The vaccine approved for the U.S. is likely to be unavailable from June 2017 until mid-2018, though the company says it has received FDA permission to distribute a different vaccine, unlicensed here, but used in 70 other countries. 

The U.S. has not experienced an outbreak of yellow fever in more than a century; the 1905 epidemic in New Orleans that killed more than 430 people was the last. Yet the past 20 years have seen the appearance or reappearance of several other mosquito-borne diseases in this country.

In 1999, it was West Nile virus, which arrived in the U.S. in New York and has since spread through almost the entire country.

In 2001, it was dengue fever, thought to have been eliminated from the U.S. 30 years earlier. Hawaii, Texas and Florida have all reported outbreaks of dengue, a virus that produces flu-like symptoms but can lead to severe illness and death.

Last year, it was the Zika virus making its first appearance in the U.S. in South Florida and Brownsville, Texas, a port city on the Mexican border.

Osterholm notes one parallel between Brazil’s latest bout with yellow fever and the appearance of West Nile virus in New York. “In 1999, when West Nile virus broke in the U.S., lack of rainfall favored the mosquito,” he says.

There is another parallel.

With West Nile, animals fell sick before humans did. Tracey McNamara, then-head pathologist at the Bronx Zoo, noticed crows dropping dead in and around the zoo. Soon afterward, doctors began seeing patients with symptoms resembling encephalitis, including fever, dizziness and fatigue. 

In Brazil, monkeys served as sentinels for the latest outbreak of yellow fever. In April 2016 — eight months before any people became sick — a single monkey was found dead on a farm in Montes Claros, about 530 miles north of Rio de Janeiro.

Even in areas where monkeys are plentiful, it is unusual to find one dead. Their bodies generally decompose quickly, or are consumed by scavengers.

In this case, health officials came to Montes Claros to collect the monkey’s remains for testing. Waldney P. Martins, a professor at Universidade Estadual de Montes Claros who studies monkeys, says it took four months to determine the cause of death.

Yellow fever. 

***

José Luis Machado, housekeeper for Fazenda Macacos, the “Farm of Monkeys,” was born just two miles away in the village of Itapina, which lies about 400 miles northeast of Rio de Janeiro.

He has been there so long, he says, that he feels like part of the forest, much like the howler monkeys he used to watch feasting on mango leaves. A group of eight to 10 monkeys were permanent residents. They clambered through the trees. Sometimes their shouts could be heard clear across the Rio Doce, or Sweet River, a mile away. 

“This was full of monkeys,” Machado says, staring at a hollow of empty trees. Like many of the Brazilians interviewed for this story, he speaks through an interpreter.

“They were very happy,” he says. “They make the house happy too.”

But on this morning in early April, the house and forest are quiet.

The property’s owner found the first dead monkey on the last day of 2016. Soon after, Machado watched other monkeys fall ill.

“When they were already very sick,” he says, “they would fall down from the tree and die on the (forest) floor.”

Mark Hoffman / Milwaukee Journal Sentinel

José Luis Machado, a housekeeper at Fazenda Macacos, looks upward into the trees where a group of eight to 10 monkeys had been permanent residents. Dead monkeys began appearing on the property in Itapina on the last day of 2016. “They would fall down from the tree and die on the (forest) floor,” Machado said.

About the same time Machado was watching the monkeys die in Itapina, University of Wisconsin-Madison researcher Karen Strier was discovering that a similar tragedy had already played out on a reserve 140 miles to the west. 

In mid-January, the professor of anthropology arrived from Wisconsin to find an unnatural quiet in the reserve. In a place she has been coming to for more than 30 years, where she was accustomed to seeing hundreds of howler monkeys, she and her Brazilian colleagues saw fewer than a dozen.

“The forest was really, really different,” she says. “It was actually pretty terrifying.”

Back east in São João Pequeno, Valdemar Braun had also been wondering about the monkey population. Two dozen or so used to come right onto his covered porch to eat juicy guava.

“They have all disappeared,” he says.

Although he cannot remember precisely, he believes the monkeys vanished around the end of last year. Before his son Virlei grew ill and died.

***

The idea that climate and disease are related dates back at least 2,000 years to the Greek physician Hippocrates. He wrote:

“Whoever wishes to investigate medicine properly should proceed thus: in the first place to consider the seasons of the year and what effects each of them produces … Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality.”

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For some of the most serious diseases, including yellow fever, it is not so much the effect of climate on humans that matters; it is the effect on insects.

“There are some people that argue that global warming’s greatest threat may also be the smallest, and, of course what we’re thinking about are insect-borne diseases,” explains Jonathan Patz, director of the Global Health Institute at the University of Wisconsin-Madison.

“And we all know that insects are cold-blooded, unlike us, and when the temperature changes a little bit, their body temperature changes with it.”

Decades of research has established that Aedes aegypti, a species of mosquito that carries yellow fever, Zika, dengue and chikungunya, thrives in warmer climates.

The mosquitoes are more active, reproduce more frequently and enjoy a longer breeding season, though there’s a catch. If the climate becomes too hot and dry it can shorten their lifespan.

In general, warmer temperatures also lead to smaller mosquito offspring which require more blood meals. In other words, they bite more. 

Mosquitoes that transmit West Nile virus show a similar sensitivity.

“Every degree above 70 degrees exponentially expands the mosquito’s ability to transmit West Nile virus,” says McNamara, the former Bronx Zoo official, now a professor of pathology at Western University of Health Sciences in Pomona, Calif.

“Forget the cockroach inheriting the Earth. It’s going to be the mosquito.”

Changing climates around the world can influence diseases. Click on a disease for examples:

A viral disease that causes fever and severe joint pain, chikungunya is spread by mosquitoes, including Aedes albopictus. In the last 30 years, the mosquitoes have expanded to new areas with warmer temperatures. They are more active, breed more and bite more in warm weather. Since 2007, chikungunya, which was once found mostly in Africa, Asia and India, has caused outbreaks in Italy, France, Croatia and 45 countries or territories in the Americas.

Chikungunya

A bacteria that can cause vomiting, abdominal pain and severe shortness of breath. The bacteria form spores that protect them in frozen temperatures. Warmer temperatures, however, are believed to have caused a 75-year-old reindeer carcass to thaw, releasing anthrax that led to the death of a child and sickened 20 other people in Siberia last summer.

Anthrax

A skin disease caused by a parasite. The parasite is transmitted by sand flies, which like warmer weather. Like mosquitoes, the flies become more active in the heat and bite more. The disease has been found in Texas and Mexico, but appears to be expanding northward. Leishmania parasites have been found in Arizona, Oklahoma and Ohio.

Leishmaniasis

A disease which causes flu-like symptoms, hantavirus is carried by rodents and passed to humans. In the Southwestern United States, six years of drought reduced predators and early heavy rainfall led to a bumper crop of pinon nuts. The lack of predators and bounty of nuts was great for white-footed mice and deer mice, which in turn brought the hantavirus to the Southwest.

Hantavirus

A disease marked by symptoms that include headache, fever, rash, fatigue and in more serious cases damage to the heart and nervous system. It is caused by a bacterium transmitted by the bite of an infected blacklegged tick. Warming winter climates have given the ticks a longer growing season, and more time to find a host. Lyme Disease has expanded northward, but also to the south, indicating that factors other than climate change are also influencing its spread.

Lyme Disease

A disease marked by vomiting, fever and diarrhea and can lead to deadly dehydration. It is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. Hotter temperatures and heavier rainfall spur the growth of the bacteria — with changes in the climate predicted to lead to more outbreaks.

Cholera

Changing climates around the world can influence diseases. Click on a disease for examples:

A viral disease that causes fever and severe joint pain, chikungunya is spread by mosquitoes, including Aedes albopictus. In the last 30 years, the mosquitoes have expanded to new areas with warmer temperatures. They are more active, breed more and bite more in warm weather. Since 2007, chikungunya, which was once found mostly in Africa, Asia and India, has caused outbreaks in Italy, France, Croatia and 45 countries or territories in the Americas.

Chikungunya

A bacteria that can cause vomiting, abdominal pain and severe shortness of breath. The bacteria form spores that protect them in frozen temperatures. Warmer temperatures, however, are believed to have caused a 75-year-old reindeer carcass to thaw, releasing anthrax that led to the death of a child and sickened 20 other people in Siberia last summer.

Anthrax

A skin disease caused by a parasite. The parasite is transmitted by sand flies, which like warmer weather. Like mosquitoes, the flies become more active in the heat and bite more. The disease has been found in Texas and Mexico, but appears to be expanding northward. Leishmania parasites have been found in Arizona, Oklahoma and Ohio.

Leishmaniasis

A disease which causes flu-like symptoms, hantavirus is carried by rodents and passed to humans. In the Southwestern United States, six years of drought reduced predators and early heavy rainfall led to a bumper crop of pinon nuts. The lack of predators and bounty of nuts was great for white-footed mice and deer mice, which in turn brought the hantavirus to the Southwest.

Hantavirus

A disease marked by symptoms that include headache, fever, rash, fatigue and in more serious cases damage to the heart and nervous system. It is caused by a bacterium transmitted by the bite of an infected blacklegged tick. Warming winter climates have given the ticks a longer growing season, and more time to find a host. Lyme Disease has expanded northward, but also to the south, indicating that factors other than climate change are also influencing its spread.

Lyme Disease

A disease marked by vomiting, fever and diarrhea and can lead to deadly dehydration. It is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. Hotter temperatures and heavier rainfall spur the growth of the bacteria — with changes in the climate predicted to lead to more outbreaks.

Cholera

Already, warmer temperatures have helped mosquitoes settle into new regions. For example, Aedes albopictus, another of the mosquitoes that carries the viral diseases dengue and chikungunya, “has undergone a dramatic global expansion facilitated by human activities,” according to the European Centre for Disease Prevention and Control.

Found originally in the tropical forests of Southeast Asia, Aedes albopictus, commonly known as the Asian tiger mosquito, has spread into Europe, the Middle East, Africa, and North and South America — largely in the last 30 years. The mosquito, first discovered in the United States in Houston in the mid-1980s, has since spread to 37 states, though not to Wisconsin.

Researchers believe the Asian tiger mosquito’s rapid advance has been fueled by international transport of old tires and bamboo, objects that retain water, making them ideal places for mosquitoes to lay eggs.

Once carried overseas, however, the mosquitoes are finding the warming climate to their liking. In a 2013 paper in the journal PLOS ONE, researchers said the Asian tiger mosquito “is poised to significantly expand its range in the northeastern United States in the next few decades primarily due to warming winter temperatures.”

Where the mosquitoes migrate, disease often follows.

In the summer of 2007, Europe experienced its first epidemic of chikungunya in northeastern Italy. In the years since, France and Croatia have experienced their own outbreaks. The disease, which causes fever and severe joint pain, had been found mostly in Africa, Asia and India.

In December 2013, chikungunya was detected for the first time in the Americas, on the Caribbean island of Saint Martin. Since then, the disease has been found in 45 countries or territories in the Americas, though it has rarely appeared in the U.S., according to the U.S. Centers for Disease Control and Prevention.

And mosquitoes aren’t the only bearers of disease that flourish in warmer climates.

Sand flies, which transmit the parasite that causes leishmaniasis, a skin disease, are also more active and take more blood meals in warmer temperatures.

Blacklegged ticks have prospered in the heat, aiding the northward expansion of Lyme Disease. Lyme cases in Canada have risen more than five-fold since 2009; Lyme cases in Wisconsin have doubled since 2000.

“The growing season’s longer. It’s great for ticks and not so great for human health, because if those ticks have another couple of weeks in which to find a host, then many more of them are likely to survive,” says Richard Ostfeld, senior disease ecologist at the Cary Institute of Ecosystem Studies and director of a study aimed at preventing tick-borne diseases.
 
In a 2005 paper in The New England Journal of Medicine, Harvard University tropical health expert Paul R. Epstein offered one example of how a change in climate can ripple through an ecosystem. Epstein described the arrival of a new disease with flu-like symptoms, carried by rodents and passed to humans:

“Six years of drought in the Southwest apparently reduced the populations of predators, and early heavy rainfall in 1993 produced a bounty of pinon nuts and grasshoppers for rodents to eat. The resulting legion of white-footed mice heralded the appearance of hantavirus in the Americas.”

Few scientists, if any, attribute the spread of these diseases to climate change alone. 

Studies suggest that other likely factors include global reductions in pesticide use and massive increases in waste plastics, such as bags, suitable for breeding by mosquitoes. In a larger sense, the growth and spread of the world’s population into rural areas is undoubtedly bringing more humans onto the turf of mosquitoes, ticks and other parasites and insects.

In Brazil, some point to another possible culprit for the current bout of yellow fever, though the theory is controversial. 

“(It is) due to the environmental disaster which happened in Mariana,” says Antônio Thadeu Tardin Giuberti, the health secretary for the municipality of Colatina.

He refers to the Nov. 5, 2015, dam failure at a mine in Mariana, 250 miles north of Rio de Janeiro. When the dam failed, a torrent of iron ore waste flooded the countryside, killing 19 people and contaminating the Doce River, the same river that flows past the villages where José Luis Machado watched the monkeys die and where Valdemar Braun lost his son.

While Giuberti also attributes the severe outbreak to low vaccination rates and the droughts, he says that the mosquito population rose sharply after the Mariana disaster. He believes the flood of waste material from the dam killed off frogs, the mosquito’s main predator.

At the Oswaldo Cruz Foundation, Márcia Chame says “there is no scientific data that links the disaster with yellow fever.”

On one point, however, she and Giuberti agree.

The outbreak turned a critical corner when the virus spread from the state of Minas Gerais, where it was regularly found, to the neighboring state of Espírito Santo, where it was not.

With no previous experience of yellow fever, many in Espírito Santo remained unvaccinated. The state began vaccinating rural residents on Jan. 23, a week after learning of its first human case, according to Giuberti.

For six days straight, health care teams worked furiously, vaccinating an average of 15,000 people a day. 

***

Aedes albopictus

Also known as tiger or forest mosquito. Two to 10 mm length with a striking white and black pattern.

Diseases carried

Many viral pathogens but also dengue fever, chikungunya fever, Zika and yellow fever virus.

Geographic distribution

These mosquitoes live in tropical, subtropical, and temperate climates, but can live in a broader temperature range and at cooler temperatures than other species. Can be found in most parts of the United States.

Transmission method

The female mosquito lays eggs in water-holding containers around or further away from homes, tree holes and bamboo internodes. It bites people, pets and wild animals.

Source: World Health Organization; Virus images: Centers for Disease Control and Prevention

Aedes albopictus

Also known as tiger or forest mosquito. Two to 10 mm length with a striking white and black pattern.

Diseases carried

Many viral pathogens but also dengue fever, chikungunya fever, Zika and yellow fever virus.

Geographic distribution

These mosquitoes live in tropical, subtropical, and temperate climates, but can live in a broader temperature range and at cooler temperatures than other species. Can be found in most parts of the United States.

Transmission method

The female mosquito lays eggs in water-holding containers around or further away from homes, tree holes and bamboo internodes. It bites people, pets and wild animals.

Source: World Health Organization; Virus images: Centers for Disease Control and Prevention

Though rarer than it once was, yellow fever retains a hellish reputation among doctors.

“This disease has struck fear in the hearts of man ever since it was discovered. It’s so severe, so lethal, such a horrible death,” says Thomas P. Monath, who has been studying yellow fever since 1968, and now serves as chief scientific officer for BioProtection Systems Corp., an Iowa-based company involved in vaccine work.

Named for the sickly yellow color that permeates a patient’s skin and eyes, the virus likely emerged about 5,000 years ago, when it was transmitted from primates to humans in Central or East Africa. 

In the 1600s, the disease and its most common carrier, Aedes aegypti, came to the Americas aboard slave ships. The U.S. experienced at least half a dozen epidemics, including one in Philadelphia in 1793 when the city was still the nation’s capital. Nearly 5,000 people died in three months, and more than one-third of Philadelphia’s 50,000 residents fled the city.

During construction of the Panama Canal in the early 1900s, yellow fever and malaria killed thousands of workers, prompting U.S. authorities to launch a campaign to improve sanitation and water, and to eliminate mosquito breeding sites.

Only in 1937 was a yellow fever vaccine developed by the South African biologist Max Theiler. Since then, vaccinations have helped rid many countries of yellow fever, though outbreaks continue to flare up in South America and Africa.

In Brazil, the outbreaks have not reached the cities in decades, remaining instead in the sylvatic, or jungle, cycle. Mosquitoes in the jungle pick up the virus from monkeys and pass it to other monkeys or humans working nearby. 

In late December 2016, Angola declared the end of a year-long yellow fever epidemic that had spread to its African neighbor the Democratic Republic of Congo, causing 400 deaths in the two countries.

A week after Angola sounded the all-clear, Brazil’s human outbreak began in the state of Minas Gerais.

***

On Dec. 30, the first two yellow fever patients showed up at the bustling Santa Rosália Hospital in Teófilo Otoni, about 450 miles north of Rio de Janeiro.

The patients, both from the nearby town of Itambacuri, entered in critical condition, “vomiting blood,” says Rodrigo Lobo, a doctor of emergency medicine at Santa Rosália. “There was blood in their feces. The whites of their eyes went yellow and their urine looked darker.” 

They were initially diagnosed with dengue fever, but the 39-year-old doctor wasn’t so sure. Lobo remembered hearing that monkeys had been found dead in Itambacuri several months prior; the cause was determined to be yellow fever. So he diagnosed the patients with yellow fever, and sent blood samples to be tested. 

By the time the tests confirming his diagnosis came back more than two weeks later, both patients were long dead. 

On New Year’s Day, sick people began arriving from other nearby towns and villages. Most were in the third and final stage of the disease. They had yellow eyes and skin, and were bleeding from their mouths.

“The walking dead,” Lobo called them. 

The doctor worked around the clock, though there was little he could do. Every patient that first week died — 16 in all. 

“In the beginning, I used to have nightmares,” Lobo says. “The evolution of the sickness is so quick. With all of the resources we were applying, to see young people dying was not easy. It was very hard to see people in the last stage bleeding, and you cannot do anything to stop the bleeding. It was horrifying.”

To make matters worse, doctors at Santa Rosália, which serves more than 60 municipalities, had not been paid for eight months due to a decrease in funding for public health. By the time of the outbreak, many employees had quit to pursue other jobs, forcing the hospital to cope with a scarcity of workers and even shortages of basic materials such as gauze and certain medicines.

Lobo was among the few who stayed. Another was Ricardo Vitorio, a 35-year-old kidney specialist who remembers working seven days a week, getting what little sleep he could at the hospital.

At first, few outside the hospital knew of the outbreak. News filtered out in an unusual way. Before any official announcements had been made, Lobo wrote to friends on the instant messaging service WhatsApp, telling them not to fish or hunt in the bush until the cause of the outbreak had been determined. 

The message reached a local reporter, 38-year-old Elvis Passos, who asked Lobo for permission to publish it. On Jan. 6, Passos shared the doctor’s warning with 34,000 followers on his Facebook news page.

According to the World Health Organization, Brazil reported the first cases that same day. But in an email interview, Passos says there was no public announcement of the outbreak until two days after his Facebook post.  

Passos would later be praised by some for alerting the public, and criticized by others for causing panic. 

In the weeks that followed, Vitorio says, he treated about 120 yellow fever patients, among them two brothers, José Ramos and Vando Ramos Ferreira, 46 and 39. The brothers were bean and coffee farmers from Novo Cruzeiro, a town about 70 miles northwest of the hospital. 

In early January, José was washing clothes in a river when he saw a dead monkey.
A few days later, he had a headache and fever. Soon he was vomiting and had no appetite.

By the time José was taken to a small local hospital, he could not stand on his own. Two days later, on Jan. 11, he was transferred from the first hospital to Santa Rosália. His brother, Vando, a father of five, arrived at Santa Rosália more than a week later.

At first, Vando appeared relatively healthy. He was placed in a regular room rather than one reserved for emergencies.

José, however, grew worse. He remembers thinking he would die, and asking God to feel pity for him.

Vitorio thought there was a 98% chance José would not survive.

“There is no drug to kill the virus,” the doctor says. “There are medicines that will give the organs conditions for recovery.”

Yellow fever primarily afflicts the liver, kidney, lymph nodes and spleen. The most critical patients at Santa Rosália were placed on dialysis. Some already had weakened livers from alcohol use, leaving doctors few options.

“How can you transplant livers for 50 or 60 people at once?” Lobo says.

Despite the dire prediction, José improved. After 32 days in the hospital, he went home. 

Now it was Vando who grew ill, so ill he had to be placed on dialysis. On April 14, his hospital stay passed the three-month mark. He continues on dialysis and may remain so for the rest of his life, Vitorio says.

His likelihood of death had been 99%, Vitorio adds, predicting the two brothers may one day be the subject of medical papers. “Why they are still alive, this is going to be studied.”

The doctor’s face tightens as he discusses the disease’s spread, made worse in his view by poverty and lack of information. Though yellow fever is endemic in the state, Vitorio says, the vaccination rate was poor. State health records show fewer than half of Minas Gerais’ 20 million residents had received the yellow fever vaccine prior to the outbreak.

“For the influenza vaccine, there is a TV campaign,” he says, “but for the yellow fever vaccine they had posters. They never had a campaign (on television).” 

Vitorio believes people fear the yellow fever vaccine, or think it unimportant.

Vaccination is mandatory for children born in 2002 or later, and many mothers get vaccinated when they bring in their children. Vaccination is far less common among men. The vast majority of yellow fever patients at Santa Rosália were men, usually age 50 or under. Many worked in the forest where they frequently came in contact with mosquitoes. 

“There is a masculine attitude,” says Lobo, the doctor of emergency medicine. “ ‘I’m a Superman. I’m strong. I’m not going to get this.’ ”

“What happened here was a catastrophe,” Vitorio says. “A lot of young adults died because of a sickness that could have been avoided … A lot of children, they remain without family. The children were required to get the vaccine. The parents weren’t.”

Within a few weeks, the virus had spread to the state of Espírito Santo, where the population was even less prepared.

***

In São João Pequeno, 3-year-old Vitor Hugo Braun plays with LEGOs on the floor, while his grandparents describe what happened to his father, Virlei Braun.

“It was too quick,” Valdemar says, staring into the distance. 

Virlei, who had never been vaccinated, fell ill almost three weeks after the first yellow fever patients had arrived at Santa Rosália. After lunch on a Sunday, he became feverish. The veins in his forehead bulged, his mother, Cecilia Braun, remembers. 

The following day he went to the hospital in Colatina. Doctors thought he might have dengue or leptospirosis, a bacterial disease that can lead to kidney damage.

“Nobody knew what it was,” Valdemar says. “They left him for two days in bed. They were giving him medicines and putting tubes into him without knowing what it was.”

Virlei remained in the hospital on Jan. 27, his son’s third birthday. 

“Mom,” he said, “bring my son. I want to give him a kiss on his birthday.”

Since the hospital would not allow children to visit, Virlei tried to rise from bed to go see Vitor Hugo at his school. But as Cecilia Braun helped her son struggle to his feet, Virlei shuddered in pain.

“Mom,” he said. “I cannot.”

He slumped back onto the bed. Two days later, doctors realized he was bleeding internally. They still had not diagnosed the disease.

Virlei heard his mother crying, and called on her to be strong.

He died a few days later on Feb. 1. Only after death was he diagnosed with yellow fever, his parents say.

They brought his body home for the funeral and tried to keep Vitor Hugo from seeing it.  But the little boy peeked in the room where the body lay.

He kept asking his grandmother: “Is he sleeping? Is he sleeping? Is he sleeping?”

***

A week or two after Virlei’s death, the virus arrived in the state of Rio de Janeiro, in a village known as Córrego da Luz, “River of Light.”

Some of the locals believe the disease was brought by a tourist from the state of Minas Gerais. They had not heard of any sick monkeys. 

However, researchers from the Oswaldo Cruz Foundation came to investigate the outbreak and found a dozen dead monkeys in the forests around the village, Márcia Chame says.

The first villager to be sickened was an energetic jokester named Watila Santos, who was 38 and married. Watila worked in construction, drove trucks and grew bananas and oranges. He and his wife had just moved to the village in January to live with relatives in a small cluster of houses built on a cleared patch of forest.

A group of men, including Watila, had gone into the jungle around the end of January to check on an area where oranges had been planted. Soon afterward Watila became sick with a fever and headache. When he went into the local hospital, “they said, ‘This is a simple virus. Go back home,’ ” his brother, Roberto dos Santos, says.

Watila spent four days sick at home. On the fifth day, his vomit was black.

“On Friday he was falling apart. When he went to the hospital and was taken to the infectologist area,” Roberto says, “it looked like his body had been painted yellow.”

It was now early in February. During a visit from his mother, Watila told her, “I’m not going to leave this hospital.” 

About this time, a few others from Córrego da Luz fell ill.

Alessandro Valença Couto, a 38-year-old social services worker, who’d never had a serious illness before, felt at first like he had a cold. But on Feb. 5, after two days of illness, he began to vomit. Like others, he had not received the yellow fever vaccine and never wore insect repellent.

“Here, it has always been a lot of mosquitoes,” he says, explaining why many don’t bother with repellent.  

Although Alessandro also went to the hospital, doctors said his illness might be meningitis or leptospirosis. He was then transferred to a bigger hospital, the State Infectology Institute in São Sebastião. Doctors diagnosed him with yellow fever and kept him hydrated through an IV line. He would spend 10 to 12 days in the hospital.

“It was horrible,” recalls Alessandro’s wife, Luciana Moreira. “I felt afraid of losing him.”

As she worried, another villager lost his fight. On Feb. 11, at 3 in the morning, Watila Santos died. Although he had always appeared healthy, relatives said he had other medical problems that may have left him unable to fight off the yellow fever virus. Within days of his death, some 30,000 people were vaccinated in the nearby city of Casimiro de Abreu. 

Alessandro proved more fortunate than Watila. A little less than a week after his neighbor’s death, Alessandro went home to his wife and their 3-year-old son, Davi Luiz. He still suffers from pain in his stomach and worries that he may have permanent damage. But the family is glad he survived.

In mid-April, Luciana Moreira was pregnant. She and her husband plan to name their new son Bernardo.

***

Mark Hoffman / Milwaukee Journal Sentinel

Vitor Hugo Braun, 3-year-old son of yellow fever victim Virlei Braun, plays by himself at his paternal grandparent’s home in São João Pequeno, Brazil.

Mark Hoffman / Milwaukee Journal Sentinel

Vitor Hugo Braun, 3-year-old son of yellow fever victim Virlei Braun, plays by himself at his paternal grandparent’s home in São João Pequeno, Brazil.

Cecilia Braun says that her son, Virlei, had a favorite Bible passage, which was read at his funeral: John 16:32.

A time is coming and in fact has come when you will be scattered, each to your own home. You will leave me all alone. Yet I am not alone, for my father is with me.

She agonizes over her son’s death, thinking maybe they should have taken him to a better hospital the instant his illness appeared serious.

“That’s where we have failed,” Valdemar Braun says quietly.

The sun is beginning to set over their little village. It’s the time of day when Virlei used to return from his farm work to pick up Vitor Hugo. There is a brief silence. 

“Now, I want to ask you a question,” says Cecilia Braun, looking as if she is straining to understand something beyond her grasp.

“Do you think that just a little mosquito can take the life of such a big, strong man?”

LA County residents cautioned of Lancaster street vendor have contracted hepatitis A

Customers who bought fruit from the streetside vendor in Lancaster recently might have been uncovered to hepatitis A, La County medical officials cautioned on Monday.

The seller was identified as having the condition and that he might have transmitted it between August. 15 and August. 22, based on a reminder in the L.A. County Department of Public Health.

To date, there has been no cases connected using the fruit cart, medical officials stated.

The seller was working a corner of West Avenue L at 20th Street West, just west from the Antelope Valley (14) Freeway.

Individuals who bought fruit from him were advised to obtain an immune globulin shot, or hepatitis A vaccination over the following week to avoid the condition, or make its effects less strong, county officials noted within the alert. Free vaccines can be found beginning Tuesday from 8 a.m. to 4:30 p.m. in the Antelope Valley Public Health Center, 335-B East Avenue K6, Lancaster.

“We are positively investigating this case,Inches stated Dr. Jeffrey Gunzenhauser, the Interim Health Officer, La County inside a statement. “Those who purchased the product should discard any remaining fruit if still present in their house.Inches

Medical officials stated the vendor’s situation might be associated with outbreaks of hepatitis A infections occurring in North Park and Santa Cruz counties. In North Park, there has been 378 cases and 15 deaths connected using the outbreaks. In Santa Cruz, there has been 62 cases.

The outbreaks in individuals counties were mostly among destitute individuals who were thought to be using drugs. La County medical officials stated the condition had been spread person-to-person through close contact or through connection with environments contaminated with feces.

The condition has additionally been found among individuals who provide services towards the destitute population in individuals counties.

In L.A. County, public medical officials have confirmed three installments of hepatitis A among individuals who resided in North Park. There have been also three secondary cases detected among individuals L.A. County health facilities.

Hepatitis A is really a liver disease with signs and symptoms which include fever, fatigue, appetite loss, nausea, vomiting, abdominal discomfort, dark urine, clay-colored bowel motions, joint discomfort, along with a yellowing of your skin or eyes or jaundice.

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