Shingles (Herpes Zoster) Transmission

People get shingles when the varicella zoster virus, which causes chickenpox, reactivates in their bodies after they have already had chickenpox.

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in their body. The virus can reactivate later, causing shingles.

Most people who develop shingles have only one episode during their lifetime. However, you can have shingles more than once.

If you have shingles, direct contact with the fluid from your rash blisters can spread VZV to people who have never had chickenpox or never received the chickenpox vaccine. If they get infected, they will develop chickenpox, not shingles. They could then develop shingles later in life.

The risk of spreading VZV to others is low if you cover the shingles rash. People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts.

People with chickenpox are more likely to spread VZV than people with shingles.

To prevent spreading VZV to others:

  • Cover the rash.
  • Avoid touching or scratching the rash.
  • Wash your hands often.
  • Avoid contact with the following people until your rash crusts:
    • pregnant women who have never had chickenpox or the chickenpox vaccine;
    • premature or low birth weight infants; and
    • people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

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Study Says Shingles May Be A Side Effect of The COVID-19 Vaccine

by: John LynchPosted: Apr 20, 2021 / 11:06 AM EDT Updated: Apr 20, 2021 / 03:17 PM EDT

Shingles (Disease), Herpes zoster, varicella-zoster virus. skin rash and blisters on body

(WTRF) – A new study shows herpes zoster infections, also known as shingles, may be a side effect of the COVID-19 vaccine.

The study in the Rheumatology Journal says scientists in Israel found six cases in a new study of patients with autoimmune inflammatory rheumatic diseases that developed the painful skin rash known as herpes zoster after receiving the Pfizer vaccine.

Emedicine describes herpes zoster as a viral infection that occurs with reactivation of the varicella-zoster virus, commonly known as chickenpox. It is usually a painful but self-limited skin rash.

Symptoms typically start with pain along the affected skin, which is followed in 2-3 days by a vesicular eruption, commonly known as a blister.

Out of 491 patients, six people or 1.2 percent experienced the infection, researchers said.

Five of them developed shingles after the first dose and the sixth got it after the second.

Dr. Victoria Furer, lead researcher on the study, said, “we cannot say the vaccine is the cause at this point,” and noted, “we can say it might be a trigger in some patients.”

“We should not scare people,” she told the Jerusalem Post. “The overall message is to get vaccinated. It is just important to be aware.”

According to the Centers for Disease Control and Prevention, the virus that causes chickenpox lies dormant in the body after a person intially recovers from it. If the varicella-zoster virus reactivates later in life, that causes shingles. The CDC says most people who develop shingles have only one episode in their lifetime, but you can have it more than once.

While you cannot get shingles from someone who has an active case of shingles, you can get chickenpox from someone who has a shingles rash. It’s important to note, the risk of spreading it is low if you cover the rash properly and wash your hands often.

Editor’s note: This article has been updated to include the commonly used names of the herpes zoster and varicella-zoster viruses, and additional context on the origin of shingles.

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Mutant Strains Of Polio Vaccine Now Cause More Paralysis Than Wild Polio June 28, 2017 3:22 PM ET

Nurses give the oral polio vaccine to a Syrian child in a refugee camp in Turkey. The oral polio vaccine used throughout most of the developing world contains a form of the virus that has been weakened in the laboratory. But it’s still a live virus.
Carsten Koall/Getty Images

For the first time, the number of children paralyzed by mutant strains of the polio vaccine are greater than the number of children paralyzed by polio itself.

So far in 2017, there have been only six cases of “wild” polio reported anywhere in the world. By “wild,” public health officials mean the disease caused by polio virus found naturally in the environment.

By contrast, there have been 21 cases of vaccine-derived polio this year. These cases look remarkably similar to regular polio. But laboratory tests show they’re caused by remnants of the oral polio vaccine that have gotten loose in the environment, mutated and regained their ability to paralyze unvaccinated children

“It’s actually an interesting conundrum. The very tool you are using for [polio] eradication is causing the problem,” says Raul Andino, a professor of microbiology at the University of California at San Francisco.

The oral polio vaccine used throughout most of the developing world contains a form of the virus that has been weakened in the laboratory. But it’s still a live virus. (This is a different vaccine than the injectable one used in the U.S. and most developed countries. The injectable vaccine is far more expensive and does not contain live forms of the virus.)

Andino studies how viruses mutate. In a study published in March, he and his colleagues found that the laboratory-weakened virus used in the oral polio vaccine can very rapidly regain its strength if it starts spreading on its own. After a child is vaccinated with live polio virus, the virus replicates inside the child’s intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person.

“We discovered there’s only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination,” Andino says. “As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It’s polio in terms of virulence and in terms of how the virus spreads.”

In June, the World Health Organization reported 15 cases of children paralyzed in Syria by vaccine-derived forms of polio. These cases come on top of two other vaccine-derived polio cases earlier this year in Syria and four in the Democratic Republic of the Congo.

“In Syria, there may be more cases coming up,” says Michel Zaffran, the director of polio eradication at the World Health Organization. He says lab work is still being done on about a dozen more cases of paralysis to confirm whether they’re polio or something else.

The cases in Syria are all in the east of the country near the border with Iraq.

It has become fairly common each year for there to be one or two small outbreaks of vaccine-derived polio. These outbreaks tend to happen in conflict zones where health care systems have collapsed.

“These outbreaks are occurring only in very rare cases and only in places where children are not immunized,” says Zaffran. The regular polio vaccine protects children from vaccine-derived strains of the virus just as it protects them from regular polio. Vaccine-derived outbreaks, he says, “occur where there are large pockets of unimmunized children, pockets sufficiently large to allow for the circulation of the virus.”

WHO is staging a massive response to the Syrian outbreak. WHO plans to work with local health officials and aid groups to vaccinate a quarter of a million children in early July. The goal is to reach every child younger than 5 in the area with two doses of two different types of polio vaccine, spaced one to two weeks apart. This would be a logistical challenge in most parts of the world, never mind in war-torn Syria.

“The access in these areas is a bit limited because of the presence of ISIS,” Zaffran says in what seems like an understatement. Eastern Syria is home right now to Syrians who’ve fled from Raqqa (the ISIS capital in Syria), other parts of the country and even Iraq. “Also there’s a risk that the fighting might actually move to this area.”

Zaffran is confident that the rogue vaccine-derived virus circulating in eastern Syria right now can be wiped out with a massive blast of more vaccine.

“We knew that we were going to have such outbreaks. We’ve had them in the past. We continue to have them now. We know how to find them, and we know how to interrupt them. We have the tools to do that,” Zaffran says. “So it’s hiccup … a very regrettable hiccup for the poor children that have been paralyzed, of course. But with regards to the whole initiative, you know it’s not something that is unexpected.”

WHO is attempting to phase out the use of live oral polio vaccine to eliminate the risk that the active virus in the vaccine could mutate into a form that can harm unvaccinated children.

But for now, the live vaccine continues to be the workhorse of the global polio eradication campaign for a couple of reasons. First it’s cheap, costing only about 10 cents a dose versus $3 a dose for the injectable, killed vaccine. Second, it can be given as drops into a child’s mouth, which makes it far easier to administer than the inactivated or “killed” vaccine, which has to be injected. Third, there simply isn’t enough killed vaccine on the market to vaccinate every child on the planet, and vaccine manufacturers don’t have the capacity to produce the quantities that would be needed if such a switch happened immediately.

And finally, the live vaccine stops transmission of the polio virus entirely in a community if sufficient numbers of people are vaccinated. The killed vaccine doesn’t fully block the virus from spreading because a person who is immunized can still carry and spread the polio virus. And this is an important difference between these two types of vaccines when the goal is to exterminate the polio virus.

“The fact is this [the live oral polio vaccine] is the only tool that we have that can eradicate the disease,” says Zaffran.

That eradication effort has been incredibly successful. In 1988, when the campaign began, there were 350,000 cases of polio around the world each year compared with the six so far this year.

Zaffran credits the oral polio vaccine with getting the world incredibly close to wiping out a terrible disease.

“Four regions of the world have totally eradicated the disease with the use of the oral polio vaccine,” he notes. “Of course we need to recognize that there have been a few cases of children paralyzed because of the vaccine virus, which is regrettable. But, you know, from a public health perspective, the benefits far outweigh the risk.”

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Amid measles scare, Wisconsin legislators seek to end ‘personal conviction’ vaccines waiver

MILWAUKEE – As the most severe wave of measles in 19 years spreads across the country, state representatives are trying, for the second time, to eliminate Wisconsin’s “personal conviction” vaccines waiver.

Rep. Gordon Hintz, D-Oshkosh, reintroduced the bill to do so Tuesday, three years after his first attempt failed to make it out of committee.

As of yesterday, the U.S. Centers for Disease Control and Prevention reported confirmed measles cases in 22 states, the highest number since the disease was eliminated from the country in 2000.

Elimination of endemic measles does not mean the disease no longer exists, it means the disease is no longer native to the U.S. Measles cases can still exist in the U.S. due to travelers bringing it here and then spreading it to people who are not vaccinated.

Wisconsin is one of 18 states that allows parents to opt-out of the vaccines recommended for children before the start of school. Only three states — Mississippi, West Virginia and California — don’t allow any nonmedical waivers, according to the National Conference of State Legislatures.

Wisconsin has a 5.3 percent exemption rate. Only four states — Arizona, Alaska, Idaho and Oregon — had higher rates of students who did not get the measles, mumps, rubella vaccine for a nonmedical reason, according to CDC data.

That increase makes public health officials worry that Wisconsin could become more vulnerable to an outbreak, should measles or another vaccine-preventable disease make its way to the state.

“We’re seeing the worst outbreak of measles in the United States in decades and, at the same time, more and more Wisconsin school kids don’t have the vaccinations currently required by state law,” said Dr. Chip Morris, president of the Wisconsin Medical Society, which supports the bill. “This is a very dangerous combination, and it’s wise that Wisconsin join with a majority of states in the nation in removing the ‘personal conviction’ exception to following the law.”

RELATED:More Wisconsin kids skip vaccines, citing ‘personal conviction.’ It’s raising immunity concerns.

RELATED:With measles spreading, will the federal government force states to tighten their vaccination laws?

Rep. Gordon Hintz
 

The bipartisan bill is co-authored by Rep. Tyler Vorpagel, R-Plymouth; Rep. Debra Kolste, D-Janesville; Rep. Jonathan Brostoff, D-Milwaukee; Rep. LaKeshia Myers, D-Milwaukee; Rep. Daniel Riemer, D-Milwaukee; and Senator Tim Carpenter, D-Milwaukee.

At a luncheon with members of the press in Milwaukee Tuesday, Gov. Tony Evers called the the effort to address the rising number of personal conviction waivers “critical.”

“We just have to understand that there are some requirements that the state must have in order to keep everybody safe and so I would support this bill,” Evers said.

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Pakistan suspends polio vaccine drive after health worker attacks

At least three polio workers have been killed in April, while thousands of parents have refused to allow their children to be inoculated. Pakistan is one of the three countries in the world where polio is endemic.

Pakistani authorities have suspended the anti-polio campaign “for an indefinite period” across the country amid increasing violent attacks on polio workers.

An anti-polio drive was launched in all districts of the country on April 22.

The South Asian country’s National Emergency Operation Centre (EOC) for polio directed all provinces on Friday to halt the drive, in an effort to protect some 270,000 polio field staff from attacks, Pakistan’s Dawn newspaper reported on Saturday.

On Thursday, gunmen opened fire on female health workers in the southwestern town of Chaman, killing one and wounding another.

In separate attacks on Tuesday and Wednesday, assailants killed two policemen who were assigned to protect a polio vaccination team in the northwest.

“After the Peshawar incident, the uncertain and threatening situation for the frontline polio workers has emerged and we need to save the program from a further major damage,” Dawn quoted the EOC as saying in a statement, adding that the Global Polio Eradication Initiative (SPEI) partners had backed the move.

“Hence, no further vaccination or catch-up activity will be conducted in any area for this campaign,” said the EOC.

The violence coincided with rumors of children suffering from adverse reactions to a polio vaccine.

Read more: WHO launches worldwide effort to completely eliminate polio

Violence and mistrust

Polio is endemic in only three countries in the world – Afghanistan, Pakistan and Nigeria. Last year, a relatively rare strain was also detected in Papua New Guinea.

Polio is a highly infectious viral disease, mainly affecting children younger than five. It can cause permanent paralysis and death, but can be prevented through immunization. The virus is spread through contaminated food and water.

Anti-polio campaigns have faced immense problems in Pakistan, with radical Islamists targeting health teams and people mistrusting the drive in some parts of the country.

Read more: Why did Germany’s Heinrich Böll Foundation leave Pakistan?

Islamists claim that the US’s Central Intelligence Agency (CIA) organized a fake vaccination drive to help track down Osama bin Laden in the city of Abbottabad, where US forces later killed the al-Qaida leader in 2011.

In July 2012, Pakistani authorities had to postpone an anti-polio campaign in the northwestern region of Waziristan after Taliban leaders banned inoculations, claiming the drive was similar to a hepatitis vaccination program run by the imprisoned Pakistani doctor Shakil Afridi, who they say had helped the CIA in the bin Laden hunt.

The same year, the United Nations suspended its polio eradication campaign in Pakistan after the Taliban killed two of its workers in the northwestern city of Charsadda.

At least 100 people have been killed in assaults targeting vaccine teams since 2012.

Read more: Amid Taliban threats, Pakistan hits record polio cases

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‘Brady Bunch’ Episode Fuels Campaigns Against Vaccines — And Marcia’s Miffed

April 28, 20198:54 AM ET

The Brady Bunch, circa 1970, with oldest sister Marcia seated in front. In one episode of the show from 1969, the sisters and brothers all stay home from school with measles.
ABC Photo Archives/Getty Images

As the number of measles cases nationwide rises to levels not seen since before the virus was declared eliminated in 2000, some people who oppose vaccines cite an odd cultural reference as evidence that the concern about measles is overblown: a 1969 episode of The Brady Bunch.

Some former Brady Bunch cast members aren’t happy about it.

The episode “Is There a Doctor in the House?” features the whole family sick with measles. First, Peter gets sent home from school. Mother Carol Brady, played by Florence Henderson, describes his symptoms as “a slight temperature, a lot of dots and a great big smile,” because he gets to stay home from school for a few days.

Once the rest of the six kids come down with measles, the youngest two Brady siblings fool around, with Bobby trying to color Cindy’s measles spots green.

“If you have to get sick, sure can’t beat the measles,” sister Marcia says, as the older Bradys sit around a Monopoly board on one of the kid’s beds. All the kids are thankful they don’t have to take any medicine or, worse, get shots, the thought of which causes Jan to groan.

People who are critical of vaccines bring the episode up often. It’s used in videos and memes and is cited by activists like Dr. Toni Bark, who testifies against vaccines in courts and at public hearings across the United States. To them, it aptly illustrates what they consider to be the harmlessness of the illness.

“You stayed home like the Brady Bunch show. You stayed home. You didn’t go to the doctor,” she says. “We never said, ‘Oh my God, your kid could die. Oh my God, this is a deadly disease.’ It’s become that.”

Del Bigtree, a TV producer who hosts a YouTube show critical of vaccines and who produced a movie about them, also looks to the episode to show that the current frenzy about the surge in measles cases is misplaced.

“We were all giggling and laughing because the whole family in the Brady Bunch got the measles,” he says. “Where is the sitcom that joked about dying from AIDS or joked about dying from cancer?”

Some former cast members are upset the show is being used in 2019 to bolster arguments against vaccines. Maureen McCormick played Marcia as a teen. She found out a few months ago that an anti-vaccination Facebook group was circulating memes of her with measles from that episode, and she was furious, she says.

“I was really concerned with that and wanted to get to the bottom of that, because I was never contacted,” she says.

“I think it’s really wrong when people use people’s images today to promote whatever they want to promote and the person’s image they’re using they haven’t asked or they have no idea where they stand on the issue,” she says, adding, “As a mother, my daughter was vaccinated.”

McCormick says that she got measles as a child and that it was nothing like the Brady Bunch episode; she got really sick.

“Having the measles was not a fun thing,” she says. “I remember it spread through my family.”

In 1969, the year that the Brady Bunch episode came out, there were more than 25,000 measles cases and 41 deaths, according to data from the Centers for Disease Control and Prevention. It was six years after the vaccine was developed, and the vast majority of people who got sick with measles fully recovered, as they do today.

Elena Conis, an associate professor at the University of California, Berkeley, who specializes in medical history, explained that circumstances in 2019 are vastly different from those in 1969.

“In 1969, we had less control over infectious diseases,” she says. “Smallpox was still a reality. There were far more cases of polio. In that context, it made sense to think of measles as a lesser threat.”

Public health officials began to try to change the public consciousness about measles once a vaccine was developed, she says.

“They were saying, ‘Well, hold on. There’s this rate of complications; there’s this number of hospitalizations; there’s this number of deaths. We really have to shift our thinking about the threat that measles poses.’ “

That effort to shift the public’s understanding about measles is evident in the 1964 public service announcement, sponsored by the vaccine manufacturer Merck, called “Mission: Measles — The Story of a Vaccine.”

“Many parents think of measles as just a common nuisance which makes their children feel miserable and keeps them out of school for a while. But physicians today know that measles is more than a nuisance,” the announcer says, going on to warn of potential complications, such as bacterial infections, fatal pneumonia and brain inflammation.

The messaging worked, accompanied by federal funding initiatives directed toward childhood immunization. Over the next two decades, measles infections and deaths decreased precipitously as immunization levels went up. By 1984, there was just one death related to measles, historically low at the time and a far cry from the roughly 500 deaths each year attributed to measles before the vaccine was introduced.

Everyone who caught measles in the Brady Bunch episode was fine by the next episode, and most people who catch measles in 2019 will be fine too. But that’s not always the case; the virus can cause pneumonia and, in severe cases, brain swelling and deafness.

In the ongoing measles outbreak in New York City, about 29 people have been hospitalized, six of whom needed intensive care, according to the city’s health department. Two pregnant women in the city have contracted the virus in recent weeks, which could have severe complications for their babies; and a flight attendant who caught the virus while on a flight from New York City to Tel Aviv, Israel, was in a coma from measles complications, according to NBC.

Lloyd J. Schwartz, son of Brady Bunch creator Sherwood Schwartz, who died in 2011, also took issue with using the show to dissuade vaccination.

“Dad would be sorry, because he believed in vaccination, had all of his kids vaccinated,” he says.

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APS and Vaccines

One study calls Hughes syndrome the “classical antiphospholipid syndrome”[1]. That study refers to similarities between plasma protein beta-2-glycoprotein-I (β2GPI), which is attacked in APS, and the tetanus vaccine. That is, the tetanus antigen has parts that are virtually identical to β2GPI, which is found virtually everywhere in the body.

Another study documents how APS can be induced in laboratory animals with tetanus vaccination[2]. Many large number of other studies document and investigate the connection between vaccines and antiphospholipid syndrome[3,4,5,6,7,8].

These studies leave little doubt that APS is caused by vaccines. That should come as little surprise, since it was first identified as a disease during the 1980s. If this disease existed prior to vaccines, it was so rare that it was unknown. Now, it can take its place among a growing list of vaccine-induced conditions, including rheumatoid arthritis, macrophagic myofasciitis, multiple sclerosis, autism, and siliconosis. The list keeps growing and many believe that all these conditions should be included under a single name, autoimmune/inflammatory syndrome induced by adjuvants, or ASIA.

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Tetanus Vaccine Causes a New Disease Known as Antiphospholipid Syndrome January 29, 2013

by Heidi Stevenson
Gaia-Health.com

The vaccine junta is not only unconcerned with vaccine-induced diseases, it’s massively gearing up this vaccine arms race against the human race. It’s known that tetanus vaccine causes a new disease, antiphospholipid syndrome. New adjuvants are composed of phospholipids, a potential disaster.

The tetanus vaccine causes a new disease known both as Hughes syndrome and antiphospholipid syndrome (APS). It’s an autoimmune condition that can attack any part of the body, though is best noted for heart attacks and killing fetuses. It’s likely that APS will become more common with the new generation of vaccine adjuvants now being produced.

The sufferers of (APS) are mostly women, and its diagnosis is often made as a result of multiple pregnancy losses. As is typical of new diseases, research is focused on finding a genetic cause, in spite of the fact that the connection with vaccines is well known and documented.

As the name implies, APS is a condition in which phospholipids, natural and necessary substances required by every part of the body, is seen as an infectious agent by the immune system. So, this substance that exists in every cell becomes subject to attack. Symptoms include:

  • Blindness
  • Cardiovascular:
    • Deep vein thrombosis (clots in veins)
    • Phlebitis
    • Thrombocytopenia (deficiency of blood platelets, causing bleeding & bruising)
    • Atherosclerosis
    • Pulmonary embolus (clots in the lungs)
    • Heart valve abnormatilies
    • Stroke
  • Headaches & migraines
  • Miscarriages
  • Neurological disorders:
    • Epilepsy
    • Chorea (sudden uncontrollable jittery movements)
    • Transverse myelitis (inflammation of the spinal cord)
    • Multiple sclerosis
    • Cognitive dysfunction
  • Skin disorders, including mottling, ulcers, and necrosis

APS can also be diagnosed—more accurately, misdiagnosed—as lupus erythematosus, which is another vaccine-induced condition.

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Genetic sequencing science breakthrough just proved that measles “outbreaks” are caused by the measles vaccine 03/06/2019 / By Mike Adams / Comments

The entire fear mongering campaign surrounding measles outbreaks in the United States centers around a “big lie” that’s pushed by vaccine propagandists. All measles outbreaks, they falsely claim, are due solely to unvaccinated children. Thus, the answer to outbreaks is more vaccines, they say.

But a science paper published in the Journal of Clinical Microbiology, entitled, “Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR,” has discovered something that vaccine fanatics don’t want the public to know. As it turns out, a large number of measles outbreaks are actually “vaccine reactions” from the measles vaccine itself (MMR vaccines).

“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations,” the study authors write. “We have developed a real-time reverse transcription-PCR (RT-PCR) method specific for genotype A measles virus (MeV) (MeVA RT-quantitative PCR [RT-qPCR]) that can identify measles vaccine strains rapidly, with high throughput, and without the need for sequencing to determine the genotype.”

With the help of this breakthrough science on genetic sequencing, these researchers have stumbled onto something the CDC is desperately trying to make sure the American public never learns. (Keep reading, below…)

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What You Need To Know About The Yellow Fever Epidemic In Brazil Mar 22, 2018,11:00am EDT

In this March 3, 2018 photo, residents stand in line to receive a free vaccine against yellow fever… [+] on the outskirts of Sao Paulo, Brazil. The Public Health Ministry and state health departments are using Twitter and Facebook to promote the vaccination campaign and to share links to information about the vaccine and the disease. (AP Photo/Andre Penner)

A yellow fever outbreak that began a year and a half ago in Brazil is spreading further, with additional cases since last July in the Brazilian states of Sáo Paulo, Minas Gerais and Rio de Janeiro, plus several cities in Bahia State.

The World Health Organization began recommending yellow fever vaccination for all travelers and residents of these areas in January, but since then, 10 travelers have contracted the disease—all unvaccinated—and four died.

Kacey Ernst, PhD, MPH, an associate professor and the program director at the University of Arizona’s Epidemiology and Biostatistics Department in Tucson, answers some key questions about the outbreak and what it means for the future. But first, here’s a primer on yellow fever and the Brazilian outbreak.

What’s Yellow Fever?

Yellow fever is a virus carried by mosquitos, usually (but not always) Aedes Aegypti, the same species that transmits dengue fever, chikungunya and Zika. It starts with typical viral symptoms, including fever, chills, headache, backache and muscle aches, about 3-6 days after infection.

For the 15% of people who develop severe illness, the disease can cause internal bleeding, organ failure, shock and death. For every five people with severe illness, one to three of them dies.

The CDC recommended last week that anyone at least 9 months old who is headed to the Brazilian states affected by the outbreak should get vaccinated against the virus at least 10 days before traveling there. Not all U.S. vaccination clinics carry yellow fever vaccine, so you can look up the nearest one to you here. However, not everyone should receive the vaccine, so be sure you are not among those people who have higher risk of a serious side effect.

Travelers should also take usual precautions to reduce the risk of mosquito bites, including wearing long pants and long sleeves, using insect repellent, staying in air conditioned buildings as much as possible and avoiding areas with lots of mosquitoes.

A Q&A with Dr. Ernst

Why is this outbreak so bad?

The geographic areas affected by this outbreak are different than where transmission typically occurs in Brazil. This means that people are less likely to have received yellow fever vaccination in the past and medical and public health professionals in the area have less experience managing these outbreaks.

Is this outbreak in Brazil surprising?

No, there are fairly regular outbreaks in Brazil and in other places in South American countries. This outbreak is somewhat different because the states affected are different than where yellow fever is typically transmitted in Brazil. It is important to review reputable information on all countries prior to travel to ensure that you are up to date on all the recommended travel vaccinations.

Will this outbreak affect production of the yellow fever vaccine?

Because yellow fever is endemic to Brazil, they produce their own vaccine in the country, and they have ramped up production of vaccine internally. Yet since this is a new area of transmission, coverage has been low in the past, so there is still a gap in vaccines available and the population that needs to receive it.

In the United States and other parts of the world, there have been vaccine shortages due to manufacturing problems of the only U.S.-licensed yellow fever vaccine, made by Sanofi Pasteur. This shortage started in 2017 and prompted the use of a fractional dose (one fifth of the vaccine), which was effective during yellow fever outbreaks in western Africa.

How does this outbreak compare to the Zika outbreak in Brazil?

The current transmission of yellow fever appears to be circulating in what we call the sylvatic cycle, which means transmission is occurring in rural forested areas where there are non-human primates probably also experiencing an epizootic (outbreak in animals). The mosquito implicated in this type of transmission is different than the Ae. aegypti, which was the primary mosquito implicated in widespread Zika transmission.

Transmission of yellow fever can occur in Ae. aegypti, however, and they are nicknamed the yellow fever mosquito because they can lead to widespread outbreaks in urban areas. If the Brazil outbreak does spill over into [cities], the mosquito control will be the same as it was during the Zika pandemic.

I think we all have our fingers crossed this will not happen because Ae. aegypti are notoriously difficult to control given their ability to exploit very small water-holding containers and their strong preference to feed on humans.

How has public information and misinformation differed between the two outbreaks?

Zika was a new pathogen to Brazil and, in effect, to the rest of the world. We knew so little about Zika at the beginning of the pandemic that there was an information vacuum. The fact that it caused severe birth defects and can be sexually transmitted mean the perception and control of the disease differ from yellow fever virus.

Yellow fever virus has been circulating in Brazil for centuries, so people are at least somewhat familiar with the disease. And the primary control measure being implemented, vaccination, differs from vector control measures for Zika. [Vectors are carriers of disease. Vector control refers to reducing populations of disease-carrying mosquitos or their opportunities to bite people.]

While vector control of Ae. aegypti to reduce the chance of urban transmission is important, most rumors are focusing on the vaccine.  I don’t think specific Zika misconceptions are spilling over, but the social and political environment that allowed misconceptions to thrive during the Zika pandemic still exist.

What is contributing to fears about the yellow fever vaccine?

Everything really boils down to trust or lack of trust in the government and public health systems. Given recent corruption and scandals in Brazilian officials, people are more likely to trust the friend, relative or other contact they know personally that spreads them misinformation through social media or in person. What’sApp has been particularly implicated as a vehicle for the spread of misinformation in this outbreak.

People think the vaccine is a way to extract money from the people. In reality, the vaccine is provided for free. The yellow fever vaccine does have slightly higher risks than other vaccines. It is a live virus vaccine, which means it is more likely to cause some reactions and adverse events.

The CDC estimates 1 in 4 will have a mild fever and some soreness near the site where the shot was given. More seriously, about 1 in 55,000 have a severe allergic reaction, 1 in 125,000 have a nervous system reaction and 1 in 250,000 have severe illness and organ failure that leads to death in about 1 in 500,000.

So if someone hears that their friend got a fever after getting vaccinated, they may automatically assume that the vaccine didn’t work and, worse yet, that it may be harmful. But if you get yellow fever, the chances of dying are about 1 in 20, and in some outbreaks, deaths have exceeded 1 in 10. That is about 50,000 times more fatal than the vaccine. But I think public health professionals don’t talk much about the rare but real potential side effects. This can exacerbate existing mistrust in the medical system and the government.

Another issue is that with the vaccine shortage, people are primarily being given the fractionalized dose, one fifth the regular dose. While this has been shown to be effective, people don’t trust that it works, leading them to refuse vaccination. Even the term “fractionalized” has been misunderstood. It is true that we don’t know how long immunity lasts from the fractionalized dose, but we do know that it has been effective during other outbreaks and is critical to keeping people safe during a vaccine shortage.

It is estimated that to prevent a possible urban outbreak, about 95% of people need to be vaccinated while the latest figures I found indicated vaccination rates hover around 80%.

What needs to be done to combat misinformation and vaccine fears?

The Brazilian Ministry of Health has been trying to combat the misconceptions through messaging in the media as well as posting information on the importance of vaccination on their websites and Facebook pages. There are even door-to-door campaigns.

Fighting misinformation spread through social media is a Herculean task, and I don’t think we are at a point yet where we can apply a standard model of intervention. Long-term initiatives need to be made that really work to build trust so that subsequent campaigns will be better received. This can be done now by making information about the current outbreak as transparent as possible.

To what extent might climate change be playing a role in these disease outbreaks?

If climate change and mosquito-borne diseases had a relationship status on Facebook, it would be “it’s complicated.” Climate change can both directly and indirectly influence transmission of mosquito-borne disease. Generally speaking, warmer and wetter conditions allow mosquitoes to thrive, and there is a correlation between having a lot of mosquitoes and having more mosquito-borne diseases. Warmer conditions also mean that the time between when a mosquito gets infected and when they become infectious (able to transmit to the next host) gets shorter.

But really hot and really cold temperatures are not good for mosquito survival, so the increasing extreme weather conditions may suppress mosquito populations. Under climate change conditions, most areas will see increasing minimum temperatures. This means mosquitoes may be able to inhabit new areas, and, in areas that are highly seasonal, the season when mosquitoes thrive may lengthen.

It could also mean, however, that some areas become drier. Depending on the mosquito, dry conditions may reduce mosquito populations. The Ae. aegypti, the mosquito that transmits Zika, dengue, yellow fever and chikungunya, however, lays its eggs in manually-filled containers. If people start storing more water during dry periods, this may sustain Ae. aegypti mosquito populations.

Other indirect impacts of climate change include increasing food insecurity, which may lead to higher levels of malnutrition. When people are malnourished, they are more susceptible to infectious diseases, including mosquito-borne illnesses. In addition, infrastructure decline that may result from more frequent and intense weather events (hurricanes, floods, etc.) may weaken existing public health response.

To what extent should we expect to see other yellow fever outbreaks or other vector-borne disease outbreaks going forward?

Evidence suggests our risk of outbreaks of yellow fever and other vector-borne diseases is increasing. This is not just due to climate change but also to globalization and trade, which means more rapid introduction of pathogens and vectors to new places, and to destruction of our natural environment, which increases human contact with new pathogens.

One of the first things that governments need to do is to build capacity to recognize outbreaks when they begin. This means enhancing surveillance capacity, not just for the pathogens but also for their vectors. We actually know quite a bit about the transmission dynamics of many vector-borne diseases, and our ability to model transmission is increasing. Yet most of these models still remain an academic exercise.

We need to invest in sustainable systems that can model periods of highest risk so that public health and communities can be on the alert. While these will always be uncertain, I think we sometimes underestimate the public’s ability to understand uncertainty. Weather forecasting is an example. I think many people understand what a 20% chance of rain means.

We also need to invest in developing strategies for disseminating this information quickly and accurately to the public. Many of these vector-borne diseases require significant community engagement to fight. Empowering people with knowledge—accurate knowledge—will aid in our fight.

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