Source: Health Canada" />

Source: Health Canada

Know before you go!
Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
Health Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician 6 to 8 weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.

Some facts from the experts
The information below has been developed and is updated in consultation with Health Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about the prevention of yellow fever for Canadians travelling internationally.

Disease profile
Yellow fever is an acute viral infection of short duration and varying severity. The disease occurs in two forms -- urban and sylvatic (jungle) yellow fever. Both forms are caused by the same virus, which is a member of the Flaviviridae family of viruses.

Transmission
Yellow fever is transmitted to humans by the bite of infected mosquitoes from a variety of species, principally the Aedes and Haemagogus species. These mosquitoes are day-time biters.

Geographic distribution
Yellow fever is constantly present (i.e., endemic) in many tropical areas of South America and Africa. From time to time in endemic areas, the number of yellow fever cases can increase dramatically to the epidemic level. For the most part, yellow fever transmission is restricted to rural and jungle areas.

Yellow Fever Risk Areas in Brazil

• Travel Health Notice
• About Yellow Fever
• Recommendations
• Don't Forget...
• Additional information

Travel Health Notice

The Ministry of Health of Brazil has updated the areas of risk for human cases in the states of Rio Grande do Sul and São Paulo.

The Public Health Agency of Canada recommends that travellers get vaccinated against yellow fever and protect themselves from mosquito bites when going to certain areas of Brazil. 

A list of the municipalities in Rio Grande do Sul and Sao Paulo where vaccination is recommended is available from the Ministry of Health of Brazil (in Portuguese only). 

About Yellow Fever

• Yellow fever is a serious viral infection, which affects everyone differently, often very severely.
• It is caused by a virus that is spread to humans by infected mosquitoes that bite during daytime hours.  
• Symptoms take three to six days to appear.  They include sudden onset of fever with chills, headache, muscle pain, loss of appetite, nausea and vomiting.
• In severe cases, yellow fever can lead to shock, bleeding, organ failure, jaundice (yellowing of skin and eyes) and even death.

For additional information on Yellow Fever, see PHAC's Disease Information Backgrounder: Yellow Fever.

Recommendations

1. Protect yourself from mosquito bites:
   1. Cover up: wear light-coloured, long-sleeved, tucked-in shirts, long pants, shoes (not sandals), and a hat
   2. Use insect repellent on exposed skin
      1. Insect repellents that contain DEET are the most effective
      2. Use as directed by the manufacturer
      3. Do not apply to cuts, scrapes, abrasions or irritated skin
      4. Do not spray directly on your face
      5. Wash your hands after you apply insect repellent to avoid contact with your lips and eyes
      6. Do not use products that contain both insect repellent and sunscreen
      7. If you want to use sunscreen and an insect repellent with DEET, apply the sunscreen first.  Let it soak into your skin for about 20 minutes, then apply repellent with DEET
      8.  Wash off repellent at the end of the day, before you go to bed.
   3. Sleep under an insecticide-treated bed net
      1. Make sure there are no tears or large holes in the net
      2. Tuck it under the mattress
      3. Ensure it is not touching you (or you still may be bitten through the net)
   4. Consider your accommodations:
      1. Stay in a well-screened or completely enclosed air-conditioned room
   5. Apply a permethrin insecticide to tents and bed nets for greater protection
      1. Permethrin-treated clothing is effective for up to two weeks or six washings.  Although permethrin isn't available in Canada, travel health clinics can advise you how to purchase permethrin and pre-treated gear before or during your trip.
         
         

         More information on precautions to take to avoid mosquito bites while travelling… 
2. Get vaccinated
   1. It is strongly recommended that you get the yellow fever vaccine before you travel to an area where there is a risk of yellow fever, even though Brazil does not currently require a vaccination for yellow fever to enter the country.
   2. The single-dose vaccine against yellow fever is safe, effective and recommended for most people who are over nine months of age. 
   3. For some people, the vaccine is not recommended (e.g. pregnant women, people with weakened immune systems and children under the age of nine months).
   4. See your physician or visit a travel clinic to determine if the vaccine is right for you. It takes 10 days before the vaccine takes effect and will begin protecting you, so leaving vaccination to the last minute will leave you at risk. The vaccine provides immunity for 10 years or more. In Canada, the vaccine is available only at designated Yellow Fever Vaccination Centres.

More information on precautions to take to avoid mosquito bites while travelling: Statement on Personal Protective Measures to Prevent Arthropod Bites - Update

Don't Forget …

1. Consult a health care provider or visit a travel health clinic at least six weeks before you travel.
2. What to do if you get sick when you are travelling.
3. What to do if you get sick after you return to Canada.
4. Know what vaccines you need and when to get them.

Additional information:

• Information on Yellow Fever from the Public Health Agency of Canada
• World Health Organization – Yellow Fever
• Foreign Affairs and International Trade Canada Travel Report on Brazil 

Symptoms
Some infected individuals have no symptoms. When they do occur, symptoms take 3 to 6 days to appear and range from self-limiting fever to sudden onset of fever with chills, headache, muscle pain (back pain), loss of appetite, nausea and/or vomiting. In severe cases, yellow fever can lead to shock, bleeding, organ failure, jaundice (i.e., yellowing of skin and eyes) and death.

Treatment
There is no specific treatment for yellow fever. The overall case-fatality rate may reach 20% to 40% in single outbreaks. Deaths from yellow fever have been reported among unvaccinated travellers.

Vaccine
The single-dose 'live' vaccine for yellow fever is safe, effective and recommended for individuals 9 months of age and older. The vaccine becomes protective after 10 days, and provides immunity to a vaccinated individual for 10 years or more. For individuals who are pregnant, immuno-suppressed or allergic to eggs, the yellow fever vaccination may not be recommended. In Canada, the vaccination is available only at designated Yellow Fever Centres.

Individuals who receive the yellow fever vaccine are provided with an International Certificate of Vaccination as proof that they have been vaccinated against yellow fever.

International Health Regulations
Under the World Health Organization's International Health Regulations, a yellow fever vaccination certificate (i.e., International Certificate of Vaccination) may be required during international travel at border crossings. Some countries require all arriving travellers to show proof of yellow fever vaccination, while other countries require some travellers arriving or in transit from countries where yellow fever occurs to show proof of vaccination.

In order for the International Certificate of Vaccination for yellow fever to be considered valid, it must indicate that the individual was vaccinated at least 10 days prior to the date of entry to the country that requires proof of vaccination. As mentioned above, it takes 10 days for the vaccine to become protective.

Countries requiring the International Certificate of Vaccination for yellow fever are listed in the tables below.

Prevention & personal precautions

Vaccination is the single most important measure for preventing yellow fever. Mosquito-control precautions will decrease the risk of exposure to the yellow fever virus.

Vaccination
Health Canada strongly recommends travellers obtain an individual risk assessment with a travel medicine physician to determine both their risk of exposure to yellow fever and their need for official proof of vaccination as determined by their travel itinerary.

Mosquito-control precautions
Taking the following personal precautions may reduce the risk of exposure to day-time biting mosquitoes:

• remain in well-screened or completely enclosed, air-conditioned areas;
• wear light-coloured clothing with full-length pant legs and sleeves; and
• use insect repellent on exposed skin.

The use of insect repellent on exposed skin is strongly recommended. Of the insect repellents registered in Canada, those containing 'N, N diethyl-m-toluamide' (DEET) are the most effective. Although the concentration of DEET varies from product to product, repellency rates are largely equivalent. In general, higher concentrations protect for longer periods of time, but there is little advantage in the duration of repellence with DEET concentrations greater than 50%, and there may be additional risk of toxicity with higher concentrations. New micro-encapsulated products containing 33% DEET are registered in Canada, and they should provide up to 8 hours of protection.

Children and DEET
In rare instances, application of insect repellents with DEET has been associated with seizures in young children (only 14 cases over 30 years of DEET use and billions of applications every year). The actual concentration of DEET varies among repellents and can be as high as 95%. However, repellents with DEET concentrations of 10% are very effective and should last 3 to 4 hours. Therefore, for children, DEET in a concentration of 10% or less should be applied sparingly to exposed surfaces only and washed off after children come indoors.

The likelihood of adverse reactions can be minimized by the following precautions:

• apply repellent sparingly and only to exposed skin;
• avoid applying high concentration products;
• avoid applying repellents to portions of children's hands that are likely to contact the eyes or mouth;
• never use repellents on wounds or irritated skin; and
• wash repellent-treated skin after children come indoors. If a reaction to insect repellent is suspected, wash treated skin and seek medical attention.

In Canada, DEET products are not recommended for use in children less than 2 years of age. Click here for more information on insecticide use.

Some things to think about...
While yellow fever is rare in travellers, some unvaccinated travellers have died from this disease. Serious delays - and serious health risks - can result if a traveller arrives in some countries without official proof of vaccination. Remember: yellow fever vaccination, when required, must be obtained at least 10 days before departure.

For more information...

• For maps of yellow fever-endemic areas, visit the World Health Organization's online publication International Travel and Health: Vaccination Requirements and Health Advice at http://www.who.int/ith/english/index.htm.
• For general information about other immunizations recommended for travel outside of Canada, click here.
• For more Know before you go! information, click here.

• The Travel Immunization Record is a practical booklet that helps you keep track of routine and specialized immunizations. To find out how to order a Travel Immunization Record (cost: $3.50 plus tax, shipping & handling), contact the Health Resources Centre, Canadian Public Health Association by email at hrccds@cpha.ca or by phone at 613-725-3769.
  

 SOURCE: http://www.phac-aspc.gc.ca/index-eng.php