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HEALTH-PARAGUAY: Vaccination, Anyone?

David Vargas

ASUNCION, Mar 25 2008 (IPS) - Now that the panic that broke out after the reappearance of yellow fever in Paraguay for the first time in 34 years has died down, health authorities are facing the challenge of expanding vaccination against the disease.

At least 1.5 million people have been vaccinated against yellow fever since the government declared a state of national emergency in mid-February, out of a population of six million.

The intensity of the vaccination campaign has eased considerably since early February, when people stood in long lines outside health centres and voices were raised angrily to complain about the shortage of vaccines.

But now that vaccines are abundant, thanks to donations from other countries in the region, the authorities complain that people are reluctant to get vaccinated, especially in Asunción and nearby towns, and in the northern province of San Pedro, considered high-risk areas because they have accounted for the largest number of cases.

Deputy Health Minister Antonio Barrios told IPS that “it’s a disgrace that people are not coming in to be vaccinated, now that we have the vaccines. The health posts are practically empty.”

Since the first case was reported in early February, the Health Ministry has reported eight deaths, 24 confirmed cases and another 11 suspected cases.

Paraguay received two million vaccines from a World Health Organisation (WHO) programme, which were added to 800,000 sent from Brazil, 144,000 from Peru, 100,000 from Venezuela, 50,000 from Bolivia and 50,000 from Cuba.

The government has issued an urgent call for people to get vaccinated.

With respect to those who visited more remote provinces during Easter week, the deputy health minister told IPS that “not only do they run a risk of getting the disease, but also of becoming carriers in areas where there have been no cases.”

In the view of some public health experts, the poor response to the campaign is a reflection of the government’s lack of effectiveness in prevention efforts.

Desirée Masi, vice president of Paraguay’s medical association, told IPS that the failure of the preventive measures was a consequence of a poorly designed and implemented awareness-raising strategy.

“The message is designed exclusively for the urban population, which has access to the media, unlike many Paraguayans,” she said. “A serious study on social communication has not yet been conducted. What we have to ask is why mosquito breeding grounds are still being found.”

Both yellow fever and dengue fever, which claimed 17 lives in 2007, out of a total of 28,000 cases, are viral diseases transmitted by the Aedes aegypti mosquito, which lives in tropical and subtropical areas of Africa and the Americas.

The incubation period for yellow fever in humans is between three and six days. In mild cases, it causes fever and chills, headache, back pain, general muscle aches, nausea, fatigue, weakness and vomiting. But in severe cases patients can experience bleeding (hemorrhagic symptoms), heart, liver and kidney problems. Liver failure causes jaundice (yellowing of the skin and the whites of the eyes), which gives yellow fever its name.

According to the U.S. Centres for Disease Control and Prevention, “when epidemics occur in unvaccinated populations, case-fatality rates range from 15 percent to more than 50 percent.”

Dr. César Pimienta, a member of the National Federation of Health Workers, said the Health Ministry’s efforts have been “improvised,” and that it has not carried out an adequate public education campaign for eliminating mosquitoes, the carriers of the disease.

“If there are mosquitoes, that means prevention and clean-up efforts have failed,” he told IPS.

“Although they were able to combat dengue last year, they forgot about yellow fever, and now we are witnessing an epidemiological catastrophe,” said Pimienta.

Public Health Professor Felipe Recalde at the National Health Institute said it is essential to step up citizen participation in the fight against the disease.

“Most of us have been waiting for the institutions to come to our houses to do what we should be doing,” he said.

Every day, dozens of health brigades are going door to door in neighbourhoods in the capital, eliminating potential breeding grounds for the Aedes aegypti mosquito, which lay its eggs in clean water that has accumulated in containers like discarded tires, flower pots or old oil drums in shady areas close to human dwellings.

“What are missing are a perception of risk and a public sense of responsibility. The media have a key role to play, but the Health Ministry and other bodies must guide and educate public opinion,” said Recalde.

The Health Ministry has come under fire from different sectors.

The Dengue Victims Association has launched a petition drive calling for the removal of Health Minister Óscar Martínez, who they accuse of negligence and of being incapable of handling the situation.

In mid-March, assistant ombudsman Édgar Villalba sent a letter to the minister urging him to resign because of his “demonstrated incapacity” to deal with the outbreak of the disease.

The WHO estimates that 200,000 people a year fall ill with yellow fever and 30,000 die worldwide.

Brazil was the first country in South America to suffer an outbreak of the disease, in late 2007.

According to a report by the Brazilian Health Ministry, 35 cases and 19 deaths have been confirmed since the alarm was sounded on Dec. 16.

In Argentina there have been three confirmed cases, including one death in the northeastern province of Misiones, and vaccination has begun. The country’s northern jungle regions are on alert. The last officially documented case of yellow fever in that country was in 1841.

Bolivia, where eight cases of yellow fever were documented in 2007, six of which were fatal, has stepped up vigilance along the border with Brazil.

Authorities in Uruguay, where the last known case of yellow fever dates back to 1929, have recommended that people be vaccinated before travelling to the parts of Brazil where cases of the disease have been reported.

Environmentalists say the reappearance of yellow fever in this region is partly due to climate change.

Elías Díaz Peña with the ecological group Sobrevivencia (Survival), said deforestation produces major changes in biological cycles and ecosystems, which leads in turn to migration of disease carriers like mosquitoes to urban areas.

“And in the particular case of diseases transmitted by animals, there are specific examples of tropical illnesses like leishmaniasis, malaria, equine encephalitis, and rabies” seen in areas where they were not previously found, she told IPS.

“When the forests are cleared, the insects move to settled areas in search of food,” she explained.

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