An expanding yellow fever outbreak has prompted the U.S. Centers for Disease Control and Prevention to strengthen its advice to Brazil-bound travelers.
"Be protected or don't go," Dr. Marty Cetron, director of global migration and quarantine at the CDC, said in a press call Friday, urging anyone planning a trip to the area to get vaccinated, but a worldwide shortage of yellow fever vaccines is compounding the issue.
The Chattanooga-Hamilton County Health Department's International Travel Clinic is the nearest site in the region now offering yellow fever vaccines. The next closest locations are in Knoxville, Nashville, Birmingham or Atlanta.
Michelle Donahoe, immunization program nurse manager for the health department, said running out of vaccines isn't a concern, but travelers should call at least six weeks in advance to schedule an appointment and allow the vaccine time to become effective.
"If they're going in the summer, now is the time for them to be coming in and getting their vaccines," Donahoe said.
Yellow fever is spread by mosquitoes and found in parts of South America and Africa. The virus is characterized by a high fever and jaundice — yellowing of the skin and eyes — that can cause serious health consequences, including death.
Brazil's outbreak began in 2016, but virus activity has since ramped up and infiltrated urban, tourist destinations including Sao Paulo and Rio de Janeiro.
Brazilian health officials recently confirmed more than 920 cases of yellow fever, including more than 300 deaths during the outbreak. So far in 2018, at least 10 unvaccinated travelers from Europe and South America have contracted yellow fever in Brazil, with eight cases originating from the popular tourist island Ilha Grande. Four of these cases ended in death.
Cetron said this number of travel-related cases, deaths and the transmission intensity has created an "unprecedented" risk for travelers.
"This number of travelers getting yellow fever from visiting the same general area at around the same time is highly unusual and suggests that Ilha Grande is an exceptionally hot spot for yellow fever virus transmission," Cetron said.
Donahoe said the health department constantly monitors yellow fever and other outbreaks around the globe to serve as a community resource. The travel clinic offers hourlong consultations overviewing information tailored to the destination, such as what to pack, needed vaccines, food and water precautions and mosquito protection strategies.
"There's other insect-borne illness, not just yellow fever, that can be in certain countries that we educate people about, like dengue, chikungunya, Zika," Donahoe said.
The cost depends on insurance, but the maximum out-of-pocket cost for the yellow fever vaccine and consultation is $186. A travel consultation by itself is $21 and no vaccines are required.
As warm weather arrives, many of the mosquito management tactics — applying repellent, wearing long sleeves, eliminating standing water — apply to the Chattanooga region, as well.
"People think mosquitoes are just pesky and they make you itch, but there's definitely diseases that we want to prevent spreading, and that's one of our goals in public health," Donahoe said. "We want people to protect themselves."
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.
This story has been corrected to fix the spelling in Michelle Donahoe's last name.