HEALTH-PARAGUAY:
Vaccination, Anyone?
By David Vargas
ASUNCION (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. |
