3-5 July 2019 Round Table: Homage Ricardo Galler HISTORY OF YELLOW - - PowerPoint PPT Presentation

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3-5 July 2019 Round Table: Homage Ricardo Galler HISTORY OF YELLOW - - PowerPoint PPT Presentation

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REGIONAL MEETING RIIP-AMERICAS 3-5 July 2019 Round Table: Homage Ricardo Galler HISTORY OF YELLOW FEVER 334 Years Yellow Fever in Brazil: and continues causing epidemic Akira Homma Assessor Cientfico Senior Bio-Manguinhos/Fundao

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Akira Homma Assessor Científico Senior Bio-Manguinhos/Fundação Oswaldo Cruz Ministério da Saúde

REGIONAL MEETING RIIP-AMERICAS 3-5 July 2019 Round Table: Homage à Ricardo Galler HISTORY OF YELLOW FEVER 334 Years Yellow Fever in Brazil: and continues causing epidemic

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Flavivirus Genome Organization

Chambers et al., 1990 2

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MOLECULAR ANALYSIS OF YF VACCINE STRAIN

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COMPLETE NUCLEOTIDE SEQUENCE OF 17D AND 17DD STRAINS

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THE MOLECULAR BASIS OF VIRAL ATENUATION AND ITS USE AS EXPRESSION VECTOR

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Yellow Fever - Origin

  • Yellow Fever vírus harbored in Monkeys - West Africa
  • First YF epidemic recorded in Yucatan in 1648,

suggestion that mosquito vector and vírus introduced during the slave trade 371 years ago

  • The term “yellow fever” used first in 1750 – oubreak

Barbados

  • 18th Century – YF became a major problem for colonial

settlements is the Americas

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Yellow Fever - Origin

  • 1793 – YF epidemic in Philadelphia, 10% of the

populations died

  • 1878 – 13.000 deaths in Mississippi Valley
  • Throughout 18th and 19th centuries caused several

epidemics/deaths in several regions in USA

  • USA, Spain, France, England, Italy, West Africa

 Increase of navigation, slave trade, disseminated vector and vírus

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Carlos Finlay and vector discovery

  • 1881, Carlos Finlay presented at the Cuban Royal Academy of

Science the theory of mosquito transmission of Yellow Fever

  • 1900, Yellow Fever Commission – W. Reed, Carrol, Lazear &

Agramonte, showed YF control through A. aegypti control

  • 1901, eradicated YF and vector from Cuba and lately from

Panamá Canal

  • 1901, Reed & Carrol - experiments on human volunteers in Cuba,

demonstrating the filterable agent transmited by A. aegypti – the

  • 1st. demonstration of a virus causing disease

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Yellow Fever - 200,000 cases annualy and 30,000 deaths

Yellow Fever – endemic regions

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YF in Americas and 334 years in Brazil, since 1685

Year/period Type of event Event Geographical location

3000 BP

Probable origin of yellow fever in Africa, according to modern sequence analysis of the viral genome.[11]

Africa

1494

Epidemic Disease outbreaks similar in signs and symptoms to yellow fever are reported from Canary islands and Cape Verde off the coast of Africa, and sometimes in coastal countries such as Gambia, and Sierra Leone.[2]

West Africa

1647

Epidemic The first definitive outbreak of yellow fever in the Americas happens in the island of Barbados

Barbados

1648

Epidemic An outbreak is recorded by Spanish colonists in the Yucatán Peninsula, where the indigenous Mayan people call the illness xekik ("blood vomit"). Yellow fever is found in Mayan manuscripts describing an

  • utbreak of the disease in the Yucatan

peninsula.[7][3]

Mexico

1649

Epidemic Yellow fever is brought in ships to and from Africa and the West Indies, to Gibraltar.[2]

Gibraltar

1668

Epidemic The first yellow fever outbreak in English- speaking North America occurs in New York City.[3]

United States

1669

Epidemic English colonists in Philadelphia and the French in the Mississippi River Valley record major outbreaks of yellow fever.[citation needed] United States

1685

Epidemic

Brazil suffers its first yellow fever epidemic, in Recife.[12]

Bethell, Leslie. Colonial Brazil. Cambridge University Press 1987

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Yellow Fever in Brazil – epidemiological and control

1685 1849

1685 – Recife - ship from Green Cape, via Santo Domingo – dissemination of epidemic waves with thousand of deaths. Spread-out to other geographic regions 1849 – Introduction of YF in Rio de Janeiro brought by USA Navarre ship, coming from Bahia with sick people

1850 1876 1873

1850 – 266,000 inhabitants – 90,658 sick & 15,000 death 1873 – 3,659 death 1876 - 3,476 death

1903 1907 1958 1942

1903 - Oswaldo Cruz assigned by Rodrigues Alves as Director of Health Services

  • Adopt Carlos Finlay theory of Aedes aegypti vector transmission
  • Establish YF Prophylaxis Service (YFPS):

. Mosquito-kill Brigade; Sulphur and píretro; . Isolation of sick people in São Sebastião Hospital; . YFPS adopt the Fire Corps procedures;

1907 - Eradication of the urban vector Aedes aegypti and Yellow Fever from the city of Rio de Janeiro 1942 – Sena Madureira, Acre – the last urban YF case in Brasil – 69 years without urban YF cases Brazil has erradicated Aedes aegypti in two

  • ccasions – 1958 and 1973

1937

1937, YF vaccination starts in Brazil

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Elaborated by Possas et al, Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation Mem. Inst. Oswaldo Cruz vol.113 no.10

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Yellow Fever Risk Areas with recommendation for vaccination, 1997 to 2008 Fonte: SVS/MS.

Brazil – Evolution of Risk areas, 1997 to 2008

1997 2008

Endemic Transition Indene

YF immunization recommended YF immunization not recommended

Potential risk

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Yellow Fever in Brazil1 01/01/2019 to 21/05/2019

Human cases notified: 1239 82 confirmed – 14 deaths 367 under investigations 790 discardeds

Epizooties in NHP: 1157 notified 48 confirmed 305 under investigation 410 not determined 394 discarded

Fonte: Ministério da Saúde, Informe n o 17 de 3 junho de 2019.

1 por município do local provável de infecção e/ou de ocorrência, no Brasil, entre as semanas epidemiológicas 01 e

20/2019.

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Fonte: SVS/MS COES 32 16/03/2017 Slide cedido pro Carla Domingues

Regions recommended for YF Vaccination Brazil, 2017. Vaccination coverage Brazil, 2007 a 2016**

Risk areas and vaccination coverage

Fonte: SIAPI/CGPNI * ACRV = Área Com Recomendação De Vacinação (3.529 municípios) ** fevereiro de 2017, preliminar 2007 a 2016

ASRV, Área sem Recomendação de Vacinação

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Yellow Fever cases in Brazil in recent years

  • July 2016 up to 07 february 2017

– 509 cases - 159 deaths

  • July 2017 up to 30 june 2018

– 7.518 cases notified – 5. 364 cases discarded – 718 in investigation – 1.376 cases confirmed – 483 deaths

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Confirmed YF cases in 2019

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Source: Possas et al, Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation Mem. Inst. Oswaldo Cruz vol.113 no.10

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Elaborated by Possas et al, Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation Mem. Inst. Oswaldo Cruz vol.113 no.10

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18 76 190 204 221 222 225 227

December 1933. Minced tissue were inoculated with monkey sera infected with Asibi strain

18 passages in minced mouse embryo tissue 58 passages in minced whole chick embryo 130 designated 17D strain 114 passages using chick embryo without nervous tissues 195 begin the 17DD strain 1936 - At 227th and 229th passages – experimental vaccination in Rockefeller Foundation employees. Acceptable tolerability, development of neutralizing antibodies

YF 17 D vaccine strain - attenuation of Asibi strain

passages using chick embryo tissues without head and spinal cord and normal monkey or human serum

30/06/1927 ASIBI virus, Mahaffi & Bauer 54 passages in rhesus monkeys

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Monath, T. In Vaccine, Plotkin S. Orenstein W & Offit Paul, 2008

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Vaccination at Fazenda Pedra Preta, on Três Pontas, MG, August 15, 1937

  • 1937 March - H. Smith brought 17D strain and started the vaccine production

in Brazil – Henrique de Azevedo Penna, the Brazilian partner  One year later > 60.000 people vaccinated  Smith, Penna e Paoliello, concluded “ there exists a safe method for production of YF vaccine in large scale”.

  • Bica, Alfredo, Anais Simpósio 50 aniversário da introdução da cepa 17 D no Brasil, 1988

Yellow Fever Vaccine in Brazil

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  • From 1937 to 1986 – 154.383.814 vacinated

– Rodopiano de Oliveira, A. In Anais Simpósio 50 aniversário da introdução da cepa 17 D no Brasil, 1988

  • From 1987 to 2018 – 693.427.980 doses supplied

to the National Immunization Program

  • 2019 – 40.183.000 doses – 19.176.500 doses

already delivered

  • CMO Libbs - 22 million doses annually
  • Derem/Bio-Manguinhos, 2011

Production and use of YF vaccine in Brazil

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Vacina FA – Exportation after WHO Pre-Qualification

Total: 72 países

Source: Derem/Bio-Manguinhos, 2011

 2001-2018 > 154.668.250 million of doses

America Central, America do Norte e Caribe 23 países. Africa 26 countries America do Sul 11 paises Asia 10 paíse Oceania 1 país

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 International data  Rare severe adverse events:

Viscerotropic events (0,3/100.000 doses); Neurologic events (0,4/100.000 doses); Anafilaxis (0,8/100.000 doses) Not indicated: allergic to egg components; imunocompromised; children < 9 meses; eldery >59 anos

Fonte: Hayes EB, 2007

Adverse events YF 17DD vaccine

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Muito obrigada pela atenção !!

Sandra.deotti@saude.gov.br

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In memorian Dr Reinaldo Martins Menezes

  • Clinical studies
  • Pharmacovigilance
  • Yellow Fever Vaccine
  • Dose-response study
  • Duration of immunity dose-

response

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Obrigado!

akira@bio.fiocruz.br http://www.bio.fiocruz.br/