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Travelers' alert: Why you might have to have the yellow fever vaccine

People travel from as far away as the Lower Peninsula of Michigan and southern Wisconsin to be vaccinated at St. Luke's in Duluth.

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(Getty Images / News Tribune)

Planning to travel to Sierra Leone?

You won’t get in if you haven’t been vaccinated for yellow fever.

The West African nation is one of 17 that won’t allow people to enter if they haven’t been vaccinated for the disease, according to the website passporthealthusa.com .

According to Sherry Johnson, a nurse practitioner with St. Luke’s Infectious Disease Associates, that distinction doesn’t belong to any other vaccine. Lack of a measles vaccination won’t get you automatically barred from entrance anywhere. Nor will lack of a hepatitis vaccination.

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(There are exceptions to everything. If you are traveling to Saudi Arabia to participate in the Muslim Hajj, you’ll be required to have the meningococcal meningitis vaccine, Johnson said, because so many people are crowded together for that pilgrimage.)

But here’s the odd thing: The yellow fever vaccine isn’t easy to get. And it’s not actually approved in the United States.

Johnson said, and the U.S. Centers for Disease Control and Prevention website confirmed , that it’s only available in two places in northern Minnesota: Essentia Health-St. Joseph’s Clinic in Brainerd and through her at St. Luke’s.

Not only that, but for 18 months until last June, it was available only in Brainerd.

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Sherry Johnson

“I don’t know if it had to do with the fact that I kept checking,” Johnson said in an interview last week about the yellow fever vaccine drought. “(I said), we need yellow fever vaccine.

Our population really does quite a bit of traveling, given our population. We have a lot of colleges. We have business travelers, we have manufacturing people. We have a lot of people that travel for pleasure. We have people that travel for school. We have missions — you know, public service types.”

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To be clear, if you’re staying in the Upper Midwest, or your travel plans keep you in North America, this is a vaccine you’ll never need. Although yellow fever outbreaks occurred in Florida in the 1700s and 1800s, it hasn’t been seen since, according to the Florida Department of Health . The last outbreak in this country was in 1905, in New Orleans.

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Travelers to much of the world, including the most popular destinations, also don’t need the vaccination.

But in much of Africa and South America it’s recommended even where it’s not required, Johnson said.

“Not all countries have yellow fever in those areas, but many do, especially around the equator,” she said.

Although there’s a risk for contracting yellow fever in only a limited part of the world, Johnson said she provides the injection fairly often. “I will give probably four or five doses of yellow fever vaccine just today,” she said during an interview last week.

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That is, in part, because St. Luke’s draws from such a large area for this vaccine. Johnson sees people from as far away as the northern part of Michigan’s Lower Peninsula, southern Wisconsin and Thunder Bay, Ontario, she said.

The vaccine is available under curious circumstances. It’s made by a French firm, Sanofi Pasteur , Johnson explained. About three years ago, Sanofi closed down production of the only yellow fever vaccine licensed in the U.S., favoring a newer vaccine called Stamaril. Although Stamaril is registered and distributed in more than 70 countries, it’s not licensed by the U.S. Food and Drug Administration. But the FDA did allow a limited amount of Stamaril to be provided in the U.S. under what’s known as its investigational new drug program.

“And so when I explain it to patients, I tell them it’s an expanded access program,” Johnson said. “It’s not an experimental drug. And there’s a script that I have to go over, and they have to sign a waiver that says they understand.”

According to the CDC’s website , Sanofi plans to again produce the vaccine that’s licensed in the U.S., which is known as YF-Vax. The manufacturer said it will provide an update by the second quarter of this year.

But Johnson is allowed 115 doses a month, which is an ample supply, she said.

Depending on the insurer, yellow fever may be covered, she said. If you have to pay, it’ll burn a $350 hole in your pocket. But it’s a one-time hole, because the vaccine is good for life. That said, individuals who spend a lot of time outdoors in the affected areas might want to get a fresh shot after 10 years, Johnson added.

It’s a live-virus vaccine, so it can give an individual flu-like symptoms for a couple of days, she said. It can’t be given to anyone younger than 9 months old. There’s no cutoff at the other end of the age spectrum, but side effects could be more severe for people 60 and older.

You should get it at least 10 days before you travel, the CDC says.

Johnson or whichever health professional gives you the vaccination then will give you a certificate, ironically known as the “yellow card.”

If you travel to Sierra Leone or one of the 16 other countries, you’ll need to have that card at the ready.

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(cdc.gov)

What is yellow fever?

Yellow fever is transmitted by the bite of a particular species of mosquito now found only in some African and South American countries, Johnson said.

The culprit mosquito is Aedes aegypti, which has never been found in Minnesota, said Dave Neitzel, supervisor of the vector-borne diseases unit of the state Department of Health. "This same mosquito transmits Zika and dengue viruses, so we are glad that they are unlikely to survive Minnesota winters," Neitzel wrote in an email.

With most cases of yellow fever, no symptoms occur, according to the U.S. Centers for Disease Control and Prevention website. When there are symptoms, they typically appear within three to six days of infection and may include sudden onset of fever, chills, severe headache, back pain, general body aches, nausea, vomiting, fatigue and weakness.

Symptoms generally last about a week, although for some people weakness and fatigue might last for several months.

In one out of seven cases of those who experience the initial symptoms, there will be a brief remission and then a more severe form of the disease will set in, according to the CDC. Then, symptoms will include high fever, yellow skin (jaundice), bleeding, shock and organ failure. Between 30-60% of those cases end in death.

The seventeen

The countries that cannot be entered without proof of yellow fever vaccination, according to the website passporthealthusa:

  • Angola

  • Burundi

  • Cameroon

  • Central African Republic

  • Cong, Republic of the

  • Côte d’Ivoire

  • Democratic Republic of Congo

  • French Guiana

  • Gabon

  • Ghana

  • Guinea-Bissau

  • Liberia

  • Mali

  • Niger

  • Sierra Leone

  • Togo

  • Uganda

To learn more

Sherry Johnson of St. Luke’s Infectious Disease Associates recommends people traveling to other countries get updated information from the CDC’s traveler’s health website: cdc.gov/yellowfever

Visit the St. Luke’s International Travel Clinic online at slhduluth.com/locations/st-lukes-international-travel-health/ or call 218-249-7990.

Related Topics: HEALTHTRAVELTOURISM
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