(task) Brazil Yellow Fever Outbreak Spawns Alert: Stop Killing the Monkeys - The New York Times

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Brazil, Yellow Fever, Epidemic, Disease Surveillance, One Health
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> https://www.nytimes.com/2017/05/02/world/americas/brazil-yellow-fever-monkeys.html?_r=0 <https://www.nytimes.com/2017/05/02/world/americas/brazil-yellow-fever-monkeys.html?_r=0>
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> Brazil Yellow Fever Outbreak Spawns Alert: Stop Killing the Monkeys
> By SIMON ROMERO <https://www.nytimes.com/by/simon-romero>MAY 2, 2017
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> Yellow fever is threatening species at risk of extinction, like the golden lion tamarin, which lives in the forests of Rio de Janeiro State. Dado Galdieri for The New York Times
> RIO DE JANEIRO — As fears spread in Brazil <http://topics.nytimes.com/top/news/international/countriesandterritories/brazil/index.html?inline=nyt-geo> over the resurgence of yellow fever <http://health.nytimes.com/health/guides/disease/yellow-fever/overview.html?inline=nyt-classifier>, health officials are issuing a warning: Stop killing the monkeys.
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> Some assailants clubbed monkeys to death in panicked reactions to Brazil’s most alarming outbreak in decades of a virus that haunted the country in the 19th and early 20th centuries. Authorities found other monkeys dead with fractured skulls after having been being attacked with stones. One monkey was burned to a crisp.
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> Infectious disease specialists say people are taking aim at the wrong target. M <https://www.cdc.gov/yellowfever/transmission/index.html>osquitoes, not monkeys, are actually the vector for the virus <https://www.cdc.gov/yellowfever/transmission/index.html>, and the monkeys are dying from yellow fever in much higher numbers than people in Brazil. Those who kill the monkeys are making matters worse by depleting primate populations that serve as beacons for where yellow fever is spreading, epidemiologists said.
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> “They’re putting human beings at greater risk by killing the messenger,” said Renato Alves, an official in Brazil’s Health Ministry who is tracking the outbreak. “Monkeys are a crucial alert mechanism that we monitor to deploy vaccines and prevention efforts to the right places.”
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> Joaquim Santos de Oliveira, 42, contracted yellow fever along with his brother Watila dos Santos, who died from the virus in Casimiro de Abreu, an area in the interior of Rio de Janeiro State. Dado Galdieri for The New York Times
> Authorities’ pleas to stop killing monkeys <https://twitter.com/saudespimprensa/status/851834900860809218> in Brazil, which has the richest primate diversity <https://books.google.com.br/books?id=unODoWa7CM4C&pg=PA12&lpg=PA12&dq=brazil+%22primate+diversity%22&source=bl&ots=lv978WS_i2&sig=dr9LRJLjbFEs6dsOePN7g47No0c&hl=en&sa=X&ved=0ahUKEwje0pmIqJ_TAhUBH5AKHSFpC4gQ6AEIRjAG#v=onepage&q=brazil%20%22primate%20diversity%22&f=false> of any country, comes amid widespread concern over the newfound vigor of a virus that ranked among the largest public health threats here before mass vaccination programs began in the 1940s.
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> Yellow fever, which can include symptoms like jaundice <http://health.nytimes.com/health/guides/symptoms/jaundice-yellow-skin/overview.html?inline=nyt-classifier>, high fevers and multiple organ failure, has killed at least 240 people <http://portalarquivos.saude.gov.br/images/pdf/2017/abril/28/COES-FEBRE-AMARELA-INFORME-38.pdf> in recent months, Brazil’s Health Ministry said. The disease, normally found in parts of the Amazon River Basin, has spread to the country’s most populous states: Minas Gerais, Rio de Janeiro and São Paulo.
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> As yellow fever made the leap out of the Amazon, the authorities in several areas of southeastern Brazil reported episodes in recent weeks of monkeys being killed <http://g1.globo.com/sp/bauru-marilia/noticia/laudo-aponta-que-macacos-mortos-em-bauru-nao-tinham-virus-da-febre-amarela.ghtml?utm_source=dlvr.it&utm_medium=twitter> illegally <http://g1.globo.com/sp/bauru-marilia/noticia/laudo-aponta-que-macacos-mortos-em-bauru-nao-tinham-virus-da-febre-amarela.ghtml?utm_source=dlvr.it&utm_medium=twitter>, involving a range of methods <http://diariodoaco.com.br/ler_noticia.php?id=47485&t=macacos-estao-sendo-mortos-por-tiros-ou-veneno> including poisoning and hunting down <http://g1.globo.com/jornal-nacional/noticia/2017/02/com-medo-da-febre-amarela-moradores-de-minas-matam-macacos.html> the primates with rifles or clubs.
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> The killings reflect broad misunderstanding in Brazil about how yellow fever spreads. Cases that are sylvatic, or in the wild, involve monkeys that are infected by mosquito species inhabiting the forest canopy.
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> The same mosquitoes then transmit the virus to humans who make incursions into jungles, like gold prospectors, hunters or loggers. Such outbreaks are often relatively small. While yellow fever is often asymptomatic in humans, patients who develop severe symptoms can die within seven to 10 days.
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> From left, Natalia Ribeiro, Oberlan Junior and Elisama Moraes used an RF antenna to locate golden lion tamarins in a conservation area in Silva Jardim, Brazil, last month. Dado Galdieri for The New York Times
> “People in regions where yellow fever is on the march often don’t realize how crucial monkeys are in informing us about the disease,” said Danilo Simonini Teixeira, the president of the Brazilian Society of Primatology.
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> Monkeys have died in much higher numbers than humans in Brazil’s current sylvatic outbreak. Brazilian authorities estimate that over 4,400 monkeys have died from yellow fever in recent months; subspecies like southern brown howler monkeys <http://www.icmbio.gov.br/portal/faunabrasileira/estado-de-conservacao/7179-mamiferos-alouatta-guariba-clamitans-guariba-ruivo> are especially vulnerable.
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> While the outbreak has many people in Brazil on edge, virus specialists fear the possibility that yellow fever could spin out of control by spreading rapidly around cities, stirring ghosts of epidemics that devastated urban areas like Rio de Janeiro more than a century ago.
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> In urban outbreaks, infected people often introduce yellow fever into heavily populated areas where the virus can be transmitted by Aedes aegypti mosquitoes, the same devilishly resilient species <https://www.theatlantic.com/science/archive/2016/04/aedes-aegypti/479619/> that spreads viruses like chikungunya, dengue and Zika <http://www.nytimes.com/news-event/zika-virus?inline=nyt-classifier>.
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> While Africa has recently faced such urban outbreaks, including a 2016 <https://www.nytimes.com/2016/12/05/health/yellow-fever-africa-vaccine.html>epidemic <https://www.nytimes.com/2016/12/05/health/yellow-fever-africa-vaccine.html> in Angola, they are rare in South American cities. In 2008, epidemiologists found yellow fever transmission by Aedes aegypti in Paraguay’s capital, Asunción. T <http://www.paho.org/bulletins/index.php?option=com_content&view=article&id=161%3Aoutbreak-of-yellow-fever-in-paraguay&lang=en>he last confirmed urban outbreak <http://www.paho.org/bulletins/index.php?option=com_content&view=article&id=161%3Aoutbreak-of-yellow-fever-in-paraguay&lang=en> of yellow fever in the Americas was previously thought to be during the 1940s.
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> Dr. Rosaura Leite Rodrigues prepared to perform a necropsy on a green monkey at the Jorge Vaitsman Veterinary Institute in Rio de Janeiro last week. Yellow fever has killed at least 240 people and over 4,400 monkeys in recent months. Roberta de Oliveira Resende
> As the authorities grapple anew with yellow fever in Brazil, they are voicing relief that it has not evolved into an urban outbreak. Nearly 19 million doses of vaccine are being distributed in areas where the virus is spreading. The World Health Organization <http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_health_organization/index.html?inline=nyt-org> is also providing Brazil with 3.5 million doses of the vaccine from its emergency stockpile.
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> In addition to urging people to get vaccinated and to stop killing monkeys, Brazilian officials are telling people to eliminate places with stagnant water where mosquitoes can breed, like discarded tires or shower floors. Still, in impoverished parts of Brazil where yellow fever has hit hard, some say that the authorities have been slow to act.
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> “It’s clear that hunting monkeys is wrong, but when monkeys started showing up dead from yellow fever the vaccinations <http://health.nytimes.com/health/guides/specialtopic/immunizations-general-overview/overview.html?inline=nyt-classifier> should have started,” said Dalila de Oliveira, 30, a manicurist. Her cousin Watila dos Santos, a 38-year-old construction worker, died in March from the virus in Casimiro de Abreu, an area in the interior of Rio de Janeiro State.
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> “He went to the public hospital and was mistakenly diagnosed with sinusitis <http://health.nytimes.com/health/guides/disease/sinusitis-chronic/overview.html?inline=nyt-classifier>,” Ms. Oliveira said. “The authorities could have been more aggressive about preventing this tragedy, but they preferred to minimize the situation.”
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> Brazil’s health minister, Ricardo Barros, acknowledged in an interview that fewer people would have died in recent months had the government responded more vigorously in the outbreak’s early stages.
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> A farmer on his land near Silva Jardim. Deforestation and climate change may be among the factors that have contributed to the yellow fever outbreak this year. Dado Galdieri for The New York Times
> “There may have been a failure in the vaccination blockade after the first monkeys began showing up dead in Minas Gerais,” said Mr. Barros, referring to the Brazilian state that has been hardest hit in the outbreak, with more than 160 fatalities.
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> Infectious disease specialists are trying to determine why yellow fever is emerging with greater ferocity this year in Brazil. Dr. Anna P. Durbin, a researcher at Johns Hopkins Bloomberg School of Public Health, said a combination of factors might be in play, including climate change and the deforestation <https://www.nytimes.com/2017/04/06/world/americas/special-ops-with-a-studious-bent-fight-destruction-of-brazils-amazon.html?rref=collection%2Fbyline%2Fsimon-romero&action=click&contentCollection=undefined&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=collection> of areas that serve as buffer zones between tropical jungles and urban areas.
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> “A big concern is for the virus to jump the Panama Canal” into Central America, Dr. Durbin said.
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> The virus may also have the potential to spread <http://www.nejm.org/doi/full/10.1056/NEJMp1702172#t=article> to Puerto Rico and cause travel-related cases in the continental United States, Dr. Anthony S. Fauci and Dr. Catharine I. Paules, both of the National Institute of Allergy and Infectious Diseases, said recently in The New England Journal of Medicine. In late April, the Centers for Disease Control and Prevention warned of a shortage <https://www.cdc.gov/mmwr/volumes/66/wr/mm6617e2.htm?s_cid=mm6617e2_w> of yellow fever vaccine in the United States because of recent manufacturing problems.
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> As epidemiologists monitor yellow fever’s advance into parts of Brazil, monkeys are still turning up dead <http://www.diarionf.com/noticia-10162/macae:-dois-macacos-sao-achados-mortos-no-parque-atalaia>, either at the hand of man <http://g1.globo.com/sp/bauru-marilia/noticia/laudo-aponta-que-macacos-mortos-em-bauru-nao-tinham-virus-da-febre-amarela.ghtml?utm_source=dlvr.it&utm_medium=twitter> or as a result of the virus. Researchers say the virus is threatening species already at risk of extinction, like the golden lion tamarin <http://www.iucnredlist.org/details/11506/0>, which lives in the forests of Rio de Janeiro State.
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> Karen Strier, an anthropologist at the University of Wisconsin who has studied monkeys <http://news.wisc.edu/yellow-fever-killing-thousands-of-monkeys-in-brazil/> in the Atlantic Forest in Brazil since the 1980s, said she had never seen monkeys die from disease in such high numbers. She described a “sense of emptiness” in a reserve near Caratinga in Minas Gerais State, where howler monkeys had largely vanished.
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> Correction: May 2, 2017
> An earlier version of this article misspelled the given name of a woman whose cousin died of yellow fever. She is Dalila de Oliveira, not Danila.