Despite fewer cases in Minas Gerais and Espirito Santo, Brazil has confirmed two cases of yellow fever in a city just 83 miles away from Rio de Janeiro, according to a new update from the European Centre for Disease Prevention and Control (ECDC)

First cases in Rio de Janeiro State, Ecuador

The ECDC's update said that Brazil confirmed two cases of the mosquito-borne illness in Rio de Janiero state on Mar 15 in the municipality of Casimiro de Abreu, located 135 km (83 miles) from the city of Rio de Janeiro.

Since January, when the current outbreak first began in Minas Gerias, experts have warned that Aedes aegypti mosquitoes and unvaccinated populations in Brazil's major cities could contribute to a yellow fever epidemic. However, the Pan American Health Organization (PAHO) said there is still no evidence that Aedes mosquitoes are involved in the current transmission cycle.

The ECDC said there were 20 new cases reported in the last week, bringing totals as of Mar 16 to 1,357 cases (933 suspected and 424 confirmed), including 249 deaths (112 suspected and 137 confirmed). The case-fatality rate is 18.3% among all cases and 32.3% among confirmed cases.

PAHO, which is also producing epidemiological updates of the yellow fever outbreak, has slightly different case numbers. As of Mar 16, they report 1,538 cases of yellow fever reported (396 confirmed, 958 suspected) and 255 deaths, representing a case-fatality rate of 34% among confirmed cases and 12% among suspected cases. PAHO says a downward trend of new cases was seen in Minas Gerias for the fifth week in a row, and in Espirito Santo.

Last Thursday, Brazilian authorities identified 47 municipalities in Rio de Janeio that were a priority for a vaccination campaign, including the municipality of Casimiro de Abreu, where the two confirmed cases are reported.

According to the ECDC, as of Mar 16, 16.15 million extra doses of yellow fever vaccine had been sent to five states: Minas Gerais (7.5 million), Sao Paulo (3.25 million), Espírito Santo (3.45 million), Rio de Janeiro (1.05 million), and Bahia (900 000).

New case in Ecuador, updated WHO travel guidance

Also, ECDC said Ecuador reported its first case of yellow fever since 2012. According to PAHO, the case was confirmed in a 31-year-old man in the province of Sucumbios, which borders Colombia.

Finally today, the World Health Organization (WHO) updated its travel recommendations for people going to Brazil in light of the two cases in Rio de Janeiro state. The Rio de Janeiro state, with the exception of the urban areas of Rio de Janeiro City and Niteroi, and the State of Sao Paulo, with the exception of the urban areas of Sao Paulo City and Campinas, should also be considered at risk for yellow fever transmission.

As such, vaccination against yellow fever is now recommended at least 10 days prior to travel in those states.

See also:

Mar 20 ECDC update

Mar 20 PAHO update

Mar 20 WHO travel update