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The proximity of summer is also a source of concern: the increased circulation of mosquitoes transmitting yellow fever. For the first time, the coast of São Paulo will have a summer with the circulation of the virus.
Although the vaccine is safe and the risk of contracting the disease is high, vaccination is contraindicated for certain groups of people. In other cases, care should be exercised and the benefit / risk ratio of the vaccine should be assessed.
People with very little immunity may develop the disease after taking the vaccine because it contains the attenuated, ie, weakened virus. This is so that when it comes in contact with the body, it stimulates the immune system to create antibodies.
Thus, if in the future the person comes into direct contact with the virus when bitten by a transmitting mosquito, the body will already have defenses to fight it. In severe cases of the disease, the mortality rate reaches 40%, according to experts consulted by the report. "In the situation where we live in the state of São Paulo, it is clear that the risk of contracting the disease is greater than the risk associated with the vaccine," said infectious diseases specialist Carlos Magno Castelo Branco Fortaleza, member Board of Directors of the Society of Infectious Diseases of São Paulo (SPI).
Check below for the groups for which there is a contraindication or precaution for the vaccine and what care if it can not be vaccinated.
Infants under six months
According to Renato Kfouri, Vice President of the Brazilian Society of Immunization (SBIM), this group should not receive the vaccine. "The virus has a capacity for affinity with the nervous system.In very young children, the barrier between the blood and the nervous system is fragile and the vaccine could cause serious side effects. child still has no structure and may have a neurological side effect, "he explains.
So, can babies over six months be vaccinated? Not quite. The Ministry of Health indicates that vaccination is only for people over nine months old. The specialist indicates that between six and nine months, vaccination is indicated in case of epidemic or when the child lives in a risk area where the circulation of the virus is very intense. "There has been no case of yellow fever between six and nine months, almost none until the age of one year," Kfouri said.
Nursing women
There are precautions for infants. The SBI specialist said that women who breastfeed babies up to the age of six months should not be vaccinated because the virus can be passed on to the child for it to be fed with milk. However, if she lives in a risk area, vaccination is released.
The Ministry of Health recommends to suspend breastfeeding for 10 days after vaccination. In this case, it is important to seek a health service for advice and follow-up in order to maintain breast milk production and ensure a return to breastfeeding.
Pregnant women
Pregnant women are also part of the precautionary group. "He is vaccinated only if the woman lives in a risk zone," says Kfouri. If the woman lives in a confirmed viral circulation area, she should be vaccinated.
Allergic to the egg
The yellow fever vaccine is produced by the cultivation of the attenuated virus in chicken eggs. Thus, people with severe food allergies, at risk of anaphylaxis, vaccination are contraindicated. However, if the allergic person needs, for whatever reason, the vaccine, it must be administered under surveillance.
People with autoimmune diseases
Rheumatoid arthritis, psoriasis, lupus and fibromyalgia, for example, are autoimmune diseases, but they do not alter all the immunity to the point that the person reacts seriously to the vaccine. Overall, there is a precaution, according to SPI, a member of the Infectious Disease Council. "The contraindication is absolute in cases that affect the thymus, an organ very involved in immunity that has been associated with a serious illness," he says.
In the case of lupus, he states that the indication of the vaccine should be evaluated according to the increased risk compared to the benefit of vaccination. "If the person lives in a rural or affected area near the forest, the risk of yellow fever is considered higher than the risk associated with the vaccine, but if the person with lupus lives in the city, the risk of the vaccine is higher. to that of fever and is contraindicated, "says Fortaleza. According to the government's introductory manual, patients with systemic lupus erythematosus are part of the contraindication group because of the possibility of immunosuppression.
In the case of rheumatism, there is caution and contraindication, and both depend on the type of medication used by the patient and the activity of the disease. "The treatment is based on drugs inducing immunosuppression (which reduces the effectiveness of the immune system). If the patient is well without drugs, there is no contraindication, but caution is required If the drugs are in high doses, it is contraindicated for a while, "says rheumatologist Gecilmara Pileggi, coordinator of the Commission of Infectious Diseases of the Brazilian Society of Rheumatology (SBR).
According to the specialist, the doctor and the patient must decide together whether it is worthwhile to temporarily suspend the drug to take the vaccine. "The interruption of the drugs may be more risky, but the epidemiological risk must be weighed.After the vaccine, it takes four weeks to resume treatment," says the rheumatologist.
SBR organized a panel of experts and patients to better define people with rheumatoid arthritis in relation to the yellow fever vaccine. Anyone without immunosuppression can be immunized with a medical evaluation.
People with low immunosuppression are part of the precautionary group and "therefore need to assess the risk closely, see how much (the drug) retains the disease," according to Gecilmara. Highly immunosuppressed individuals have an increased risk of contracting the vaccine and developing the infection.
The rheumatologist warns that it is important to consult the doctor with whom the treatment is performed before taking the vaccine, not the post. "Sometimes he will not understand the patient's situation," he explains. This reinforces the fact that diseases such as gout, arthritis and fibromyalgia do not alter immunity and are therefore not part of the group of contraindications. People living with HIV and chemotherapy are also part of this group.
People with neurological diseases
Contraindication or precaution depends on an illness, according to the infectious disease of restless legs syndrome. There are cases where the acute neurological disease is due to the previous dose of the vaccine itself. "In such cases, it is necessary to consider the benefit / risk ratio of the vaccine," he said. The problem arises when the virus causes an inflammation of the neurological system, for example generating encephalitis, or degeneration of the cells in the weeks following the vaccine. "It could weaken the muscles or cause brain disease," says Fortaleza.
How to protect yourself
"The only form of prevention is to avoid areas of viral circulation and to use protective barriers, such as mosquito nets and mosquito nets on the windows of the house," explains Kfouri. For groups that have no precaution or contraindication to the vaccine, the specialist warns not to wait until cases of the disease occur and then only to be vaccinated. At the beginning of the year, high demand due to the yellow fever epidemic released the nine-hour queue for vaccination. "It is better to do this without breaking the bank and getting out of the epidemic," Kfouri said.
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