Caracas Chronicles

Photo: El País, retrieved.

A patient admitted last September in the Ruiz y Páez Hospital, in Bolívar State, was recently confirmed as the first positive case of yellow fever in Venezuela since 2005. 

The case originated in the Urinam municipality and the patient remains hospitalized due to renal complications. Tellingly, it took eight weeks to get a laboratory confirmation of the disease, and the test could only be performed at the National Institute of Hygiene in Caracas, highlighting the noxious dynamic of public health labs around the country.

As usual, neither regional nor national health authorities have declared anything on the case and the only reason that we know of is the reports from the Pan-American Health Organization (PAHO) and the Venezuelan Society of Public Health. A fumigation and vaccination campaign has reportedly started in Kamarata, the small Pemon settlement in the middle of Canaima National Park, where the case originated, and where sanitary authorities have been discretely deployed since November 15th, three days before the Venezuelan Society of Public Health first addressed it. The World Health Organization advises all travelers to Venezuela aged nine months or above to vaccinate against the disease, except if their itineraries are limited to Aragua, Carabobo, Miranda, Vargas, Yaracuy, Falcon, Margarita island, Caracas, or areas over 2,300 meters above sea level in the states of Merida, Trujillo and Tachira.

This vaccine has been increasingly hard to find, to the point where people who need it to travel to certain countries often resort to buying the vaccination certificate in the black market without actually getting the shot.

In Venezuela, with the exception of isolated outbreaks (the last was successfully controlled in 2005) yellow fever is traditionally limited to remote jungles south of the country, where the virus is sustained by the bite of mosquitoes from the genus Haemagogus on howling monkeys. But other mosquitoes from the genus Aedes, widely spread all over the country and responsible for dengue, zika and chikungunya fever, can also transmit the disease in urban areas. 

Normally this wouldn’t be a problem, since the existence of an effective vaccine makes it relatively hard for the disease to spread out of its sylvatic focuses. In Venezuela, however, this vaccine has been increasingly hard to find, to the point where people who need it to travel to certain countries often resort to buying the vaccination certificate in the black market without actually getting the shot. A quick search into Mercadolibre will throw out several results of people selling the little yellow cardboards for about $30. By 2016, vaccination coverages in Venezuela were estimated to be under 40% and a number of people between 3.9 to 6.2 million were considered unvaccinated.

Yellow fever is a deadly disease and a long-lasting problem in Latin America. It prevented the French from building the Panama Canal in the 19th century and cost the U.S. millions of dollars in mosquito-control programs. It still is a major problem in places like Brazil, where over 2,000 cases and more than 700 deaths were reported between 2016 and 2018, with the disease reaching cities like Sao Paulo, previously considered risk-free. 

It’s hard to think that the same ministry that has failed to publish any epidemiological data in almost three years can guarantee the proper control of this disease.

The implications of this reappearance are chilling. Even though the current case seems to be of sylvatic origin—meaning it’s transmitted from infected apes to humans—and restricted to a small town, the possibility of the disease spreading in and out of Bolívar, just like malaria, diphtheria and measles did, is unsettling. Lethality rates are variable but can reach up to 40%, depending on the health system’s readiness and resources.

It’s hard to think that the same ministry that has failed to publish any epidemiological data in almost three years and has systematically denied the existence of a humanitarian crisis in the country can guarantee the proper control of this disease. Meanwhile, the network Médicos Unidos por Venezuela says there might be three new cases in Bolívar and Monagas. “The Health Minister keeps silence,” they say. “The outbreak will explode in his face.”