CDC Watch - Level 1, Practice Usual Precautions

Bolivia Reports Hemorrhagic Fever Case

CDC Travel Alert issued for a Bolivian viral hemorrhagic fever case
bolivian children in a doorway
South America (Vax Before Travel)

Health officials in the South American country of Bolivia have reported a potential outbreak of a hemorrhagic fever associated with an arenavirus, similar to Chapare arenavirus. 

In response to this report, the US Centers for Disease Control and Prevention (CDC) issued a Level 1 Travel Alert on July 18, 2019. 

This CDC Travel Alert says ‘until the source for the virus is determined, travelers to Bolivia should avoid contact with rodents, with rodent urine or feces, and with people who are sick.’ 

The CDC reported the 1st case was in a man from Caranavi Province, which is located east of La Paz, Bolivia, in a remote, mountainous region.   

Additional testing is ongoing to determine the exact cause of this case. 

This is important news since the Chapare virus, can cause Chapare hemorrhagic fever (CHHF), which is a single-strand RNA virus of the Arenaviridae family.

The precise mortality of CHHF is unknown and the only described case was fatal. 

Patients who have suffered from other arenaviruses may continue to excrete virus in urine or semen for weeks after recovery. 

For this reason, these fluids should be monitored for infectivity, since convalescent patients have the potential to infect others, such as sexual partners, via these fluids, says the CDC. 

Treatment for arenavirus infection is supportive, including intravenous fluids and transfusions. 

During the Hemorrhagic fever 2003 outbreak, a small number of people became ill, and one died. That fatal case had a clinical course that included fever, headache, arthralgia, myalgia, and vomiting with subsequent deterioration and multiple hemorrhagic signs. 

Four rodent-borne arenaviruses are known to cause hemorrhagic fever. These include Junín, Machupo, Guanarito, and Sabiá viruses, which are found in rural areas of Argentina, Bolivia, Venezuela, and Brazil, respectively. 

Since 2004, no additional Hemorrhagic fever case has been reported in Bolivia. 

Some arenaviruses have also been associated with secondary person-to-person spread, including in health care settings. 

The CALM algorithm is for use by Emergency Room clinicians in assessing a patient with signs, symptoms, and/or diagnostic findings concerning for a possible viral hemorrhagic fever. 

While there are many types of VHFs, all of which are rare, this algorithm covers the relatively more common types seen globally: Ebola virus, Marburg virus, Lassa virus, and Crimean-Congo Hemorrhagic Fever virus. 

The CALM algorithm is not intended to be a comprehensive guideline and should be used in conjunction with your hospital’s established policies for managing suspect/confirmed VHFs, says the CDC.

South American news

Regarding additional health risks to Bolivia visitors, the CDC suggested on June 18, 2019, that visitors ensure they are current with certain vaccines, such as Routine Vaccines and the measles-mumps-rubella (MMR) vaccine.

Additionally, the CDC says the Yellow fever virus is a risk in certain parts of Bolivia. 

The CDC suggests the Stamaril Yellow Fever vaccine for all travelers older than 9 months of age, visiting certain areas. The Stamaril vaccine should be administered at least 10 days before entering an endemic area for the protective immunity to be achieved.

Furthermore, Bolivia is also included in the CDC’s Global Measles Outbreak Notice, issued on June 10, 2019.

Pre-departure vaccination services, related travel medications, and counseling appointments can be scheduled with a local pharmacy by visiting Vax-Before-Travel.

And, vaccine financial support programs can be found at Vaccine Discounts.

Article by
Dani Reiter