Yellow fever outbreak reported in Brazil: 38 confirmed deaths and in Minas Gerais and 3 deaths in São Paulo, respectively.

WHO warned that a large epidemic of yellow fever is possible in Brazil after dozens of suspected deaths from the disease were reported in an area with low vaccination coverage.

As of Jan. 23, the Brazil Ministry of Health (MOH) said 133 suspected cases and 38 confirmed deaths (24/01/2016) from yellow fever had been reported since Dec. 18 in Minas Gerais and in São Paulo — the first yellow fever outbreak in the inland state since 2002-2003, according to WHO.

In response, the MOH sent 735,000 doses of vaccine to Mina Gerais last week, increasing the total number in the state to more than 1 million doses. The ministry recommended that people living in rural areas of the 24 affected municipalities in Minas Gerais get vaccinated.

According to WHO, one dose of yellow fever vaccine offers lifetime protection. However, the MOH recommends two doses for people in Brazil: one at age 9 months and another at age 4 years. Travelers wishing to protect themselves from yellow fever should be vaccinated at least 10 days before their trip.

The rapid spread of yellow fever could be due to low vaccine coverage in Minas Gerais, and there is concern that the outbreak will cross the border to neighboring states that also have low vaccine coverage but favorable ecosystems for the transmission of the virus, such as Espirito Santo and Bahia, WHO said.

The outbreak response includes a house-to-house immunization campaign in rural areas of the affected municipalities of Minas Gerais and preparedness activities in bordering states, according to WHO.

Minas Gerais also borders the state of Rio de Janeiro, which encompasses the populous city of the same name. However, according to the MOH, the last cases of urban yellow fever — transmitted by Aedes aegypti mosquitoes — occurred in Brazil in 1942 and Rio de Janeiro remains outside the recommended area for yellow fever vaccination.