VCU Global Health & Disparities Program's May-June Northern Honduras Trip

Hi everyone, I have posted new information about our May 26-June 3rd medical and public health relief trip to the Department of Yoro area of northern Honduras on the Global Health & Health Disparities Program (GH2DP) site.

Click here for a slideshow of pictures from the trip.

You can read more about the trip here.

Yellow Fever Vaccination Boosters: Unnecessary per WHO

Aedes aegypti mosquito (the mosquito that transmits the
yellow fever virus); cdc.gov

Here is a press release from the World Health Organization regarding yellow fever vaccination; this is a 'game changer' for immunization programs in endemic countries as well as for people traveling to endemic areas.

"Yellow fever" refers to the disease caused by the yellow fever virus that is transmitted by mosquitoes in areas of Africa and South America. This a hemorrhagic fever virus associated with substantial mortality and high morbidity. Worldwide there are approximately 200,000 cases yearly with 30,000 deaths. Although a safe and effective vaccine is available for this disease, there is no treatment (other than supportive care) for people who contract it. 

The press release refers to an analysis that was done looking at whether "booster" doses of yellow fever vaccine are needed following initial vaccination. The current practice is to administer a booster dose every 10 years. Yellow fever is (nearly) unique in that it is one of the only vaccine-preventable diseases where there is an international requirement to have documentation of having received the vaccine (or having a medical contraindication) to allow travel to many countries in Africa and South America. The vaccine is generally well tolerated, although it is a live virus vaccine and is contraindicated for people with immune-suppressing conditions. 

The press release noted that over 600 million doses of yellow fever vaccine have been administered since the 1930s when yellow fever vaccination began. There have only been 12 cases of yellow fever following vaccination and these did not occur greater than 10 years following vaccination; all told, the analysis was inconsistent with waning immunity and need for booster immunization. 

This is welcome news, although time will tell how this will effect vaccination programs as well as international travel requirements for yellow fever vaccination. 

Household Chlorination Program to Improve Drinking Water Quality in Rural Haiti

Local creation of sodium hypochlorite solution in Haiti (http://www.cdc.gov/safewater/chlorination.html) 

This is an interesting article on a long-term program in Haiti using household chlorination to improve drinking water quality by Harshfield and colleagues. They evaluated the utility of a Safe Water System (SWS) program that was established in a rural part of Haiti in 2002. In 2010 they conducted a survey with concurrent water testing of 201 SWS program participants as well as 425 control households. These authors found that 56% of participants were correctly treating their water with chlorine (as opposed to 10% of controls) with a 59% odds reduction in diarrheal illness in children under 5 (OR 0.41, 95% confidence interval 0.21-0.79). The interesting thing about this study is the SWS program was sustainable and was having a positive impact 8 years after its creation.

We have been working in the Yoro area of northern Honduras since 2008, with our efforts focused in and around the remote, mountainous village of La Hicaca (find out more about our work here). Our public health work is primarily focused on improving access to clean drinking water via a water filter program. The above study is intriguing in that it could provide an alternative, potentially sustainable mechanism to improve access to safe drinking water for the population we serve. However, Gaby Halder conducted a large survey on access to technologies to treat drinking water in 2011 of our population and found very few people used chlorine. This was largely due to poor chlorine access due to financial and geographic barriers. If a SWS program is to be employed in a rural, remote setting such as the one we practice in, addressing these key barriers will be critical.