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Dengue fever and measles: Two serious concerns for 2014 FIFA World Cup in Brazil

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With the 20th FIFA World Cup football tournament scheduled to commence in Brazil in less than a month (June 12), there are several health and safety concerns anytime you import 600,000 foreigners into a country.

Two of the biggest concerns have to do with infectious diseases, and for different reasons. First, there is dengue fever. A Reuters report today notes that a possible dengue outbreak is serious enough to warrant a high alert in three of the 12 host cities (Natal, Fortaleza and Recife).

Dengue fever is an infectious disease carried by mosquitoes and caused by any of five (researchers recently identified a fifth dengue subtype, the first in 50 years) related dengue viruses. This disease used to be called “break-bone fever” because it sometimes causes severe joint and muscle pain that feels like bones are breaking.

The World Health Organization (WHO) estimates there may be 50–100 million dengue infections worldwide every year. However, new research from the University of Oxford and the Wellcome Trust, using cartographic approaches, estimate there to be 390 million dengue infections per year worldwide.

There are three types of dengue fever in order of less severe to most: the typical uncomplicated dengue fever, dengue hemorrhagic fever (DHS) and dengue shock syndrome (DSS). There is not a vaccine for dengue fever. There is no treatment for dengue, just treat the symptoms.

In 2013, Brazil alone accounted for 1.4 million of the 2.3 million dengue fever cases in the Americas, and according to the Reuters report, more than 7 million infections were recorded between 2000 and 2013, making it the dengue fever capital of the world.

Barcelona-based scientist, Dr. Rachel Lowe, the lead author of a Lancet Infectious Diseases study published today says:

"Recent concerns about dengue fever in Brazil during the World Cup have made dramatic headlines, but these estimates have been based solely on averages of past dengue cases. The possibility of a large dengue fever outbreak during the World Cup, capable of infecting visitors and spreading dengue back to their country of origin, depends on a combination of many factors, including large numbers of mosquitoes, a susceptible population, and a high rate of mosquito-human contact"

Physicians in countries where their population attended the World Cup must be alert to the symptoms of dengue fever in returning fans.

The other infectious disease of major concern is measles; however, for a very different reason. As Deputy Director of the Pan American Health Organization (PAHO), Dr. Jon K. Andrus writes in an article Friday, he is concerned about the importation of measles to Brazil, where it could threaten the impressive gains the country has made against the vaccine-preventable disease.

Andrus says measles, which once "ravaged" Brazil, was declared eradicated in 2002. However, in recent years, like in many countries in the Americas, measles has returned to Brazil, primarily imported cases.

In an effort to prevent measles from becoming a big problem associated with the World Cup, the PAHO developed a campaign for the 12th Vaccination Week in the Americas (April 26–May 3), stressing the importance of action against all vaccine-preventable diseases: measles and a dozen other diseases.

In the United States, the Centers for Disease Control and Prevention (CDC) issued a travel notice in March for football (soccer) fans heading to Brazil for the World Cup, which outlines the vaccines, food and water safety guidelines, mosquito bite prevention and even a swimming advisory for travelers to the games.

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