Measles, a serious threat to the Yanomami

Because of the epidemiological vulnerability to diseases that are foreign to them, the outbreak can be fatal for a large part of its population. Communities between the border of Venezuela and Brazil are affected by this disease.

Caracas, July 20, 2018.- A health report received by the Yanomami staff last March triggered alarm by reporting that indigenous communities of Alto Ocamo, sector Parima, in Venezuela, and the Ônkiola region, by part of Brazil, had symptoms of what could be measles.

At that time, a health center in Boa Vista confirmed one of the cases and another 23 were under evaluation. Later, health agencies of the Amazonas state, in Venezuela, identified another 25 potential cases in the communities of Oroshi and Irotha where seven confirmed deaths, as the Regional Director of Health of Amazonas said. However, until July 7 of this year, representatives of the Yanomami people informed Wataniba, socio-environmental working group in the Amazon,that there were around 121 people with the same symptoms, mainly in the sector of Alto Ocamo and Alto Padamo. According to the Venezuelan Society of Public Health (SVSP), this corresponds to an incidence rate of 8,402 x 100,000 inhabitants, or 953 x 100,000 inhabitants of the Alto Orinoco municipality where they reside. Yanomami health agents also reported that there were approximately 53 deaths so far, which implies a case fatality rate of 43.8 per 100 patients and a mortality rate of 3,680 per 100,000 inhabitants of the Yanomami Sanema and 417 per 100,000. inhabitants of the Alto Orinoco municipality, as specified by the SVSP.

Although these figures are alarming, the total impact of this outbreak is unknown for at least two reasons. On the one hand, these populations live in remote areas that are difficult to access, and, on the other, in respect to their customs, the deceased are incinerated and their ashes reserved for a later ritual, so that in many cases when arriving at the communities what the state health personnel or Yanomami health assistants find are the ashes reserved for the ritual.

At the level of Venezuela, the Pan American Health Organization (PAHO) presented in its March and June 2018 reports that the highest incidence of measles cases in Venezuela was limited to people under 19 years of age. In its June report, it indicated that from 2017 to the first semester of 2018, 2,154 cases had been reported, with 35 deaths nationwide. According to the PAHO, the highest proportion of suspected cases would be in the Bolívar state and the Capital District, while the highest mortality occurred in the Delta Amacuro state, with 33 deaths, mostly linked to the Warao indigenous group. All this is prior to the knowledge of the outbreak among the Yanomami people.

The outbreak of measles in the Venezuelan Yanomami seems to respond to a boomerang effect, according to the SVSP. That is, after the export of cases from Venezuela to Brazil, a situation that was identified for the first time at the beginning of February 2018, as a result of the mass exodus of people who have migrated from the Bolívar and Delta Amacuro states, the virus arrives even the Venezuelan Yanomami as a result of the high cross-border mobilization of illegal miners carrying the virus. For the Yanomami organizations, the source of the virus is also associated with illegal miners, a situation that has not been proven. For this moment, the Ministry of Health of Brazil revealed (Wednesday July 18) 677 confirmed cases of measles in the border states of Roraima and Amazonas, in Brazil, with 216 and444 people infected, respectively. “It was proven by the genotype of the virus (D8) that was identified, it is the same one that circulates in Venezuela,” the ministry said in a report published on its website.

According to the data provided by Yanomami health agents, the incidence of measles deviates from the national pattern since it is not limited to children under 19, on the contrary they affect the entire population. This can be explained because many of the settlements where the outbreak appeared contacted in recent times (less than six years), so they have not been benefited with massive vaccination days. This further triggers the alarms because the Venezuelan indigenous people are particularly sensitive to foreign viruses and strangers to them. Hence, the highest number of deaths, even in official figures, is associated with groups such as the Warao and now the Yanomami, in particular the Sanema subgroup.

The Yanomami organizations of both countries are very concerned about the situation. For Venezuela, the Yanomami organization TODAY, together with other representatives of this town, have made public a statement through, in addition to sending letters to national agencies with competence in the case, to urge more forceful and sustained actions. The national and regional health agencies have responded to the problem and carried out visits to verify the conditions of the outbreak (April 2018) and two days of vaccination (April 2018 and end of June and beginning of July 2018), which according to the informed Yanomami health staff reached all age groups. During those days they visited 27 communities. However, the actions still look insufficient given the large area to be covered and the dispersion of the communities on that surface. For this month of July, the health agents indicated to Wataniba, that another operation was planned that would reach 28 new communities.

From Wataniba, together with the indigenous peoples with whom we work, we urgently call for immediate measures to be taken to assist all the indigenous communities affected by the measles outbreak. The mortality that has been reported among the Yanomami is very high, but all the affected indigenous peoples must be attended to in Amazonas, Delta Amacuro and Bolívar. Vaccination days are urgent and should reach, in the case of the Yanomami of recent contact, all the inhabitants, since none of its members have been previously vaccinated and entire communities are at risk of dying.

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