Yellow fever is an acute viral haemorrhagic disease that is endemic in tropical areas of Africa and Latin America. Cases can be difficult to distinguish from other viral hemorrhagic fevers such as arenavirus, hantavirus or dengue.
Symptoms of yellow fever usually appear 3 to 6 days after the bite of an infected mosquito. In the initial phase, they include fever, muscle pain, headache, shivers, loss of appetite, and nausea or vomiting. For most patients, these symptoms disappear after 3 to 4 days. However, 15% of patients enter a second, more toxic phase within 24 hours of the initial remission. High fever returns, and several body systems are affected, including the kidneys. Half of patients who enter this toxic phase die within 10 to 14 days, while the rest recover without significant organ damage.
Treatment is symptomatic, aimed at reducing symptoms for the comfort of the patient. Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, providing effective immunity within 30 days for 99% of those vaccinated. A single dose is sufficient to confer sustained immunity and life-long protection, with no need for a booster.
Signs and symptoms
Once contracted, the yellow fever virus incubates in the body for 3 to 6 days. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days.
A small percentage of patients, however, enter a second, more toxic phase within 24 hours of recovering from initial symptoms. High fever returns and several body systems are affected, usually the liver and the kidneys. In this phase people are likely to develop jaundice (yellowing of the skin and eyes, hence the name ‘yellow fever’), dark urine and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Half of the patients who enter the toxic phase die within 7 - 10 days.
Diagnosis
Yellow fever is difficult to diagnose, especially during the early stages. A more severe case can be confused with severe malaria, leptospirosis, viral hepatitis (especially fulminant forms), other haemorrhagic fevers, infection with other flaviviruses (such as dengue haemorrhagic fever), and poisoning.
Polymerase chain reaction (PCR) testing in blood and urine can sometimes detect the virus in early stages of the disease. In later stages, testing to identify antibodies is needed (ELISA and PRNT).
Transmission
The yellow fever virus is an arbovirus of the flavivirus genus and is transmitted by mosquitoes, belonging to the Aedes and Haemogogus species. The different mosquito species live in different habitats - some breed around houses (domestic), others in the jungle (wild), and some in both habitats (semi-domestic). There are 3 types of transmission cycles:
- Sylvatic (or jungle) yellow fever: In tropical rainforests, monkeys, which are the primary reservoir of yellow fever, are bitten by wild mosquitoes of the Aedes and Haemogogus species, which pass the virus on to other monkeys. Occasionally humans working or travelling in the forest are bitten by infected mosquitoes and develop yellow fever.
- Intermediate yellow fever: In this type of transmission, semi-domestic mosquitoes (those that breed both in the wild and around households) infect both monkeys and people. Increased contact between people and infected mosquitoes leads to increased transmission and many separate villages in an area can develop outbreaks at the same time. This is the most common type of outbreak in Africa.
- Urban yellow fever: Large epidemics occur when infected people introduce the virus into heavily populated areas with high density of Aedes aegypti mosquitoes and where most people have little or no immunity, due to lack of vaccination or prior exposure to yellow fever. In these conditions, infected mosquitoes transmit the virus from person to person.
Treatment
Good and early supportive treatment in hospitals improves survival rates. There is currently no specific anti-viral drug for yellow fever but specific care to treat dehydration, liver and kidney failure, and fever improves outcomes. Associated bacterial infections can be treated with antibiotics.
- Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients.
- Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue.
- A small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days.
- The virus is endemic in tropical areas of Africa and Central and South America.
- Large epidemics of yellow fever occur when infected people introduce the virus into heavily populated areas with high mosquito density and where most people have little or no immunity, due to lack of vaccination. In these conditions, infected mosquitoes of the Aedes aegypti specie transmit the virus from person to person.
- Yellow fever is prevented by an extremely effective vaccine, which is safe and affordable. A single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease. A booster dose of the vaccine is not needed. The vaccine provides effective immunity within 10 days for 80-100% of people vaccinated, and within 30 days for more than 99% of people vaccinated.
- Good supportive treatment in hospitals improves survival rates. There is currently no specific anti-viral drug for yellow fever.
- The Eliminate Yellow fever Epidemics (EYE) Strategy launched in 2017 is an unprecedented initiative. With more than 50 partners involved, the EYE partnership supports 40 at-risk countries in Africa and the Americas to prevent, detect, and respond to yellow fever suspected cases and outbreaks. The partnership aims at protecting at-risk populations, preventing international spread, and containing outbreaks rapidly. By 2026, it is expected that more than 1 billion people will be protected against the disease.
PAHO/WHO has prepared guidelines for use at district and national levels including case definitions, instructions for specimen collection and laboratory referrals, and for managing control efforts.
PAHO/WHO has developed a detailed map of yellow fever risk areas in South America and Panama, based on associated environmental conditions.
Yellow fever has unique status in the International Health Regulations (2005), which outline requirements for proof of vaccination for people who travel to specific countries or enter some countries from an area where yellow fever is endemic.
PAHO/WHO promotes mass preventive vaccination campaigns during interepidemic periods.
