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  • Yellow fever is a viral disease found in tropical regions of Africa and the Americas that mainly affects humans and monkeys and is transmitted by the same type of mosquito that spreads dengue and the Zika virus. Hundreds of thousands of people died from it in the Americas before a vaccine was developed in 1938. If traveling to an area with a Yellow Fever Advisory, you need to plan ahead in order to be properly vaccinated for protection from Yellow fever.


    Yellow Fever Travel Advisory:




    A ProMED-mail post


    ProMED-mail is a program of the

    International Society for Infectious Diseases <http://www.isid.org>


    Date: Mon 17 Apr 2017

    Source: PAHO/WHO Epidemiological Update Yellow Fever [edited] <http://www2.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=39286&lang=en>

    Situation summary in the Americas


    Since epidemiological week (EW) 1 to EW 15 of 2017 [1 Jan-14 Apr 2017], Brazil, Colombia, Ecuador, Peru, the Plurinational State of Bolivia, and Suriname have reported suspected and confirmed yellow fever cases.

    Following is an update on the situation in Brazil.

    In Brazil, since the beginning of the outbreak in December 2016 up to

    12 Apr 2017, there were 2422 cases of yellow fever reported (623 confirmed, 1128 discarded, and 671 suspected under investigation), including 326 deaths (209 confirmed, 53 discarded, and 64 under investigation). The case fatality rate (CFR) is 34 percent among confirmed cases.

    According to the probable site of infection, the cases were reported in 359 municipalities, while the confirmed cases were distributed among 108 municipalities in 5 states (Espírito Santo, Minas Gerais, Pará, Rio de Janeiro, and São Paulo).

    With regard to the confirmed fatal cases and their probable site of infection, 151 were in Minas Gerais, 4 in São Paulo, 48 in Espírito Santo, four in Pará, and 2 in Rio de Janeiro. In descending order, the CFR among confirmed cases by state is 100 percent in Pará, 80 percent in São Paulo, 34 percent in Minas Gerais, 31 percent in Espírito Santo, and 20 percent in Rio de Janeiro.

    In the state of Minas Gerais, no new suspected cases have been reported since 23 Mar 2017, and the date of symptoms onset of the last reported case is 14 Mar 2017. In the state of Espírito Santo, since EW 9 of 2017 [week ending 4 Mar 2017], a 2nd increase has been observed in the number of cases, the majority of which are being reported from municipalities in the south of the state. Local and state authorities are intensifying immunization activities in the area and the possibility that additional cases could be detected among susceptible persons in the area is not excluded.

    In Rio de Janeiro, an increase in the number of suspected cases was observed between [15-25 Mar 2017] however, no new cases have been reported since [6 Apr 2017] (Figure 1). Of the 10 confirmed cases, 8 had as probable site of infection the municipality of Casimiro de Abreu, one had the municipality of São Fidelis, and the probable site of infection for the case who resided in Porciúncula is still under investigation.

    Moreover, in the state of Pará, the number of confirmed cases remains unchanged from EW 13 of 2017.

    To date, _Aedes aegypti_ has not been reported to have a role in transmission. However, confirmed epizootics in large cities, such as Vitoria in Espírito Santo and Salvador in Bahia, represent a high risk for a change in the transmission cycle.

    Figure 1 [graphs]. Distribution of reported yellow fever cases by date of symptoms onset and probable state of infection. Brazil, 1 Dec

    2016-13 Apr 2017.

    Figure 2 illustrates the municipalities with confirmed cases and cases under investigation, as well as confirmed epizootics, and epizootics under investigation that correspond to the cumulative total in three different dates.

    Figure 2 [maps]. Geographic distribution of reported human yellow fever cases and yellow fever epizootics, 31 Jan-2 Mar, and 12 Apr 2017.

    Reports of epizootics currently under investigation in states bordering Argentina, Bolivia, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela represent a risk of spread of the virus to the bordering countries, especially in areas with similar ecosystems.



    Given the current yellow fever situation in Brazil and the emergence of cases in areas where cases have not been detected in several years, the Pan American Health Organization, Regional Office of the World Health Organization (PAHO/WHO) urges Member States to continue efforts to detect, confirm, and adequately and timely treat cases of yellow fever. To this end, health care workers should be kept up-to-date and trained to detect and treat cases especially in areas of known virus circulation.

    PAHO/WHO encourages Member States to take the necessary actions to keep travelers, heading to areas where yellow fever vaccination is mandatory, informed and vaccinated.



    The yellow fever vaccine is safe and affordable and provides effective immunity against the disease in the range of 80 to 100 percent of those vaccinated after 10 days and 99 percent immunity after 30 days.

    A single dose provides life-long protection against yellow fever disease. A booster dose of yellow fever vaccine is not needed. There have been rare reports of serious side- effects from the yellow fever vaccine.

    Given the limitations on the availability of vaccines and with the aim of promoting the rational use, PAHO / WHO reiterates its recommendations to national authorities:

    1. Conduct an assessment of vaccination coverage against yellow fever in areas at risk at the municipal level to guarantee at least 95 percent coverage among the resident population of these areas.
    2. Countries that are not currently experiencing outbreaks should not conduct immunization campaign. Priority should be given to the use of vaccines in susceptible populations and to avoid revaccination.
    3. Ensure vaccination of all travelers to endemic areas at least 10 days before traveling.
    4. Depending on vaccine availabilities, Member States should have a small stock that allows them to respond to outbreaks.
    5. Postpone routine vaccination in children in non-endemic areas until sufficient vaccines are available. Once there is availability, catch-up campaigns should be conducted to complete vaccination schedules.



    It is recommended to individually assess the epidemiological risk of contracting disease when faced with the risk of an adverse event occurring in persons over 60 years who have not been previously vaccinated.

    – The vaccine can be offered to individuals with asymptomatic HIV infection with CD4+ counts 200 cells/mm3 or more requiring vaccination.

    – Pregnant women should be vaccinated in an emergency situation and following recommendations of health authorities.

    – Vaccination is recommended in lactating women who live in endemic areas, since the risk of transmitting the vaccine virus to the child is lower than the benefits of the vaccination of breastfeeding women.

    – For pregnant or lactating women traveling to areas with yellow fever transmission, vaccination is recommended when travel cannot be postponed or avoided. They should receive advice on the potential benefits and risks of vaccination to make an informed decision. The benefits of breastfeeding are superior to those of other nutritional alternatives.


    The following people are usually excluded from yellow fever


    – Immunocompromised individuals (Including those with thymus disorders, symptomatic HIV, malignant neoplasms under treatment, and those that are receiving or have received immunosuppressive or immunomodulatory treatments, recent transplants, and current or recent radiation therapy).

    – People with severe allergies to eggs and their derivatives.

    Communicated by:

    ProMED-mail Rapporteur Mary Marshall

    [1] Continued spread

    Date: Wed 5 Apr 2017

    Source: CIDRAP [edited]



    The World Health Organization (WHO) said today that yellow fever continues to march toward Brazil’s Atlantic coast, where much of the urban population is unvaccinated against the mosquito-borne disease.

    Since the country’s outbreak began in January [2017] in the interior state of Minas Gerais, experts have warned that urban transmission of yellow fever posed a huge threat to Brazil.


    According to the WHO, as of [Mon 3 Apr 2017], there have been several suspected epizootic cases of yellow fever currently under investigation in Bahia state along the northern coastal area, including the urban area of Salvador.


    An epizootic was confirmed to be caused by yellow fever virus infection in the municipality of Feira de Santana, and in the proximity of the urban area of Campinas in Sao Paulo State. In Rio de Janeiro state, epizootics are under investigation near both the city of Rio de Janeiro and near Niteroi, part of the same metropolitan area.


    So far, yellow fever is currently being transmitted by 2 types [genera] of mosquitoes on Brazil, the _Haemagogus_ or _Sabethes_. If yellow fever is introduced to a major urban center, the virus could jump to the _Aedes aegypti_ mosquito, making human transmission more likely.


    “There is no evidence of human cases of yellow fever virus infection transmitted by _Aedes aegypti_ the vector that could sustain urban transmission of yellow fever,” the WHO said in its update.


    For the 1st time since the yellow outbreak began, the WHO said travelers to the urban areas of Rio de Janeiro state and Sao Paulo should get vaccinated against yellow fever at least 10 days prior to their trip. Previously, the urban centers were excluded from this recommendation.


    As of [Fri 31 Mar 2017], the European Centre for Disease Prevention and Control (ECDC) said Brazil had reported 1589 cases (1093 suspected and 496 confirmed). The vast majority of those cases, 1203, are in Minas Gerais state.


    [Byline: Stephanie Soucheray]


    Communicated by:

    ProMED-mail from HealthMap Alerts



    [Although the numbers of new cases in Minas Gerais and Espirito Santo states continue to decline, YF continues to spread geographically. So far, all cases are related to the sylvan (forest) cycle of transmission, with no reported cases due to _Aedes aegypti_ urban transmission. One hopes that the YF vaccination campaign will effectively halt the transmission to humans, although it may continue in non-human primates.


    A HealthMap/ProMED-mail map of Brazil can be accessed at:

    <http://healthmap.org/promed/p/6>. – Mod.TY]



    [2] Rio de Janeiro state

    Date: Tue 4 Apr 2017

    Source: The Rio Times [edited]




    The state of Rio de Janeiro has confirmed a 2nd death due to yellow fever. The Municipal Health Department of Itaperuna, a city located in northwestern part of the state, confirmed on[Tue 4 Apr 2017] a 33-year-old man died on [Sun 26 Feb 2017] due to the disease.


    Rio de Janeiro is one of the states on alert due to the growing number of yellow fever cases reported.


    “Municipalities are […] to prioritize the vaccination of people living in rural areas and near the forests. Our objective is to work together and support the municipalities so that the mobilizations for vaccination can be organized,” stated Luiz Antônio Teixeira Jr, Health Secretary of Rio de Janeiro state last week [week of 26 Mar 2017].


    Teixeira announced that the state had already distributed more than 3 million doses of vaccines against yellow fever since January [2017] to

    92 municipalities in the state. According to the official the municipalities closer to the state of Minas Gerais, where the outbreak began, have been given priority.


    The expectation of state officials is to vaccinate, until the end of this year [2017], the entire population of the state. This, say health authorities, will require between 8 and 9 million additional doses of the vaccine.


    Last week [week of 26 Mar 2017].the state’s health department confirmed a 6th case of yellow fever, 5 from Casimiro de Abreu, in the interior of Rio de Janeiro in an area that stretches inland between Buzios and Macaé and another from São Fidelis, about 100km [62.13 miles] from Casimiro.


    In a press release the municipal secretary of Health of Itaperuna, Alexandre Martins, reassured the population that at the moment there are no suspected cases of yellow fever in the city of Rio.


    [Byline: Lise Alves]


    Communicated by:

    ProMED-mail from HealthMap Alerts



    [One hopes that the YF vaccination campaign will effectively halt the transmission to humans, although it may continue in non-human primates. Starting now, the Health Ministry has changed the regimen for the yellow fever vaccination. There will only be one dose applied for those planning to travel to areas in the country where the vaccination is advised. Up until now, the Brazilian vaccination regimen has included 2 doses, with the 2nd recommend to be taken 10 years after the 1st. The change was released on [Wed 1 Apr 2017]. The new treatment approach follows what the World Health Organization has been recommending since 2014.


    – Mod.TY]



    [3] WHO

    Date: Tue 4 Apr 2017

    Source: WHO Emergencies preparedness, response; Yellow fever – Brazil [edited] <http://www.who.int/csr/don/04-april-2017-yellow-fever-brazil/en/>



    This is an update to the WHO advice posted in the Disease Outbreak News of 27 Jan 2017, 6 Mar 2017, and 20 Mar 2017; and on the WHO International Travel and Health website on 31 Jan 2017, 14 Feb 2017, 6 Mar 2017, and 17 Mar 2017.


    As of [Mon 3 Apr 2017], yellow fever virus transmission continues to expand towards the Atlantic coast of Brazil in areas not deemed to be at risk for yellow fever transmission prior to the revised risk assessment, supported by the scientific and technical advisory group on geographical yellow fever risk mapping (GRYF).


    As of [Mon 3 Apr 2017], epizootics and human cases are under investigation for yellow fever virus infection in Bahia State along the northern coastal area, including the urban area of Salvador, with an epizootic confirmed to be due to yellow fever virus infection in the municipality of Feira de Santana; epizootics associated with yellow fever virus infection were confirmed in the proximity of the urban area of Campinas in São Paulo State, with additional epizootics being under investigation in the same area; and, in Rio de Janeiro State, epizootics are under investigation for yellow fever virus infection in the proximity of the urban areas of Rio de Janeiro City and Niterói. These reports are consistent with the increased yellow fever activity observed in the southern areas of Bahia State, bordering Espírito Santo and Minas Gerais States, and in areas of Rio de Janeiro and São Paulo States, all sharing the same ecosystem – tropical and sub-tropical moist broad leaves forest. As of [Mon 3 Apr 2017], there is no evidence of human cases of yellow fever virus infection transmitted by _Aedes aegypti_, the vector that could sustain urban transmission of yellow fever.


    Therefore, the WHO Secretariat has determined that the following areas in the States of Bahia, Rio de Janeiro, and São Paulo should also be considered at risk for yellow fever transmission:


    – Bahia State: Municipalities of Agua Fria, Acajutiba, Aiquara, Alagoinhas, Amelia Rodrigues, Amargosa, Anguera, Antonio Cardoso, Apora, Apuarema, Aracas, Aracatu, Aramari, Aratuipe, Aurelino Leal, Barra da Estiva, Barra do Rocha, Barrocas, Biritinga, Boa Nova, Boa Vista do Tupim, Bom Jesus da Serra, Breoes, Cabaceiras do Paraguacu, Cachoeira, Caetanos, Cairu, Camacari, Camamu, Candeal, Candeias, Caraibas, Cardeal da Silva, Castro Alves, Catu, Conceicada Feira, Conceicado Almeida, Conceicado Jacuipe, Conde, Contendas do Sincora, Coracade Maria, Cravolandia, Cruz das Almas, Dario Meira, Dias d’Avila, Dom Macedo Costa, Elisio Medrado, Entre Rios, Esplanada, Feira de Santana, Gandu, Gongogi, Governador Mangabeira, Guajeru, Iacu, Ibirapitanga, Ibirataia, Igrapiuna, Iguai, Inhambupe, Ipecaeta, Ipiau, Ipira, Irajuba, Iramaia, Irara, Itaberaba, Itagi ,Itagiba, Itamari, Itanagra, Itaparica, Itaquara, Itatim, Itirucu, Itubera, Jacaraci, Jaguaquara, Jaguaripe, Jandaira, Jequie, Jiquirica, Jitauna, Lafaiete Coutinho, Laje, Lajedo do Tabocal, Lamarao, Lauro de Freitas, Licinio de Almeida, Madre de Deus, Maetinga, Manoel Vitorino, Marau, Maracas, Maragogipe, Marcionilio Souza, Mata de Sao Joao, Milagres, Mirante, Mortugaba, Muniz Ferreira, Muritiba, Mutuipe, Nazare, Nilo Pecanha, Nova Ibia, Nova Itarana, Ouricangas, Pedrao, Pindai, Pirai do Norte, Planaltino, Pojuca, Presidente Janio Quadros, Presidente Tancredo Neves, Rafael Jambeiro, Riachao do Jacuipe, Rio Real, Sao Felix, Sao Felipe, Sao Francisco do Conde, Sao Goncalo dos Campos, Sao Miguel das Matas, Sao Sebastiao do Passe, Salinas da Margarida, Salvador, Santa Barbara, Santa Ines, Santa Teresinha, Santanopolis, Santo Amaro, Santo Antonio de Jesus, Santo Estevao, Sapeacu, Saubara, Sebastiao Laranjeiras, Serra Preta, Serrinha, Simoes Filho, Tanhacu, Tanquinho, Taperoa, Teodoro Sampaio, Teofilandia, Teolandia, Terra Nova, Ubaira, Ubaitaba, Ubata, Urandi, Valenca, Varzedo, Vera Cruz, Wenceslau Guimaraes;


    – Rio de Janeiro State: Urban areas of Rio de Janeiro City and Niterói. The addition of these urban areas makes the entire State of Rio de Janeiro at risk for yellow fever transmission;


    – São Paulo State: Urban area of Campinas.


    Consequently, vaccination against yellow fever is recommended for international travellers visiting those areas in the States of Rio de Janeiro and São Paulo. The typology of activities that international travellers anticipate to undertake while visiting areas determined to be at risk for yellow fever transmission should be weighted in the risk-benefit analysis informing the individual decision to be immunized against yellow fever.


    There are no other additional changes with respect to other areas of Brazil determined to be at risk for yellow fever transmission in 2013, as published by WHO in the Disease Outbreak News on 27Jan 2017, 6 Mar 2017, and 20 Mar 2017.


    The determination of new areas considered to be at risk for yellow fever transmission is an ongoing process and updates will be provided regularly.


    The current advice by the WHO Secretariat for international travellers going to areas of Brazil deemed to be at risk is the following:


    – Vaccination against yellow fever at least 10 days prior to the travel. Note that, as per Annex 7 of the International Health Regulations (2005), a single dose of a yellow fever vaccine approved by WHO is sufficient to confer sustained immunity and life-long protection against yellow fever disease. Travellers with contraindications for yellow fever vaccine (children below 9 months, pregnant or breastfeeding women, people with severe hypersensitivity to egg antigens, and severe immunodeficiency) or over 60 years of age should consult their health professional for advice;


    – Adoption of measures to avoid mosquito bites;


    – Awareness of symptoms and signs of yellow fever;


    – Seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission.


    For 2017, updates on requirements for the International Certificate of Vaccination or Prophylaxis, with proof of vaccination against yellow fever, and WHO vaccination recommendations for international travellers, are available on the WHO International Travel and Health

    website: Annex 1 and country list. More specific information about requirements for the International Certificate of Vaccination or Prophylaxis, with proof of vaccination against yellow fever, implemented by Member States in the Region of the Americas is available on the PAHO yellow fever website.


    Communicated by:

    ProMED-mail rapporteur Marianne Hopp



    [4] Vaccination recommendations, Colombia

    Date: Mon 3 Apr 2017

    Source: Lonely Planet [edited]




    The U.S. Embassy advises U.S. citizens in Colombia to carry evidence of yellow fever vaccination. Although there has not been a single case of yellow fever diagnosed in Colombia this year [2017], neighboring Brazil continues to experience a large outbreak. The Colombian Ministry of Health and Social Protection has initiated a campaign to ensure all residents have been vaccinated against yellow fever.

    Airlines and the media have reported confusion over which travelers need yellow fever vaccination.


    The embassy recommends that all travelers between the ages of 1 – 60 years receive the yellow fever vaccine at least 10 days before traveling to areas in Colombia

    (<https://www.minsalud.gov.co/Documents/mapa-5.pdf>) determined to be at high risk of yellow fever transmission. Bogota, Cartagena, and Medellin are not high risk areas. National parks located in high risks areas may deny entry to travelers who do not have proof of yellow fever vaccination. Airlines may request vaccination cards for passengers traveling to high risk areas, and may screen passengers for symptoms of yellow fever. One dose of the vaccine provides life-long immunity, so boosters are not usually recommended or required. U.S.

    citizens should travel with their yellow International Certificate of Vaccination.


    The following individuals should not receive the yellow fever vaccine:

    children under the age of 9 months, pregnant women, adults over the age of 60, people with a life-threatening condition, an immune deficiency, a thymus disorder or allergic to eggs.

    Communicated by:

    ProMED-mail from HealthMap Alerts



    [This report raises some interesting concerns about risk of yellow fever (YF) spread beyond Brazil. Viremic individuals could move considerable distances from Brazil in a short period of time. Should those travelers arrive in YF-free countries that have significant populations of _Aedes aegypti_ and little YF vaccine coverage of their human residents, an urban outbreak could be triggered. Health authorities in countries meeting these criteria would be well advised to have contingency plans in place now should that occur. – Mod.TY.


    A map of South America showing the location of Colombia in relation to Brazil can be accessed at:

    <http://www.worldatlas.com/webimage/countrys/sa.htm>. – Mod.TY




    A HealthMap/ProMED-mail map can be accessed at:


    [1] Minas Gerais, São Paulo: new human cases

    Date: Mon 30 Jan 2017

    Source: Fox News, Associated Press (AP) report [edited] <http://www.foxnews.com/health/2017/01/30/brazil-confirms-more-yellow-fever-cases-over-100-infected.html>

    The vast majority of [yellow fever] cases are in the southeastern state of Minas Gerais, where authorities had confirmed 97 cases as of [Fri 27 Jan 2017]. Of those, 40 died.

    The Health Department of São Paulo on [Mon 30 Jan 2017] said it has now confirmed 6 cases of the disease, 4 of whom became infected in Minas Gerais. All of the patients died.

    Much of Brazil is considered at risk for yellow fever, but the country has not seen this large an outbreak since 2000. The World Health Organization has said it expects the mosquito-borne to spread to more states.

    Communicated by:






    A ProMED-mail post


    ProMED-mail is a program of the

    International Society for Infectious Diseases <http://www.isid.org>


    Date: Tue 26 Apr 2016

    Source: Outbreak News Today [edited]


    In a follow-up to a previous report on yellow fever in Central Peru, the Pan American Health Organization (PAHO) reports that through the 1st week of April 2016, there were 25 suspected cases of yellow fever reported, including 2 deaths. Of the reported cases, 9 were confirmed;

    11 were classified as probable, and 5 were discarded.

    The regions reporting the highest number of cases — confirmed and probable — were Junin (8 cases) and San Martin (6 cases). Currently, Peru is the only country in the Americas to report confirmed yellow fever in 2016.

    The number of cases reported to date in 2016 exceeds the total of cases reported in the preceding 2 years; with 15 cases reported in 2014 and 17 cases reported in 2015.

    PAHO reports the global supply of yellow fever vaccines has been insufficient for years. The PAHO/WHO Revolving Fund provides about 50 per cent of the demand in the region of the Americas. The current outbreak in Angola has stretched existing yellow fever vaccine supplies.

    Yellow fever is a disease caused by a virus that is spread through mosquito bites. Symptoms take 3-6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15 percent of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

    [byline: Robert Harriman]

    communicated by:

    ProMED-mail from HealthMap Alerts


    [The Amazon Basin, including the part pertaining to Peru, is endemic for yellow fever (YF) virus, where it is maintained in the sylvan (forest or jungle) cycle. Sporadic human YF cases occur here. Last year (2015) as of 28 Nov 2015, Peru reported 21 cases of human sylvan yellow fever in 7 regions, with 5 cases in Junin. Curiously, no mention is made of the deaths of YF virus infected monkeys in the forest, which is often the indicator of circulation of the virus in the area. Sylvan human cases bring the risk of subsequent spill over into urban and suburban human populations when infected individuals bring the virus into areas where the urban cycle vector, _Aedes aegypti_ occurs, and when these populations are not vaccinated. The developing shortage of YF vaccine is of concern, should an urban transmission cycle be initiated.

    A HealthMap/ProMED-mail map of Peru can be accessed at <http://healthmap.org/promed/p/34697>, and a map showing the location of the places mentioned can be accessed at <http://www.lib.utexas.edu/maps/americas/peru_admin_06.jpg>. – Mod.TY

    A HealthMap/ProMED-mail map can be accessed at:


    Published on May 9, 2016

    It’s Up to You: Dengue – Yellow Fever Control (USPHS, 1945)

    From: U.S. National Library of Medicine

    Zika and Chikungunya were not a problem in 1944, but the basic concepts still apply to this domestic mosquito.

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