16 Apr 2015

Yellow fever: Peru

Cases of Yellow fever have been reported from Loreto, Pasco, Piura, Puno and San Martin

As of 28 March 2015, the Ministry of Health in Peru has confirmed a total of nine cases of yellow fever (YF), including three deaths, since the start of this year. Cases have been reported from the states of Loreto (two), Pasco (one), Piura (one) Puno (one) and San Martin (four) [1].

Areas below 2,300m in the states of Loreto, Pasco Puno, San Martin and eastern Piura are considered areas with risk of YF transmission. Puno city and Lake Titicaca destinations above 2,300m are not risk areas of YF transmission.

Vaccination is the most important preventive measure against YF.

Yellow fever in the Americas

In the first three months of 2015, two countries in the Americas with a risk of YF transmission, have reported human cases (Brazil and Peru) [1-3].  In addition, in early April 2015, the Ministry of Health in Argentina has reported unconfirmed cases of YF from a number of states; 19 of these possible cases are still under investigation [4].

In South and Central America, 13 countries are considered endemic for YF. These are listed by the World Health Organization (WHO) as countries with risk of YF transmission [5]. Over the last three decades, the majority of cases of YF in the Americas have been reported from Peru (54% of all cases), Bolivia (18%), Brazil (16%) and Colombia (7%) [6].

In the Americas, the YF virus is usually transmitted in jungle areas via the bite of the Haemagogus spp. mosquito. The preferred biting/feeding time for this mosquito is unknown. The Aedes aegypti mosquito, also prevalent in the Americas, favours an urban environment and can also transmit YF. Urban areas are at risk of introduction of YF due to human traffic between jungle and urban locations. A. aegypti feeds predominantly during daylight hours.

Advice for health professionals

When undertaking YF risk assessment, health professionals should refer to the individual country information pages where detail relating to risk areas, recommendation for YF vaccination and certificate requirements are available. A map of the current areas where YF vaccine is recommended in the Americas has been produced by the WHO. This provides a useful guide for the consultation, and health professionals are also encouraged to access the Outbreak Surveillance Database, where verified and some unverified outbreaks of YF are posted.

Under International Health Regulations (2005), countries are no longer required to automatically report YF outbreaks to the WHO; surveillance and reporting of YF in YF risk countries can be poor.

Advice for travellers

If you are travelling to or through areas of Peru or countries in the Americas with risk of YF, vaccination is recommended for your personal protection.

YF is transmitted to humans via the bite of an infected mosquito. You should take insect bite avoidance measures, day and night, when visiting countries with a risk of any disease transmitted by insects.

Full details of YF vaccination recommendations can be found on the Country Information pages. Some travellers may require vaccination for certificate purposes.  Details of the countries that require proof of YF vaccination as a condition of entry under the International Health Regulations (2005) are also provided.

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