01 Apr 2015

Yellow Fever: Brazil

A new case of yellow fever has been confirmed in Brazil

On 26 March 2015, a case of yellow fever (YF) was confirmed by the Government of Amapá State in a child, who did not contract YF in the state, but sought medical care in the state capital, Macapá. The individual is a resident of Gurupá [1], a municipality on the Amazon River in the adjoining state, Pará.

YF is endemic in both Amapá and Pará states; urban outbreaks have not been reported for many decades [1].

Urban areas are at risk of introduction of YF infection. Public health measures, including vaccination and enhanced surveillance for cases have been implemented in the areas through which the infected individual travelled [1].

Vaccination is the most important preventative measure against YF.

Yellow fever in the Americas

This new case, reported by authorities in Macapá, Amapá state, brings the total number of cases reported in Brazil during 2015 so far to three; two cases were also reported in Goiás State in January 2015 [2].

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 [3]. 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%) [4].

In the Americas, the 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 tool, where verified and unverified outbreaks of YF are posted.

Under International Health Regulations (2005), countries are no longer required to automatically report YF outbreaks to the WHO [5]; surveillance and reporting of YF in YF risk countries can be poor.

Advice for travellers

YF is transmitted to humans via the bite of an infected mosquito. You should take mosquito bite avoidance measures day and night.

If you are travelling to or through areas of Brazil with risk of YF, including the states of Amapá and Pará or Goiás, vaccination is recommended for your personal protection.

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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