04 Dec 2017
Yellow fever outbreak Brazil: São Paulo State/City revisedHuman and monkey cases in São Paulo State and municipalities are a public health concern
Since December 2016, an outbreak of yellow fever has been ongoing in Brazil . As of 20 November 2017, over 700 human cases have been reported since the start of this outbreak, some in areas previously considered not at risk for yellow fever transmission [1, 2]. This has resulted in an expansion of risk areas including Rio de Janeiro, and parts of Bahia and São Paulo states, and revision of vaccine recommendations .
Between September and mid-October 2017, two human cases with one death, were confirmed in Itatiba, Campinas, São Paulo State. These are the first confirmed human cases to be reported in Brazil since June 2017; additional suspected human cases are under investigation. In addition, parts of São Paulo State have reported yellow fever outbreaks in the monkey population in some urban areas including in several large parks of São Paulo city and in the municipality of Campinas (in the cities of Campo Limpo Paulista, Atibaia and Jarinu) [2, 4]. These outbreaks are the first in urban areas of Brazil since 1942, and because of the potential for spread to a large urban human population they represent a public health concern .
Public health responses including enhanced surveillance, disease monitoring and vaccination campaigns are continuing throughout Brazil, including in some urban areas of São Paulo city where monkey cases have been reported. In São Paulo city, an estimated 10 million people remain unvaccinated .
The expansion of risk areas during this outbreak is evolving and further updates will be given when information becomes available.
Advice for travellers
Yellow fever 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, including yellow fever.
Although there is no requirement for a certificate of vaccination for entry to Brazil (unless arriving from specified other countries with yellow fever risk), yellow fever vaccination is recommended for your personal protection if you are travelling to risk areas in Brazil.
If you are travelling to São Paulo State, including some urban areas of São Paulo city where the area of risk appears to be expanding you should seek advice from a health professional regarding recommendation for vaccination.
One dose of yellow fever vaccine will, in most circumstances, provide lifelong protection against this disease. You should seek advice from a health professional if you need to clarify your vaccination status.
You can search for a Yellow Fever Vaccination Centre (YFVC) on the NaTHNaC YFVC database.
Full details of yellow fever vaccination recommendations can be found on our Country Information pages; Travellers are reminded that countries may change their certificate requirements at short notice.
Advice for health professionals
Brazil is a country classified by WHO as having evidence of persistent or periodic yellow fever virus transmission. Yellow fever vaccination is recommended for all travellers to risk areas [3, 5].
Areas of risk appear to be expanding in São Paulo State; travellers may be at risk in some cities not previously considered at risk for yellow fever transmission by WHO, including some urban areas of São Paulo city (please see Brazil: outbreaks). Scrupulous mosquito bite avoidance should be advised, and for some, yellow fever vaccination may be considered after careful individual risk assessment. You may wish to seek specialist advice.
NaTHNaC Country specific information, including vaccine recommendations, certificate requirement and detail on current outbreak situations can be accessed on the Brazil Country Information page.
YF certificate requirements are not necessarily connected to the risk of disease for a traveller.
- Ministério de Saude. Monitoramento do Período Sazonal da Febre Amarela Brasil – 2017/2018 Informe No2. 20 November 2017
- World Health Organization. Yellow fever – Brazil. 24 November 2017
- World Health Organization. Updates on yellow fever vaccination recommendations for international travellers related to the current situation in Brazil. 4 April 2017.
- Governo do Estado de São Paulo. Boletim Epidemiológico Febre Amarela – 2017. 27 November 2017.
- International Travel and Health. List of countries, territories and areas: Vaccination requirements and recommendations for international travellers, including yellow fever and malaria. World Health Organization 16 February 2017.