15 Mar 2018
Yellow fever cases in travellers: Update
Cases of yellow fever in unvaccinated travellers who visited risk areas in Brazil continue to be reported
- This updates the previous report of Yellow fever cases in travellers 27 February.
Further to the cases previously reported in unvaccinated returned travellers who had visited Brazil from the Netherlands, France, Argentina and Chile, two additional cases have been reported in travellers from Romania and Switzerland. These cases had travelled in Brazil including Ilha Grande in the municipality of Angra do Reis in the state of Rio de Janeiro where monkey and human cases have recently been reported [1]. On 15 March 2018, a case of yellow fever was reported in England in a traveller who had returned from Brazil [2,3].
A total of 11 cases of yellow fever have now been reported in unvaccinated travellers who had visited Brazil since the start of 2018 [3]. This represents an increase in cases in travellers who visited areas where yellow fever transmission is reported compared to previous years. Five cases were reported in unvaccinated travellers from Europe and USA between August 2016 and March 2017. Of these cases three were contracted in Peru, one case in Bolivia and one in Suriname [4,5]. Between 1970 and 2015, a total of 10 cases were reported in unvaccinated travellers from Europe and USA (five cases were contracted in South America and five in Africa) [6].
Advice for travellers
Yellow fever is spread 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.
If you are travelling to areas of risk of yellow fever in Brazil both mosquito bite avoidance and vaccination are recommended for your personal protection. Full details of yellow fever vaccination recommendations for countries can be found on our Country Information pages.
Map: Areas of risk for yellow fever in Brazil
Details of countries that require proof of yellow fever vaccination as a condition of entry under the International Health Regulations (IHR) (2005) are also provided on our Country Information pages. Travellers are reminded that countries may change their certificate requirements at short notice.
If you have recently visited a yellow fever risk area, and become unwell with symptoms such as fever or flu like illness you are advised to seek advice from your GP or NHS111. Remember to tell your healthcare provider that you have travelled abroad.
Advice for health professionals
When undertaking yellow fever risk assessment, health professionals should refer to individual Country Information pages which provide detail relating to risk areas, recommendation for yellow fever vaccine and IHR (2005) certificate requirements. Some travellers may require vaccine for certificate purposes.
A map showing the current areas where yellow fever vaccine is recommended in Brazil is available from the European Centre for Disease prevention and Control (ECDC).
Health professionals are also encouraged to access the Outbreak Surveillance database where the details of outbreaks are posted.
Yellow fever should be considered in the differential diagnoses for illnesses in relation to unvaccinated individuals returning from yellow fever risk areas [7]. Discussion with the local microbiology, virology or infectious disease consultant is recommended. Health professionals can contact the Imported Fever Service (IFS) for advice about unwell returned travellers. Health professionals seeking information about testing samples from patients with a possible viral haemorrhagic fever (VHF) should read Viral haemorrhagic fever: sample testing advice.
Resources
- Pan American Health Organization: Yellow Fever – Epidemiological Update
- Brazil Ministry of Health. Informes de Febre Amarela
- Yellow fever factsheet
- World Health Organization: Yellow fever
- European Centre for Disease Prevention and Control. Rapid risk assessment: 18 January 2018
- Eurosurveillance: Increased risk of yellow fever infections among unvaccinated European travellers due to ongoing outbreak in Brazil, July 2017 to March 2018, Volume 23, Issue 11, 15 March 2018
- World Health Organization. Disease outbreak news. Yellow fever – Brazil. 9 March 2018. [Accessed 15 March 2018]
- Public Health England. Yellow fever reported in traveller returning from Brazil. 15 March [Accessed 15 March 2018]
- Gossner CM, Haussig JM, Bellegarde de Saint Lary C, et al Increased risk of yellow fever infections among unvaccinated European travellers due to ongoing outbreak in Brazil, July 2017 to March 2018. Eurosurveillance, Volume 23, Issue 11, 15 March 2018.
- European Centres for Disease prevention and Control. Rapid Risk Assessment. Yellow fever among travellers returning from South America 14 March 2017 [Accessed 15 March 2018]
- Centers for Disease Control and Prevention (US CDC) Notes from the Field: Fatal Yellow Fever in a Traveler Returning from Peru — New York, 2016 MMWR Weekly / September 1, 2017 / 66(34);914–915. [Accessed 15 March 2018]
- Gershman MD, Staples JE, Yellow fever, Chapter 3 in Centers for Disease Control and Prevention (US CDC) Yellow book Health Information for International Travel 2018 [Accessed 15 March 2018]
- European Centres for Disease Prevention and Control. Rapid Risk Assessment: Outbreak of Yellow Fever in Brazil, second update. 18 January 2018
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