Global & Disaster Medicine

“….As we have seen with dengue, chikungunya, and Zika, A. aegypti–mediated arbovirus epidemics can move rapidly through populations with little preexisting immunity and spread more broadly owing to human travel. Although it is highly unlikely that we will see yellow fever outbreaks in the continental United States, where mosquito density is low and risk of exposure is limited, it is possible that travel-related cases of yellow fever could occur, with brief periods of local transmission in warmer regions such as the Gulf Coast states, where A. aegypti mosquitoes are prevalent…..”

NEJM

Aedes mosquito

“….The clinical illness manifests in three stages: infection, remission, and intoxication.

  • During the infection stage, patients present after a 3-to-6-day incubation period with a nonspecific febrile illness that is difficult to distinguish from other flulike diseases.
  • High fevers associated with bradycardia, leukopenia, and transaminase elevations may provide a clue to the diagnosis, and patients will be viremic during this period.
  • This initial stage is followed by a period of remission, when clinical improvement occurs and most patients fully recover.
  • However, 15 to 20% of patients have progression to the intoxication stage, in which symptoms recur after 24 to 48 hours. This stage is characterized by high fevers, hemorrhagic manifestations, severe hepatic dysfunction and jaundice (hence the name “yellow fever”), renal failure, cardiovascular abnormalities, central nervous system dysfunction, and shock. ……
  • Case-fatality rates range from 20 to 60% in patients in whom severe disease develops, and
  • [T]reatment is supportive, since no antiviral therapies are currently available…..”

Person getting a vaccine in the arm

 


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