Alert – Level 2, Practice Enhanced Precautions in Brazil due to Yellow Fever
March 23rd, 2018Yellow Fever in Brazil
Key Points
- There is a large, ongoing outbreak of yellow fever in multiple states of Brazil(https://wwwnc.cdc.gov/travel/destinations/traveler/none/brazil). Since early 2018, a number of unvaccinated travelers to Brazil contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State). Several have died.
- Travelers to Brazil should protect themselves from yellow fever by getting yellow fever vaccine at least 10 days before travel, and preventing mosquito bites.
- In addition to areas in Brazil where yellow fever vaccination has been recommended since before the recent outbreaks, the vaccine is now also recommended for people who are traveling to or living in: All of Espirito Santo State, São Paulo State, and Rio de Janeiro State as well as a number of cities in Bahia State.
- People who have never been vaccinated against yellow fever should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.
- Travelers going to areas with ongoing outbreaks may consider getting a booster dose of yellow fever vaccine if it has been 10 or more years since they were vaccinated.
- Yellow fever vaccine is available at a limited number of clinics in the United States, so travelers should plan ahead to get the vaccine.
What is yellow fever?
Yellow fever is caused by a virus that is spread through mosquitoes. Symptoms of yellow fever (fever, chills, headache, backache, and muscle aches) take 3–6 days to develop. About 15% of people who get yellow fever develop serious illness including bleeding, shock, organ failure, and sometimes death.
What is the current situation?
In early 2017, the Brazilian Ministry of Health reported outbreaks of yellow fever in several eastern states, including areas where yellow fever was not traditionally considered to be a risk. Since the end of 2017, yellow fever cases have reoccurred in several states, especially in the states of Rio de Janeiro, Minas Gerais, and São Paulo, including areas close to the city of São Paulo.
In early 2018, a case of yellow fever was reported in an unvaccinated Dutch traveler who had stayed near the São Paulo metropolitan region. Since then, there have been reports of other unvaccinated travelers to Brazil who visited areas with yellow fever outbreaks and contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janieiro State). Several of these travelers died. None were from the United States.
In response to the outbreak that began in early 2017, the World Health Organization has expanded the list of areas where yellow fever vaccination is recommended for international travelers to Brazil.
In addition to areas in Brazil where yellow fever vaccination has been recommended since before the recent outbreaks, the vaccine is now also recommended for people who are traveling to or living in:
- All of Espirito Santo State
- All of São Paulo State, the city of São Paulo and all coastal islands
- All of Rio de Janeiro State, including the city of Rio de Janeiro and all coastal islands
- A number of cities in Bahia State
Expanded Yellow Fever Vaccine Recommendation Areas in Brazil
The Brazilian Ministry of Health maintains a regular list of all other cities in Brazil for which yellow fever vaccination has been recommended since before the recent outbreaks. This list does not include recently added areas above. It is located at http://portalsaude.saude.gov.br/images/pdf/2015/novembro/19/Lista-de-Municipios-ACRV-Febre-Amarela-Set-2015.pdf.
What can travelers do to prevent yellow fever?
Get yellow fever vaccine
- Yellow fever vaccine is the best protection against yellow fever disease, which can be fatal. Anyone 9 months or older who travels to areas where yellow fever vaccine is recommended should be vaccinated against yellow fever at least 10 days before travel. For most travelers, one dose of yellow fever vaccine provides long-lasting protection. However, parts of Brazil are currently higher risk because of the outbreak. Travelers may consider getting a booster dose of yellow fever vaccine if traveling to areas with yellow fever outbreaks and it’s been 10 or more years since they were vaccinated. Areas with outbreaks include the states of Rio de Janeiro, Minas Gerais, and São Paulo.
People who have never been vaccinated against yellow fever for any reason should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.
Yellow fever vaccine is currently available at only a limited number of clinics in the United States. Travelers should contact a yellow fever vaccine provider well in advance of travel. Search for a yellow fever vaccine provider near you(https://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search).
Yellow fever vaccine is not recommended for some people. Talk with a health care provider if you have questions about the yellow fever vaccine.
Prevent insect bites
Because yellow fever and other diseases are spread by mosquito bites, all travelers to Brazil should prevent mosquito bites by using insect repellent, wearing long-sleeved shirts and pants when outdoors, and sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net.
If you get sick during or after travel
Talk to a doctor or nurse if you get sick, especially if you have a fever. Tell them you have been in a country with yellow fever.
Additional Information
Clinician Information
- Yellow Fever in CDC Health Information for International Travel (“Yellow Book”)
- Yellow Fever Vaccination: Information for Healthcare Professionals
- Yellow Fever Vaccine: Recommendations of the Advisory Committee on Immunization Practices (MMWR 2010)
- Yellow Fever Vaccine Booster Doses: Recommendations of the Advisory Committee on Immunization Practices, 2015