Yellow Fever: DR .. Magdi El Baloola Ahmed Physcian & Gastrohepatologist

YELLOW FEVER
DR .. MAGDI EL BALOOLA AHMED

PHYSCIAN & GASTROHEPATOLOGIST
Definition
Yellow fever is an acute RNA flavivirus

infection spread by the bite of an infected
mosquito (Aedes aegypti).
The disease occurs in tropical Africa and South

America but it has never been reported in Asia
despite the presence of the vector.
Historical Background
1648; First outbreak of YF occurring in the New
World.YF virus most likely introduced by
slave_trading vessels from west Africa .
1778; Saint Louis-Senegal 1st outbreak reported

in Africa .
1900; Decisive test prove virus transmission by

Aedes Aegypti .
Historical Background
1927; YF virus isolation .
1932; Establishment of the relationship between

the disease in monkeys & in human by
Fred Sposer .
1935; YF vaccine developed .

Epidemiological patterns :-
1- Urban yellow fever; the viral reservoir is
man and the disease is spread between humans
by the Aedes aegypti mosquitoes that live and breed
in close association with humans.
2- Savannah yellow fever; The cycle exists that
involves transmission of virus from mosquitoes
to humans living or working in jungle border
areas ,the virus can be transmitted from
monkey to human or from human to human
via mosquitoes.
3- Jungle yellow fever; is transmitted among non-
human hosts (mainly monkeys) by forest
mosquitoes. Humans may become infected when
they enter into the forest habitat and can become
the source of urban outbreaks.
Yellow fever can reappear with outbreaks after

long intervals of apparent quiescence. Rural
populations are at greatest risk of yellow fever
but in recent years urban outbreaks have
occurred both in West Africa and South America.
Symptoms of YF
Incubation period is 3-6 days (travelers may be viremic
demonstrate symptoms) .
Symptoms manifest in one in every 20 immune & one in
every 5 immunologically naïve patients .
Initial symptoms;-
1- fever & chills 2- severe headach
3-back pain 4- Myalgia
5- nausea 6- prostration
These followed by toxic phase after a period of transient
(up to 24 hr) remission
Toxic phase :-
1- High fever 2- headach 3- lumbosacral pain
4- nausea 5- vomiting 6- abd.pain 7- somnolence
Hepatic _ induced coagulopathy :-

Haematemesis, epistaxis, gum bleeding, petechial &
purpuric haemmorrhage .
Jaundice and albuminurea .
Late stage :- 1- Hypotension 2- shock 3- M.acidosis

4- acute tubular necrosis 5- arrhythmia
6- myocardial dysfunction
Secondary bacterial infection are frequent complication.

Aedes aegypti
petechiae / purpura bleeding gum
Immunization
Re-immunisation every ten years has been
recommended but the WHO Strategic
Advisory Group of Experts (SAGE) on
Immunization has stated that with some
exceptions protection lasts for at least 35 years,
is likely to be much longer and could be life-
long. Therefore revaccination should be offered
to .
The following groups should be immunised :-
 laboratory workers handling infected material
 persons aged nine months or older who are travelling

to countries that require an International Certificate of
Vaccination or Prophylaxis (ICVP) for entry .
 persons aged nine months or older who are travelling

to or living in infected areas or countries in the yellow
fever endemic zone , even if these countries do not
require evidence of immunisation on entry.
The vaccine should not be given to
 those aged under six months
 those who have had a confirmed anaphylactic
reaction to a previous dose of yellow fever vaccine
reaction to any of the components of the vaccine
reaction to egg
 those who have a thymus disorder
 patients considered immunocompromised due to a
congenital condition, disease process or treatment
Precautions
 People over 60 years of age; The risk for neurologic and
viscerotropic adverse events increases with age .
 Pregnancy ; Yellow fever vaccine should not generally be

given to pregnant women because of the theoretical risk of
foetal infection from the live virus vaccine.
 Breast-feeding ; There is some evidence of transmission of

live vaccine virus to infants under two months of age from
breast milk. For women who are breast-feeding children
under the age of nine months expert advice should be
sought
Precautions
 Infants ; Infants under nine months are at
higher risk of vaccine-associated encephalitis.
Infants aged six to nine months should only be
immunised if the risk of yellow fever during
travel is unavoidable. Infants aged less than six
months should never be immunised
 Immunosuppression and HIV infection;

Unless the yellow fever risk is unavoidable,
asymptomatic HIV-infected persons should not be
immunised.
Adverse reactions
Adverse reactions following vaccination
include ;
headache, myalgia, low grade fever and/or
soreness at
the injection .
Rash, urticaria, vaccine-associated encephalitis,

Yellow fever vaccine-associated viscerotropic
disease (YEL-AVD) bronchospasm and
anaphylaxis occur rarely.
Yellow fever vaccine-associated
viscerotropic disease
Yellow fever vaccine-associated viscerotropic

disease (YEL-AVD) is a newly recognized
syndrome of fever and multi-organ failure that
resembles severe yellow fever, first described
in 2001 ,Two to seven days following vaccination,
patients develop fever, malaise, headache and
myalgia that progress to hepatitis, hypotension and
multi-organ failure; death has occurred in more
than 60% of reported cases.
Diagnosis
1- Detection of antibody IgM ;

By ELISA 7-10 days after the onset of illness .
2- Detection of antigen ;
By polymerase chain reaction (PCR) .
Management of YF
Record Patient Information
 Diagnosis
 Date of consultation and of onset of
symptoms
 Age, sex, address
 Specimens obtained
 Treatment
 Outcome
Management of YF
 No curative therapy exists

 Good supportive care is vital
 Use bed nets for all suspected YF patients
 Prevent or correct dehydration and electrolyte
imbalance
 Treat other infections
Management of YF
 Give anti-emetics and anti-convulsants, if

indicated.
 Give paracetamol, not aspirin (aspirin may
aggravate bleeding)
 Do not transfuse routinely

-use the haematocrit in well hydrated patients
as a guide .
-will not help seriously ill patients in shock, or
those with severe liver damage .
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YELLOW FEVER

DR .. MAGDI EL BALOOLA AHMED

Yellow fever is an acute RNA flavivirus

The disease occurs in tropical Africa and South

1778; Saint Louis-Senegal 1st outbreak reported

1900; Decisive test prove virus transmission by

1932; Establishment of the relationship between

1935; YF vaccine developed .

Yellow fever can reappear with outbreaks after

Hepatic _ induced coagulopathy :-

Jaundice and albuminurea .

Late stage :- 1- Hypotension 2- shock 3- M.acidosis

Secondary bacterial infection are frequent complication.

 laboratory workers handling infected material

 persons aged nine months or older who are travelling

 persons aged nine months or older who are travelling

 Pregnancy ; Yellow fever vaccine should not generally be

 Breast-feeding ; There is some evidence of transmission of

 Immunosuppression and HIV infection;

Rash, urticaria, vaccine-associated encephalitis,

Yellow fever vaccine-associated viscerotropic

1- Detection of antibody IgM ;

 No curative therapy exists

 Give anti-emetics and anti-convulsants, if

 Do not transfuse routinely

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