Presentation of yellow fever in children and adolescent adolescents previously immunized

immunised in Minas Gerais State, Brazil

For Brazil, although urban cases of yellow fever (YF) has not reported Although

urban yellow fever (YF) cases have not been reported in Brazil since 1942, sylvatic YF is still

endemic to the northern and middle-western states. In 2017 and 2018, virus emerged in the

brazilian southeast, causing the largest outbreak in recent decades, involving mainly states for

Minas Gerais and São Paulo; From July 2017 to June 2018 1,127 cases of YF were confirmed

in Brazilthe virus emerged in the Brazilian southeast, causing the largest outbreak in recent

decades, involving mainly the states of Minas Gerais and São Paulo. From July 2017 to June

2018, 1,127 cases of YF were confirmed in Brazil, and 328 (29%) patients died. After a

seven-year periodseven years without registration of human cases, Minas Gerais recorded

huge epidemic ona huge epidemic during that period. One of main areas affected were the

metropolitan region of Belo Horizonte, the main areas affected was the metropolitan region

of Belo Horizonte, the state capital.8

Most The most effective way to avoid yellow fever is through vaccination. The yellow

fever vaccination elaborated with live attenuated virus strain 17DD, elaborated with live

attenuated virus strain 17DD, is safe and effective from people above 9 months of age, living

in or travelling to high riskfor people above nine months of age living in or travelling to high-

risk areas. Based in on a recent literature review, the World Health Organization (WHO)

stated that a single dose of the vaccine is highly immunogenic and confers life-long

protection against YF. Vaccines against yellow fever have been available for Brazil since

1976 and are offered at 9 months old in Brazil since 1976 and are offered at nine months of

age. Despite WHO recommendation of a single YF vaccine dose, a second dose in age 5 was

offered in Brazil until April-2017,the WHO recommendation of a single YF vaccine dose, a

second dose at age five was provided in Brazil until April 2017 in a way to improve vaccine

protection in an endemic country. However, in the face of YF outbreak, the government

withdrew the second dose of the vaccine scheme as a way to guarantee the immunization of

the YF outbreak, the government withdrew the second dose of the vaccine scheme to

guarantee the immunization of the exposed population with at least one dose.

This study aims to describe the incidence of children and adolescents with YF who

had been previously immunized immunised in the disease outbreak from July 2017 to June

2018 in the state of Minas Gerais, and describe clinical and laboratorial and describe clinical

and laboratory manifestations of the disease in this group.

This work is first study to demonstrate the higher incidence of yellow fever on

children and adolescents vaccinated in the early childhood, in accordance tothe first study to

demonstrate the higher incidence of yellow fever in children and adolescents vaccinated in

early childhood, based on what had previously been observed in the vaccine immunological

response. Thus on Brazil and endemic countries where YF vaccination is routinely

administered during the first year of life, in Brazil and endemic countries where YF

vaccination is routinely administered during the first year of life, a second immunization

immunisation or a booster dose might therefore be indicated, consistent with evidence

suggesting that those groups appear to mount less intense responses after vaccination.