YELLOW FEVER

Deptt of Community Medicine

 Yellow fever is a zoonotic disease caused by an
arbovirus.
 It affects principally monkeys and other vertebrates in
tropical America and Africa and is transmitted to man
by certain culicine mosquitoes.
 Widely variable presentation -
 ranging from a minimal flulike illness to
 a fulminant disease characterized by haemorrhage,
hepatic failure, renal failure and death
 The Yellow Fever virus is an arbovirus, of the family
Flaviviridae
 Despite being currently restricted to parts of Africa
and Latin America, Yellow fever has the potential to
cause large outbreaks in other areas due to the
presence of suitable vectors and climatic conditions.
 The “yellow” in the name originates from the
jaundice that occurs in seriously ill patients.

 Although an effective vaccine has been available

for 60 years, the number of people infected over
the last two decades has increased
Problem statement
 47 countries in Africa and Latin America, with a
combined population of more than 900 million, are
at risk of yellow fever.
 Yellow fever has never been reported from Asia.
 However, WHO considers this region to be at risk
because the appropriate primates and vectors are
present.
Agent :
 The viral pathogen is a Flavivirus belonging to the
family Togaviridae.
 It is a small (40 to 60 nm), single stranded positive
sense, enveloped RNA virus.
 Reservoir of infection :
 In forest areas, the reservoir of infection is mainly
monkeys and forest mosquitoes.
 In urban areas, the reservoir is man (subclinical
and clinical cases) besides Aedes aegypti
mosquitoes.
 Vectors :

 The virus is transmitted by several different species of the

Aedes and Haemogogus (only in South America)
 The principal urban vector is the Aedes aegypti.
 Female mosquitoes become infected by during the first to
third day of fever.
 virus can be transmitted transovarially, allowing viral
survival in the absence of adult mosquitoes.
 Feeding Habit
 Day biter

 Mainly feeds on human beings (anthrophilic) in

domestic and peridomestic situations
 Bites repeatedly

 Resting Habit
 Rests in the domestic and peridomestic situations

 Rests  in the dark corners of the houses, on hanging

objects like clothes, umbrella, etc. or under the
furniture.
 Outside, they rest where it is cool and shady.
 Breeding Habits
 Aedes aegypti  mosquito breeds in any  type of
man made containers or storage containers having
even a small quantity of water.
 Eggs of Aedes aegypti can live without water for
more then one year.
Mosquito breeding can occur in any
water - storage containers:
•desert coolers,
•flower vases, coconut shells,
•construction sites,
•overhead uncovered or partially
covered water tanks,
•discarded buckets, tyres, utensils and
large containers used for collecting rain
water which are not emptied and
cleaned periodically.
 Host factors:
 AGE AND SEX: All ages and both sexes are susceptible to
yellow fever in the absence of immunity.
 OCCUPATION : Persons whose occupation brings them
in contact with forests (wood cutters, hunters) where
yellow fever is endemic are exposed to the risk of
infection
 IMMUNITY : One attack of yellow fever gives lifelong
immunity; second attacks are unknown. Infants born of
immune mothers have antibodies up to 6 months of life.
Transmission:

Three transmission cycles can be distinguished

 The sylvatic (or jungle): in jungle areas, mainly

affecting the wild monkeys

 Intermediate: primarily affecting both man and

monkeys
 Urban: mainly affecting human beings in high
population density areas
Transmission cycles
Incubation Period :
 The intrinsic incubation period in human beings is
between 3 to 6 days.

 The extrinsic incubation period in a mosquito varies

from 4 to 18 days (average 12 days), with the
temperature and humidity.

 Once the mosquito becomes infective, it remains so

for the rest of its life.
 Clinical Features
 The disease presents in two phases.
 Some infections may be completely asymptomatic.
 Usually the first “acute” phase is characterized by fever,
muscle pain, headache, loss of appetite, nausea and
vomiting.
 Bradycardia even high fever may be paradoxically
associated with a slow pulse.
 After three to four days most patients improve and their
symptoms disappear
 About 15% of patients enter a “toxic phase” within 24
hours
 The patient rapidly develops jaundice and has
abdominal pain with vomiting.
 Bleeding can occur from the mouth, nose, eyes and/ or
stomach.
 Blood may appear in the vomit and faeces.
 Kidney function deteriorates.
 About half of the patients in the “toxic phase” die
within 10 - 14 days
Treatment
 There is no specific treatment for yellow fever, only
supportive care to treat dehydration and fever.
 Associated bacterial infections can be treated with
antibiotics.
 Supportive care may improve outcomes for
seriously ill patients.
Prevention and Control

Vector control and vaccination are the

cornerstones of Yellow fever control.
VACCINATION:

 Rapid immunization of the population at risk is the

most effective control strategy for yellow fever.
 For international use, the approved vaccine is the 17D
vaccine.
 It is a live attenuated vaccine prepared from a non-
virulent strain (17D strain).
 It has to be stored between +5 and - 30 deg. C,
preferably below zero deg. C until reconstituted with
the sterile, cold physiological saline diluent provided.
 Reconstituted vaccine should be kept on ice, away from
sunlight, and discarded if not used within half an hour.
 The vaccine is administered subcutaneously at the
insertion of deltoid in a single dose of 0.5 ml
irrespective of age.
 Immunity begins to appear on the 7th day and lasts
possibly for life.

 The international Yellow fever vaccination

certificate becomes valid 10 days after vaccination
and remains valid for LIFELONG.
 People who should not be vaccinated include:
(a) children aged under 9 months for routine
immunization (or under 6 months during an
epidemic);
(b) pregnant women - except during a yellow fever
outbreak when the risk of infection is high;
(c) people with severe allergies to egg protein; and
(d) people with severe immunodeficiency caused by
symptomatic HIV/AIDS or other causes, or in the
presence of thymus disorder.
 International measures
 India is a yellow fever "receptive" area, that is, "an area
in which yellow fever does not exist, but where
conditions would permit its development if introduced".

1. The population of India is unvaccinated and susceptible

to yellow fever.
2. The vector, Aedes aegypti is found in abundance.
3. The common monkey of India (Macacus spp) is
susceptible to yellow fever.
 The missing link in the chain of
transmission is the ‘virus’ of yellow fever
which does not seem to occur in India.
 The virus of yellow fever could get imported into
India in two ways:
(i) through infected travellers (clinical and
subclinical cases}, and
(ii) through infected mosquitoes.
 TRAVELLERS :
 All travellers (including infants) exposed to the risk of
yellow fever or passing through endemic zones of
yellow fever - must possess a valid international
certificate of vaccination against yellow fever before
they are allowed to enter yellow fever "receptive“
areas.
 If no such certificate is available, the traveller is placed
on quarantine, in a mosquito- proof ward, for 6 days
from the date of leaving an infected area.
 If the traveller arrives before the certificate becomes
"valid" , he is isolated till the certificate becomes valid.
MOSQUITOES :
 The aircraft and ships arriving from endemic areas
are subjected to aerosol spraying with prescribed
insecticides on arrival for destruction of insect
vectors.

 Further, airports and seaports are kept free from the

breeding of insect vectors over an area extending at
least 400 metres around their perimeters.

 The "aedes aegypti index" is kept below 1.

 VECTOR CONTROL MEASURES

 Personal prophalatic measures

 Use of mosquito repellent creams, liquids, coils, mats etc.
 Wearing of full sleeve shirts and full pants with socks
 Use of bednets for sleeping infants and young children during day time to
prevent mosquito bite
 Biological control
 Use of larvivorous fishes, namely Gambusia and Guppy in in ornamental
tanks, fountains, water tanks and other water sources.
 Use of biocides
 Chemical control
 Use of chemical larvicides like abate in big breeding containers
 Pyrethrum extract (0.1% ready-to-use emulsion) can be sprayed in rooms
(not outside) to kill the adult mosquitoes hiding in the house. Aerosol space
spray during day time
 VECTOR CONTROL MEASURES…

 Environmental management & source reduction methods

 Detection & elimination of mosquito breeding sources
 Management of roof tops, porticos and sunshades
 Proper covering of stored water
 Observation of weekly dry day
 Health education
 Impart knowledge to common people regarding the disease
and vector through various media sources like T.v., Radio,
Cinema slides, etc.
 Community participation
 Sensitilizing and involving the community for detection of
Aedes breeding places and their elimination
 Thank You