YELLOW FEVER

Yellow fever is an acute infectious disease caused by an arbovirus i,e. flavivirus fibricus transmitted to
men by culicine mosquitoes characterised by fever, jaundice, albuminuria and haemorrhagic
manifestation such as epistaxis hematemesis and Malena. There is severe hepatic and renal
involvement.

INCIDENCE:

• It is prevalent in tropical forests of central Africa and northern part of South America
• Yellow fever virus is estimated to cause 200,000 cases of disease and 30,000 deaths each year,
with 90% occurring in Africa
• 20% to 50% of infected persons who develop severe disease die.

EPIDEMIOLOGICAL FACTORS:

AGENT FACTORS:

1. Agent: Flavivirus fibricus (RNA virus)

2. Reservoir of Infection: Monkeys & forest mosquitoes, Aedes aegypti mosquitoes
3. Period of communicability: In man, during the first 3-4 days of illness and the mosquitoes
become infective in 8-12 days after an “extrinsic incubation period”. The virus multiples in the
insect vector. After becoming Infective, the mosquito remains so for life.
❖ The extrinsic incubation period (EIP) is the viral incubation period between the time
when a mosquito takes a viremic(presence of virus in blood) bloodmeal and the time
when that mosquito becomes infectious.

HOST FACTORS:
1. Age & sex: All age group and both the sexes
2. Occupation: Wood cutters & hunters (endemic) are exposed to risk of Infection
3. Immunity: An attack of yellow fever gives life long immunity . Infants born of immune
mother’s have antibodies upto 6 months

ENVIRONMENTAL FACTORS:
• Temperature of over 24°c
• Humidity over 60%
• Deforestation, urbanization, expanding population

MODE OF TRANSMISSION:

The disease spread from monkeys to monkeys, monkeys to human being and then from men to men
through the bite of infected female Aedes mosquitoes . There are three known cycles of
transmissioni,e. the jungle the intermediate and urban cycles

1. The sylvatic (jungle) : Yellow fever occurs in monkeys through infected by wild mosquitoes.
Infected monkeys then pass the virus to other mosquitoes that feed on them.The infected
mosquitoes bite human beings entering the forest resulting in cases of yellow fever.
2. The intermediate yellow fever: This is spread through semi domestic mosquitoes that breed in
the forest an aroundh household which infect both the monkeys and human beings infected
mosquitoes can transmit the disease to many villages simultaneously causing an epidemic.
3. Urban yellow fever: In this transmission occurs from infected person to other persons in
densely populated areas with a large number vof unimmunized people through infected Aedes
aegeypti mosquitoes. This results in large Epidemics.

INCUBATION PERIOD:

3-6 days

CLINICAL FEATURES:
 Classified in 3 stages:

1. Stage of Infection:
a. Sudden onset with fever, headache, backache, flushing of face, photophobia,
nausea, vomiting and chilliness. Fever may reach 104°F by second day
b. There is faget’s sign, i,e. A decreasing pulse rate appears in the presence of a
constant or rising temperature. This stage lasts for 3-4 days
2. Stage of remission:
It is characterized by Fall off temperature to normal and patient becomes symptom free but
this last for only a few hours to one day
3. Stage of intoxication:
a. This begins from 4th -5th day . It is marked by hepatic & renal involvement. Jaundice
develops gradually.
b. There are hemorrhages in the skin, gastrointestinal tract causing Malena and black
vomit i,e. grave sign haemorrhage from nose (epistaxis) and from the gums.
c. There is albuminuria or anuria . Temperature falls, pulse increases, shock occurs,
patient becomes agitated, stuporous and goes into coma. Death may occur between
5th and 10th day of illness. 80% mortality.

TREATMENT:
No specific treatment is there for yellow fever.
• Patient should be hospitalized. Only supportive Treatment is provided, that is ample fluid
replacement to treat dehydration, fever and hypoglycemia.
• Fluid and electrolyte balance should be maintained
• Blood transfusion may be done
• Antibiotic to treat bacterial infections

CONTROL:
A) VACCINATION

Vaccination of humans with 17 be vaccine is the only control measure

17D: For international use, the approved vaccine is the 17 D vaccine it is a live attenuated vaccine
prepared from a non virulent strain 17 D strain which is grown in chick embryo and subsequently freeze
dried.

Storage temperature between +5 and minus 30 degrees Celsius preferably below 0 degrees C.

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 last for more than 35 years and possibly for life. However
WHO recommends revaccination after 10 years for international travel.

People who should not be vaccinated include:

o Children under 9 months

• Pregnant women except during a yellow fever outbreak when the risk of infection is high
 • People with severe allergies to egg protein
• People with severe immunodeficiencies

B) VECTOR CONTROL:

The objective of vector control is to reduce rapidly the vector population to the lowest possible level and
thereby stop or reduce transmission quickly.

The vector Aedes mosquito is peri domestic in habits it can be controlled by vigorous anti adult and
anti larval measures

Personal protection against contact with insect it includes use of repellents, mosquito Nets, mosquito
coils and fumigation mats

C) SURVEILLANCE:

AEDES AEGYPTI INDEX: Aedes aegypti Index is the ratio expressed as percentage of the number of
houses in a well defined limited area in surrounding of which breeding places of Aedes aegypti has been
identified to the total number of houses surveyed in that area.