Current Infectious Disease Reports

, Volume 14, Issue 3, pp 246–255 | Cite as

Mapping the Risk of Yellow Fever Infection

Tropical and Travel Medicine (LH Chen, Section Editor)


The World Health Organization coordinated a comprehensive, systematic review of the countries and areas at risk for yellow fever (YF) virus transmission. The review applied the following evidence to each country and area considered: human and non-human YF cases, human serology for anti-YF antibody obtained prior to widespread YF vaccination, altitude, vegetation, and vector distribution. The result was the categorization of countries or areas as endemic, transitional, low potential for infection, or no risk. This information was adapted to create a map that defined the areas where vaccination against YF may be recommended. Travel health professionals, countries, and public health bodies can use this information as they determine recommendations and requirements for vaccination. This paper reviews the process and outcomes of the review of YF risk, and places it in the context of providing YF vaccination.


Yellow fever Viscerotropic Epidemiology Risk mapping South America Africa Neurologic Adverse events 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Informal Working Group on Geographic Risk of Yellow Fever, World Health Organization. Background for the consultation on yellow fever and international travel, 2010 (update February 2011). 2011, World Health Organization: Geneva. p. 1–47. Available at: Provides all of the background information and rationale for YF risk categorisation.
  2. 2.
    •• Jentes ES, Poumerol G, Gershman MD, et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis. 2011;11:622–32. Definitive paper describing the process and outcomes of the YF risk mapping. PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organization. Revised recommendations for yellow fever vaccination for international travellers, 2011. Wkly Epidemiol Rec. 2011;86:401–11.Google Scholar
  4. 4.
    World Health Organization. International travel and health. Geneva: World Health Organization; 2011.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. CDC health information for international travel 2012. Atlanta: US Department of Health and Human Services, Public Health Service; 2011.Google Scholar
  6. 6.
    • World Health Organization. Yellow fever surveillance and outbreak response: revision of case definitions, October 2010. Wkly Epidemiol Rec. 2010;85:465–72. Review and publication of new case definitions for YF surveillance. Google Scholar
  7. 7.
    World Health Organization. Yellow fever in the WHO African and American Regions, 2010. Wkly Epidemiol Rec. 2011;86:370–6.Google Scholar
  8. 8.
    World Health Organization. International Health Regulations (2005) Geneva: World Health Organization; 2005. p. 1–60.Google Scholar
  9. 9.
    Poland JD, Calisher CH, Monath TP, et al. Persistence of neutralizing antibody 30–35 years after immunization with 17D yellow fever vaccine. Bull World Health Organ. 1981;59:895–900.PubMedGoogle Scholar
  10. 10.
    Coulange Bodilis H, Benabdelmoumen G, Gergely A, et al. Long term persistence of yellow fever neutralising antibodies in elderly persons. Bull Soc Pathol Exot. 2011;104:260–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Sawyer WA. The present geographic distribution of yellow fever and its significance. In: The Harvey lectures. New York: The Williams & Wilkins Company; 1936. p. 66–92.Google Scholar
  12. 12.
    Theiler M. Susceptibility of white mice to the virus of yellow fever. Science. 1930;71:367.PubMedCrossRefGoogle Scholar
  13. 13.
    Sawyer WA, Lloyd W. The use of mice in tests of immunity against yellow fever. J Exp Med. 1931;54:533–55.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Rooyan C, Rhodes A. Virus diseases of man. 2nd ed. New York: Nelson; 1948.Google Scholar
  15. 15.
    United Nations Relief and Rehabilitation Administration. Third report of the expert commission on quarantine. Epidemiol Inf Bull. 1945;1:687–701.Google Scholar
  16. 16.
    Smith HH. Controlling yellow fever. In: Strode GK, editor. Yellow fever. New York: McGraw-Hill Book Co; 1951. p. 539–628.Google Scholar
  17. 17.
    Bonnel PH, Deutschman Z. La fièvre jaune en Afrique au cours des années récentes. Bull WHO. 1954;11:325–89.PubMedGoogle Scholar
  18. 18.
    Lindsey NP, Schroeder BA, Miller ER, et al. Adverse event reports following yellow fever vaccination. Vaccine. 2008;26:6077–82.PubMedCrossRefGoogle Scholar
  19. 19.
    World Health Organization. Outbreak news. Yellow fever, Paraguay. Wkly Epidemiol Rec. 2008;83:105.Google Scholar
  20. 20.
    World Health Organization. Yellow fever in Africa and Central and South America, 2008–2009. Wkly Epidemiol Rec. 2011;86:25–36.Google Scholar
  21. 21.
    Holzmann I, Agostini I, Areta JI, et al. Impact of yellow fever outbreaks on two howler monkey species (Alouatta guariba clamitans and A. caraya) in Misiones, Argentina. Am J Primatol. 2010;72:475–80.PubMedGoogle Scholar
  22. 22.
    • Vasconcelos PF. Yellow fever in Brazil: thoughts and hypotheses on the emergence in previously free areas. Rev Saúde Pública. 2010;44:1144–9. Thoughtful consideration of risk factors for reemergence of YF in São Paolo State in Brazil. PubMedCrossRefGoogle Scholar
  23. 23.
    Moreno ES, Rocco IM, Bergo ES, et al. Reemergence of yellow fever: detection of transmission in the State of São Paulo, Brazil, 2008. Rev Soc Bras Med Trop. 2011;44:290–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Briand S, Beresniak A, Nguyen T, et al. Assessment of yellow fever epidemic risk: an original multi-criteria modeling approach. PLoS Negl Trop Dis. 2009;3:e483.PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor RM. Epidemiology. In: Strode GK, editor. Yellow fever. New York: McGraw-Hill Book Co; 1951. p. 427–538.Google Scholar
  26. 26.
    • Camara FP, Gomes AL, Carvalho LM, Castello LG. Dynamic behavior of sylvatic yellow fever in Brazil (1954–2008). Rev Soc Bras Med Trop. 2011;44:297–9. Investigates the occurrence of YF epidemics in Brazil over several decades and determines that there is a 7 year cycle in central-western regions and a 14 year cycle in the northern region. PubMedCrossRefGoogle Scholar
  27. 27.
    Vasconcelos PF, Luna EJ, Galler R, et al. Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases. Lancet. 2001;358:91–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Martin M, Tsai TF, Cropp B, et al. Fever and multisystem organ failure associated with 17D-204 yellow fever vaccination: a report of four cases. Lancet. 2001;358:98–104.PubMedCrossRefGoogle Scholar
  29. 29.
    Chan RC, Penney DJ, Little D, et al. Hepatitis and death following vaccination with 17D-204 yellow fever vaccine. Lancet. 2001;358:121–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Adhiyaman V, Oke A, Cefai C. Effects of yellow fever vaccination. Lancet. 2001;358:1907–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Troillet N, Laurencet F. Effects of yellow fever vaccination. Lancet. 2001;358:1908–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Werfel U, Popp W. Effects of yellow fever vaccination. Lancet. 2001;358:1909.PubMedCrossRefGoogle Scholar
  33. 33.
    Centers for Disease Control and Prevention. Fever, jaundice, and multiple organ system failure associated with 17D-derived yellow fever vaccination, 1996–2001. MMWR. 2001;50:643–5.Google Scholar
  34. 34.
    •• Staples JE, Gershman M, Fischer M. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59:1–27. Key resource that reviews all aspects of YF vaccination. Google Scholar
  35. 35.
    •• Thomas RE, Lorenzetti DL, Spragins W, et al. Active and passive surveillance of yellow fever vaccine 17D or 17DD-associated serious adverse events: systematic review. Vaccine. 2011;29:4544–55. Comprehensive review of the literature for SAE associated with YF vaccination. PubMedCrossRefGoogle Scholar
  36. 36.
    • Thomas RE, Lorenzetti DL, Spragins W, et al. The safety of yellow fever vaccine 17D or 17DD in children, pregnant women, HIV + individuals, and older persons: systematic review. Am J Trop Med Hyg. 2012;86:359–72. Sub-analysis of SAE in persons with special health needs who have received YF vaccination. PubMedCrossRefGoogle Scholar
  37. 37.
    Thomas RE, Lorenzetti DL, Spragins W, et al. Reporting rates of yellow fever vaccine 17D or 17DD-associated serious adverse events in pharmacovigilance data bases: systematic review. Curr Drug Saf. 2011;6:145–54.PubMedCrossRefGoogle Scholar
  38. 38.
    Nishioka SD, Nunes-Araujo FRF, Pires WP, et al. Yellow fever vaccination during pregnancy and spontaneous abortion: a case-control study. Trop Med Int Health. 1998;3:29–33.CrossRefGoogle Scholar
  39. 39.
    Kengsakul K, Sathirapongsasuti K, Punyagupta S. Fatal myeloencephalitis following yellow fever vaccination in a case with HIV infection. J Med Assoc Thai. 2002;85:131–4.PubMedGoogle Scholar
  40. 40.
    Mota LM, Oliveira AC, Lima RA, et al. Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases. Rev Soc Bras Med Trop. 2009;42:23–7.PubMedCrossRefGoogle Scholar
  41. 41.
    • Seligman SJ. Yellow fever virus vaccine-associated deaths in young women. Emerg Infect Dis. 2011;17:1891–3. Analysis of nine cases of fatal YELAVD, all of which occurred in women aged 19–34 years. PubMedGoogle Scholar
  42. 42.
    Barwick Eidex R, for the Yellow Fever Vaccine Safety Working Group. History of thymoma and yellow fever vaccination (letter). Lancet. 2004;364:936.CrossRefGoogle Scholar
  43. 43.
    Hayes EB. Acute viscerotropic disease following vaccination against yellow fever. Trans Roy Soc Trop Med Hyg. 2007;101:967–71.PubMedCrossRefGoogle Scholar
  44. 44.
    Bae HG, Domingo C, Tenorio A, et al. Immune response during adverse events after 17D-derived yellow fever vaccination in Europe. J Infect Dis. 2008;197:1577–84.PubMedCrossRefGoogle Scholar
  45. 45.
    Pulendran B, Miller J, Querec TD, et al. Case of yellow fever vaccine–associated viscerotropic disease with prolonged viremia, robust adaptive immune responses, and polymorphisms in CCR5 and RANTES genes. J Infect Dis. 2008;198:500–7.PubMedCrossRefGoogle Scholar
  46. 46.
    • Barrett AD, Teuwen DE. Yellow fever vaccine–how does it work and why do rare cases of serious adverse events take place? Curr Opin Immunol. 2009;21:308–13. Review of the possible pathogenic mechanisms for SAE in YF vaccine recipients. PubMedCrossRefGoogle Scholar
  47. 47.
    Silva ML, Espirito-Santo LR, Martins MA, et al. Clinical and immunological insights on severe, adverse neurotropic and viscerotropic disease following 17D yellow fever vaccination. Clin Vaccine Immunol. 2010;17:118–26.PubMedCrossRefGoogle Scholar
  48. 48.
    • Roukens AH, Soonawala D, Joosten SA, et al. Elderly subjects have a delayed antibody response and prolonged viraemia following yellow fever vaccination: a prospective controlled cohort study. PLoS ONE. 2011;6:e27753. Demonstration of how persons aged ≥60 years handle YF vaccine virus, compared with a younger cohort. PubMedCrossRefGoogle Scholar
  49. 49.
    Centers for Disease Control and Prevention. Transmission of yellow fever vaccine virus through breast-feeding–Brazil, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:130–2.Google Scholar
  50. 50.
    Traiber C, Coelho-Amaral P, Ritter VR, Winge A. Infant meningoencephalitis caused by yellow fever vaccine virus transmitted by breast milk. J Pediatr (Rio J). 2011;87:269–72.CrossRefGoogle Scholar
  51. 51.
    • Kuhn S, Twele-Montecinos L, MacDonald J, et al. Case report: probable transmission of vaccine strain of yellow fever virus to an infant via breast milk. CMAJ. 2011;183:E243–5. One of three cases of YF vaccine virus transmission to infants who are breast-feeding. PubMedCrossRefGoogle Scholar
  52. 52.
    • Monath TP, Fowler E, Johnson CT, et al. An inactivated cell-culture vaccine against yellow fever. N Engl J Med. 2011;364:1326–33. Trial of an inactivated YF vaccine demonstrating good immunogenicty and tolerabilty. PubMedCrossRefGoogle Scholar
  53. 53.
    McMahon AW, Eidex RB, Marfin AA, et al. Neurologic disease associated with 17D-204 yellow fever vaccination: a report of 15 cases. Vaccine. 2007;25:1727–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Frank H Netter MD, School of MedicineQuinnipiac UniversityHamdenUSA

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