Yellow fever

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Epidemiology

Due to non-specific acute febrile illness in its early stage including substantial number of asymptomatic cases, there are limitations to define the true incidence and case fatality rate of YF.

• WHO suggests case definitions to survey YF with suspected case as Any person with acute onset of fever, with jaundice appearing within 14 days of onset of the first symptoms.

World Health Organization. (2022). Yellow Fever Outbreak Toolbox. https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/yellow-fever-outbreak-toolbox

• A mathematical estimation using Bayesian model showed probability of asymptomatic infection, mild disease and severe disease as 55%, 33% and 12%, respectively, as well as case fatality rate among severe disease as 47%, but the 11 studies authors collected for the study were highly heterogeneous.

Johansson, M. A., Vasconcelos, P. F. C., & Staples, J. E. (2014). The whole iceberg: Estimating the incidence of yellow fever virus infection from the number of severe cases. Transactions of the Royal Society of Tropical Medicine and Hygiene, 108(8), 482–487. https://doi.org/10.1093/trstmh/tru092

• A systematic review and meta-analysis concluded from 14 articles that case fatality rate of YF among severe disease is 39% (95%CI 31-47).

Servadio, J. L., Muñoz-Zanzi, C., & Convertino, M. (2021). Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis. BMC Infectious Diseases, 21(1), 1–12. https://doi.org/10.1186/s12879-021-06535-4

transmission

• sylvatic cycle
• savannah cycle only in Africa
• urban cycle
• reason why YF doesn't exist in Asia is unknown

clinical features

• 3-6 days incubation
• infection phase
• remission phase
  • most patients ended with remission phase
• intoxication phase

prevention

• new XRX-001 vaccine may be safer