• Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. It is called “yellow” because some patients develop jaundice.
• Symptoms: high fever, headache, jaundice, myalgia, nausea, vomiting and fatigue.
• A small proportion of patients infected with the virus develop severe symptoms, and about half of them die within 7-10 days.
• The virus is endemic in tropical areas of Africa and Central and South America.
• Large epidemics of yellow fever occur when infected people bring the virus into densely populated areas with high mosquito population densities and little or no immunity to the disease in the majority of the population due to lack of vaccination. Under such conditions, human-to-human transmission of the virus by infected mosquitoes begins.
• Yellow fever is extremely preventable effective vaccinations. The vaccine is safe and affordable. One dose of yellow fever vaccine is sufficient to provide lifelong immunity against yellow fever without the need for booster vaccination. The yellow fever vaccine is safe and affordable, providing effective immunity against yellow fever in 80-100% of vaccinated individuals within 10 days and in more than 99% of individuals within 30 days.
• Providing good supportive care in hospitals improves survival rates. On this moment There are no antiviral drugs against yellow fever.
• The End Yellow Fever Epidemic (EYE) strategy, launched in 2017, is an unprecedented initiative involving more than 50 partners.
• The EYE Partnership supports 40 at-risk countries in Africa and the Americas to prevent, detect and respond to outbreaks and suspected cases of yellow fever. The goal of the partnership is to protect vulnerable populations, prevent the international spread of the disease and quickly eliminate outbreaks. By 2026, more than a billion people are expected to be protected from the disease.

Signs and symptoms

The incubation period of the virus in the human body is 3-6 days. In many cases, the disease is asymptomatic. When symptoms appear, the most common are fever, muscle pain with severe back pain, headache, loss of appetite and nausea or vomiting. In most cases, symptoms disappear within 3-4 days.

However, in a small proportion of patients, a second, more severe phase of the disease occurs within 24 hours after the initial symptoms disappear. The temperature rises again and a number of body systems are damaged, usually the liver and kidneys. This phase is often characterized by jaundice (yellowing of the skin and eyeballs, hence the name of the disease - “yellow fever”), dark urine, abdominal pain and vomiting. There may be bleeding from the mouth, nose, or stomach bleeding. Half of the patients whose disease enters the toxic phase die within 7-10 days.

Diagnostics

Yellow fever is difficult to diagnose, especially in the early stages. Severe forms of the disease can be mistaken for severe form malaria, leptospirosis, viral hepatitis(especially fulminant), other hemorrhagic fevers, infection with other flaviviruses (for example, dengue hemorrhagic fever) and poisoning.

In some cases, a blood test (RT-PCR) can detect the virus in the early stages of the disease. On later stages disease requires testing for antibodies ( linked immunosorbent assay and plaque neutralization reaction).

At-risk groups

Forty-seven countries—in Africa (34) and Central and South America (13)—are either endemic or have regions where yellow fever is endemic. Modeling based on data from African countries estimated the burden of yellow fever in 2013 to be 84,000–170,000 severe cases and 29,000–60,000 deaths.

Occasionally, travelers to countries where yellow fever is endemic may introduce the disease to countries where it is not present. To prevent imported infections, many countries require proof of yellow fever vaccination when issuing visas, especially if the person lives in or has visited an endemic area.

In the past (in the 17th-19th centuries), yellow fever came to North America and Europe, causing major outbreaks of the disease, harming countries' economies, undermining their development and, in some cases, leading to large numbers of deaths.

Transmission of infection

Yellow fever virus is an arbovirus of the genus flavivirus, and the main vectors are mosquitoes of the Aedes and Haemogogus species. The habitats of these mosquito species can vary: some breed either near homes (domestic), or in the jungle (wild), or in both habitats (semi-domestic). There are three types of transmission cycles.

• Forest yellow fever: In tropical rainforests, monkeys, which are the main reservoir of infection, become infected by the bite of wild Aedes and Haemogogus mosquitoes and transmit the virus to other monkeys. Periodically, infected mosquitoes bite people working or staying in forests, after which people develop yellow fever.
• Intermediate yellow fever: in in this case semi-domestic mosquitoes (those that reproduce both in wildlife, and near dwellings) infect both monkeys and humans. More frequent contact between people and infected mosquitoes leads to more frequent transmission, and outbreaks can occur simultaneously in many isolated villages in separate areas. This is the most common type of outbreak in Africa.
• Urban yellow fever: Major epidemics occur when infected people introduce the virus into densely populated areas with high population densities of Aedes and Haemogogus mosquitoes and little or no immunity to the disease in the majority of the population due to lack of vaccination or previous yellow fever. Under these conditions, infected mosquitoes transmit the virus from person to person.

Treatment

Proper and timely supportive care in hospitals improves patient survival rates. There is currently no antiviral drug for yellow fever, but providing treatment for dehydration, liver or kidney failure and elevated temperature helps reduce the likelihood of an unfavorable outcome. Related bacterial infections can be treated with antibiotics.

Prevention

1. Vaccination

Vaccination is the main way to prevent yellow fever.

The yellow fever vaccine is safe and inexpensive. Moreover, one dose of the vaccine is sufficient to form lifelong immunity without the need for revaccination.

A number of strategies are used to prevent yellow fever and its spread: Routine childhood immunization infancy; conducting mass vaccination campaigns to expand coverage in countries at risk of disease outbreaks; vaccination of travelers to areas where yellow fever is endemic.

In high-risk areas with low vaccine coverage, the most important condition epidemic prevention is the timely detection and suppression of disease outbreaks through mass vaccination of the population. At the same time, in order to prevent further spread of the disease in the region where the outbreak is recorded, it is important to ensure high immunization coverage of the population at risk (at least 80%).

In rare cases, serious side effects of the yellow fever vaccine have been reported. The incidence rate of serious “adverse events following immunization” (AEFI), where liver, kidney and liver damage occurs after vaccine administration. nervous system, ranges from 0.09 to 0.4 cases per 10,000 vaccine doses in populations not exposed to the virus.

The risk of AEFI is higher in persons over 60 years of age, patients with severe immunodeficiency associated with symptomatic HIV/AIDS or other factors, and persons with impaired thymus gland. Vaccination of people over 60 years of age should be carried out after a careful assessment of the potential risks and benefits of immunization.

As a rule, people who are not eligible for vaccination include:

• infants under 9 months;
• pregnant women (except in cases of yellow fever outbreak and high risk of infection);
• persons with severe forms of egg white allergy;
• persons with severe immunodeficiency due to symptomatic HIV/AIDS or other factors, and persons with disorders of the thymus gland.

Under the International Health Regulations (IHR), countries have the right to require travelers to provide proof of vaccination against yellow fever. If there are medical contraindications to vaccination, you must provide an appropriate certificate from the competent authorities. The IHR is a legally binding framework designed to prevent the spread of infectious diseases and other public health threats. The requirement for travelers to provide proof of vaccination is left to the discretion of each participating State and is not currently practiced by all countries.

2. Control of mosquitoes that transmit the disease

The risk of yellow fever transmission in urban areas can be reduced by eliminating mosquito breeding sites, including - treating tanks and other objects with standing water with larvicides.

Both surveillance and vector control are elements of strategies for the prevention and control of diseases caused by insect vectors, including those used to prevent disease transmission during epidemics. In the case of yellow fever, epidemiological surveillance of mosquitoes of the species Aedes aegypti and other types Aedes helps to obtain information about the risk of outbreaks in cities.

Based on information about the distribution of mosquito species across the country, it is possible to identify areas where human disease surveillance and testing need to be strengthened, and vector control activities need to be developed. Currently, the arsenal of safe, effective and cost-effective insecticides that can be used against adult mosquitoes is limited. This is mainly due to the resistance of these mosquito species to common insecticides, as well as the abandonment or recall of certain pesticides for safety reasons or high prices for re-registration.

In the past, mosquito control campaigns have eradicated Aedes aegypti, the vector of yellow fever, from urban areas in much of Central and South America. However, Aedes aegypti has re-introduced urban areas in the region, again creating a high risk of urban transmission. Mosquito control programs targeting wild mosquito populations in forested areas are not suitable for preventing the transmission of sylvatic yellow fever.

To avoid mosquito bites, it is recommended to use personal protective equipment such as covered clothing and repellents. The use of mosquito nets on beds has limited effectiveness because mosquitoes Aedes active during the daytime.

3. Epidemic preparedness and response

Rapid detection of yellow fever and rapid response by launching emergency vaccination campaigns - the most important means outbreak control. However, there is a problem incomplete identification cases: the actual number of cases is estimated to be 10 to 250 times higher than today's official statistics.

WHO recommends that every country at risk of a yellow fever epidemic have at least one national laboratory that can perform basic blood tests for yellow fever. One case in an unvaccinated population is already being considered an outbreak of yellow fever. In any case, all laboratory-confirmed cases should be subject to thorough investigation. Investigation teams must assess the characteristics of the outbreak and implement both immediate and long-term response measures.

WHO activities

In 2016, two linked outbreaks of yellow fever occurred in the cities of Luanda (Angola) and Kinshasa ( Democratic Republic Congo) led to the disease spreading widely from Angola throughout the world, including China. This fact confirms that yellow fever is a serious global threat that requires a new strategic approach.

The Ending Yellow Fever Epidemic (EYE) strategy was developed in response to the growing threat of urban yellow fever outbreaks and the spread of the disease throughout the world. The strategy is led by WHO, UNICEF and GAVI (Global Alliance for Vaccines and Immunization) and covers 40 countries. Over 50 partners are working on its implementation.

The EYE global strategy is designed to solve three strategic objectives:

1. protection of the population at risk
2. preventing the spread of yellow fever throughout the world
3. quickly eliminate outbreaks

To successfully solve these problems, five components are required:

1. accessible vaccines and a stable vaccine market
2. strong political will at the international and regional levels, as well as at the level of individual countries
3. high-level decision-making based on long-term partnership
4. synergy with other health programs and sectors
5. Research and development to improve tools and practices.

The EYE strategy is complex, multi-component, combining the efforts of many partners. In addition to recommended vaccination activities, the strategy calls for the creation of urban sustainability centres, urban outbreak preparedness planning and more consistent application of the International Health Regulations (2005).

EYE Strategy partners are supporting countries at high and moderate risk of yellow fever in Africa and the Americas by strengthening their surveillance and laboratory capacity to respond to yellow fever outbreaks and cases. In addition, EYE strategy partners support the deployment and sustainable implementation of routine immunization programs and vaccination campaigns (preventive, proactive and reactive) anywhere in the world and at any time when needed.

• Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. It is called “yellow” because some patients develop jaundice.
• Symptoms: high fever, headache, jaundice, myalgia, nausea, vomiting and fatigue.
• A small proportion of patients infected with the virus develop severe symptoms, and about half of them die within 7 to 10 days.
• The virus is endemic in tropical areas of Africa and Central and South America.
• Large epidemics of yellow fever occur when infected people bring the virus into densely populated areas with high mosquito population densities and little or no immunity to the disease in the majority of the population due to lack of vaccination. Under such conditions, human-to-human transmission of the virus by infected mosquitoes begins.
• Yellow fever can be prevented with extremely effective vaccinations. The vaccine is safe and affordable. One dose of yellow fever vaccine is sufficient to provide lifelong immunity against yellow fever without the need for booster vaccination. The yellow fever vaccine is safe and affordable, providing effective immunity against yellow fever in 80-100% of vaccinated individuals within 10 days and in more than 99% of individuals within 30 days.
• Providing good supportive care in hospitals improves survival rates. There are currently no antiviral drugs against yellow fever.
• The End Yellow Fever Epidemic (EYE) strategy, launched in 2017, is an unprecedented initiative involving more than 50 partners.
• The EYE Partnership supports 40 at-risk countries in Africa and the Americas to prevent, detect and respond to outbreaks and suspected cases of yellow fever. The goal of the partnership is to protect vulnerable populations, prevent the international spread of the disease and quickly eliminate outbreaks. By 2026, more than a billion people are expected to be protected from the disease.

Signs and symptoms

The incubation period of the virus in the human body is 3-6 days. In many cases, the disease is asymptomatic. When symptoms appear, the most common are fever, muscle pain with severe back pain, headache, loss of appetite and nausea or vomiting. In most cases, symptoms disappear within 3-4 days.

However, in a small proportion of patients, a second, more severe phase of the disease occurs within 24 hours after the initial symptoms disappear. The temperature rises again and a number of body systems are damaged, usually the liver and kidneys. This phase is often characterized by jaundice (yellowing of the skin and eyeballs, hence the name of the disease - “yellow fever”), dark urine, abdominal pain and vomiting. There may be bleeding from the mouth, nose, or stomach bleeding. Half of the patients whose disease enters the toxic phase die within 7-10 days.

Diagnostics

Yellow fever is difficult to diagnose, especially in the early stages. Severe forms of the disease can be confused with severe malaria, leptospirosis, viral hepatitis (especially fulminant), other hemorrhagic fevers, infection with other flaviviruses (for example, dengue hemorrhagic fever) and poisoning.

In some cases, a blood test (RT-PCR) can detect the virus in the early stages of the disease. In the later stages of the disease, testing for the presence of antibodies is necessary (enzyme immunoassay and plaque neutralization test).

At-risk groups

Forty-seven countries—in Africa (34) and Central and South America (13)—are either endemic or have regions where yellow fever is endemic. Modeling based on data from African countries estimated the burden of yellow fever in 2013 to be 84,000–170,000 severe cases and 29,000–60,000 deaths.

Occasionally, travelers to countries where yellow fever is endemic may introduce the disease to countries where it is not present. To prevent imported infections, many countries require proof of yellow fever vaccination when issuing visas, especially if the person lives in or has visited an endemic area.

In the past (17th to 19th centuries), yellow fever spread to North America and Europe, causing major outbreaks of the disease, damaging the economies of countries, disrupting their development and, in some cases, leading to the death of large numbers of people.

Transmission of infection

Yellow fever virus is an arbovirus of the genus flavivirus, and the main vectors are mosquitoes of the Aedes and Haemogogus species. The habitats of these mosquito species can vary: some breed either near homes (domestic), or in the jungle (wild), or in both habitats (semi-domestic). There are three types of transmission cycles.

• Forest yellow fever: In tropical rainforests, monkeys, which are the main reservoir of infection, become infected by the bite of wild Aedes and Haemogogus mosquitoes and transmit the virus to other monkeys. Periodically, infected mosquitoes bite people working or staying in forests, after which people develop yellow fever.
• Intermediate yellow fever: in this case, semi-domestic mosquitoes (those that breed both in the wild and near homes) infect both monkeys and humans. More frequent contact between people and infected mosquitoes leads to more frequent transmission, and outbreaks can occur simultaneously in many isolated villages in separate areas. This is the most common type of outbreak in Africa.
• Urban yellow fever: Major epidemics occur when infected people introduce the virus into densely populated areas with high population densities of Aedes and Haemogogus mosquitoes and little or no immunity to the disease in the majority of the population due to lack of vaccination or previous yellow fever. Under these conditions, infected mosquitoes transmit the virus from person to person.

Treatment

Proper and timely supportive care in hospitals improves patient survival rates. There is currently no antiviral drug for yellow fever, but providing treatment for dehydration, liver or kidney failure, and fever can reduce the likelihood of an adverse outcome. Associated bacterial infections can be treated with antibiotics.

Prevention

1. Vaccination

Vaccination is the main way to prevent yellow fever.

The yellow fever vaccine is safe and inexpensive. Moreover, one dose of the vaccine is sufficient to form lifelong immunity without the need for revaccination.

A number of strategies are used to prevent yellow fever and its spread: routine immunization of infants; conducting mass vaccination campaigns to expand coverage in countries at risk of disease outbreaks; vaccination of travelers to areas where yellow fever is endemic.

In high-risk areas characterized by low vaccination coverage, the most important condition for preventing epidemics is the timely detection and suppression of disease outbreaks through mass vaccination of the population. At the same time, in order to prevent further spread of the disease in the region where the outbreak is recorded, it is important to ensure high immunization coverage of the population at risk (at least 80%).

In rare cases, serious side effects of the yellow fever vaccine have been reported. The incidence of these serious “adverse events following immunization” (AEFIs), where liver, kidney and nervous system damage occurs after vaccine administration, ranges from 0.09 to 0.4 per 10,000 vaccine doses in populations not exposed to the virus.

The risk of AEFI is higher in persons over 60 years of age, patients with severe immunodeficiency due to symptomatic HIV/AIDS or other factors, and persons with thymus gland disorders. Vaccination of people over 60 years of age should be carried out after a careful assessment of the potential risks and benefits of immunization.

As a rule, people who are not eligible for vaccination include:

• infants under 9 months;
• pregnant women (except in cases of yellow fever outbreak and high risk of infection);
• persons with severe forms of egg white allergy;
• persons with severe immunodeficiency due to symptomatic HIV/AIDS or other factors, and persons with disorders of the thymus gland.

Under the International Health Regulations (IHR), countries have the right to require travelers to provide proof of vaccination against yellow fever. If there are medical contraindications to vaccination, you must provide an appropriate certificate from the competent authorities. The IHR is a legally binding framework designed to prevent the spread of infectious diseases and other public health threats. The requirement for travelers to provide proof of vaccination is left to the discretion of each participating State and is not currently practiced by all countries.

2. Control of mosquitoes that transmit the disease

The risk of yellow fever transmission in urban areas can be reduced by eliminating mosquito breeding sites, including - treating tanks and other objects with standing water with larvicides.

Both surveillance and vector control are elements of strategies for the prevention and control of diseases caused by insect vectors, including those used to prevent disease transmission during epidemics. In the case of yellow fever, epidemiological surveillance of mosquitoes of the species Aedes aegypti and other types Aedes helps to obtain information about the risk of outbreaks in cities.

Based on information about the distribution of mosquito species across the country, it is possible to identify areas where human disease surveillance and testing need to be strengthened, and vector control activities need to be developed. Currently, the arsenal of safe, effective and cost-effective insecticides that can be used against adult mosquitoes is limited. This is mainly due to the resistance of these mosquito species to common insecticides, as well as the abandonment or recall of certain pesticides due to safety reasons or high re-registration costs.

In the past, mosquito control campaigns have eradicated Aedes aegypti, the vector of yellow fever, from urban areas in much of Central and South America. However, Aedes aegypti has re-introduced urban areas in the region, again creating a high risk of urban transmission. Mosquito control programs targeting wild mosquito populations in forested areas are not suitable for preventing the transmission of sylvatic yellow fever.

To avoid mosquito bites, it is recommended to use personal protective equipment such as covered clothing and repellents. The use of mosquito nets on beds has limited effectiveness because mosquitoes Aedes active during the daytime.

3. Epidemic preparedness and response

Rapid detection of yellow fever and rapid response through the initiation of emergency vaccination campaigns are critical tools for controlling outbreaks. However, there is a problem of under-reporting of cases, with the actual number of cases estimated to be 10 to 250 times higher than today's official statistics.

WHO recommends that every country at risk of a yellow fever epidemic have at least one national laboratory that can perform basic blood tests for yellow fever. One case in an unvaccinated population is already being considered an outbreak of yellow fever. In any case, all laboratory-confirmed cases should be subject to thorough investigation. Investigation teams must assess the characteristics of the outbreak and implement both immediate and long-term response measures.

WHO activities

In 2016, two linked outbreaks of yellow fever in the cities of Luanda (Angola) and Kinshasa (Democratic Republic of Congo) resulted in the disease spreading widely from Angola throughout the world, including China. This fact confirms that yellow fever is a serious global threat that requires a new strategic approach.

The Ending Yellow Fever Epidemic (EYE) strategy was developed in response to the growing threat of urban yellow fever outbreaks and the spread of the disease throughout the world. The strategy is led by WHO, UNICEF and GAVI (Global Alliance for Vaccines and Immunization) and covers 40 countries. Over 50 partners are working on its implementation.

The EYE global strategy is designed to solve three strategic objectives:

1. protection of the population at risk
2. preventing the spread of yellow fever throughout the world
3. quickly eliminate outbreaks

To successfully solve these problems, five components are required:

1. accessible vaccines and a stable vaccine market
2. strong political will at the international and regional levels, as well as at the level of individual countries
3. high-level decision-making based on long-term partnership
4. synergy with other health programs and sectors
5. Research and development to improve tools and practices.

The EYE strategy is complex, multi-component, combining the efforts of many partners. In addition to recommended vaccination activities, the strategy calls for the creation of urban sustainability centres, urban outbreak preparedness planning and more consistent application of the International Health Regulations (2005).

EYE Strategy partners are supporting countries at high and moderate risk of yellow fever in Africa and the Americas by strengthening their surveillance and laboratory capacity to respond to yellow fever outbreaks and cases. In addition, EYE strategy partners support the deployment and sustainable implementation of routine immunization programs and vaccination campaigns (preventive, proactive and reactive) anywhere in the world and at any time when needed.

Yellow fever is a particularly dangerous viral infection common in the countries of South America and Central Africa. The only way to protect against the disease is a specific vaccination. Anyone planning to visit dangerous regions must provide an international vaccination certificate.

Description of yellow fever

Story

The indigenous population of endemic areas has suffered from this disease for centuries. However, people who are constantly infected with small doses of the virus usually get mildly ill or are completely immune.

European encounters with yellow fever revealed its deadly nature. Since the 16th - 17th centuries, since the conquest and colonization of South America and the Caribbean islands, epidemics have constantly broken out there, claiming thousands of lives.

IN late XIX century, it was established that the infection is carried by mosquitoes of the genus Edes aegyptii. The systematic extermination of these insects began, which significantly reduced the number of cases.

In the 40s of the 20th century, vaccination began (the drug was created by virologist Max Taylor), which made it possible to further reduce the risk of epidemics.

Transmission routes

There are two types of circulation of the yellow fever virus in nature:

1. In wild areas and tropical forests, the infection is contained in the blood of monkeys and other animals. A mosquito that bites such an animal can transmit the virus to humans. This situation can be compared with immunization (vaccinations) - many local residents do not get sick with fever, but develop lifelong immunity.
2. In cities, the virus is transmitted from a sick person who is bitten by a mosquito. There are rare cases of infection due to exposure to infected blood and infection of virology laboratory employees. But the main way of spreading the disease remains transmission - through mosquito bites. Therefore, the patient should be under a mosquito net for the first four days, when the virus remains in his blood.

It should be noted that the higher the ambient temperature, the faster the virus multiplies inside the mosquito, which means it can infect humans. If it is cool outside (from +17 degrees and below), then the spread of infection does not occur at all. However, in regions where the disease spreads in a tropical climate, the temperature, as a rule, stays at +25 and above.

Symptoms of yellow fever

The incubation period of the disease lasts from 3 to 10 days. During this time, the virus concentrates in the lymph nodes closest to the site of the mosquito bite. There it multiplies, reaches a high concentration and enters the bloodstream.

The first manifestations of yellow fever coincide with the period of viremia (spread throughout the body with blood). The typical course is characterized sharp increase body temperature (up to 41 degrees), aches in muscles and bones, headaches and dizziness, vomiting, weakness. The patient's face becomes puffy and swollen. The skin and conjunctiva turn red.

• Liver and kidneys;
• Bone marrow and spleen;
• Brain and spinal cord;
• And so on.

Vessels and capillaries become thinner and become too permeable. Because of this, small and massive hemorrhages are possible. The skin and whites of the sick person's eyes turn yellow (due to this symptom giving its name to fever).

With a mild course, after the first wave of fever, to fourth day, relief comes - a period of remission. But in many patients such “enlightenment” turns out to be fleeting or completely absent.

The next period of the disease is characterized by severe damage to the bloodstream. Venous outflow is disrupted. Internal organs stop functioning and suffer from hemorrhages. It is these phenomena that most often lead to the death of the patient.

The fatality rate of yellow fever varies from 5% to 60% in epidemic areas.

If the situation develops favorably, by the end of 8-9 days the disease begins to recede and the condition improves.

Diagnosis and treatment

To make a correct diagnosis, it is important to compare the patient’s survey data with his condition:

• if a person has recently (within a week) been in areas where yellow fever is widespread without being vaccinated;
• if the patient has damage to the liver, kidneys, and spleen due to fever;
• if there is evidence of blood clotting disorders, all this should lead the specialist to think about a particularly dangerous infection.

Important: the sick person himself is not dangerous to others. If the air temperature is below +18 degrees, then mosquitoes will not be carriers of infection. If the air temperature is above +18 degrees, then you should immediately place the patient on a bed under a mosquito canopy and protect him in every possible way from mosquito bites. Such quarantine should last 4 days from the first symptoms of the disease (viremia period).

There is no specific treatment for yellow fever. Bed rest, control and maintenance of basic body functions are required. It is necessary to maintain metabolism, water-salt balance, and keep blood clotting at a normal level.

Prevention

In countries where yellow fever is endemic, mosquito eradication efforts are ongoing. The entire population is vaccinated and explained how to protect themselves from insect bites.

The yellow fever vaccine is recognized as one of the safest. It should not be administered only to infants under 9 months, pregnant women, people with severe intolerance to chicken protein and severe damage to the immune system (AIDS). At the same time, if an epidemic is registered, then infants are allowed to be vaccinated from 6 months, and pregnant women are also vaccinated.

Anyone planning to visit dangerous regions must be vaccinated ten days before departure. After vaccination, a certificate is issued that remains valid for ten years.

Immunity is developed that lasts for many years. Researchers often talk about lifelong immunity to yellow fever.

Yellow fever

What is Yellow Fever -

Yellow fever(yellow fever, fievre jaune, fiebre amarilla, vomito negro, febris flava) is an acute obligate-transmissible disease with natural focality from the group of viral hemorrhagic fevers. Refers to particularly dangerous infections. Characterized by a severe course with high fever, liver and kidney damage, jaundice, and bleeding from the gastrointestinal tract. First clinical picture yellow fever was described during an outbreak in America in 1648. In the 17th-19th centuries, numerous epidemics were recorded in Africa and South America, and outbreaks of the disease in southern Europe. The vector-borne route of transmission of infection through Aedes aegypti mosquitoes was established by K. Finlay (1881), its viral etiology was established by W. Reed and D. Carroll (1901). The natural focality of the disease, the role of monkeys in the circulation of the pathogen in the foci was established by the studies of Stokes (1928) and Soper et al. (1933). In 1936, Lloyd et al. developed effective vaccine against yellow fever.

What provokes / Causes of Yellow fever:

The causative agent of yellow fever- RNA genomic virus Viscerophilus tropicus of the Flavivirus genus of the Flaviviridae family. The diameter of viral particles is 17-25 nm. It is antigenically related to the Japanese encephalitis and dengue fever viruses. Pathogenic to monkeys, white mice and guinea pigs. Cultivated in developing chick embryos and tissue cultures. It is stored for a long time (more than a year) in a frozen state and when dried, but at 60 ° C it is inactivated within 10 minutes. It quickly dies under the influence of ultraviolet rays, ether, and chlorine-containing drugs in normal concentrations. Low pH values ​​have a detrimental effect on it. Populations at risk of yellow fever The population of 45 endemic countries in Africa and Latin America, totaling more than 900 million people, is at risk. In Africa, an estimated 508 million people living in 32 countries are at risk. The remaining populations at risk live in 13 Latin American countries, with Bolivia, Brazil, Colombia, Peru and Ecuador most at risk. An estimated 200,000 cases of yellow fever occur worldwide each year (30,000 of which are fatal). A small number of imported cases occur in countries free of yellow fever. Although the disease has never been introduced into Asia, the region is at risk because it has the conditions necessary for transmission. Reservoir and sources of infection- various animals (monkeys, marsupials, hedgehogs, possibly rodents, etc.). In the absence of a carrier, a sick person is not dangerous to others. Transmission mechanism- transmission. The carriers are mosquitoes of the genera Haetagogus (on the American continent) and Aedes, especially A. aegypti (in Africa), which have a close connection with human habitation. Vectors breed in decorative ponds, water barrels, and other temporary water reservoirs. They often attack humans. Mosquitoes become infectious within 9-12 days after blood-sucking at ambient temperatures up to 25°C and after 4 days at 37°C. At temperatures below 18 °C, the mosquito loses its ability to transmit the virus. If infected blood comes into contact with damaged skin and mucous membrane, a contact route of infection is possible. Natural receptivity people are high, post-infectious immunity is long-lasting. Main epidemiological features. Yellow fever is considered a quarantine disease (especially dangerous disease), subject to international registration. The highest incidence is recorded in tropical areas, but outbreaks of this disease occur almost everywhere where there are carriers of the virus. The spread of the virus from endemic areas can occur both through sick individuals and through mosquitoes during the transportation of goods. There are two types of foci: natural (jungle) and urban (anthropurgic). The latter more often manifest themselves in the form of epidemics; in this case, the sources of infection are patients during the period of viremia. IN last years yellow fever becomes more of an urban disease and acquires the features of anthroponosis (transmission occurs along the chain “human - mosquito - human”). If there are conditions for the spread of the pathogen (virus carriers, a large number of carriers and susceptible individuals), yellow fever can become epidemic.

Pathogenesis (what happens?) during Yellow Fever:

Reproduction of the virus that enters the body through a mosquito bite occurs in the regional lymph nodes during incubation period. During the first few days of illness, the virus disseminates through the bloodstream throughout the body, causing damage to the vascular apparatus of the liver, kidneys, spleen, bone marrow, myocardium, brain and other organs. They develop pronounced dystrophic, necrobiotic, hemorrhagic and inflammatory changes. Characterized by multiple hemorrhages in the gastrointestinal tract, pleura and lungs, as well as perivascular infiltrates in the brain.

Symptoms of Yellow Fever:

There are three variants of yellow fever in humans. These are jungle fever (rural type), city fever and an intermediate type. Rural option(yellow jungle fever). In tropical forests (selva), yellow fever occurs in monkeys infected by the bites of “wild” mosquitoes. Infected monkeys can spread the infection by passing it on to healthy mosquitoes. Infected "wild" mosquitoes bite and transmit the virus to people in the forest. This chain leads to isolated cases of infection, mainly in young people working in logging, without leading to epidemics or large outbreaks. The infection can also spread between infected people. Intermediate option infection occurs in humid or semi-humid African savannas and is the dominant form of infection on the continent. There are limited-scale epidemics that differ from the urban variant of the infection. “Semi-domestic” mosquitoes infect both animals and people. During such epidemics, several villages can be affected simultaneously, but the mortality rate with this variant of yellow fever is lower than with urban ones. Urban option infections are accompanied by large-scale epidemics, which are caused by the influx of migrants into urbanized regions with high population densities. "Domestic mosquitoes" (species Aedes aegypti) transmit the virus from person to person; monkeys are not involved in the epidemic chain of transmission of the disease. Incubation period lasts about a week, occasionally up to 10 days. In typical cases, the disease goes through several successive stages. Hyperemia phase. The acute onset of the disease is manifested by a rapid increase in body temperature above 38 °C with chills, headache, myalgia, pain in the back muscles, nausea and vomiting, agitation and delirium. In the dynamics of this phase of the disease, these symptoms persist and intensify. When examining patients, hyperemia and puffiness of the face, neck, shoulder girdle, bright hyperemia of the vessels of the sclera and conjunctiva, photophobia, lacrimation. Hyperemia of the tongue and oral mucosa is very characteristic. Severe tachycardia persists in severe cases of the disease or is quickly replaced by bradycardia, initial arterial hypertension- hypotension. The size of the liver and, less commonly, the spleen increase slightly. Oliguria, albuminuria, and leukopenia occur. Cyanosis, petechiae appear, and symptoms of bleeding develop. At the end of the phase, icterus of the sclera may be noted. The duration of the hyperemia phase is 3-4 days. Short-term remission. Lasts from several hours to 1-2 days. At this time, body temperature usually decreases (up to normal values), the well-being and condition of the patients are somewhat improving. In some cases, with mild and abortive forms, recovery gradually occurs in the future. However, more often, after a short-term remission, it reappears high fever, which can last up to 8-10 days, counting from the onset of the disease. In severe cases, remission is replaced by a period of venous stasis. During this period, there is no viremia, but fever persists, pallor and cyanosis of the skin, icteric staining of the sclera, conjunctiva and soft palate are noted. The patient's condition worsens, cyanosis, as well as jaundice, progress rapidly. Widespread petechiae, purpura, and ecchymosis occur. Hepatolienal syndrome is pronounced. Characterized by vomiting blood, melena, bleeding gums, and organ bleeding. Oliguria or anuria and azotemia develop. Infectious-toxic shock and encephalitis are possible. Infectious-toxic shock, renal and liver failure lead to the death of patients on the 7-9th day of illness. Complications infections can be pneumonia, myocarditis, gangrene of soft tissues or extremities, sepsis as a result of the layering of a secondary bacterial infection. In cases of recovery, it develops a long period convalescence. Post-infectious immunity is lifelong.

Diagnosis of Yellow Fever:

In Ukraine, yellow fever can only occur in the form of imported cases. In clinical differential diagnosis pay attention to the sequential change of the main two phases in the development of the disease - hyperemia and venous stasis - with a possible short period of remission between them. Laboratory data IN initial stage The disease is characterized by leukopenia with a sharp shift to the left, neutropenia, thrombocytopenia, at its height - leukocytosis, progressive thrombocytopenia, increased hematocrit, blood nitrogen and potassium. The amount of protein in the urine increases, red blood cells and casts appear. Hyperbilirubinemia and high activity of aminotransferases (mainly AST) are noted. In specialized laboratories, it is possible to isolate the virus from blood in initial period, using biological methods diagnostics (infection of newborn mice). Antibodies to the virus are determined using RNGA, RSK, RNIF, inhibition reaction indirect hemagglutination, ELISA.

Treatment of Yellow Fever:

Treatment of yellow fever is carried out according to the same principles as hemorrhagic fever with renal syndrome, in the conditions of infectious diseases departments for working with especially dangerous infections. Causal therapy has not been developed. Convalescent blood plasma, used in the first days of illness, gives a weak therapeutic effect. Forecast: the mortality rate of the disease ranges from 5%-10% to 15-20%, and during epidemic outbreaks - up to 50-60%.

Prevention of Yellow Fever:

Preventive actions are aimed at preventing the introduction of the pathogen from abroad and are based on compliance with the International Health Regulations and the Rules for the sanitary protection of the territory. They destroy mosquitoes and their breeding sites, protect premises from them and use individual funds protection. Specific tests are carried out at foci of infection immunoprophylaxis with live attenuated vaccine. It is administered subcutaneously to persons of all ages in a volume of 0.5 ml. Immunity develops within one week in 95% of vaccinated people. Immunity develops after 7-10 days and lasts for at least 10 years. Vaccination of children and adults is carried out before leaving for endemic areas (South Africa), where the disease in new arrivals is very severe and has a high mortality rate. Immunization against yellow fever is recommended:- persons traveling on a business or tourist trip (even for a short time), or living in a region where the disease is endemic - unvaccinated persons traveling from an endemic to a non-endemic region. In accordance with the established rules, a stamp of vaccination against yellow fever must be affixed to the International Certificate, as well as signed and approved by an accredited yellow fever vaccination center. - This vaccination certificate is valid for 10 years, starting from the 10th day after the date of vaccination. - persons at risk of infection due to their professional duties, HIV-infected persons in the asymptomatic stage. In accordance with established rules, a mark on vaccination against yellow fever must be affixed to the International Certificate, as well as signed and approved by an accredited yellow fever vaccination center. This vaccination certificate is valid for 10 years, starting on the 10th day after the date of vaccination. Contraindications to vaccination against yellow fever: General contraindications for yellow fever vaccination are similar to those for any vaccination: - infectious diseases in the active stage, - progressive malignant diseases, - current immunosuppressive therapy. Specific contraindications: - documented allergy to egg whites, - acquired or congenital immunodeficiency. Pregnant women and children under 6 months of age are not recommended to be vaccinated. However, in the event of an epidemic, pregnant women and infants from 4 years of age one month old, can be vaccinated. In difficult cases, you should consult a doctor. Precautions for yellow fever vaccination- In persons with allergic diseases a test is indicated to assess sensitivity to the drug by intradermal injection of 0.1 ml of vaccine. If there are no reactions within 10 - 15 minutes, the remaining 0.4 ml of vaccine should be administered subcutaneously. - IN special cases a decision may be made to vaccinate patients receiving immunosuppressive therapy. It is best not to vaccinate until 1 month after the end of such therapy and, in any case, you should make sure that the biological indicators are within normal limits. - In difficult cases, you should consult a doctor. Adverse reactions Sometimes, 4-7 days after vaccination, general reactions may occur - headache, malaise, slight increase in body temperature. Activities in the epidemic outbreak Patients are hospitalized in the infectious diseases department. If a sick person is detected on a ship during a voyage, he is isolated in a separate cabin. Disinfection is not carried out in the outbreak. Any vehicle, arriving from countries affected by yellow fever, must have information about the disinfestation carried out. Unvaccinated persons arriving from endemic areas are subject to isolation with medical supervision for 9 days. If an outbreak of yellow fever occurs, mass immunization of the population begins immediately. List of countries requiring an international certificate of vaccination against yellow fever. 1. Benin 2. Burkina Faso 3. Gabon 4. Ghana 5. Democratic Republic of the Congo 6. Cameroon 7. Congo 8. Ivory Coast 9. Liberia 10. Mauritania 11. Mali 12. Niger 13. Peru (only when visiting jungle areas) 14. Rwanda 15. Sao Tome and Principe 16. Togo 17. French Guiana 18. Central African Republic 19. Bolivia List of countries with zones endemic for this infection, upon entry to which it is recommended to have an international certificate of vaccination against yellow fever : South American countries 1. Venezuela 2. Bolivia 3. Brazil 4. Guyana 5. Colombia 6. Panama 7. Suriname 8. Ecuador African countries 1. Angola 2. Burundi 3. Gambia 4. Guinea 5. Guinea-Bissau 6. Zambia 7. Kenya 8. Nigeria 9. Senegal 10. Somalia 11. Sudan 12. Sierra Leone 13. Tanzania 14. Uganda 15. Chad 16. Equatorial Guinea 17. Ethiopia

Which doctors should you contact if you have Yellow fever:

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This virus is transmitted by the yellow fever mosquito (Aedes Aegypti species), and is especially common in Latin America, South America and Africa.

Despite the fact that the yellow fever vaccine was invented 60 years ago, epidemics still occur from time to time in Africa due to the fact that immunization in cities is insufficient.

Yellow fever

If you are going to travel to a sub-Saharan African country, it is better to take care of vaccination. Prevention of this disease is very important as it can lead to hepatitis and seriously damage your liver. In fact, the main symptoms of yellow fever - jaundice and fever - occur because the virus damages the liver. This disease can lead to other damage to internal organs, even fatal, so taking safety measures is a matter of life and death.

What is yellow fever? Understanding the Virus

Yellow fever is a viral infection that causes damage to organs, especially the liver. About 200,000 cases are reported annually, of which 30,000 die. Number of cases per Lately has increased critically, due to the fact that cities are growing, the climate is changing, but immunization of the population is often low. According to WHO, Latin America has the highest risk of contracting yellow fever in the world.

So what causes yellow fever? It is most often transmitted by infected mosquitoes through a bite.

How is yellow fever transmitted?

In most cases, people become infected with yellow fever when they are bitten by an infected mosquito. The virus can also be transmitted directly through an infected person, through dirty needles, for example. There is no other way to spread this disease from person to person.

Symptoms of yellow fever

Some people who are infected do not develop yellow fever symptoms. Usually the infection has 3 stages. The first begins a few days after the mosquito bite and may include following symptoms:

• Headache
• Dehydration
• Pain in muscles and joints
• Backache
• Loss of appetite
• Vomit
• Cold-like symptoms
• Chills

After the initial phase, most patients get better and often the disease does not progress further. However, in approximately 15-25% of patients, the condition worsens again and enters the third, more serious stage. During this phase, the following symptoms may appear:

• High fever
• Dehydration
• Internal bleeding
• State of shock
• Bleeding from the eyes, mouth and nose
• Bloody stool
• Bloody vomiting
• Jaundice - yellowing of the skin and eyes
• Redness of the tongue, eyes and face
• Liver inflammation or hepatitis
• Multiple organ failure
• Seizures
• Death

These are the symptoms of viral hemorrhagic fever, it damages internal organs And circulatory system. This condition is life-threatening for the patient. About half of patients with stage three yellow fever do not survive.

But the one who survived will need a life sentence health care because some of the organs, including the heart, lungs, kidneys or liver, may be seriously damaged. Patients with kidney damage may require lifelong hemodialysis. If your heart is damaged due to yellow fever, you will need to take ongoing medications or undergo other treatments to prevent heart failure or a heart attack. Even when yellow fever subsides, the patient's life can change critically.

Where is yellow fever common?

Yellow fever is more common in Africa and central and south America. These areas are endemic for yellow fever. In West Africa and South America, its prevalence is particularly high. According to the Centers for Disease Control and Prevention, among those who were not vaccinated and stayed in West Africa for only 2 weeks, 50 in 100,000 became infected with yellow fever. Among people who spent a two-week vacation in South America, 5 in 100,000 became infected.

Countries with especially high level Prevalence of yellow fever:

• Benin
• Cameroon
• Republic of the Congo
• Cote d'Ivoire
• Burkina Faso
• Gabon
• Guiana
• Central African Republic
• Liberia
• Angola
• Niger
• Rwanda
• Democratic Republic of the Congo
• Sao Tome and Principe

In addition to these countries, some countries in sub-Saharan Africa, as well as countries in central and South America. City residents are more susceptible to the virus. In Russia, all cases of yellow fever are imported. In our country, this infection has been known for a long time. Back in 1805, a decree would have been issued with its description and information about the need to protect port cities from this disease. The largest yellow fever epidemic in Russia was during the construction of the Panama Canal, when 500 thousand people got sick.

How do you know if you have yellow fever?

The only way to know if you have contracted yellow fever is to visit a doctor. If you have been to a country where this disease is common and then develop a fever or other symptoms, contact your doctor immediately. The doctor will clarify the symptoms and conduct tests for yellow fever. Tests may also be done to check for damage to the liver or other organs. When the first symptoms appear, it is important to immediately consult a doctor, because without treatment, fever can lead to irreparable consequences.

Treatment of yellow fever

There is no treatment as such, unless there is only symptomatic therapy, and the latter must be timely. If you are affected by this virus, doctors will advise hospitalization so that it is easier to monitor your symptoms and provide care depending on your condition.

For example, you may be given medications to reduce your fever and muscle pain, and may be given an IV to treat dehydration. If you regularly take anti-inflammatory medications that thin your blood, such as aspirin, you will need to stop taking them. Such medications increase the risk of internal bleeding in this disease. If your condition worsens due to organ damage, doctors at the hospital will be able to help you.

Yellow fever vaccination

Since there is no cure for this virus, it is important to get vaccinated against yellow fever before traveling to a country with a high risk of infection. Moreover, to enter some countries, you will need an international vaccination certificate with a record of vaccination against yellow fever.

Like any vaccine, the yellow fever vaccine has side effects. This vaccine is live and therefore carries more risks than inactivated vaccines. Some patients experience cold-like symptoms, while others may develop severe allergic reactions. Sometimes reactions to the vaccine develop that threaten the patient's life. If your condition changes after vaccination, consult your doctor immediately.

Remember that any vaccine is not 100% effective. Some vaccinated people may still get yellow fever.

As a rule, doctors recommend that all travelers over 9 months of age who are heading to countries where yellow fever is endemic be vaccinated. However, to avoid serious side effects, you should consult your doctor before vaccination if:

• Do you have problems with immune system due to HIV or other condition
• You are undergoing treatment for cancer or any other treatment that is difficult for the body
• You have cancer or is in remission
• Have problems with the thymus gland
• You are 65 years or older
• You need to vaccinate your child under 9 months
• Have you ever had an allergic reaction to the yellow fever vaccine or any other vaccines?
• You are allergic to gelatin, chicken or eggs
• Are you pregnant or planning to become pregnant?
• Are you breastfeeding?

If your doctor thinks you should not get the yellow fever vaccine because the risk of serious side effects is too high, it is best to reconsider your plans. If you still need to travel to a country with a high risk of contracting this virus, you may need a contraindication entry on the international vaccination certificate; some countries may simply not allow you to enter.

How long does the yellow fever vaccine last?

The vaccine takes about 10 days to become active, and most doctors recommend getting the shot at least 10 days before travel. Some doctors advise getting vaccinated a month in advance so that all possible side effects from the vaccine go away. You may need additional recovery time even if you only have cold-like symptoms after vaccination. It’s better to stay home and recover, otherwise all the fun of the trip may come to naught.

The yellow fever vaccine lasts for 10 years, so no matter how often you travel to countries where this disease is common, you will need to get vaccinated once every 10 years. If you want to know more about the risk of infection and the side effects of vaccination, it is best to consult your doctor.

Prevention of yellow fever

How to avoid getting yellow fever while traveling? The best prevention- avoid mosquito bites. The following tips will help you protect yourself:

• Use repellents. The most effective are those containing DEET, IR3535, picaridin, lemon and eucalyptus oils. Always check the expiration date and follow the instructions carefully.
• Apply repellent to clothing, your tent, hotel window screens, and any other mosquito screens.
• Be sure to use mosquito nets on the windows of the place where you plan to live. Check the screens regularly for damage.
• Spray all mosquito nets with repellent at night. This will further protect you.
• Wear long sleeves and long pants. Cover your skin as much as possible so that mosquitoes don't have a chance to bite. It is better to choose clothes in light shades. Light colors Mosquitoes are less susceptible to mosquitoes, and, among other things, such clothing will protect you from overheating.
• At sunrise and sunset, try to avoid areas with high mosquito counts. It is at this time of day that these insects are most active.

It is almost impossible to avoid all mosquito bites; write down all your trips in a special journal and register there all the insect bites that you notice on yourself. If you develop any unusual symptoms, these records will help doctors make the correct diagnosis.

Lasting Solutions to Mosquito Problems

Most people become infected with yellow fever through a mosquito bite. If you reduce the number of mosquitoes around you, you will significantly reduce the risk of bites and infection. Despite the fact that there are no natural foci of yellow fever in Russia, travelers often return from endemic areas infected with this virus or other diseases. Local mosquitoes can transmit diseases from these travelers to healthy people.

In addition to yellow fever, the yellow fever mosquito can also transmit dengue fever and chikungunya. If there are mosquitoes on your property, you are at risk of becoming infected. Preventing yellow fever should start with reducing the mosquito population in your yard.

The best method of protection is to reduce the number of mosquitoes around you. If you want to reduce your risk of being bitten and contracting diseases, there are several steps you can take to reduce your mosquito population.

The very first and simplest step is to reduce the number of places where mosquitoes can breed. These insects like to lay their eggs in damp and warm places. For the appearance of thousands of eggs and larvae, a lake, a pond, or any (even minimal) volume of standing water is enough. Such places, as well as shady areas, can be eliminated on your site. Particular attention should be paid to:

• Standing water in tires
• Bird drinkers
• Ditches and ditches
• Standing water in flower pots and other containers
• Rain barrels
• Tall grass

In some cases, it may not be possible to eliminate standing water. For example, you may not be able to remove a swimming pool from your neighbor's property or drain the swamps in your neighborhood. In this case, mosquito traps can help.

Traps serve to reduce the mosquito population (especially when the area is surrounded by a high, impenetrable fence), they specifically catch females. It is the females who drink blood; they need it to lay eggs. After just a few weeks of using the trap, there will be a noticeable decrease in the number of mosquitoes. The World Health Organization notes that the most effective prevention of yellow fever is to control the number of mosquitoes.

Use Mosquito Magnet traps to reduce mosquito numbers

You don't need any complicated systems to reduce the number of bloodsuckers near your home. Mosquito Magnet traps emit heated and humidified carbon dioxide along with an additional attractant. When mosquitoes approach the trap, they are sucked inside, where they dry out and die. It is a safe alternative to chemical sprays.

If you combine traps from Mosquito Magnet with repellents and the destruction of standing water, the number of mosquitoes in your yard will be critically reduced (especially if your yard is surrounded by a high enough fence). Isn't it great to enjoy summer vacation without mosquito bites? Not only will you be protected from those nasty itchy blisters, but you'll also avoid contracting vector-borne diseases.

Protect your family, pets and guests from mosquito-borne diseases with the Mosquito Magnet Trap - a long-lasting, scientifically proven solution.