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14 Apr 2017

#Outbreak of #yellowfever in #Brazil- First #update, 13 April 2017 (@ECDC_EU, summary)


Title: #Outbreak of #yellowfever in #Brazil- First #update, 13 April 2017.

Subject: Sylvatic Yellow Fever Outbreak in Brazil, multi-state, risk assessment update.

Source: European Centre for Disease Prevention and Control (ECDC), full PDF file: (LINK). Summary.

Code: [     ]



Outbreak of yellow fever in Brazil- first update, 13 April 2017


Suggested citation: European Centre for Disease Prevention and Control. Outbreak of yellow fever in Brazil, First update – 13 April 2017. Stockholm: ECDC; 2017.

© European Centre for Disease Prevention and Control, Stockholm, 2017


Conclusions and options for response

  • Brazil has been experiencing a yellow fever outbreak since January 2017 and vaccination requirements and recommendations for international travellers, including yellow fever, have been updated by WHO accordingly [1-6].
  • The Brazilian authorities have only reported yellow fever cases related to sylvatic transmission in 2016 and 2017.
  • However, this outbreak should be carefully monitored as the establishment of an urban yellow fever cycle would have the potential to quickly affect a large number of people. 
  • EU travellers travelling to areas at risk of yellow fever in South America should be informed of the potential exposure to yellow fever virus and an individual risk benefit analysis should be conducted during pre-travel medical consultation. 
  • The risk of yellow fever transmission in the EU/EEA is currently very low as it depends on the virus being introduced by viraemic travellers to an area with an established, competent and active mosquito vector population. 


Advice to travellers

  • EU citizens who travel to, or live in areas where there is evidence of periodic or persistent yellow fever virus transmission, especially those in outbreak-affected regions, are advised to:
    • Be aware of the risk of yellow fever in endemic areas throughout South America, including recently affected States in Brazil (Minas Gerais, Espírito Santo, Pará, Rio de Janeiro and São Paulo).
      • WHO publishes and provides an updated list of countries, territories and areas with yellow fever vaccination requirements and recommendations [1,7,8].
    • Check vaccination status and get vaccinated if necessary.
      • Vaccination against yellow fever is recommended from nine months of age for people visiting or living in yellow fever risk areas.
      • An individual risk-benefit analysis should be conducted prior to vaccination, taking into account the period, destination, duration of travel and likelihood of exposure to mosquitoes (e.g. visits to rural areas, forests) as well as individual risk factors for adverse events following yellow fever vaccination. 
    • Take measures to prevent mosquito bites indoors and outdoors, especially between sunrise and sunset when Aedes and sylvatic yellow fever mosquito vectors are most active [9].
      • These measures include:
        • the use of mosquito repellent in accordance with the instructions indicated on the product label;
        • wearing long-sleeved shirts and long trousers;
        • sleeping or resting in screened/air-conditioned rooms, or using mosquito nets at night and during the day.
  • International travellers returning from affected areas should be able to show proof of yellow fever vaccination (or a contraindication certificate) as these could be requested by countries or territories infested with Aedes aegypti mosquitoes


Advice to health professionals

  • Physicians, health professionals and travel health clinics should be provided with or have access to regularly updated information on areas with ongoing yellow fever transmission and should consider yellow fever in the differential diagnoses for illnesses in relation to unvaccinated travellers returning from affected areas. 
  • According to the updated recommendation from WHO (4 April 2017), vaccination against yellow fever for international travellers has been extended to the coastal area of Bahia State, Rio de Janeiro State and to the urban area of Campinas in São Paulo State [6].
  • ECDC will publish and regularly update a map of risk areas for yellow fever transmission in accordance with WHO recommendations. This map will also show distribution by State of confirmed yellow fever cases in Brazil* [10].
  • To reduce the risk of adverse events following immunisation, healthcare practitioners should be aware of the contraindications and follow the manufacturers’ advice on precautions before administering yellow fever vaccine [11,12]. 


Options for safety of SoHO

  • If an organ donor has received yellow fever vaccine during the four weeks before donation, an individual risk assessment of the immune status of all prospective recipients is mandatory.
  • Yellow fever vaccination is contraindicated for immunocompromised patients after solid organ and haematopoietic stem cell transplantation.
  • Potential transplant patients living in countries endemic for yellow fever or planning travel to endemic countries in the future should be immunised before transplantation.
  • There are no specific criteria for the deferral of a prospective SoHO donor with a history of yellow fever. Therefore, it is suggested that a general recommendation be applied that donors must have recovered, be afebrile and asymptomatic on the day of donation and may donate SoHO 14 days after full recovery.
  • Deferral of donors returning from areas affected by malaria will be sufficient to prevent yellow fever infectious donations.
  • Precautionary deferral is suggested for 28 days of non-vaccinated donors returning from an area affected by yellow fever but non-endemic for malaria.



Keywords: ECDC; Updates; European Region; Yellow Fever; Brazil.