Yellow Fever: guidance, data and analysis
Travel and clinical advice on yellow fever including symptoms, diagnosis and epidemiology.
Yellow fever is a viral disease that is transmitted by several species of mosquito. It is caused by the yellow fever virus, which belongs to the Flaviviridae family. It is endemic in tropical regions of Africa and South America where the World Health Organization (WHO) estimates approximately 200,000 cases occur each year, with 30,000 deaths.
In 2016, a large yellow fever outbreak was reported in Angola and the Democratic Republic of Congo. Further details are available on the WHO website.
Humans and monkeys are the principle reservoirs for the virus. The most common types of mosquito that transmit the yellow fever virus are Aedes spp (including Aedes aegypti), Haemagogus spp and Sabethes spp. Yellow fever does not naturally occur in the UK as the mosquitoes that transmit yellow fever are not established in the UK. The last known case to have occurred in the UK was in 1930 in a laboratory worker who had been working with yellow fever virus.
There are three main transmission cycles. Sporadic cases resulting from sylvatic (jungle) transmission are seen in South America and Africa. The intermediate cycle of transmission occurs in the moist savannah zones of Africa only, when semi-domestic mosquitoes infect both animals and humans and may cause small epidemics in rural villages. Urban transmission can occur where the virus is introduced into urban areas and the domestic Aedes aegypti mosquito is widespread. This can lead to large outbreaks if the virus is introduced into unvaccinated populations.
Yellow fever varies in severity. There are two stages to yellow fever; 3 to 6 days after infection symptoms may include fever, headache, nausea or vomiting, muscle pain (often with backache), and loss of appetite. Most people will make a full recovery after 3 to 4 days, however a small number (approximately 15%) will go on to develop jaundice, abdominal pain, renal failure and haemorrhage (bleeding). Up to half of those who develop the severe symptoms may die. Infection results in life long immunity in those who recover.
Send the appropriate samples (with full clinical, travel and vaccination history including relevant dates) to PHE’s Rare and imported pathogens laboratory (RIPL). RIPL is a specialist centre for advice and diagnosis of a wide range of unusual viral and bacterial infections including yellow fever.
Prevention and advice for travellers
Yellow fever is rare in travellers, but between 1996 and 2016 6 fatal cases have been recorded in European and US travellers. All the fatal cases were in unvaccinated travellers.
The yellow fever vaccine is very effective and safe, although there have been a few reports of rare adverse events associated with its use. It is considered to provide lifelong immunity in most travellers. Yellow fever vaccine is an entry requirement for some countries under the International Health Regulations (2005), it will also be recommended for those travelling to endemic areas even if there is no entry requirement. Further information is available on the National Travel Health Network and Centre (NaTHNaC) country pages including details of your nearest yellow fever vaccination centre.
Changes to yellow fever vaccination certificates
On 11 July 2016, changes were made to the International Health Regulations (IHR, 2005) regarding the validity of the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever vaccine. The period of validity of the ICVP has changed from 10 years to the duration of the life of the person vaccinated. Further details are available from the NaTHNaC.