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Epidemiological update: Yellow fever outbreak in Brazil

03 Feb 2017
Yellow fever is a viral infection that is present in some tropical areas of Africa and South America. The virus is transmitted by mosquitoes, which also act as an important reservoir. Since 6 January 2017, Brazil has been experiencing an outbreak of yellow fever.
 

Weekly summary

Since the beginning of the outbreak, five states have reported autochthonous transmission of yellow fever: Minas Gerais, Espírito Santo and São Paulo have reported confirmed locally-acquired cases, while Bahia and Tocantins have reported suspected locally-acquired cases.

As of 2 February 2017, 826 cases (including 155 confirmed) have been reported in Brazil. This represents an increase of 315 cases (including 67 confirmed) since the last CDTR. The most-affected state remains Minas Gerais, with 740 cases (including 138 confirmed) reported.

The World Health Organization (WHO) issued “Temporary yellow fever vaccination recommendations for international travellers related to current situation in Brazil” on 31 January 2017.
 

Epidemiological summary

On 6 January 2017, Brazil reported an outbreak of yellow fever. The index case had onset of symptoms on 18 December 2016. The first laboratory confirmation was notified on 19 January 2017.

As of 2 February 2017, Brazil has reported 826 cases (671 suspected and 155 confirmed), including 139 deaths (82 suspected and 57 confirmed), in five states. The case fatality rate is 16.8% among all cases and 36.8% among confirmed cases.

States reporting suspected and confirmed cases:
- Minas Gerais has reported 740 cases (602 suspected and 138 confirmed), including 128 deaths (77 suspected and 51 confirmed).
- Espírito Santo has reported 65 cases (52 suspected and 13 confirmed), including eight deaths (five suspected and three confirmed).
- São Paulo has reported seven cases (three suspected and four confirmed), including three confirmed deaths.

States reporting suspected cases:
- Bahia has reported eight suspected cases, none fatal.
- Tocantins has reported four suspected cases, none fatal.

Investigations are ongoing to determine the probable infection site of two further suspected cases.

The Ministry of Health of Brazil has launched mass vaccination campaigns targeting the affected areas.

Sources: Brazil MoH ¦ Minais Gerais MoH
 

ECDC Assessment

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.

In Brazil, authorities have reported only sylvatic cases 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. Therefore, EU/EEA Member States should consider a range of options for response.

EU/EEA citizens who travel to, or live in, areas where there is evidence of yellow fever virus transmission, particularly in the states of Brazil reporting confirmed local transmission, should consider the risk of yellow fever, check their vaccination status and get medical advice about getting vaccinated against yellow fever.
ECDC monitors closely this event in collaboration with WHO. ECDC has published a rapid risk assessment on 26 January 2017. ECDC has also published an epidemiological update and a map for travel advice.
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