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Yellow fever among travellers returning from South America, rapid risk assessment

16 Mar 2017

​The recent increase in the number of cases among EU travellers returning from South America has prompted ECDC to assess the risk for EU travellers and introduction to the EU/EEA in a new rapid risk assessment.

A travel-associated case of yellow fever has been reported by the Netherlands in March 2017 after travel to Suriname. During the past eight months, four travel-associated cases of yellow fever have been identified among EU travellers returning from South America. This represents a significant increase in comparison with the four travel-associated cases of yellow fever among EU travellers during the last 27 years.

The risk of introduction into the EU/EEA countries of yellow fever virus by infected returning travellers is considered low, as most travellers coming from affected areas are likely to have been immunised.
The risk of onward transmission in the EU/EEA is currently very low as it depends on the virus being introduced to an area with an established, competent and active mosquito population. In Europe, Aedes aegypti, the primary vector of yellow fever in urban settings, is only present in Madeira. Current weather conditions in Europe are not favourable for mosquito vector activity.
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.
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. WHO publishes a list of countries, territories and areas with yellow fever vaccination requirements and recommendations.
  • 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 the likelihood of exposure to mosquitoes (e.g. 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. 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.
Advice to health professionals
Physicians, health professionals and travel health clinics should be provided with or have access to regularly updated information about areas with ongoing yellow fever transmission and should consider yellow fever in the differential diagnoses for illnesses in relation to travellers returning from affected areas.
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