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Epidemiological update: Yellow fever outbreak in Brazil

28 Apr 2017
Yellow fever is a mosquito-borne viral infection present in some tropical areas of Africa and South America. On 6 January 2017, Brazil reported an outbreak of yellow fever that started in December 2016 and that has been ongoing since then. Bolivia, Colombia, Ecuador, Peru and Suriname have also reported cases of yellow fever in 2017.
 

Weekly summary

Between 12 and 20 April 2017, Brazil reported 155 additional cases of yellow fever (97 suspected and 58 confirmed). The additional confirmed cases have been reported in Espírito Santo (30), Minas Gerais (22), São Paulo (5) and Tocantins (1). This is the first confirmed autochthonous case reported in Tocantins since the beginning of the outbreak, although it is not a recent case. The additional confirmed cases reported in Espírito Santo and Minas Gerais are not recent cases either.
 
Between weeks 14 and 15 of 2017, Peru reported two additional suspected cases of yellow fever.
 

Epidemiological summary

Between 6 January and 20 April 2017, Brazil reported 1 449 cases of yellow fever (768 suspected and 681 confirmed), including 270 deaths (35 suspected and 235 confirmed). The case-fatality rate is 18.6% overall and 34.5% among confirmed cases.
 
States reporting suspected and confirmed autochthonous cases:
- Minas Gerais has reported 723 cases (252 suspected and 471 confirmed), including 178 deaths (13 suspected and 165 confirmed).
- Espírito Santo has reported 474 cases (289 suspected and 185 confirmed), including 75 deaths (17 suspected and 58 confirmed).
- São Paulo has reported 122 cases (112 suspected and 10 confirmed), including seven deaths (two suspected and five confirmed).
- Rio de Janeiro has reported 33 cases (23 suspected and 10 confirmed), including three deaths (one suspected and two confirmed).
- Pará has reported 21 cases (17 suspected and four confirmed), including four confirmed deaths.
- Tocantins has reported eight cases (seven suspected and one confirmed), including one confirmed death.
 
States reporting suspected autochthonous cases:
Fourteen states have reported 68 suspected cases: Paraná (15, including 1 fatal), Bahia (12), Goiás (12), Rio Grande do Sul (6), Rondônia (5), Santa Catarina (5), Amapá (3), Maranhão (2), Mato Grosso (2), Mato Grosso do Sul (2), Amazonas (1), Ceará (1), Distrito Federal (1, fatal) and Paraíba (1).
 
Other countries in South America:
From the beginning of 2017 to 25 April, five other countries have reported suspected and/or confirmed cases of yellow fever: Peru (14), Colombia (2), Bolivia (1), Ecuador (1) and Suriname (1).
 
 
ECDC assessment
The ongoing outbreak should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to quickly affect a large number of people. EU/EEA citizens who travel to, or live in, areas where there is evidence of yellow fever virus transmission should check their vaccination status and obtain medical advice about being vaccinated against yellow fever.
 
In Europe, Aedes aegypti, the primary vector of yellow fever in urban settings, is present in Madeira. Recent studies have shown that Aedes albopictus can potentially transmit the yellow fever virus. However, the risk of the virus being introduced into local competent vector populations in the EU through viraemic travellers from Brazil is considered to be very low, as the current weather conditions in Europe are not favourable for vector activity.
 
Actions
ECDC closely monitors this event in collaboration with the World Health Organization. ECDC published its updated rapid risk assessment on 14 April 2017. ECDC is also producing epidemiological updates and a map for travel advice.
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