Yellow Fever among returning travellers from Brazil
Two travel-associated cases of yellow fever have been reported, one by France in February and one by the Netherlands in January. Both cases were in unvaccinated travellers returning from Brazil.
Brazil has been experiencing a yellow fever outbreak since January 2017 and travel recommendations have been updated accordingly. Therefore, people 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 during pre-travel medical consultation should be performed.
The ongoing yellow fever outbreak in Brazil should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to rapidly affect a significant number of people. The risk of introduction and further transmission of the yellow fever virus in the EU is currently considered very low.
Advice to Travellers
People 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 in South America, including recently affected States in Brazil. WHO publishes a list of countries, territories and areas with yellow fever vaccination requirements and recommendations. WHO now recommends vaccination against yellow fever for international travellers visiting any area in the state of São Paulo.
- 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 following the instructions indicated on the product label;
- wearing long-sleeved shirts and long trousers;
- sleeping or resting in screened or 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 affecting returning travellers from affected areas.
- To reduce the risk of adverse events following immunisation, healthcare practitioners should be aware of the contraindications and comply with the manufacturers’ advice on precautions before administering yellow fever vaccine.
Further information:
ECDC Communicable disease threats report 11-17 February 2018, week 7
ECDC Rapid risk assessment: Outbreak of yellow fever in Brazil, Second update - 18 January 2018
WHO Yellow fever vaccination requirements and recommendations