SUSTAINED PUBLIC HEALTH SURVELLAINCE AT THIS TIME OF GLOBAL IN STABILITY - LOOMING YELLOW FEVER THREAT?

Health and social workers talk to relatives of Watila Santos, who died from yellow fever in Casimiro de Abreu, Brazil, in March. CreditLeo Correa/Associated Press

Three years ago, the West African Ebola epidemic set off a worldwide panic and the biggest global-health security crisis in years. Then Zika struck and the reality of those transmittable disease threats was brought even closer to home in the United States, with more than 5,000 cases reported and America still on high alert. Yet today, an even greater potential threat to the world is sweeping across Brazil.

The disease, yellow fever, is a deadly virus that spreads as rapidly as Zika, with symptoms that can be as horrific as Ebola. It is transmitted by certain species of mosquito, including the same Aedes aegypti that carries Zika. Up to 15 percent of those bitten become severely ill, with symptoms that include black vomit and bleeding from the nose, mouth and eyes. For up to half of those who develop severe symptoms, yellow fever ends in a painful death.

Until about a century ago, the disease regularly caused urban epidemics in the United States, including one in Philadelphia that killed 10 percent of the population in 1793, forcing President George Washington and others in his administration to flee what was then the nation’s capital.

Now, with Brazil facing an unusually large outbreak of yellow fever — there are 715 confirmed cases, more than 820 suspected cases and 240 confirmed deaths — another global health crisis looms. So far, the outbreaks have largely been confined to sparsely populated jungle areas. There is serious concern, however, that if the virus starts spreading in a major city, health authorities will be ill equipped to contain it. Rio de Janeiro, for one, is aggressively vaccinating its citizens in hopes of inoculating 12 million by the end of the year.

Yellow fever already kills upward of 30,000 people a year worldwide, though in 2013 as many as 60,000 might have died from the disease. With the threat of yellow fever returning to regions where it was once expunged, that number could rise significantly. What is particularly worrying is the possibility of yellow fever taking hold in previously unaffected parts of the world like Asia. The combination of Aedes aegypti being prevalent there and about 1.8 billion unvaccinated people living in densely populated parts of that continent makes for a potential disaster.

While there is no cure for yellow fever, a licensed vaccine has long been available that is safe, affordable and highly effective, providing lifetime protection with just one dose.’’

Africa Center for Clin Gov Research & Patient Safety

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