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| {{DiseaseDisorder infobox | | |||
| Name = Yellow fever | | |||
| Image = | | |||
| Caption = | | |||
| ICD10 = {{ICD10|A|95||a|90}} | | |||
| ICD9 = {{ICD9|060}} | | |||
| ICDO = | | |||
| OMIM = | | |||
| DiseasDB = 14203 | | |||
| MedlinePlus = | | |||
| eMedicineSubj = med | | |||
| eMedicineTopic = 2432 | | |||
| eMedicine_mult = {{eMedicine2|emerg|645}} | | |||
| MeshID = D015004 | |||
| }} | |||
| {{Taxobox | |||
| <!-- Color parameter is not needed -- automatically assigned --> | |||
| | name = ''Yellow fever virus'' | |||
| | image = YellowFeverVirus.jpg | |||
| | image_caption = ] ]: Multiple yellow fever virions (234,000x magnification). | |||
| | virus_group = iv | |||
| | familia = '']'' | |||
| | genus = '']'' | |||
| | type_species = '''''Yellow fever virus''''' | |||
| }} | |||
| {{otheruses}} | |||
| '''Yellow fever ''' (also called ''yellow jack'', ''black vomit'' or ''vomito negro'', or sometimes ''American Plague'') is an acute ] disease.<ref name=Baron>{{cite book | author = Schmaljohn AL, McClain D.| title = Alphaviruses (Togaviridae) and Flaviviruses (Flaviviridae). ''In: Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch|year = 1996 isbn= 0-9631172-1-1 }}</ref> It is an important cause of ] illness in many ]n and ]n countries despite existence of an effective ]. The ''yellow'' refers to the ] symptoms that affect some patients.<ref name =WHO2000>{{cite web|url=http://www.who.int/csr/resources/publications/surveillance/WHO_Report_Infectious_Diseases.pdf |title=WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases |accessdate=2007-06-11|author=Anker M, Schaaf D, ''et al''|date= 2000-01-07| |format=PDF |publisher=WHO |pages=11 }}</ref> | |||
| Yellow fever has been a source of several devastating ]s. French soldiers were attacked by yellow fever during the ] ]; more than half of the army perished due to the disease.<ref name=Bollet_2004>{{cite book | last = Bollet | first = AJ | title = Plagues and Poxes: The Impact of Human History on Epidemic Disease | pages=pp. 48–9 | publisher = Demos Medical Publishing | year = 2004 | id = ISBN 188879979X }}</ref> Outbreaks followed by thousands of deaths occurred periodically in other ] locations until research, which included human volunteers (some of whom died), led to an understanding of the method of transmission to humans (primarily by ]s) and development of a vaccine and other preventative efforts in the early 20th century. | |||
| Despite the costly and sacrificial breakthrough research by Cuban physician ], American physician ], and many others over 100 years ago, unvaccinated populations in many developing nations in Africa and Central and South America continue to be at risk.<ref name=Tomori_2002>{{cite journal | author=Tomori O | title=Yellow fever in Africa: public health impact and prospects for control in the 21st century | journal=Biomedica | year=2002 | pages=178-210 | volume=22|issue=2|pmid = 12152484 }}</ref> As of 2001, the ] (WHO) estimates that yellow fever causes 200,000 illnesses and 30,000 deaths every year in unvaccinated populations.<ref name=WHO_2001>{{cite web | title=Yellow fever fact sheet | work=WHO—Yellow fever | url=http://www.who.int/mediacentre/factsheets/fs100/en/ | accessdate=2006-04-18}}</ref> | |||
| ==Pathogenesis== | |||
| ]'' mosquito on a human host, about to obtain a blood meal]] | |||
| Yellow fever is caused by an ] of the family ], a positive single-stranded ] virus. Human infection begins after deposition of viral particles through the skin in infected ] ]. The mosquitos involved are '']'', '']'', and '']'' in Africa, the '']'' genus in South America,<ref name=WHO_2001 /> and the '']'' genera in France. | |||
| Yellow fever is frequently severe but more moderate cases may occur as the result of previous infection by another flavivirus. After infection the virus first replicates locally, followed by transportation to the rest of the body via the ].<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill|year = 2004|id = ISBN 0-8385-8529-9 }}</ref> Following systemic lymphatic infection the virus proceeds to establish itself throughout organ systems, including the heart, kidneys, ]s, and the ] of the liver; high viral loads are also present in the blood.<ref name=Baron /> Necrotic masses (]) appear in the ] of ]s.<ref name=Sherris /><sup>,</sup><ref name=Quaresma_2006>{{cite journal | author=Quaresma JA, Barros VL, Pagliari C, Fernandes ER, Guedes F, Takakura CF, Andrade HF Jr, Vasconcelos PF, Duarte MI | title=Revisiting the liver in human yellow fever: virus-induced apoptosis in hepatocytes associated with TGF-beta, TNF-alpha and NK cells activity | journal=Virology | year=2006 | pages=22-30 | volume=345 | issue=1 | id= PMID 16278000 }}</ref> | |||
| There is a difference between disease outbreaks in rural or forest areas and in towns. Disease outbreaks in towns and non-native people may be more serious because of higher densities of ] ] and higher population densities.<ref>{{cite journal |last=Barnett |first=ED |year=2007 |month=March |title=Yellow fever: epidemiology and prevention. |journal=Clin Infect Dis |volume=44 |issue=6 |pages=850-6 |accessdate= 2007-12-05}}</ref> | |||
| ==Symptoms== | |||
| The virus remains silent in the body during an ] of three to six days. There are then two disease phases. While some infections have no symptoms the first, ''acute'' phase is normally characterized by fever, muscle pain (with prominent backache), headache, shivers, loss of appetite, and nausea or vomiting. The high fever is often paradoxically associated with a slow pulse (known as ]). After three or four days most patients improve and their symptoms disappear. | |||
| Fifteen percent of patients, however, enter a ''toxic phase'' within 24 hours. Fever reappears and several body systems are affected. The patient rapidly develops ] and complains of abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes, and stomach. Once this happens, blood appears in the vomit and feces. ] deteriorates; this can range from abnormal protein levels in the urine (]) to ] with no urine production (]). Half of the patients in the "toxic phase" die within fourteen days. The remainder recover without significant organ damage. | |||
| Yellow fever is difficult to recognize, especially during the early stages. It can easily be confused with ], ], ] diseases, ]s (e.g. Lassa), ] infections (e.g. ]), ], ] and poisoning (e.g. ]). A laboratory analysis is required to confirm a suspect case. Blood tests (serology assays) can detect yellow fever ] that are produced in response to the infection. Several other techniques are used to identify the virus itself in blood specimens or liver tissue collected after death. These tests require highly trained laboratory staff using specialized equipment and materials. | |||
| ==Prevention== | |||
| In 1937, ], working at the ], developed a ] for yellow fever that gives a ten-year or more immunity from the disease and effectively protects people traveling to affected areas, while at the same time being a means to control the disease. According to the travel clinic at the University of Utah Hospital, the vaccine presents a significantly increased risk of severe allergic reaction in adults aged 60 and older, with the risk increasing again after age 65, and again after age 70. The reaction is capable of producing multiple organ failure and should be evaluated carefully by a qualified health professional before being administered to the elderly. | |||
| Woodcutters working in tropical areas should be particularly targeted for vaccination. ]s, protective clothing, and screening of houses are helpful, but not always sufficient for mosquito control; people should always use an insecticide spray while in certain areas. In affected areas, ] methods have proven effective in decreasing the number of cases.<ref>{{cite web|url=http://www.epa.gov/pesticides/health/mosquitoes/mosquitojoint.htm#programs |title= Joint Statement on Mosquito Control in the United States from the U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control and Prevention (CDC) |accessmonthday= June 25 |accessyear=2006 |date= 2000-05-03| |format=PDF |publisher=Environmental Protection Agency |}}</ref> | |||
| Recent studies have noted the increase in the number of areas affected by mosquito-borne viral infections and have called for further research and funding for vaccines.<ref name=Pugachev_2005>{{cite journal | author=Pugachev KV, Guirakhoo F, Monath TP | title=New developments in flavivirus vaccines with special attention to yellow fever | journal=Curr Opin Infect Dis | year=2005 | pages=387-94 | volume=18 | issue=5 | id=PMID 16148524}}</ref><sup>,</sup><ref name=Petersen_2005>{{cite journal | author=Petersen LR, Marfin AA | title=Shifting epidemiology of Flaviviridae | journal=J Travel Med | year=2005 | pages=S3-11 | volume=12 Suppl 1 | id={{PMID|16225801}} }}</ref> | |||
| ==Treatment== | |||
| There is no true cure for yellow fever, therefore vaccination is important. Treatment is ] and supportive only. ], fighting ] and ] is generally needed only in severe cases. In cases that result in ], ] may be necessary. A fever victim needs to get a lot of rest, fresh air, and drink plenty of fluids. | |||
| ==Current research== | |||
| In the hamster model of yellow fever, early administration of the antiviral ] is an effective early treatment of many pathological features of the disease.<ref name=Sbrana_2004>{{cite journal | author=Sbrana E, Xiao SY, Guzman H, Ye M, Travassos da Rosa AP, Tesh RB | title=Efficacy of post-exposure treatment of yellow fever with ribavirin in a hamster model of the disease | journal=Am J Trop Med Hyg | year=2004 | pages=306-12 | volume=71|issue=3|id={{PMID|15381811}} }}</ref> Ribavirin treatment during the first five days after virus infection improved survival rates, reduced tissue damage in target organs (liver and spleen), prevented hepatocellular ], and normalized alanine aminotransferase (a liver damage marker) levels. The results of this study suggest that ribavirin may be effective in the early treatment of yellow fever, and that its mechanism of action in reducing liver pathology in yellow fever virus infection may be similar to that observed with ribavirin in the treatment of hepatitis C, a virus related to yellow fever.<ref name=Sbrana_2004 /> Because ribavirin had failed to improve survival in a virulent primate (rhesus) model of yellow fever infection, it had been previously discounted as a possible therapy.<ref name=Huggins_1989>{{cite journal | author=Huggins JW | title=Prospects for treatment of viral hemorrhagic fevers with ribavirin, a broad-spectrum antiviral drug | journal=Rev Infect Dis | year=1989 | pages=S750-61 | volume=11 Suppl 4 | id={{PMID|2546248}} }}</ref> | |||
| In 2007, the World Community Grid launched a project where by computer modeling of the yellow fever virus (and related viruses) thousands of small molecules are screened for their potential anti-viral properties in fighting yellow fever. This is the first project to utilize computer simulations in seeking out medicines to directly attack the virus once a person is infected. This is a distributed process project similar to ] where the general public downloads the World Community Grid agent and the program (along with thousands of other users) screens thousands of molecules while their computer would be otherwise idle. If the user needs to use the computer the program sleeps. There are several different projects running, including a similar one screening for anti-AIDS drugs. The project covering yellow fever is called "Discovering Dengue Drugs – Together." The software and information about the project can be found at: | |||
| * | |||
| ==Prognosis== | |||
| Historical reports have claimed a mortality rate of between 1 in 17 (5.8%) and 1 in 3 (33%).<ref name =Virginia>{{cite web|url=http://etext.lib.virginia.edu/etcbin/fever-browse?id=N2659002 |title= Mosquito control ends fatal plague of yellow fever|accessdate = 2007-06-11 |author=Mauer HB |accessyear=2006 |publisher=etext.lib.virginia.edu}} (undated newspaper clipping)</ref> The ] factsheet on yellow fever, updated in 2001, states that 15% of patients enter a "toxic phase" and that half of that number die within ten to fourteen days, with the other half recovering.<ref name=WHOfactsheet>{{cite web |title = WHO Yellow Fever Fact Sheet |url=http://www.who.int/mediacentre/factsheets/fs100/en/ | accessdate = 2007-02-22 }}</ref> | |||
| ==Epidemiology== | |||
| ] | |||
| ] | |||
| Yellow fever occurs only in Africa, South and Central America, and the Caribbean.<ref>{{cite web|url=http://www.who.int/csr/disease/yellowfev/impact1/en/index.html |title= Yellow fever: a current threat |accessmonthday= June 25 |accessyear=2006 |publisher=WHO |}}</ref> Most outbreaks in South America are to people who work within the tropical rain forests and have direct contact with the organisms within the rainforest. | |||
| The disease can remain locally unknown in humans for long periods of time and then suddenly break out in an epidemic fashion. In Central America and Trinidad, such epidemics have been due to a form of the disease (''jungle yellow fever'') that is kept alive in ] monkey populations and transmitted by ''Haemagogus'' mosquito species which live only in the canopy of rain forests. The virus is passed to humans when the tall rainforest trees are cut down. Infected woodcutters can then pass on the disease to others via species of ''Aedes'' mosquitoes that typically live at low altitudes, thus triggering an epidemic.<ref name=Theiler_1973>{{cite book | author = Theiler, Max and Downs, W. G. | title = The Arthropod-Borne Viruses of Vertebrates: An Account of The Rockefeller Foundation Virus Program 1951-1970 | edition = | publisher = Yale University Press | year = 1973 | id = ISBN 0-300-01508-9 }}</ref> | |||
| <br clear="all" /> | |||
| ==History== | |||
| ]'' eradication program in ], ]]] | |||
| Yellow fever has had an important role in the history of ], the ], ], and the ]. | |||
| ===Europe 541-549=== | |||
| Fragile after the ], ] was further weakened by "Yellow Plague" (yellow fever). The ] suffered as well.<ref>{{cite web | title=The Yellow Plague | work=Oxford Journals |url=http://jhmas.oxfordjournals.org/cgi/content/citation/IV/1/5 | | |||
| accessdate=2006-11-08}}</ref> | |||
| ===Cuba: 1762-1763=== | |||
| British and American colonial troops died by the thousands in ] between 1762-1763. Epidemics struck coastal and island communities throughout the area during the next 140 years. | |||
| ===Philadelphia: 1793=== | |||
| {{main|Yellow Fever Epidemic of 1793}} | |||
| In 1793, the largest yellow fever epidemic in American history killed as many as 5,000 people in ]—roughly 10% of the population.<ref>{{cite web | title=Yellow Fever Attacks Philadelphia, 1793 | work=EyeWitness to History|url=http://www.eyewitnesstohistory.com/yellowfever.htm|accessdate=2007-06-22}}</ref> | |||
| ===Haiti: 1802=== | |||
| In ], an army of forty thousand sent by First Consul ] of ] to ] to suppress the ] was dwindled out by an epidemic of yellow fever (including the expedition's commander and Bonaparte's brother-in-law, ]). Some historians believe Haiti was to be a staging point for an invasion of the ] through ] (then still under French control).<ref>{{cite book |title=Almost History: Close Calls, Plan B's, and Twists of Fate in American History |last=Bruns |first=Roger |year=2000 |publisher=Hyperion |isbn=0786885793 }}</ref> | |||
| ===Norfolk, Virginia: 1855=== | |||
| A ship carrying persons infected with the virus arrived in ] in southeastern ] in June 1855 .<ref name =Virginia/> The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of ] and ]. The ], a benevolent organization, was formed to help coordinate assistance in the form of funds, supplies, and medical professionals and volunteers which poured in from many other areas, particularly the ] and ] areas of the ]. See also "The Mermaids and Yellow Jack. A NorFolktale." children's historical fiction written by Norfolk Author Lisa Suhay retelling of the event and founding of the Bon Secours DePaul Hospital system in the United States in response to the epidemic.<ref>{{cite web |url=http://iparentingmediaawards.com/winners/13/20794-2-751.php |title=The Mermaids and Yellow Jack. A NorFolktale. |accessdate=2007-12-26 |last=Suhay |first=Lisa |work=iParenting Media Awards}}</ref> | |||
| ===Memphis, Tennessee: 1878=== | |||
| Worst yellow fever epidemic in U.S. history occurred in 1878 with over 5,000 deaths in Memphis alone and 20,000 deaths in the whole of the Mississippi Valley. | |||
| ===Carlos Finlay and Walter Reed=== | |||
| ] | |||
| ], a Cuban doctor and scientist, first proposed proofs in 1881 that yellow fever is transmitted by ]es rather than direct human contact.<ref name=Chaves-Carballo_2005>{{cite journal | author=Chaves-Carballo E | title=Carlos Finlay and yellow fever: triumph over adversity | journal=Mil Med | year=2005 | pages=881-5 | volume=170|issue=10|id={{PMID|16435764}} }}</ref> Dr.], M.D., (1851-1902) was an ] surgeon who led a team that confirmed Finlay's theory. This risky but fruitful research work was done with human volunteers, including some of the medical personnel such as ] and ] winner surgeon ] who allowed themselves to be deliberately infected and died of the virus.<ref name=Reed_Army_Bio>{{cite web | title=General info on Major Walter Reed | work=Major Walter Reed, Medical Corps, U.S. Army | url=http://www.wramc.amedd.army.mil/visitors/visitcenter/history/pages/biography.aspx | accessdate=2006-05-02}}</ref> The acceptance of Finlay's work was one of the most important and far-reaching effects of the Walter Reed Commission of 1900.<ref>{{cite web | title=Phillip S. Hench Walter Reed Yellow Fever Collection | work=UVA Health Sciences: Historical Collections | url=http://etext.lib.virginia.edu/healthsci/reed/browse/Public_Health.html | accessdate=2006-05-06}}</ref> Applying methods first suggested by Finlay, the elimination of yellow fever from Cuba was completed, as well as the completion of the Panama Canal. Lamentably, almost 20 years had passed before Reed's efforts were recognized while most of the scientific community ignored Finlay's methods of mosquito control. | |||
| Finlay and Reed's work was put to the test for the first time in the United States when a yellow fever epidemic struck ] in ]; according to the ] '']'' documentary ''The Great Fever'', houses were fumigated, cisterns for drinking water were inspected, and pools of standing water were treated with ]. The result was that the death toll from the epidemic was much lower than that from previous yellow fever epidemics, and that there has not been a major outbreak of the disease in the United States since. Although no cure has yet been discovered, an effective vaccine has been developed, which can prevent and help people recover from the disease. | |||
| ==See also== | |||
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| ==References== | |||
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| ===Further reading=== | |||
| *{{cite journal | author = Downs, Wilbur H., et al. | title = Virus diseases in the West Indies | journal = Caribbean Medical Journal | year = | volume = 1965 | issue = XXVI(1-4)| pages = – | url= }} | |||
| * Theiler, Max and Downs, W. G. ''The Anthropod-Borne Viruses of Vertebrates: An Account of the Rockefeller Foundation Virus Program, 1951-1970''. Yale University Press, 1973. | |||
| ==External links== | |||
| * | |||
| *:from Centers for Disease Control and Prevention | |||
| ===Historical yellow fever information=== | |||
| * | |||
| * | |||
| * an extensive website | |||
| *: a detailed story with maps, slides, and quiz | |||
| *: a case study | |||
| *. | |||
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| * | |||
| ===Vaccine development=== | |||
| * - article by Christine Soares | |||
| {{Viral diseases}} | |||
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