Abstract

PIP: Transmitted from person to person by Aedes aegypti, urban yellow fever was eliminated in the first half of this century, with the eradication of its mosquito vector from most of South America. However, reinfestation began in the 1970s is now almost complete, and vector control is considerably more difficult now than before. The threat of urban yellow fever is greatest in towns such as Santa Cruz, Bolivia, near the forest, but improved transport links increase the likelihood of spread by viremic people to nonendemic areas. Van der Stuyft et al. have reported the first instance of urban transmission of yellow fever in the Americas in 44 years. Since residents of the densely populated cities and much visited areas in coastal South America have never been vaccinated, an outbreak there would facilitate widespread dissemination of the disease, even to other continents. While urban yellow fever is a significant threat, carrying a case-fatality rate of about 20%, the constrained dynamics of transmission, early recognition of the striking clinical presentation, and efforts to control the infection should limit the impact of the disease. Laboratory-based surveillance, together with the prevention and control strategies outlined by van der Stuyft et al. are the key defensive measures against the future threat of urban epidemics.