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Review
. 2020 Oct 30;12(11):1233.
doi: 10.3390/v12111233.

Re-Emergence of Yellow Fever in Brazil during 2016-2019: Challenges, Lessons Learned, and Perspectives

Poliana de Oliveira Figueiredo  1 , Ana Gabriella Stoffella-Dutra  1 , Galileu Barbosa Costa  2 , Jaqueline Silva de Oliveira  1 , Carolina Dourado Amaral  1 , Juliane Duarte Santos  3 , Kamila Lorene Soares Rocha  3 , João Pessoa Araújo Júnior  4 , Maurício Lacerda Nogueira  5 , Magno Augusto Zazá Borges  6 , Adriano Pereira Paglia  7 , Angelle Desiree LaBeaud  8 , Jônatas Santos Abrahão  1 , Erna Geessien Kroon  1 , Danilo Bretas de Oliveira  3 , Betânia Paiva Drumond  1 , Giliane de Souza Trindade  1
Affiliations
Review

Re-Emergence of Yellow Fever in Brazil during 2016-2019: Challenges, Lessons Learned, and Perspectives

Poliana de Oliveira Figueiredo et al. Viruses. .

Abstract

Yellow fever (YF) is a re-emerging viral zoonosis caused by the Yellow Fever virus (YFV), affecting humans and non-human primates (NHP). YF is endemic in South America and Africa, being considered a burden for public health worldwide despite the availability of an effective vaccine. Acute infectious disease can progress to severe hemorrhagic conditions and has high rates of morbidity and mortality in endemic countries. In 2016, Brazil started experiencing one of the most significant YF epidemics in its history, with lots of deaths being reported in regions that were previously considered free of the disease. Here, we reviewed the historical aspects of YF in Brazil, the epidemiology of the disease, the challenges that remain in Brazil's public health context, the main lessons learned from the recent outbreaks, and our perspective for facing future YF epidemics.

Keywords: Brazil; ecology; epidemic; epidemiology; public health; yellow fever.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Map of the natural history of Yellow Fever in Brazil. (A) The timeline highlights sanitary measures adopted to fight against Yellow Fever in Brazil. (B) A map of Brazil showing the detection and distribution of Yellow Fever virus (YFV). The red lines connect the events of viral emergence in different regions of the country. The grey scale indicates the regions of Brazil from the lightest to the darkest as follows South, Northeast, Southeast, North, and Midwest.
Figure 2
Figure 2
Spatial distribution of Yellow Fever (YF) cases in Brazil during 2001–2019. The map shows a correlation between human confirmed cases of YF and biomes (A), and confirmed epizootics in the Southeast region (B) during the 2016–2019 outbreak. The map was created using the Quantum GIS (QGIS) software.
Figure 3
Figure 3
Distribution of human cases of YF in Brazil. (A) Distribution of confirmed human cases per year in Brazil for the monitoring period of (July to June) 2001–2019. (B) Distribution of YF human cases according to gender in Brazil during 2001–2016. (C) Clinical outcome of human cases of YF in Brazil during 2001–2016. All data was obtained from Sistema de Informação de Agravos de Notificação (SINAN), and epidemiological reports of the Brazilian Ministry of Health.
Figure 4
Figure 4
An overview of the YF re-emergence in Brazil. The flowchart highlights some progress that can be recognized during the 2016–2019 epidemic, and the challenges that still need to be covered to contribute to the surveillance and control of YF in Brazil.
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