eMedicine Specialties > Infectious Diseases > Gastrointestinal Tract and Intra-abdominal Infections

Yellow Fever: Treatment & Medication

Author: Mary T Busowski, MD, Fellow, Infectious Diseases, Orlando Health
Coauthor(s): Mark Raymond Wallace, MD, Infectious Disease Fellowship Director, Orlando Regional Healthcare; Clinical Professor of Medicine, Florida State University; Janelle L Robertson, MD, Staff Physician, Department of Infectious Diseases, Wilford Hall Medical Center
Contributor Information and Disclosures

Updated: Apr 17, 2009

Treatment

Medical Care

No specific treatment exists for yellow fever.

  • Supportive care is critical.
    • Severely ill patients should be treated in an intensive care setting. The required management consists of vasoactive medications, fluid resuscitation, ventilator management, and treatment of disseminated intravascular coagulation, hemorrhage, secondary infections, and renal and hepatic dysfunction.
    • Endotracheal intubation may be required in patients with significant hemorrhage, pulmonary edema, secondary bacterial infections, and shock.
    • Central venous access may be required for vasopressors and medications when patients enter the toxic stage of the illness.
    • To manage the coagulopathy, various recommendations have been made, as follows:
      • In actively bleeding patients, administer fresh frozen plasma to maintain prothrombin time at 25-30 seconds.
      • In patients with disseminated intravascular coagulation, heparin has been recommended for treatment.
    • A nasogastric or orogastric tube may be required to provide nutritional support.
    • Patients with renal failure or refractory acidosis may require dialysis.
    • Salicylates should be avoided because of the increased risk of bleeding secondary to platelet dysfunction.
  • Because viremic patients bitten by mosquitoes can transmit the virus to other patients, the patient should be isolated with mosquito netting in areas with potential vector mosquitoes.
  • Yellow fever virus is not transmitted person to person, but other infections in the differential diagnoses can be transmitted; thus, the patient should be isolated until a definitive diagnosis is made.
  • One case of infection of a health care worker (a phlebotomist) has been reported. However, no documented needlesticks or blood splashes explained the transmission in this case.

Surgical Care

No surgical care changes the course of yellow fever. In addition, liver biopsy is contraindicated in living patients given the risk of hemorrhage.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Vaccines

The live attenuated virus (17D) vaccine was created by serial passages of yellow fever virus through chick and mouse embryo cells. Dr. Max Theiler of the Rockefeller Institute developed this vaccine in 1937. Since 1945, more than 200,000,000 doses have been administered. The WHO, United Nations Children's Fund (UNICEF), and the World Bank have recommended that yellow fever vaccine be added to the routine Expanded Program on Immunization in developing nations. However, poor financing remains a problem and a major reason for low vaccination rates among residents of endemic areas. In the United States, the yellow fever vaccine is available at designated state health departments and selected travel clinics.

Up-to-date information on yellow fever vaccination and travel requirements may be obtained by contacting Health Information for Travelers, Centers for Disease Control and Prevention, Atlanta, GA 30333, fax (404) 332-4265, document number 220022#, phone (404) 332-4559.


Yellow fever vaccine (YF-VAX)

This vaccine should be administered to residents of and travelers to endemic areas. The seroconversion rate for adults and children receiving the vaccine is 99%. Protective antibodies form within 7-10 d, and protection lasts for at least 10 y. Vaccine is safe and effective in asymptomatic adult patients with HIV and CD4 counts >200/µL. The vaccine appeared ineffective when administered to 1-year-old infants who were HIV positive (CD4 count >200/µL).

Adult

0.5 mL SC once

Pediatric

<6 months: Should not receive because of increased risk of developing encephalitis
6-9 months: only if risk of disease is significant and other methods of prevention cannot be employed
9-12 months: Postpone vaccination if they are living in urban nonepidemic regions; judicious use if traveling in endemic areas
>12 months: Administer as in adults

Seroconversion is not affected by coadministration with measles, poliomyelitis, hepatitis A, hepatitis B, pertussis, tetanus, BCG, and purified virulence antigen capsular polysaccharide typhoid fever vaccines; do not administer cholera vaccine within 3 wk of yellow fever vaccination

Documented hypersensitivity; severely immunosuppressed persons; thymus disease or history of thymus disease; persons who are infected with HIV and have CD4 counts <200/µL, lactation, hypersensitivity to eggs or gelatin, family history of adverse events with yellow fever vaccine

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Nonspecific minor reactions occur in 5% of patients; postvaccination encephalitis is exceptionally rare and usually occurs in infants <4 mo; adverse reactions are uncommon (5-10%), including development of low-grade fever, headache, and/or myalgias within 10 d after vaccination; during epidemics, the protection offered by vaccinating women who are pregnant may outweigh theoretical fetal risks; persons with egg allergies may experience immediate hypersensitivity reactions (rash, urticaria, bronchospasm); this reaction occurs in <1/1,000,000 persons who are vaccinated, usually in persons with a known egg allergy; an alternate formulation not derived from chick embryo cells has been developed and may be suitable for patients who are allergic to eggs in the future

More on Yellow Fever

Overview: Yellow Fever
Differential Diagnoses & Workup: Yellow Fever
Treatment & Medication: Yellow Fever
Follow-up: Yellow Fever
Multimedia: Yellow Fever
References
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References

  1. Bob Arnebeck. A Short History of Yellow Fever in the US. Available at http://www.geocities.com/bobarnebeck/history.html. Accessed November 11, 2008.

  2. Kean BH, Dahlby T. Coming of age in Panama. In: One Doctor's Adventures Among the Famous and Infamous from the Jungles of Panama to a Park Avenue Practice. New York, NY: Ballantine Books; 1990:Ch 2.

  3. Tsai TF, Vaughn DW, Solomon T. Flaviviruses. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Philadelphia, Pennsylvania: Elsevier, Inc.; 2005:Ch 149; 1926-9.

  4. Centers for Disease ControlMMR WeeklyApril 14, 2000/49(14);303-5. Fatal Yellow Fever in a Traveler Returning from Venezula, 1999. CDC. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm491a3.htm. Accessed November 11, 2008.

  5. World Health Organization 2008. Yellow Fever. Pub Med. Available at http://www.who.int/mediacentre/factsheets/fs100/en/print.html. Accessed November 2008.

  6. Barnett ED. Yellow fever: epidemiology and prevention. Clin Infect Dis. Mar 15 2007;44(6):850-6. [Medline].

  7. CDC Health Information for International Travel 2008. Center for Disesae Control; 2008.

  8. Roukens, AH, Visser LG. Yellow fever vaccine: past, present and future. Expert Opinion Biol Ther. November 2008;8(11):1787-95. [Medline].

  9. McFarland JM, Baddour LM, Nelson JE, et al. Imported yellow fever in a United States citizen. Clin Infect Dis. Nov 1997;25(5):1143-7. [Medline].

  10. Peters CJ. Infections caused by arthropod- and rodent-borne viruses. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 16th ed. United States: McGraw Hill; 2005:Ch 180; 1172-3.

  11. Robertson SE, Hull BP, Tomori O, et al. Yellow fever: a decade of reemergence. JAMA. Oct 9 1996;276(14):1157-62. [Medline].

  12. Thompson C, O'Leary JP. Yellow fever in New Orleans. Am Surg. May 1996;62(5):424-6. [Medline].

  13. Tsai TF. Yellow fever virus. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders and Co; 1998:2234-37.

  14. Van der Stuyft P, Gianella A, Pirard M, et al. Urbanisation of yellow fever in Santa Cruz, Bolivia. Lancet. May 8 1999;353(9164):1558-62. [Medline].

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Further Reading

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Keywords

yellow fever, sylvatic fever, jungle yellow fever, viral hemorrhagic fever, VHF, epidemic yellow fever, urban yellow fever, Flavivirus, Aedes aegypti, A aegypti, Haemagogus mosquito, yellow fever virus

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Contributor Information and Disclosures

Author

Mary T Busowski, MD, Fellow, Infectious Diseases, Orlando Health
Mary T Busowski, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American College of Physicians, American Medical Association, Florida Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Raymond Wallace, MD, Infectious Disease Fellowship Director, Orlando Regional Healthcare; Clinical Professor of Medicine, Florida State University
Mark Raymond Wallace, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Janelle L Robertson, MD, Staff Physician, Department of Infectious Diseases, Wilford Hall Medical Center
Janelle L Robertson, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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