Pediatric Yellow Fever Treatment & Management

Author: David J Cennimo, MD, FACP, FAAP, AAHIVS; Chief Editor: Russell W Steele, MD more...

Updated: Feb 10, 2012

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Approach Considerations
Supportive Care
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Approach Considerations

No specific treatment for yellow fever (YF) is noted. Supportive care is the mainstay of management. Base management decisions on the presence of dehydration, electrolyte imbalance, organ failure, concurrent infections, secondary infections, hemorrhagic diathesis, and generalized symptoms. The managing physician must be thoroughly versed in critical care management to coordinate the various interventions to the maximum benefit of the patient.

Patients who recover do so with minimal end-organ damage. In addition, they develop life-long immunity from further infection with YF virus.

Supportive Care

Monitor fluid status, and hydrate to maintain organ perfusion. Monitor electrolyte status, and promptly correct any abnormalities.

Monitor and be prepared to manage organ failure secondary to direct organ injury from YF virus that leads to cardiogenic shock, hepatic coma, and renal failure necessitating dialysis.

Monitor the coagulation profile, and correct any abnormalities. Blood products may be required. Anticipate possible disseminated intravascular coagulation (DIC). Also anticipate possible secondary bacterial infections, particularly pneumonia. Exclude concurrent malaria.

If the necessary clinical expertise, monitoring capability, and treatment modalities necessary for managing YF are not available at the current institution, transfer the patient to another institution. Ensure that the patient is stable enough for transfer.

Physicians with experience in pediatric medicine, infectious or tropical diseases, pediatric critical care, and nephrology should be readily available at the institution to which the patient is being transferred. An attending physician at that institution must accept the patient in transfer.

The recommended diet and level of activity are based on the patient’s general status, the presence of any organ failure, and the development of a hemorrhagic diathesis.

Proceed to Medication

Contributor Information and Disclosures

Author

David J Cennimo, MD, FACP, FAAP, AAHIVS Assistant Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Co-Director Physician's Core, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

David J Cennimo, MD, FACP, FAAP, AAHIVS is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Medical Association, HIV Medicine Association of America, Infectious Diseases Society of America, Medical Society of New Jersey, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Patrick B Hinfey, MD Research Director and Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Amy J Behrman, MD Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine

Amy J Behrman, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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This female Aedes aegypti mosquito is shown here after landing on a human host. The A aegypti mosquito is a known transmitter of both dengue fever and yellow fever. A aegypti is sometimes referred to as the yellow fever mosquito. The viruses are transferred to the host when bitten by a female mosquito. Image courtesy of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

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