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Review
. 2020 Jan 23;17(1):9.
doi: 10.1186/s12985-019-1277-7.

Recent sylvatic yellow fever virus transmission in Brazil: the news from an old disease

Natalia Ingrid Oliveira Silva  1 , Lívia Sacchetto  1 , Izabela Maurício de Rezende  1 , Giliane de Souza Trindade  1 , Angelle Desiree LaBeaud  2 , Benoit de Thoisy  3 , Betânia Paiva Drumond  4
Affiliations
Review

Recent sylvatic yellow fever virus transmission in Brazil: the news from an old disease

Natalia Ingrid Oliveira Silva et al. Virol J. .

Abstract

Yellow fever (YF) is an acute viral disease, affecting humans and non-human primates (NHP), caused by the yellow fever virus (YFV). Despite the existence of a safe vaccine, YF continues to cause morbidity and mortality in thousands of people in Africa and South America. Since 2016, massive YF outbreaks have taken place in Brazil, reaching YF-free zones, causing thousands of deaths of humans and NHP. Here we reviewed the main epidemiological aspects, new clinical findings in humans, and issues regarding YFV infection in vectors and NHP in Brazil. The 2016-2019 YF epidemics have been considered the most significant outbreaks of the last 70 years in the country, and the number of human cases was 2.8 times higher than total cases in the previous 36 years. A new YFV lineage was associated with the recent outbreaks, with persistent circulation in Southeast Brazil until 2019. Due to the high number of infected patients, it was possible to evaluate severity and death predictors and new clinical features of YF. Haemagogus janthinomys and Haemagogus leucocelaenus were considered the primary vectors during the outbreaks, and no human case suggested the occurrence of the urban transmission cycle. YFV was detected in a variety of NHP specimens presenting viscerotropic disease, similar to that described experimentally. Further studies regarding NHP sensitivity to YFV, YF pathogenesis, and the duration of the immune response in NHP could contribute to YF surveillance, control, and future strategies for NHP conservation.

Keywords: Arbovirus; Epidemiology; Epizootic; Flavivirus; Non-human primate; Outbreak; Pathogenesis; Vector; Yellow fever; Yellow fever virus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sylvatic yellow fever (YF) human cases and epizootics occurrence in Brazil, from 2016 to 2019. The map presents the Amazon (in light green), Caatinga (in light orange), Cerrado (in light yellow), Atlantic Forest (in dark green), Pampa (in dark yellow), and Pantanal (in light brown) biomes in Brazil. Municipalities are colored according to YF cases in non-human primate (NHP) (in blue), in humans (in grey), and both in humans and NHP (in red). Brazilian states abbreviations are as follows: North: AC (Acre), AP (Amapá), AM (Amazonas), PA (Pará), RO (Rondônia), RR (Roraima), and TO (Tocantins); Northeast: AL (Alagoas), BA (Bahia), CE (Ceará), MA (Maranhão), PB (Paraíba), PE (Pernambuco), PI (Piauí), RN (Rio Grande do Norte), and SE (Sergipe); Midwest: MT (Mato Grosso), MS (Mato Grosso do Sul), GO (Goiás), and DF (Federal District/Brasília); Southeast: MG (Minas Gerais), SP (São Paulo), RJ (Rio de Janeiro), and ES (Espírito Santo); South: RS (Rio Grande do Sul), PR (Paraná), and SC (Santa Catarina). The map was created using QGIS v.2.18.16 [59]. The numbers of YF cases were obtained from Sistema de Informação de Agravos de Notificação (SINAN) and official bulletins from the Brazilian Ministry of Health Brazil and State Health Departments [–73]. YF: yellow fever. H: humans. NHP: non-human primates
Fig. 2
Fig. 2
Historical series of sylvatic yellow fever human cases in Brazil, from 1980 to June 2019. The numbers of cases (grey line) and the lethality rate (red dotted line) are showed by year (1980–2015) or by epidemiological periods (EP) (July to June of 2016/2017, 2017/2018, and 2018/2019). The numbers of YF cases were obtained from Sistema de Informação de Agravos de Notificação (SINAN) and official bulletins from the Brazilian Ministry of Health Brazil and State Health Departments [–73]
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