Management and Treatment of Yellow Fever

Presently, there is no specific antiviral for treating yellow fever. However, the illness can become quite severe, and related complications can require medical care, where good and early supportive treatment can help to improve survival rates i.e., patients should take appropriate rest, stay hydrated and seek medical treatment. This is one reason why preventive measure such as vaccination is very important.

People with severe symptoms of yellow fever infection should be hospitalized for close observation and supportive care. Supportive treatment is usually aimed at controlling the symptoms, enough rest, fluids, and use of medicines to help relieve fever and aching. Certain medications should be avoided, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), which may increase the risk of bleeding.

Since there is no effective treatment or vaccine, prevention is critical.  This is best accomplished by avoiding mosquito bites entirely. Even very short periods outdoors can lead to exposure to mosquito bites, so people should wear proper protective clothing. This protection includes long sleeves, long pants, socks, and closed-toe shoes. Pant legs can be tucked into socks to prevent bites to exposed ankles. Children’s wading pools should be emptied and stored on their sides, and tire swings should have holes drilled into the bottom to allow trapped water to drain.

Mosquitoes Avoidance

The avoidance of mosquito bites (use of insect repellant, wearing proper clothing, etc.) is among the most important measures to prevent infection with yellow fever. People with yellow fever should be protected from further mosquito exposure (for example, they should stay indoors or under a mosquito net) during the first days of illness, so as not to contribute to the disease transmission cycle by infecting uninfected mosquitoes that can spread the virus to other people. Dress children in clothing that covers arms and legs. Cover strollers and baby carriers with mosquito netting.

Transmission is common during the warmer months, and mosquitoes may bite through very thin clothing, so treating clothing with repellents containing permethrin, DEET, oil of lemon eucalyptus, or other EPA-registered insect repellants will reduce this risk. Permethrin should not be applied directly to the skin, but when applied to clothing, it provides protection even after the clothing is washed. Transmission is most frequent when mosquitoes feed, between dawn and dusk, so outdoor activities during this period should be avoided. However, one of the mosquitos responsible for transmitting the virus, Aedes, feeds during the daytime; so, there is no safe time during the day for a traveler without repellent and wearing protective clothing.

Travelers should sleep in air-conditioned spaces or use mosquito nets or screens to prevent bites during sleep. Standing water is a breeding ground for mosquitoes, so flower pots, buckets, and other containers should be drained.

It is believed that people who have had yellow fever do develop lifelong immunity.

Yellow Fever Vaccination

An effective vaccine also exists to prevent yellow fever. Yellow fever vaccine is a live-virus vaccine, and a single dose protects against disease for 10 years or more. If a person is at continued risk of infection, a booster dose is recommended every 10 years.

Yellow fever vaccine is recommended for persons aged 9 months or older who are traveling to (or living in) areas at risk for yellow fever virus transmission in South America and Africa. Some countries require individuals entering their borders to display a valid International Certificate of Vaccination or Prophylaxis, documenting their receipt of the yellow fever vaccine.

Serious adverse events can occur following yellow fever vaccination. Therefore, persons should only be vaccinated if they are at risk of exposure to the yellow fever virus or require proof of vaccination for country entry. Individuals considering yellow fever vaccination should discuss their underlying health conditions with their healthcare provider. A medical waiver can be given for persons with a precaution or contraindication to vaccination. Among those persons who should not receive the yellow fever vaccine (contraindications) are individuals who have:

• A compromised immune system
• A history of (or current) thymus disease
• Egg, chicken, or gelatin allergy
• Are younger than 6 months

In addition, the vaccine should be given with caution and only after carefully considering the potential risks and benefits (precautions) for those who are:

• Pregnant
• Lactating
• Age 60 years or more
• Age between 6 - 8 months

This vaccine is administered only at designated vaccination centers.

It should be understood that treating yellow fever can only be supervised at the hospital and not at home. And these supervisions include:

• Prevention of Bleeding: Because of the risk of bleeding, medications that induce it, such as aspirin, ibuprofen, and naproxen, should generally be avoided.
• Hydration: Maintaining hydration throughout the illness with oral or IV fluids may be necessary, particularly if one experiences vomiting or low blood pressure.
• Fever Control: Generally, yellow fever is associated with low-grade fevers. But if the fever becomes higher than expected, there may be a need for medication to lower the temperature.
• Pain: If one experiences muscle pain or generalized discomfort, it may be managed with oral or injected pain relievers.
• Blood Pressure Support: For those who are in shock, which occurs when blood pressure is extremely low, blood pressure can be raised with medications that constrict the blood vessels, often referred to as pressors.
• Management of Organ Failure: When yellow fever causes organ failure, those organs need to be supported while the infection improves. For example, a ventilator may be needed to assist with breathing; dialysis may be required to do the work of the kidneys.

Yellow Fever Prognosis

If a person has a less severe form of yellow fever, they will probably recover from the symptoms in about seven days. There may be feelings of being tired and weak for much longer than a week. After the person recovers, he/she has immunity to yellow fever.