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

Yellow fever (YF) is a re-emerging viral zoonosis caused by the (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.

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References

Ferreira C, Campi-Azevedo A, Peruhype-Magalhaes V, Costa-Pereira C, de Albuquerque C, Muniz L . The 17D-204 and 17DD yellow fever vaccines: an overview of major similarities and subtle differences. Expert Rev Vaccines. 2017; 17(1):79-90. DOI: 10.1080/14760584.2018.1406800. View

Delatorre E, Abreu F, Pereira Ribeiro I, Gomez M, Dos Santos A, Ferreira-de-Brito A . Distinct YFV Lineages Co-circulated in the Central-Western and Southeastern Brazilian Regions From 2015 to 2018. Front Microbiol. 2019; 10:1079. PMC: 6543907. DOI: 10.3389/fmicb.2019.01079. View

Massad E, Amaku M, Coutinho F, Struchiner C, Lopez L, Coelho G . The risk of urban yellow fever resurgence in Aedes-infested American cities. Epidemiol Infect. 2018; 146(10):1219-1225. PMC: 9134282. DOI: 10.1017/S0950268818001334. View

Vasconcelos P, Calisher C . Emergence of Human Arboviral Diseases in the Americas, 2000-2016. Vector Borne Zoonotic Dis. 2016; 16(5):295-301. DOI: 10.1089/vbz.2016.1952. View

Campi-Azevedo A, Peruhype-Magalhaes V, Coelho-Dos-Reis J, Antonelli L, Costa-Pereira C, Speziali E . 17DD Yellow Fever Revaccination and Heightened Long-Term Immunity in Populations of Disease-Endemic Areas, Brazil. Emerg Infect Dis. 2019; 25(8):1511-1521. PMC: 6649311. DOI: 10.3201/eid2508.181432. View

Flores H, Taneja de Bruyne J, ODonnell T, Tuyet Nhu V, Giang N, Thi Xuan Trang H . Multiple Wolbachia strains provide comparative levels of protection against dengue virus infection in Aedes aegypti. PLoS Pathog. 2020; 16(4):e1008433. PMC: 7179939. DOI: 10.1371/journal.ppat.1008433. View

da Costa-Rocha I, Campi-Azevedo A, Peruhype-Magalhaes V, Coelho-Dos-Reis J, Fradico J, Souza-Lopes T . Duration of Humoral and Cellular Immunity 8 Years After Administration of Reduced Doses of the 17DD-Yellow Fever Vaccine. Front Immunol. 2019; 10:1211. PMC: 6598206. DOI: 10.3389/fimmu.2019.01211. View

Gubler D . Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol. 2002; 10(2):100-3. DOI: 10.1016/s0966-842x(01)02288-0. View

Ortiz-Martinez Y, Patino-Barbosa A, Rodriguez-Morales A . Yellow fever in the Americas: the growing concern about new epidemics. F1000Res. 2017; 6:398. PMC: 5414809. DOI: 10.12688/f1000research.11280.2. View

10.

Faerstein E, Winkelstein Jr W . Carlos Juan Finlay: rejected, respected, and right. Epidemiology. 2009; 21(1):158. DOI: 10.1097/EDE.0b013e3181c308e0. View

11.

. Duration of post-vaccination immunity against yellow fever in adults. Vaccine. 2014; 32(39):4977-84. DOI: 10.1016/j.vaccine.2014.07.021. View

12.

Mir D, Delatorre E, Bonaldo M, Lourenco-de-Oliveira R, Vicente A, Bello G . Phylodynamics of Yellow Fever Virus in the Americas: new insights into the origin of the 2017 Brazilian outbreak. Sci Rep. 2017; 7(1):7385. PMC: 5547128. DOI: 10.1038/s41598-017-07873-7. View

13.

de Rezende I, Sacchetto L, de Mello E, Augusto Alves P, de Melo Iani F, Adelino T . Persistence of Yellow fever virus outside the Amazon Basin, causing epidemics in Southeast Brazil, from 2016 to 2018. PLoS Negl Trop Dis. 2018; 12(6):e0006538. PMC: 6002110. DOI: 10.1371/journal.pntd.0006538. View

14.

Carrington C, Foster J, Pybus O, Bennett S, Holmes E . Invasion and maintenance of dengue virus type 2 and type 4 in the Americas. J Virol. 2005; 79(23):14680-7. PMC: 1287558. DOI: 10.1128/JVI.79.23.14680-14687.2005. View

15.

Stoffella-Dutra A, de Oliveira J, Barbosa Costa G, Kroon E, Abrahao J, LaBeaud A . Absence of YF-neutralizing antibodies in vulnerable populations of Brazil: A warning for epidemiological surveillance and the potential risks for future outbreaks. Vaccine. 2020; 38(42):6592-6599. DOI: 10.1016/j.vaccine.2020.07.077. View

16.

Nnaji C, Shey M, Adetokunboh O, Wiysonge C . Immunogenicity and safety of fractional dose yellow fever vaccination: A systematic review and meta-analysis. Vaccine. 2019; 38(6):1291-1301. DOI: 10.1016/j.vaccine.2019.12.018. View

17.

Possas C, Lourenco-de-Oliveira R, Tauil P, De Paula Pinheiro F, Pissinatti A, da Cunha R . Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation. Mem Inst Oswaldo Cruz. 2018; 113(10):e180278. PMC: 6135548. DOI: 10.1590/0074-02760180278. View

18.

Teixeira L . [Water and culicid transmission: yellow fever in the Sao Paulo Medical and Surgical Society]. Rev Bras Hist. 2009; 21(41):217-42. DOI: 10.1590/s0102-01882001000200012. View

19.

Ho Y, Joelsons D, Leite G, Malbouisson L, Song A, Perondi B . Severe yellow fever in Brazil: clinical characteristics and management. J Travel Med. 2019; 26(5). DOI: 10.1093/jtm/taz040. View

20.

Rocha M, Duarte M, Mansur S, Silva B, Pereira T, Adelino T . Pluripotency of against Arboviruses: the case of yellow fever. Gates Open Res. 2019; 3:161. PMC: 6561079. DOI: 10.12688/gatesopenres.12903.2. View