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Published Date: 2018-01-15 20:29:25
Subject: PRO/AH/EDR> Yellow fever - Netherlands: ex Brazil (SP)
Archive Number: 20180115.5561671

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 14 Jan 2017
From: Chantal Reusken <> [edited]

We report a confirmed case of yellow fever virus (YFV) infection in a 46-year-old male patient who had returned from Brazil to the Netherlands on 8 Jan 2018, following a stay in Brazil since 19 Dec 2017. The patient had stayed in the state of Sao Paulo and in particular in Maripora, a municipality in the Sao Paulo metropolitan region.

The 1st day of illness was 7 Jan 2018, with reported symptoms of fever (40 C [104 F]), headache, myalgia, nausea, vomiting and diarrhea. That patient had no history of YFV vaccination.

Real-time RT-PCR specific for yellow fever virus (YFV) detected YFV RNA in urine, whole blood and plasma collected on day 4 post onset symptoms for 2 independent genome targets and on 2 independent occasions. Furthermore, samples were positive in a pan-Flavi RT-PCR. A small fragment of NS5 was sequenced confirming yellow fever. More complete genome sequencing will be done for completion and epidemiological investigation.

Upon hospitalization in the Erasmus University Medical Centre the patient showed rapid recovery.

Currently, circulation of YFV in the Sao Paulo metropolitan area has heightened attention of the Brazilian authorities with increasing fears for the establishment of an urban transmission cycle involving _Aedes aegypti_ mosquitoes. Since October 2017, authorities have closed public parks in the area because of confirmed YFV circulation in monkeys in the parks. The 1st 3 human cases, including 2 deaths, from the disease in the Sao Paulo area were reported on 6 Jan 2018, all thought to have contracted the disease while travelling to Maripora, where 90 percent of the population was vaccinated for YFV in early 2017 in a prevention campaign (ProMED-mail Yellow fever - Americas: Brazil (SP) 20180109.5546267).

The Dutch YFV case linked to the Sao Paulo metropolitan region illustrates the urgent need for YFV vaccination before travel to affected regions and preventive measures for mosquito bites. Furthermore, a yellow fever infection should be included in the differential diagnosis of febrile travelers returning from YFV endemic areas, now including urban areas.

Chantal Reusken, Corine GeurtsvanKessel, Perry van Genderen, Lennert Slobbe, Marion Koopmans
(on behalf of the medical and laboratory team)
WHO Collaborating Centre for Arbovirus and Viral Haemorraghic Fever Reference and Research,
Department of Virology,
Erasmus MC,
Rotterdam, the Netherlands

[ProMED-mail thanks Chantal Reusken and colleagues for submitting the report of this case. Their comments underscore the need for taking a complete travel history of the patient in order to include yellow fever (YF) in the diagnostic rule-outs and the need for YF vaccination of travelers 10 or more days before they go to YF endemic areas. YF is a serious disease, with a case fatality rate of up to 30 percent. - Mod.TY

HealthMap/ProMED-mail map:
Sao Paulo, Brazil:]

See Also

Yellow fever - Americas: Brazil (SP) 20180109.5546267
Yellow fever - Americas (66): PAHO/WHO 20171214.5504146
Yellow fever - Americas (65): Brazil (SP,RS) RFI 20171212.5496846
Yellow fever - Americas (64): Brazil (SP) WHO 20171125.5464211
Yellow fever - Americas (63): Brazil (SP) susp, RFI 20171110.5435274
Yellow fever - Americas (62): Brazil (SP) 20171109.5432965
Yellow fever - Americas (61): Brazil (SP) 20171030.5414276
Yellow fever - Americas (60): Brazil (SP) 20171027.5409406
Yellow fever - Americas (58): Brazil (SP) fatal, conf. 20171024.5401984
Yellow fever - Americas (57): Brazil
Yellow fever - Americas (48): Brazil 20170618.5113064
Yellow fever - Americas (47): Brazil, PAHO/WHO 20170530.5071826
Yellow fever - Americas (46): Brazil, virus mutations 20170516.5040265
Yellow fever - Americas (45): Brazil 20170513.5034249
Yellow fever - Americas (44): PAHO/WHO 20170503.5010684
Yellow fever - Americas (43): Brazil, monkey 20170503.5009843
Yellow fever - Americas (42): USA vaccine 20170428.5002436
Yellow fever - Americas (42): USA vaccine 20170428.5002436
Yellow fever - Americas (41): PAHO/WHO 20170426.4996759
Yellow fever - Americas (40): Brazil (RJ) 20170423.4988191
Yellow fever - Americas (30): PAHO/WHO, Brazil, Netherlands ex Suriname 20170318.4910486
Yellow fever - Americas (20): Brazil comment 20170211.4832763
Yellow fever - Americas (10): Brazil 20170129.4801425
Yellow fever - Americas (01): PAHO/WHO 2016 20170110.475350
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