Yellow Fever Rob Sukumar, BIOL 402

Overview Acute disease caused by virus Virus is within the class of flaviviruses Mosquito vector Two potential stages of the virus Effective vaccine exists

Present in 45 countries All in Latin America, Africa

Vector (Aedes Aegypti) - Also causes Dengue fever and Chikungunya Preferred breeding areas are in stagnant water - Genome was sequenced, and published by researchers at Notre Dame in 2007

Yellow Fever has Three Transmission Cycles

Initial symptoms are not severe 3-6 day incubation Acute, febrile phase Aches, nausea, shivers Average fever lasts 3.3 days

Toxic Phase can follow after remission Acute phase goes into 24-hour remission 15% of patients advance to toxic phase Hepatorenal disease Excessive bleeding

Liver Damage  Jaundice Yellowing of skin, eyes Caused by increased levels of bilirubin Bilirubin product of liver

Virus is single-stranded, positive-sense 10 proteins (3 structural, 7 NS proteins) NS proteins responsible for replication in cells

Infects Kupffer cells, hepatocytes

Initial Diagnosis is Difficult Toxic phase far more obvious

No Antiviral Treatment Treat symptoms

Effective Vaccine Exists! Yellow fever 17D vaccine Required for certain travel

There are ways to limit the risk of yellow fever Increase vaccine distribution Mosquito control

Yellow Fever is a reemerging disease One of six reemerging diseases (CDC) Asia extremely vulnerable Yellow Fever Initiative (WHO,UNICEF)

Sources Images http://www.lib.uiowa.edu/Hardin/md/pictures22/cdc/PHIL_2176_lores.jpg http://www.cdc.gov/ncidod/dvbid/yellowfever/images/YellowFeverWorld.jpg http://tropisme.files.wordpress.com/2009/10/aedes_aegypti_during_blood_meal.jpg http://www.mdconsult.com.libproxy.lib.unc.edu/das/article/body/195197795-2/jorg=journal&source=&sp=12238347&sid=0/N/311485/f01000160003.gif http://www.mdconsult.com.libproxy.lib.unc.edu/das/article/body/195197795-4/jorg=journal&source=&sp=12238347&sid=0/N/311485/f01000160005.gif http://www.well-women.com/images/liver3.jpg http://upload.wikimedia.org/wikipedia/commons/d/de/Jaundice_eye.jpg http://www.technion.ac.il/~mdcourse/274203/slides/Liver/8-Kupffer%20Cells%20-C.jpg http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hcv&part=ch1 http://www.skinsight.com/images/dx/webAtlas/yellowFever_26180_lg.jpg http://www.historycooperative.org/journals/jah/94.3/images/mr06_fig01b.jpg http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2008/02/15/yellow460.jpg http://www.tarrantcounty.com/ehealth/lib/ehealth/mosquito-breeding1.jpg

Sources (continued) Information Monath, Thomas. “Yellow Fever: an update.” The Lancet Infectious Diseases, 1.1. August 2001. CM Rice, EM Lenches, Eddy SR, SJ Shin, RL Sheets, JH Strauss. “Nucleotide Sequence of Yellow fever virus.” Science 229.4715 (August 1985). Robertson SE, Hull BP. “Yellow Fever: A Decade of Reemergence.” Journal of the American Medical Association 276.14. (October 9, 1996) “Yellow Fever Fact Sheet.” Weekly Epidemiological Record 85.5. (January 2009) World Health Organization. “Yellow Fever.” December, 2009. http://www.who.int/mediacentre/factsheets/fs100/en/ Center for Disease Control and Prevention. “Yellow Fever.” November, 2007. http://www.cdc.gov/ncidod/dvbid/yellowfever/ Monath TP, Barrett AD. “Pathogenesis and Pathophysiology of Yellow Fever.” Department of Microbiology, Harvard School of Public Health, 2003. Nichols EM, Gleyzer A. “Yellow Fever.” October 22, 2009. http://emedicine.medscape.com/article/787964-overview