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For further information, see CMDT Part 32-04: Viral Hemorrhagic Fevers

Key Features

  • Zoonotic viral infection transmitted by the bite of the Aedes mosquito

  • Found in tropical and subtropical South America and Africa

  • Incubation period is typically 3–6 days

  • Adults and children equally susceptible

  • Mortality rate of severe disease is 20–50%

Clinical Findings

  • Mild form (85%)

    • Fevers

    • Malaise

    • Retroorbital pain

    • Nausea

    • Photophobia

    • Bradycardia

  • Severe form (15%)

    • Begins with the same symptoms as the mild form of the disease

    • Then, after initial remission of symptoms, a toxic phase ensues with fever, bradycardia, hypotension, jaundice, delirium, hemorrhage


  • Leukopenia, elevated liver enzymes, and bilirubin can occur

  • Proteinuria is present and usually disappears completely with recovery

  • Bleeding dyscrasias with elevated prothrombin and partial thromboplastin times, decreased platelet count, and presence of fibrin-split products, can also occur

  • In the early stages of the disease (up to 10 days), diagnosis is confirmed if yellow fever virus RNA is detected by (RT-PCR) in blood from a person with no history of recent yellow fever vaccination

  • Presence of yellow fever virus-specific IgM antibody and negative ELISA panel for other relevant flaviviruses confirm the diagnosis

  • If ELISA is positive for other flaviviruses, plaque reduction neutralization assay, which measures the titer of the neutralizing antibodies in the serum towards the infecting virus, should be done


  • Supportive measures, including analgesia and hydration

  • No specific antiviral therapy

  • Prevention

    • A highly effective and safe vaccine is available and should be used when living or traveling to endemic areas

    • Mosquito control measures

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