Yellow fever

One shot of a vaccine gives long-lasting immunity, but low coverage in parts of the world leads to periodic epidemics

An MSF staff member vaccinates a child in Democratic Republic of Congo.
DEMOCRATIC REPUBLIC OF CONGO 2016 © Dieter Telemans
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Yellow fever is a mosquito-borne acute hemorrhagic viral disease without a cure. It occurs mostly in sub-Saharan Africa but is on the rise in Central and South America. In 2015-16, during the largest outbreak in 30 years, our teams vaccinated over 1 million people in Democratic Republic of Congo.

One
vaccine dose
provides long-lasting immunity
610 million
people
at risk of infection globally
1,167,600
people
vaccinated by MSF in 2016

Facts about yellow fever

What causes yellow fever?

Yellow fever is transmitted through the daytime bite of infected female Aedes mosquitoes.  

Large epidemics occur in regions without good vaccination coverage—often a sign of a failing health system. Outbreak risk is especially high when displaced people move into heavily populated areas with high mosquito density and where the disease is common.

What are the symptoms of yellow fever?

Most infections show no symptoms or only mild illness three to six days after infection, with fever and sometimes headache, chills, back pain, fatigue, nausea, and vomiting.

About 15 percent of infections progress to a severe phase, with recurring fever plus jaundice due to liver damage, causing yellow eyes. Some patients develop abnormal bleeding, for example in the mouth, eyes, and gastrointestinal tract. Half of these patients die within 10 days.

Surviving the infection provides long-lasting immunity, and typically there is no permanent organ damage.

How can yellow fever be prevented and controlled?

Vaccination is the best way to prevent infection and stop outbreaks. People can also protect themselves against mosquito bites by wearing long clothing and using repellents and insecticide-treated mosquito nets, where available. At the community level, control measures include eliminating stagnant water where mosquitoes breed, and spraying insecticide.

How is yellow fever diagnosed?

Yellow fever is difficult to diagnose because many of its mild, early flu-like symptoms resemble those of many other infections. So, more severe cases can be confused with severe malaria, poisoning, viral hepatitis, or certain other viral diseases. Yellow eyes, due to jaundice, help doctors diagnose late-stage disease.

Definitive diagnosis requires testing of blood samples at specialized laboratories, and is usually done only if a new outbreak is suspected. Once the first cases are confirmed as yellow fever, an outbreak can be reported.

How is yellow fever treated?

There is no specific antiviral drug for yellow fever, but hospital-based supportive care can save the lives of some patients.

Our response to yellow fever

We have responded to yellow fever epidemics since the year 2000 in countries including Angola, Democratic Republic of Congo, Guinea, Sudan, Sierra Leone, the Central African Republic, and Chad. We aim to control outbreaks through mass vaccination campaigns and community-wide insecticide spraying to kill the mosquitoes that spread the disease, and to provide care for people with severe cases. We also work to improve the reach of a limited vaccine stockpile, and to advocate for increased vaccine supply and better routine vaccination coverage.

Vaccinating millions

The largest yellow fever outbreak of the past 30 years began in Angola in December 2015 and spread to neighboring Democratic Republic of Congo. In response, we participated in a wide-scale vaccination campaign that collectively immunized over 8 million people in less than two weeks. We mobilized 100 teams of 16 people in parts of Kinshasa, the capital, to reach 760,000 people—10% of the target population in the city—and another 69 teams that vaccinated the 370,000 residents of Matadi, near the Angolan border. Such rapid, large-scale campaigns come with many logistical challenges, especially to ensure that vaccines are kept cold. Every day, teams needed to replenish 4,000 ice packs and coolers in different locations.

Eliminating mosquito breeding grounds

Spraying and fumigating typically targets homes, to kill adult mosquitoes, and trash heaps and stagnant water that provide breeding sites. These activities are carried out in settings where cases have been confirmed and in vulnerable locations such as hospitals, schools, and markets.

Providing supportive care to patients

During outbreaks, we treat patients directly and also support national and/or local health departments in providing care, through preparing selected hospitals to manage patients and training health staff.  

Supporting vaccine advancements

Shortages in yellow fever vaccine supply became especially acute during the major 2015-2016 outbreak. Looking for ways to expand the number of people who could be vaccinated, the World Health Organization and partners conducted a study which showed that the vaccine is effective even when used at one-fifth the usual dose. Using this research, our nurses administered fractional doses of the yellow fever vaccine, significantly expanding the numbers of at-risk people protected through the vaccination campaign. We also support efforts to secure adequate supplies of vaccines by increasing production.

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Our research on yellow fever

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