Infectious disease experts in the United States suspect the ongoing yellow fever outbreak in Brazil could carve an epidemic path similar to Zika virus, according to The Washington Post.
Since December, yellow fever has infected 326 people in Brazil with hundreds more cases under investigation. Among the confirmed cases, 220 people have died, according to the Pan American Health Organization. While viral transmission of yellow fever has been limited to forest dwelling mosquitoes in jungle areas, these regions are close to major urban centers like Rio de Janeiro and Sao Paolo.
In the New England Journal of Medicine, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and Catharine Paules, MD, a third-year infectious disease fellow with the National Institutes of Health, warn that if the virus is picked up by the city-dwelling Aedes aegypti mosquito — the insect responsible for spreading Zika — the virus could spread to these densely populated city centers where the yellow fever vaccine is not regularly administered.
"Although it is highly unlikely that we will see yellow fever outbreaks in the continental United States, where mosquito density is low and risk of exposure is limited, it is possible that travel-related cases of yellow fever could occur, with brief periods of local transmission in warmer regions such as the Gulf Coast states, where A. aegypti mosquitoes are prevalent," wrote the authors.
Dr. Fauci and Dr. Paules also warned that U.S. territories like Puerto Rico — where more than 37,000 people have contracted Zika since January 2015 — could be vulnerable to outbreaks of yellow fever. Both the World Health Organization and the CDC, which issued a travel warning for Brazil in February, are closely monitoring the yellow fever outbreak.
Yellow fever symptoms include fever, chills, severe headache, back pain, general body aches, nausea and vomiting. While most of those infected experience no illness or mild illness, approximately 15 percent experience a more serious form of the disease. In these cases, 20 to 50 percent may die, according to the CDC.
In an interview with the Post, Dr. Fauci said infectious disease clinicians should be wary of yellow fever moving forward as most have not encountered the virus before.
"This is not 'chicken little, the sky is falling,'" he said. "It's a public health heads-up."
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