Yellow Fever: an old disease but with new challenges

Abstract

Introduction: In the last two years, Brazil has been registering an important dissemination of Yellow Fever (YF), mainly in Southeast. The disease spread to an area which 8 million people live, and in 2018, the population in risk exceeds 32 million. That’s why it is important to seek for new thereapeutic modalities and immunization. Objectives: To describe the current epidemiological situation of YF in Brazil and identify new methods used in treatment and immunization. Methods: Narrative review of articles selected from SciELO and PubMed database, published in the past 20 years, with the following keywords: “yellow fever”; “treatment”; “vaccine”; “sofosbuvir”; “plasmapheresis”; “liver transplant”. Results: The YF has been expanding in areas which were not considered of risk, and some treatments as sofosbuvir and plasmapheresis showed great inicial results. In severe cases liver transplantation is chosen, with the challenge of defining the criteria for its indication. The immunization had an increment in cities that vaccination was indicated, showing the need to fraction the dose because of the big amount of people considered in risk. This is a reason of concern about the duration of protection when this strategy is used. Conclusion: As YF has expanded, it was necessary to seek for new treatments which include the use of sofosbuvir, plasmapheresis and liver transplant. Regarding the prevention, there is a debate about the recommendation of using a single vaccine dose for the entire population, and the duration of protection when the fractioned dose is used.

Keywords: Yellow fever; Treatment; Vaccine; Sofosbuvir; Plasmapheresis; Liver transplant.