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YELLOW FEVER

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Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17Slide 18Slide 19Slide 20Slide 21Slide 22Slide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30Slide 31Slide 32Slide 33Slide 34Slide 35Slide 36Slide 37Slide 38Slide 39Slide 40Slide 41Slide 42Slide 43Slide 44Slide 45Slide 46Slide 47Slide 48Slide 49Slide 50Dr.I.Selvaraj,I.R.M.SB.SC.,M.B.B.S.,(M.D Community medicine).,D.P.H.,D.I.H.,P.G.C.H&FW(NIHFW,New delhi)Sr.D.M.O(ON STUDY LEAVE)INDIAN RAILWAYS MEDICAL SERVICEIn 1881, Carlos Juan Finlay, a physician in Havana, first proposed that yellow fever was a mosquito-borne illness, which subsequently was proven by Walter Reed and colleagues. U.S. Army doctor Discovered the Cause of Yellow Fever August 27, 1900Research and Walter ReedWalter Reed, M.D., (1851-1902) was an American Army surgeon who led the team which proved the theory first set forth in 1881 by the Cuban doctor and scientist Dr. Carlos Finlay that yellow fever is transmitted by mosquitoes rather than direct contact. The risky but fruitful research work was done with human volunteers, including some of the medical personnel such as Clara Maass and surgeon Jesse W. Lazear Walter Reed Medal winner who allowed themselves to be deliberately infected and died of the virus. All this lead to the elimination of Yellow Fever from Cuba and allowed the final construction of the Panama Canal.Clara MaassOn August 14, 1901, Maass allowed herself to be bitten by infected mosquitoes for the seventh time. Maass once again became ill with yellow fever on August 18 and died on August 24. Her death roused public sentiment and put an end to yellow fever experiments on humans.•Thirty-three countries, with a combined population of 508 million, are at risk in Africa. These lie within a band from 15°N to 10°S of the equator.• In the Americas, yellow fever is endemic in nine South American countries and in several Caribbean islands. Bolivia, Brazil, Colombia, Ecuador and Peru are considered at greatest risk.•There are 200,000 estimated cases of yellow fever (with 30,000 deaths) per year.Countries regarded as yellow fever infectedAfrica: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo (Zaire), Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast (Cote D'Ivoire), Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan (South of 15° N), Togo, Uganda, Tanzania, Zambia. America: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname, Trinidad and Tobago, Venezuela, Panama.•As of 6 December 2005, the Federal Ministry of Health,SUDAN reported to WHO a total of 565 cases, including 143 deaths, with a case fatality rate of 25.3%. •As of 19 December2005, the Ministry of Health, Guinea has reported a total of 114 suspected cases of yellow fever with 26 deaths, Twenty-three of these cases have been laboratory confirmed.There are no reported cases of yellow fever in Asia. It is suspected that the high incidence of dengue fever helps confer protection against yellow fever, and that the Asian mosquito strains are not as competent as vectors of the disease.AGENT •Genus :Flavivirus fibricus, Group B Arbovirus Family : Toga virus•The yellow fever virus is 35-40 nm in•size. It consists of a single strand of RNA virusThe photomicrograph shows multiple virions of the yellow fever virus at a magnification of 234,000xAedes mosquitoes, including A. aegypti, A. africanus, A. simpsoni, A. furcifer, B. luteocephalus, and A. albopictus (Asian tiger mosquito). Urban yellow fever is transmitted by the Aedes aegypti mosquito. Jungle, or sylvatic, yellow fever is transmitted by Haemagogus and other mosquitoes (such as Masoni africana) of the forest canopy (tree-hole breeding mosquitoes). VECTORS•Reservoir: Monkey, Human, Mosquito•Incubation period: Intrinsic IP:3to 6 Days Extrinsic IP: 1to 2 weeks.Period of communicability: First 4 days of illnessMode of Transmission : 1.Sylvan cycle 2. Urban cycleRace: No known racial predilection exists. Sex: Both sexes are infected equallyAge: All ages are suceptible to yellow fever.Jungle yellow fever primarily affects nonimmunized adults who work as foresters,wood cutters & hunters in endemic areas and persons residing on the edge of the jungle. Infants born of immune mothers have antibodies up to 6 months of lifeENVIRONMENTAL FACTORS•TROPICAL CLIMATE•HUMIDITY (60%)•TEMPERATURE ( 24ºC)•SOCIAL FACTORS : URBANISATION , TRAVEL &EXCESSIVE RAINS•The natural host for the yellow fever virus in forest areas is non-human primates (usually monkeys and chimpanzees).•The vectors of yellow fever in forest areas in Africa are Aedes africanus . In South America, the primary vector is the Haemagogus species. •In urban areas of both Africa and South America, the vector is Aedes aegypti.The natural yellow-fever cycle is mosquito-monkey-mosquito. The shift from jungle yellow fever to urban yellow fever is thought to be the result of humans entering the sylvan setting and becoming part of the yellow-fever cycle: Initially, wood cutters and other forest workers were bitten by forest-canopy mosquitoes carrying the yellow-fever virus. The humans then returned to the urban settings.Clinical features of yellow feverYellow fever presents with a variety of clinical signs and outcomes ranging from mild to severe and fatal cases. Yellow fever in human beings has the following characteristics:· An acute phase lasting for four to five days and presenting with:- a sudden onset of fever- headache or backache- muscle pain- nausea- vomiting- red eyes (infected conjunctiva).The diagnosis can be strongly suspected when Faget's sign is present. Faget's sign: The simultaneous occurrence of a high fever with a slowed heart rate.This phase of yellow fever can be confused with other diseases that also present with fever, headache, nausea and vomiting because jaundice may not be present in less severe (or mild) cases of yellow fever. The less severe cases are often non-fatal.· A temporary period of remission follows the acute phase in 5% to 20% of cases. The period of remission lasts for up to 24 hours.A toxic phase can follow the period of remission and presents with:- jaundice- dark urine- reduced amounts of urine production- bleeding from the gums, nose or in the stool-


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