title: Yellow Fever outbreaks in unvaccinated populations, Brazil, 2008-2009.
abstract: Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever.
authors.affiliation: Secretariat for Health Surveillance, Brazilian Ministry of Health, Brasilia, Brazil; Department of Animal Science, Federal University of Goiás, Goiania, Brazil.
authors.forename: Alessandro Pecego Martins
authors.initials: AP
authors.lastname: Romano
authors.affiliation: Secretariat for Health Surveillance, Brazilian Ministry of Health, Brasilia, Brazil.
authors.forename: Zouraide Guerra Antunes
authors.initials: ZG
authors.lastname: Costa
authors.affiliation: Secretariat for Health Surveillance, Brazilian Ministry of Health, Brasilia, Brazil.
authors.forename: Daniel Garkauskas
authors.initials: DG
authors.lastname: Ramos
authors.affiliation: Department of Animal Science, Federal University of Goiás, Goiania, Brazil.
authors.forename: Maria Auxiliadora
authors.initials: MA
authors.lastname: Andrade
authors.affiliation: Department of Animal Science, Federal University of Goiás, Goiania, Brazil.
authors.forename: Valéria de Sá
authors.initials: Vde S
authors.lastname: Jayme
authors.affiliation: Health Surveillance Center, Rio Grande do Sul State Health Department, Porto Alegre, Brazil.
authors.forename: Marco Antônio Barreto de
authors.initials: MA
authors.lastname: Almeida
authors.affiliation: Health Surveillance Center, Rio Grande do Sul State Health Department, Porto Alegre, Brazil.
authors.forename: Kátia Campomar
authors.initials: KC
authors.lastname: Vettorello
authors.affiliation: Epidemiological Surveillance Center, São Paulo State Health Department, São Paulo, Brazil.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mascheretti
authors.affiliation: Pan American Health Organization, Brasilia, Brazil; Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000009:adverse effects / Q000706:statistics & numerical data; D015004:Yellow Fever / Q000453:epidemiology*; D022341:Yellow Fever Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D022341:Yellow Fever Vaccine