title: Yellow fever risk assessment in the Central African Republic.
abstract: BACKGROUND
  Starting in 2008, the Central African Republic (CAR) experienced an unprecedented number of reported yellow fever (YF) cases. A risk assessment of YF virus (YFV) activity was conducted to estimate potential disease risk and vaccine needs.
  
  
  METHODS
  A multistage cluster sampling design was used to sample humans, non-human primates, and mosquitoes in distinct ecologic zones. Humans and non-human primates were tested for YFV-specific antibodies; mosquitoes were tested for YFV RNA.
  
  
  RESULTS
  Overall, 13.3% (125/938) of humans were found to have naturally-acquired YFV antibodies. Antibody levels were higher in zones in the southern and south central regions of CAR. All sampled non-human primates (n=56) were known YFV reservoirs; one tested positive for YFV antibodies. Several known YF vectors were identified including Aedes africanus, Ae. aegypti, Ae. luteocephalus, and Ae. simpsoni. Several more urban locations were found to have elevated Breateau and Container indices for Ae. aegypti.
  
  
  CONCLUSIONS
  A country-wide assessment of YF risk found YFV to be endemic in CAR. The potential for future YF cases and outbreaks, however, varied by ecologic zone. Improved vaccination coverage through mass campaign and childhood immunization was recommended to mitigate the YF risk.
authors.affiliation: Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA estaples@cdc.gov.
authors.forename: J Erin
authors.initials: JE
authors.lastname: Staples
authors.affiliation: Institut Pasteur de Dakar, BP 220, Dakar, Senegal.
authors.forename: Mawlouth
authors.initials: M
authors.lastname: Diallo
authors.affiliation: Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA.
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Janusz
authors.affiliation: World Health Organization, 1416 Bangui, Central African Republic.
authors.forename: Casimir
authors.initials: C
authors.lastname: Manengu
authors.affiliation: World Health Organization, 1211 Geneva 27, Switzerland.
authors.forename: Rosamund F
authors.initials: RF
authors.lastname: Lewis
authors.affiliation: World Health Organization, 1211 Geneva 27, Switzerland.
authors.forename: William
authors.initials: W
authors.lastname: Perea
authors.affiliation: World Health Organization, 1211 Geneva 27, Switzerland.
authors.forename: Sergio
authors.initials: S
authors.lastname: Yactayo
authors.affiliation: Institut Pasteur de Dakar, BP 220, Dakar, Senegal.
authors.forename: Amadou A
authors.initials: AA
authors.lastname: Sall
mesh_terms: D000330:Aedes / Q000821:virology; D000818:Animals; D000914:Antibodies, Viral / Q000276:immunology; D002488:Central African Republic / Q000453:epidemiology; D016000:Cluster Analysis; D006801:Humans; D007303:Insect Vectors / Q000821:virology; D011159:Population Surveillance; D018419:Primate Diseases / Q000453:epidemiology; D011323:Primates; D012367:RNA, Viral / Q000032:analysis; D018570:Risk Assessment; D015004:Yellow Fever / Q000453:epidemiology* / Q000517:prevention & control; D015005:Yellow fever virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
keywords: Aedes mosquitos; Central African Republic; Enzyme-linked immunosorbent assay; Reverse transcriptase polymerase chain reaction; Yellow fever; Yellow fever virus