title: A public health risk assessment for yellow fever vaccination: a model exemplified by an outbreak in the state of São Paulo, Brazil.
abstract: We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Ana Freitas
authors.initials: AF
authors.lastname: Ribeiro
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Ciléa
authors.initials: C
authors.lastname: Tengan
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Helena Keico
authors.initials: HK
authors.lastname: Sato
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Roberta
authors.initials: R
authors.lastname: Spinola
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mascheretti
authors.affiliation: Centro de Vigilância Epidemiológica, São Paulo, SP, Brasil.
authors.forename: Ana Cecilia Costa
authors.initials: AC
authors.lastname: França
authors.affiliation: Instituto Florestal, São Paulo, SP, Brasil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Port-Carvalho
authors.affiliation: Superintendência de Controle de Endemias, São Paulo, SP, Brasil.
authors.forename: Mariza
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Instituto Adolfo Lutz, São Paulo, SP, Brasil.
authors.forename: Renato Pereira de
authors.initials: RP
authors.lastname: Souza
authors.affiliation: Faculdade de Medicina Veterinária e Zootecnia.
authors.forename: Marcos
authors.initials: M
authors.lastname: Amaku
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo Nascimento
authors.initials: MN
authors.lastname: Burattini
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Francisco Antonio Bezerra
authors.initials: FA
authors.lastname: Coutinho
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luis Fernandez
authors.initials: LF
authors.lastname: Lopez
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Massad
mesh_terms: D001938:Brazil / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D062665:Epidemiological Monitoring; D006801:Humans; D015233:Models, Statistical; D011634:Public Health / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D014611:Vaccination / Q000401:mortality*; D015004:Yellow Fever / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000009:adverse effects*
chemical_list: D022341:Yellow Fever Vaccine