title: Yellow fever cases in Asia: primed for an epidemic.
abstract: There is currently an emerging outbreak of yellow fever in Angola. Cases in infected travellers have been reported in a number of other African countries, as well as in China, representing the first ever documented cases of yellow fever in Asia. There is a large Chinese workforce in Angola, many of whom may be unvaccinated, increasing the risk of ongoing importation of yellow fever into Asia via busy commercial airline routes. Large parts of the region are hyperendemic for the related Flavivirus dengue and are widely infested by Aedes aegypti, the primary mosquito vector of urban yellow fever transmission. The combination of sustained introduction of viraemic travellers, an ecology conducive to local transmission, and an unimmunized population raises the possibility of a yellow fever epidemic in Asia. This represents a major global health threat, particularly in the context of a depleted emergency vaccine stockpile and untested surveillance systems in the region. In this review, the potential for a yellow fever outbreak in Asia is discussed with reference to the ecological and historical forces that have shaped global yellow fever epidemiology. The limitations of surveillance and vector control in the region are highlighted, and priorities for outbreak preparedness and response are suggested.
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: sean.wasserman@gmail.com.
authors.forename: Sean
authors.initials: S
authors.lastname: Wasserman
authors.affiliation: Division of Infectious Diseases, National University of Singapore, Singapore.
authors.forename: Paul Anantharajah
authors.initials: PA
authors.lastname: Tambyah
authors.affiliation: Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
authors.forename: Poh Lian
authors.initials: PL
authors.lastname: Lim
mesh_terms: D000330:Aedes / Q000821:virology; D000818:Animals; D001208:Asia / Q000453:epidemiology; D004196:Disease Outbreaks; D058872:Epidemics; D006801:Humans; D007303:Insect Vectors / Q000821:virology; D015004:Yellow Fever / Q000453:epidemiology* / Q000517:prevention & control
keywords: Aedes aegypti; Arboviruses; Emerging infectious diseases; Flaviviruses; Yellow fever