Yellow fever in South America – A plea for action and call for prevention also in travelers from SLAMVI, ESGITM, EVASG, ALEIMC, GEPI-SEIMC, SEMEVI, and CMTZMV-ACIN
The origin of yellow fever (YF) is believed to be in Africa, with the disease arriving in the Caribbean and Brazil on slave ships during the 1500s. Then, it spread from the Caribbean to the United States of America (USA), reaching the cities of New Orleans and Philadelphia. It was identified on European soil, arriving via conquistador ships and causing major outbreaks in the French port city of Marseille. Since then, the YF virus has easily adapted to naïve vectors and reservoirs in the tropical Americas, where it is endemic [[1], [2], [3], [4]], and intermittently epidemic (https://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/yellow-fever.html). YF, caused by the YF virus (YFV) (Flaviviridae family) (Orthoflavivirus flavi) (ICTV 2022/2024) (http://bit.ly/4kTkS9z) [5], a mosquito-borne viral disease and one of the most critical hemorrhagic fevers endemic to tropical and subtropical regions of Africa and South America, continues to pose significant challenges to public health, particularly in low and middle-income countries of the latter [1,6]. Globally, about 1.54 billion individuals live in regions conducive to YF transmission [7]. In recent years, South America has experienced a resurgence in YFV and geographical expansion of transmission in some countries, affecting both human and non-human primate (NHP) populations [8,9]. More than 300 cases of YF have been reported in six South American countries during the outbreaks initiated in 2024 and ongoing in 2025, representing up to July 6 2025 a fourfold increase compared to the cases reported in 2024 (61 in 2024 and 255 in half of 2025) (https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON570), with more than 40% resulting in a fatal outcome (Table 1). Such a staggering case fatality rate, in a vaccine-preventable disease, not only highlights the urgency to improve coverage rates and traveler awareness but also underscores YF's standing as one of the deadliest vaccine-preventable viral infections.
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