Download Appendix A: Disease-Specific Chapters

Infectious Diseases Protocol
Appendix A:
Disease-Specific Chapters
Chapter: Yellow Fever
Revised December 2014
Yellow Fever
Communicable
Virulent
Health Protection and Promotion Act:
Ontario Regulation 558/91 – Specification of Communicable Diseases
Health Protection and Promotion Act:
Ontario Regulation 559/91 – Specification of Reportable Diseases
1.0 Aetiologic Agent
Yellow fever is caused by the Yellow Fever virus: genus Flavivirus and family Flaviviridae.1
2.0 Case Definition
2.1 Surveillance Case Definition
See Appendix B
2.2 Outbreak Case Definition
Not applicable
3.0 Identification
3.1 Clinical Presentation
Yellow fever is an acute viral disease of short duration and varying severity. The mildest
cases may be clinically indeterminate.1
Typically, the clinical presentation is characterized by sudden onset of fever, chills,
headache, backache, generalized muscle pain, prostration, nausea and vomiting. The pulse
may be slow and weak out of proportion to the elevated temperature (Faget sign). Jaundice
is moderate early in the disease and intensifies later.1
Most infections resolve after the 5th day, however some cases progress after a brief remission
of hours to a day into the ominous stage of intoxication manifested by hemorrhagic
symptoms including epistaxis, gingival bleeding, hematemisis (coffee ground or black),
melaena and liver and renal failure. 20-50% of jaundiced cases are fatal.1
3.2 Diagnosis
See Appendix B for diagnostic criteria relevant to Case Definitions.
Note: Diagnosis is made by isolation or detection of viral antigen or nucleic acid of the
yellow fever virus from the body fluid or tissues, or serological confirmation; this is
supported by clinical and epidemiological evidence.1
For further information about human diagnostic testing, contact the Public Health Ontario
Laboratories or refer to the Public Health Ontario Laboratory Services webpage:
2
http://www.publichealthontario.ca/en/ServicesAndTools/LaboratoryServices/Pages/default.as
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4.0 Epidemiology
4.1 Occurrence
Yellow fever exists in nature in three transmission cycles: a sylvatic or jungle cycle that
involves Aedes and Haemagogus mosquitos and nonhuman primates; an intermediate cycle
involving humans and various Aedes spp; and an urban cycle involving humans and mainly
Aedes aegypti mosquitos.1
Yellow fever is not endemic to Ontario and reported cases in Ontario are attributed to recent
immigration or travel to yellow fever endemic countries. It is endemic in tropical areas of
Africa and Latin America.1 Between 2007 and 2011, no cases of yellow fever were reported
in Ontario.
Please refer to the Public Health Ontario Monthly Infectious Diseases Surveillance Reports
and other infectious diseases reports for more information on disease trends in Ontario.2, 3
http://www.publichealthontario.ca/en/DataAndAnalytics/Pages/DataReports.aspx
4.2 Reservoir
Humans in urban areas; in forest areas, vertebrates other than humans, mainly monkeys and
possibly marsupials.1
4.3 Modes of Transmission
Yellow fever is transmitted via the bite of infected mosquitoes, primarily those of the genus
Aedes.1 There is no human to human transmission.
4.4 Incubation Period
3-6 days1
4.5 Period of Communicability
Mosquitoes can acquire the virus from an infected person shortly before onset of fever and
for the first 3 – 5 days of illness.1 The disease is highly communicable where many
susceptible people and abundant vector mosquitoes coexist; it is not communicable through
contact or common vehicles.1 Aedes aegypti mosquitoes require 9 to 12 days after a blood
meal to become infectious and remain so for life.1
4.6 Host Susceptibility and Resistance
Vaccine preventable; recovery from yellow fever is followed by lasting immunity; mild
unapparent infections are common in endemic areas; previous infections with dengue give
some degree of immunity.
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5.0 Reporting Requirements
5.1 To local Board of Health
Individuals who have or may have yellow fever shall be reported as soon as possible to the
medical officer of health by persons required to do so under the Health Protection and
Promotion Act, R.S.O. 1990 (HPPA).4
5.2 To the Ministry of Health and Long-Term Care (the ministry) or Public Health
Ontario (PHO), as specified by the ministry
Report only case classifications specified in the case definition.
Cases shall be reported using the integrated Public Health Information System (iPHIS), or
any other method specified by the ministry within five (5) business days of receipt of initial
notification as per iPHIS Bulletin Number 17: Timely Entry of Cases.5
The minimum data elements to be reported for each case are specified in the following:
•
Ontario Regulation 569 (Reports) under the Health Protection and Promotion Act
(HPPA);6, 4
•
The iPHIS User Guides published by PHO, and
•
Bulletins and directives issued by PHO.
6.0 Prevention and Control Measures
6.1 Personal Prevention Measures
Preventive measures:1
•
Immunization of travellers with yellow fever vaccine when appropriate and travelling to
endemic areas.
•
Use of protective clothing, bed nets and repellents with DEET in high risk areas.
6.2 Infection Prevention and Control Strategies
Defer blood donations from persons with a history of yellow fever or recent immigration
from, or travel to, endemic countries.
For healthcare settings, implementing routine infection prevention and control strategies is all
that is necessary.
Refer to Public Health Ontario’s website at www.publichealthontario.ca to search for the
most up-to-date Provincial Infectious Diseases Advisory Committee (PIDAC) best practices
on Infection Prevention and Control (IPAC). PIDAC best practice documents can be found
at:
http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/PIDAC/Pages/PID
AC_Documents.aspx.
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6.3 Management of Cases
Information required to be reported to the medical officer of health is specified in Ontario
Regulation 569 under the HPPA.6, 4 Investigate the case to determine source of infection and:
•
Apply case definition
•
Investigate risk factors for acquisition including but not limited to 3-6 days prior to onset:
o history of travel, specific geographic location, season, and duration of exposure
o immunization status
o history of mosquito bites
Provide education about transmission of infection and use of personal protective measures
against mosquito bites.
There is no specific treatment for yellow fever except for supportive treatment.1
6.4 Management of Contacts
Not applicable
6.5 Management of Outbreaks
Not applicable
7.0 References
1. Heymann DL, editor. Control of communicable diseases manual. 19th ed. Washington,
DC: American Public Health Association; 2008.
2. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Monthly
infectious diseases surveillance report. Toronto, ON: Queen’s Printer for Ontario; 2014.
Available from:
http://www.publichealthontario.ca/en/ServicesAndTools/SurveillanceServices/Pages/Mo
nthly-Infectious-Diseases-Surveillance-Report.aspx
3. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Reportable
disease trends in Ontario, 2011. Toronto, ON: Queen’s Printer for Ontario; 2014.
Available from:
http://www.publichealthontario.ca/en/eRepository/Reportable_Disease_Trends_in_Ontari
o_2011.pdf
4. Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Available from:
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm.
5. Ontario. Ministry of Health and Long-Term Care. Timely entry of cases. iPHIS Bulletin.
Toronto, ON: Queen’s Printer for Ontario; 2014:17.
6. Reports, R.R.O. 1990, Reg. 569. Available from:
http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900569_e.htm
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8.0 Additional Resources
Government of Canada [Internet]. Ottawa, ON: Government of Canada; c2014. Diseases:
Yellow fever; 2014 May 14 [cited 2014 May 30]: Available from:
http://travel.gc.ca/travelling/health-safety/diseases/yellow-fever
National Advisory Committee on Immunization; Public Health Agency of Canada. Canadian
immunization guide. Evergreen ed. Ottawa, ON: Her Majesty the Queen in Right of Canada;
2013. Available from: http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php.
World Health Organization. International travel and health. Geneva: WHO; 2012. Chapter 6,
Vaccine-preventable diseases and vaccines (2013 update). Available from:
http://www.who.int/ith/ITH_chapter_6.pdf?ua=1
Monath TP. Yellow fever. In: Plotkin SA, Orenstein WA, Offit P, editors. Vaccines. 4th ed.
Philadelphia, PA: Saunders; 2004. p. 1095-1176.
9.0 Document History
Table 1: History of Revisions
Revision Date
December 2014
Document Section
General
Description of Revisions
New template.
Title of Section 4.6 changed from
“Susceptibility and Resistance” to “Host
Susceptibility and Resistance”.
Title of Section 5.2 changed from “To Public
Health Division (PHD)” to “To the Ministry of
Health and Long-Term Care (the ministry) or
Public Health Ontario (PHO), as specified by the
ministry”.
Section 9.0 Document History added.
December 2014
3.2 Diagnosis
Entire section revised.
December 2014
4.1 Occurrence
Entire section revised.
December2014
5.1 To Local Board of “Confirmed and suspected cases shall be
Health
reported to the medical officer of health…”
revised to “Individuals who have or may have
yellow fever shall be reported as soon as
possible to the medical officer of health…”
December 2014
5.2 To the Ministry of
Health and LongTerm Care (the
ministry) or Public
Health Ontario (PHO)
as specified by the
First sentence, deletion of “to PHD”.
Third paragraph, second and third bullets revised
to: “The iPHIS User Guides published by PHO”
and “Bulletins and directives issued by PHO.”
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Revision Date
Document Section
Description of Revisions
Ministry
December 2014
6.2 Infection
Prevention and
control Strategies
Entire section revised.
December 2014
6.3 Management of
Cases
First paragraph revised from “Refer to the
Ontario Regulation 569 for relevant data to
collect. Investigate the case to determine source
of infection as well as the following…” to
“Information required to be reported to the
medical officer of health is specified in Ontario
Regulation 569 under the HPPA. Investigate the
case to determine source of infection and…”
December 2014
7.0 References
Entire section revised.
December 2014
8.0 Additional
Resources
Entire section revised.
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