Notifiable Disease: Analysis of Yellow Fever

Topic: CareersNursing
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Last updated: February 23, 2019

The disease selected for this analysis is yellow fever.  Bryant, Holmes, and Barrett (2007) in their review of yellow fever report that the symptoms of this disease were reported in North and South America, Africa, and Europe from the fifteenth through the nineteenth century.  Although the disease carried with it considerable mortality, it was not until the year 1900 that Walter Reed was able to isolate the virus which causes the disease.  In his research, Reid identified that Aedes aegypti mosquitoes transmitted the yellow fever virus.  This discovery led to increased protocols to control the mosquito population thereby reducing the incidence of this disease across the globe.  Presently, the yellow fever virus is found only in South America and Africa, where Aedes aegypti mosquitoes live.  Before identification of the virus and its mode of transmission, researchers hypothesized that the virus made its way to the United States through mosquito populations that had developed on slave ships from Africa and the Caribbean (Bryant, et al.

, 2007).  Eradication of the mosquitoes that carry the disease has resulted in an elimination of yellow fever outbreaks in the United States.  Yellow fever vaccinations are required for travelers visiting countries with a high prevalence of the disease.  Entrance of the virus into the United States would occur via an infected patient that had been bitten by a mosquito carrying the disease (Bryant, et al., 2007).

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Although there have not been any outbreaks in the United States, the Centers for Disease Control (CDC) would like to make healthcare workers and individuals aware of the symptoms and its manifestations.  According to the CDC (2007), yellow fever takes between three to six days to incubate, leaving the patient symptom free.  After the incubation period, symptoms of the condition will include fever and chills, severe headache, back pain, general muscle aches, nausea, fatigue, and weakness.  Preliminary diagnosis is often based on the patient’s clinical features, places of travel, activities, and epidemiologic history of the location where infection occurred.  Diagnosis of yellow fever is made through testing of cerebrospinal fluid (CSF) to detect virus specific immunoglobulin M and neutralizing antibodies.  During an acute infection, some viruses can be isolated in a culture or detected by nucleic acid amplification.

  All test results are sent to the state health department for recording.  After a short period of symptom remission, a resurgence of fever and headache are accompanied with hepatic coagulopathy.  The results are hemorrhagic symptoms that include hematemesis (black vomit), epistaxis (nosebleed), gum bleeding, and purpuric hemorrhages (bruising).

  In the late stages of the disease, patients can develop hypotension, shock, metabolic acidosis, myocardial dysfunction, and cardiac arrhythmia.  Confusion, seizures, and coma can also occur.  When epidemics occur in unvaccinated populations, case fatality rates range from 15% to more than 50%.  Those who recover usually have a lasting immunity against infection and experience weakness and fatigue that may last several months (CDC, 2007).  The prevalence of the disease can be found in enzootic countries.In review of the prevalence of the disease around the world, the CDC (2008) informs us that the disease occurs only in sub-Saharan Africa and tropical South America, where it is endemic and intermittently epidemic.  Despite this, the CDC does note that between 1996 and 2002, six cases have been reported in the United States and Europe.

 It was found in travelers to Africa and South America who became infected and returned home before symptoms manifested.  With the realization that the disease occurs only in certain areas, the World Health Organization (WHO) (2008) provides a review of cases, deaths, and mortality rates in each country where the disease has been reported.  Table 1 provides a review of the prevalence rate of yellow fever for 2006 in African and South American countries:Table 1: Reported Cases/Deaths Due to Yellow Fever, 2006African Countries# of Cases# of DeathsFatality RateCameroon100Central African Republic100Côte d’Ivoire16319%Ghana100Guinea100Mali5480%South American CountriesBolivia161063%Brazil22100%Colombia55100%Peru633454%(WHO, 2008)The WHO (2008) notes that outbreaks of the disease occur in regions of the world where the Aedes aegypti mosquitoes are most common.

 In 2006, they launched a yellow fever initiative that provides access and maintains the emergency stockpile of vaccines for use in preventive vaccination campaigns.  It is anticipated that the stockpile will prevent deaths from yellow fever and ensure that the vaccine is affordable by supporting the market.  This stockpile serves two distinct purposes: it allows rapid access for outbreak response while also allowing use in preventive campaigns.

  In these areas, efforts have been made to improve access to the stockpile of vaccines against yellow fever.  Countries in need of assistance are given access to the stockpile to prevent the spread of the disease when cases are reported.  In spite of that, problems arise when stockpiles run low and outbreaks of yellow fever occur in remote locations difficult for public health officials to provide support to patients, increasing the number of cases of the disease.

 In some countries,  WHO (2008) states that in cases when outbreaks occur, a request must be submitted to the International Coordinating Group on Vaccine Provision, which is composed of four international organizations (the International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF and WHO).  After an epidemiological investigation at the field level, any affected country is able to access the stockpile.  The CDC (2008) notes that individuals should take precautions and attempt to stay indoors or in well-screened areas.  If traveling outside is necessary, individuals should wear protective clothing including long sleeved shirts and long pants.  Insect repellents containing DEET or picaridin are also recommended for exposed skin that is not protected by clothing.  In addition, permethrin-containing repellents can be applied to clothing to help further reduce the exposure to a mosquito bite.  Because mosquitoes transmit the virus, protection of mosquito bites is the only way to reduce transmission of the disease during an outbreak (CDC, 2008).  Given effective surveillance, the disease can be controlled.

The final issue that must be considered in the context of this analysis is the way in which information about the disease could be used to inform nursing practice across the globe in both a community and hospital setting.  In a community setting, prior to infection, nurses should focus on prevention of the disease through vaccination.  In addition, education about preventive practices, i.e., protective clothing and repellants, could also be used.  Sheff (2005) notes that in a post infection hospital setting, nurses will fill a supporting role in providing patient care.

  There is no treatment for curing the symptoms of yellow fever.  Supportive care may include administering oxygen, I.V. fluids, and replenishing clotting factors with vitamin K and fresh frozen plasma (Sheff, 2005).  In addition, nurses in the community or hospital setting can get involved with the Health Department in surveillance and become a leader in workshops at local levels in all enzootic countries.

  Zoonotic surveillance has been adopted, primarily in Brazil and Venezuela.  When nurses travel to these countries and provide education on the prevention of mosquito bites, they have an impact on the incidence of the disease.Combating yellow fever must include prevention of mosquito bites and control of the mosquito population.  Since the isolation and detection of the virus, surveillance and prevention have been effective in combating the disease.  In areas prone to outbreaks of yellow fever, education and vaccination can improve health outcomes.

 When cases of yellow fever do arise, supportive health measures can be applied to help the patient combat the disease.  Without any current treatment for yellow fever, prevention of the disease is the most effective means to reduce its impact. 


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