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Situation summary in the Americas
Since epidemiological week (EW) 1 to EW 13 of 2017, Brazil, Colombia, Ecuador, Peru, the Plurinational State of Bolivia, and Suriname have reported suspected and confirmed yellow fever cases.
Following is a summary of the situation in Brazil.
In Brazil, since the beginning of the outbreak in December 2016 up to 29 March 2017, there were 1,987 cases of yellow fever reported (574 confirmed, 926 discarded, and 487 suspected under investigation), including 282 deaths (187 confirmed, 24 discarded, and 71 under investigation). The case fatality rate (CFR) is 33% among confirmed cases.
According to the probable site of infection, the cases were reported in 330 municipalities, while the confirmed cases were distributed among 101 municipalities in 5 states (Espírito Santo, Minas Gerais, Pará, Rio de Janeiro, and São Paulo).
With regard to the confirmed fatal cases and their probable site of infection, 137 were in Minas Gerais, four in São Paulo, 43 in Espírito Santo, two in Pará, and one in Rio de Janeiro. In descending order, the CFR among suspected and confirmed cases by state is 100% in Pará, 80% in São Paulo, 32% in Minas Gerais, 31% in Espírito Santo, and 17% in Rio de Janeiro.
In the states of Minas Gerais and Espírito Santo, the downward trend in reported cases continues for a fifth consecutive week. In the state of Rio de Janeiro an increasing trend was observed between 9 and 15 March; it will be necessary to observe if this trend is maintained in the following weeks (Figure 1). In Rio de Janeiro, the 6 confirmed autochthonous cases were reported in the municipality of Casimiro de Abreu, which is located 136 km away from the city of Rio de Janeiro. Moreover, in EW 13, two autochthonous cases of yellow fever were confirmed in the state of Pará, in the municipality of Alenquer. The state of Pará is within the area considered at risk for yellow fever and, between July 2014 and May 2016, two cases were confirmed.
To date, Aedes aegypti has not been reported to have a role in transmission. However, confirmed epizootics in large cities, such as Vitoria, Espírito Santo and Salvador, Bahia, represent a high risk for a change in the transmission cycle.
Since the last yellow fever Epidemiological Update up to 29 March 2017, 1,484 new epizootics were reported in nonhuman primates (NHP). Since the beginning of the outbreak up to 29 March 2017, a total of 2,712 NHP epizootics were reported, of which 466 were yellow fever confirmed, 896 remain under investigation, and 74 were discarded.
Epizootics in NHP were reported in the Federal District and in the states of Alagoas, Amazonas, Bahia, Goiás, Espírito Santo, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraíba, Paraná, Pernambuco, Rio Grande do Norte, Rio Grande do Sul, Rio de Janeiro, Rondônia, Roraima, Santa Catarina, São Paulo, Sergipe, and Tocantins.
Reports of epizootics currently under investigation in the states of Amazonas (bordering Colombia, Peru, and Venezuela), Mato Grosso do Sul (bordering Bolivia and Paraguay), Pará (bordering Guyana and Suriname), Paraná (bordering Argentina and Paraguay), Rio Grande do Sul (bordering Uruguay and Argentina), Rondônia (bordering Bolivia), Roraima (bordering Guyana and Venezuela), and Santa Catarina (bordering Argentina) represent a risk of spread of the virus to the bordering countries, especially in areas with similar ecosystems.