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1 1 (April 27, 2017)

handle is hein.crs/govcfvz0001 and id is 1 raw text is: -- Fr, . April 27, 2017 Infectious Disease Outbreaks: Yellow Fever in South America Since 1980, emerging infectious diseases (EID) have resulted in more frequent outbreaks that are causing higher numbers of human infections. EID are either new diseases or existing ones that have emerged in new areas. In recent decades, new EID have included Severe Acute Respiratory Syndrome (SARS) and HIV/AIDS. EID that have spread to new geographical areas have included yellow fever and Zika. Zoonotic pathogens (organisms that spread from animals to humans, often through a vector like a mosquito) sicken some 1 billion people annually, roughly 15 million of whom die. Notable EID outbreaks caused by zoonotic pathogens include SARS (2003), Avian Influenza H5N1 (2005), Pandemic Influenza H IN 1 (2009), Middle East Respiratory Syndrome coronavirus (MERS-CoV, 2013), West Africa Ebola (2014), Zika (2015), and Central Africa Yellow Fever (2016) and South America Yellow Fever (2016-2017). On average, Congress has provided about $130 million annually through regular appropriations to the U.S. Agency for International Development (USAID) and the U.S. Centers for Disease Control and Prevention (CDC) for global pandemic preparedness efforts. Emergency responses to EID outbreaks have varied, however, but tend to follow introduction of the disease into the United States. For example, the 114th Congress appropriated roughly $5 billion and $2 billion to help control the West Africa Ebola and Zika outbreaks, respectively, but other Congresses did not provide funds to address SARS or yellow fever outbreaks. Due to the unpredictable nature of EID outbreaks, some question whether Congress will continue to emphasize infectious diseases that reach the U.S. shores or whether the 115th Congress might develop a more proactive approach. The reemergence of yellow fever in several South American countries is the latest event highlighting the global threat of EID outbreaks. The importation of the disease from Angola-where an outbreak of unprecedented proportions occurred in 2016-and the frequency at which EID outbreaks are spreading globally have sparked further concern. For more information on the outbreak in Angola, see CRS In Focus IF10603, Infectious Diseases Outbreaks: Yellow Fever in Central Africa, by Tiaji Salaam-Blyther. Moreover, some global health experts have expressed concerns about the vulnerability of the United States to EID (including yellow fever) and about the capacity of the international health system to control future outbreaks. B k Pkproud C~r Y&d ,ow e r Yellow fever is a disease transmitted by mosquitoes endemic in 47 countries across sub-Saharan Africa (SSA) and South America (see Figure 1). Roughly 90% of annual yellow fever cases occur in SSA. Many who contract the virus do not exhibit symptoms. Among symptomatic cases, victims often develop fever, nausea, muscle pain, and vomiting. In most instances, related symptoms resolve within four days. According to the CDC, roughly 15% of those who contract yellow fever develop severe symptoms, including organ failure. The yellow in the name of the disease refers to the j aundice-yellowing of the skin and whites of the eyes, often indicating liver damage-that typically occurs among severe cases. About half of those who experience severe yellow fever die within 10 days. While specific treatment for the virus does not exist, yellow fever can be prevented through vaccination. Eradication is not considered feasible, as the disease is also found in primates, from which mosquitos can transmit the disease to humans. Yellow fever is reemerging in South America. It is sickening and killing primates and people in numbers not seen for decades. A growing number of cases are being detected in primates in forested areas across Argentina, Bolivia, Colombia, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela. Experts are tracking this phenomenon and working to avoid a scenario in which the disease moves from being transmitted by Haemogogus (forest-dwelling) mosquitos to Aedes (urban-dwelling) mosquitos. To date, most human cases in South America have been detected among people who either reside in or have traveled to forested or rural areas, including through ecotourism. The scope of yellow fever outbreaks vary across the region: * In Bolivia, Colombia, Ecuador, and Suriname, the disease was detected in ecotourists. These cases were rapidly detected and did not cause further transmission. * A yellow fever outbreak that began in Peru in 2016 sickened 78 people and killed 26 of them. That outbreak was the largest seen in Peru since 2006. No new cases have been reported since February 2017. * Brazil is working to contain an outbreak that began in 2016. Health experts are concerned about the continued spread of the disease across Brazil, particularly as outbreaks approach densely populated urban areas with populations who frequently travel throughout the region, including to the United States. As of April 20, 2017, the disease has infected 681 people in Brazil, 234 of whom have died. Health officials are investigating an additional 768 suspected cases and 35 deaths. YOlow Fkhve, Vacct'a.., In Brazil, most human yellow fever cases are occurring in parts of the country that had not been considered at risk of yellow fever transmission. The largest clusters of cases are in the states of Minas Gerais (471 confirmed cases and 252 .O 'T p\w -- , gn'a', goo mppm qq\ a , q 'S I 11LULANJILiN,

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