Historically, the virus ravaged cities across the Americas, Europe and Africa, until a vaccine was introduced in 1937 and its range shrunk significantly. But now, as climate change creates favorable conditions for virus-carrying mosquitoes, scientists are seeing outbreaks in unexpected areas.
How is climate change contributing to this pattern, and could it get worse in the future?
Primates, such as howler monkeys, carry the yellow fever virus, which then gets picked up mosquitoes that bite the monkeys and later spread the germ to humans. (Image credit: CDC)
Devastating yellow fever epidemics spread in the 17th to 19th centuries, before the development of a vaccine. Nowadays, an estimated 31,000 to 82,000 yellow fever deaths occur each year; severe cases have an estimated fatality rate of 20% to 50%.
Although there is an effective vaccine for yellow fever, cases have been on the rise in the past three decades. This led the World Health Organization (WHO) to set out a strategy in 2017 for eliminating yellow fever epidemics by 2026 through outbreak prevention and containment.
Weather patterns and deforestation
Changing weather patterns play a role, too. In 2017-2018, Brazil saw its first yellow fever outbreak in a city in almost a century. That outbreak, primarily in Belo Horizonte and São Paulo, was likely a result of drought, according to one study.
Dr. Joelle Ivy Rosser, infectious-disease researcher at Stanford University
"Extremes of weather in either direction" — very wet or very dry — "can exacerbate mosquito-borne disease transmission," Rosser said.
Experts are paying particular attention to the edges of cities, where urban centers meet the forest. The risk of yellow fever transmission from monkeys to humans via mosquitoes is rising at these edges due to both climate change and deforestation.
Similar patterns have been seen with other mosquito-borne infections, such as malaria.
The yellow fever virus (pictured) is in the family Flaviviridae, which also includes the dengue and Zika viruses. (Image credit: BSIP via Getty Images)Could yellow fever return to the U.S.?
Europe is predicted to face the largest increase in exposure to Ae. aegypti mosquitoes compared to the rest of the world, and the U.S. and Canada are predicted to see increases too. In the U.S., the mosquito species already lives in a number of states, including Florida, Mississippi, Arizona and New Mexico. However, warming would increase the chances of mosquitoes surviving in locations further north, such as Philadelphia and New York, which suffered major yellow fever outbreaks in the past. One model predicts Ae. aegypti could spread as far north as Chicago by 2050.
Dr. Seth Judson, infectious-disease physician-scientist at UCLA
"If yellow fever virus reestablished itself in our local Aedes aegypti population, then that would be very concerning," Rosser said.
For local transmission to take hold, "there needs to be significant numbers of infections [passed to locals], and infections among travelers," Judson said. "But … it's in the realm of possibility."
"There's access to medicines and vaccines; we pipe water to our homes, so we don't have standing water around," Caldwell said. "So it is a concern, but it's never going to be the next COVID."
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Whatever happens, this is a time for heightened awareness of the virus, Judson said.
This article is for informational purposes only and is not meant to offer medical advice.
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