Hannah Lividini

Yellow Fever

In 1793, a plague struck Philadelphia. Summer had brought mosquitos and with them, a

great illness. The streets were desolate, save for the carriage of the coroner and the doctor, and

the hospital was overwhelmed with populace. Around 4,000 individuals died, and an estimated

20,000 fled the city. Yellow fever had struck the nation’s largest city, and it would not subside

until the following November (Gum).

The outbreak of yellow fever in Philadelphia, 1793 is the first great epidemic of yellow

fever known in the United States. For centuries it was a feared disease, especially in the summer

and wetlands, and the virus was even coined the “Plague of the Americas”. Around this time, it

was a widespread disease with many outbreaks occurring globally, because the disease is

transmitted through a two species of female mosquitos known as Aedes or Haemagogus(CDC).

Yellow fever is and RNA virus known as flavivirus. A flavivirus is a single stranded, gram-

positive, RNA virus. This means that the virus its self has an enveloped capsule of RNA, for

production of the viruses proteins.

Yellow fever has three transmission cycles depending on where the mosquito picks the

virus up from or where and who it transfers the virus to. The first cycle is known as the

“Savannah” cycle. This can be transmitted from primate to human, or from human to human

through Aedes mosquitos. This is only observed in Africa, giving it the name of the “Savannah”

cycle. The second cycle occurs primarily in Africa and South America. It is called the “Jungle”
cycle. It is the transfer of yellow fever from primate to primate then eventually to a human being

via the Aedes or Haemagogus mosquitos. The last cycle is the “Urban” cycle. It is the arrival of

yellow fever in an urban environment by a human who was infected via the “Savannah” or

“Jungle” cycles. It is transferred when an urban Aedes mosquito bites the individual with Yellow

fever then spreads the virus through biting others in the urban community (CDC).

Once the virus is in the body, the disease causes eosinophilic degeneration causing a

failure of the immune system to fight the virus off, and destruction of the hepatocytes in the liver

which leads to a decreased synthesis of and the shortage of Vitamin K. Because there is a lack of

Vitamin K, this causes another shortage in clotting factors in the blood, which leaves the body

susceptible to a hemorrhagic diatheses, and death by Exsanguination. (Up To Date).

There is an incubation period of 6 days (Mayo Clinic). After the 6 days, symptoms and

signs begin to occur and the virus enters an acute phase, then enters a toxic phase. In the

beginning, the acute phase, symptoms include dizziness, headache, muscle aches, nausea, fever,

loss of appetite, and red eyes, face and/or tongue. Once the virus enters the toxic phase, more

serious symptoms start to occur.

Once the toxic phase begins, the most common symptom of the toxic phase is jaundice,

or the yellowing of the eyes and the skin giving yellow fever its name. Other symptoms of the

toxic phase include regurgitation, possibly containing blood, bleeding of the G.I. tract, liver and

kidney failure, delirium, seizures, and the possibility of a coma or encephalitis, and hemorrhagic

fevers that include bleeding from the orifices of the face.

There is not currently a treatment for Yellow Fever, but there is a highly effective

vaccine, which is recommended for those living in or traveling to countries of South America
and Africa where yellow fever is commonly endemic. It occurs most often in children, and with

age, a natural immunity begins to occur (CDC). Yellow fever is a serotype virus, which means it

has a specific variation, so the vaccination is preventative of all strains of yellow fever, and

serious adverse effects are not a common occurrence (Up To Date).

The vaccine has a unique history. The man who developed the vaccine, Max Theiler, was

the first and only person to win a Nobel Prize for a vaccination. In 1927, the virus was isolated

from a blood sample of a 28-year old survivor of Yellow fever, named Asibi. Theiler was able to

inoculate that same strain of the virus into the brain of a mouse, which was far less costly to that

of primate, and also provided an easy way to test for antibodies to the yellow fever virus. From

there, Theiler was able to transfer the virus from the mouse brain to culture the virus in a chicken

embryo. He found that once the virus has been passed on and passed on through different

chicken embryos, that it reached a point where it lacked the damaging and pathogenic properties

that caused physiological and neurological issues such as hemorrhages and encephalopathy in the

mice. From this discovery, Theiler was able to develop an attenuated vaccine for Yellow Fever

(Norrby).

Today, Yellow fever is endemic in 33 Africa and 11 in the tropical regions of South

America (World Health Organization). There is no cure or treatment besides supportive care and

about 15% of patients progress to the toxic stage of the disease and the mortality rate once it has

progressed to toxicity is 20-50% (CDC). In 2014, there was 54 reported cases, which is a

dramatic drop from around 5,500 reported cases in 1988.(World Health Organization). The best

way to prevent the disease is to avoid mosquito bites, use mosquito netting, use insect repellent,

or vaccination between periods of 10 years.

 References
"Yellow Fever." Centers for Disease Control and Prevention. Centers for Disease Control and
Prevention, 12 July 2016. Web. 02 Aug. 2016
Gum, Samual A. The Pennsylvania Center for the Book - Yellow Fever Epidemic of 1793. The
Pennsylvania Center for the Book - Yellow Fever Epidemic of 1793. N.p., June-July 2010. Web. 02
Aug. 2016.
Up To Date. "Yellow Fever." Yellow Fever. Up To Date, n.d. Web. 03 Aug. 2016.
Norrby, Erling. "Yellow Fever and Max Theiler: The Only Nobel Prize for a Virus Vaccine." Yellow
Fever and Max Theiler: The Only Nobel Prize for a Virus Vaccine. The Rockefeller University Press,
26 Nov. 2007. Web. 03 Aug. 2016.
World Heath Organization. "Yellow Fever." WHO. N.p., n.d. Web. 03 Aug. 2016.