Yellow fever medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

There is no antivirals approved for the treatment of for yellow fever, therefore vaccination is important. Treatment is symptomatic and supportive only. Fluid replacement, managing hypotension and transfusion of blood derivates is generally needed only in severe cases. In cases that result in acute renal failure, dialysis may be necessary.

Medical Therapy

• No specific antiviral treatment has been found to benefit patients with yellow fever.
• Whenever possible, yellow fever patients should be hospitalized for supportive care and close observation.
• Treatment is symptomatic. Rest, fluids, and use of pain relievers and medication to reduce fever.
• Care should be taken to avoid certain medications, such as aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, which may increase the risk of bleeding.
• H2 receptor antagonists, such as ranitidine or famotidine, may be used to prevent or diminish the risk of gastric bleeding.
• Yellow fever patients should be protected from further mosquito exposure (staying indoors and/or under a mosquito net) during the first few days of illness.
• This way, yellow fever virus in their bloodstream will be unavailable to other uninfected mosquitoes, thus breaking the transmission cycle and reducing risk to the persons around them.

Antimicrobial Regimen

• Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.

• Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.