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Yellow fever in Asia - a risk analysis

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Title: Yellow fever in Asia - a risk analysis
Authors: Cracknell Daniels, B
Gaythorpe, K
Imai, N
Dorigatti, I
Item Type: Journal Article
Abstract: Background There is concern about the risk of yellow fever (YF) establishment in Asia, owing to rising numbers of urban outbreaks in endemic countries and globalisation. Following an outbreak in Angola in 2016, YF cases were introduced into China. Prior to this, YF had never been recorded in Asia, despite climatic suitability and the presence of mosquitoes. An outbreak in Asia could result in widespread fatalities and huge economic impact. Therefore, quantifying the potential risk of YF outbreaks in Asia is a public health priority. Methods Using international flight data and YF incidence estimates from 2016, we quantified the risk of YF introduction via air travel into Asia. In locations with evidence of a competent mosquito population, the potential for autochthonous YF transmission was estimated using a temperature-dependent model of the reproduction number and a branching process model assuming a negative binomial distribution. Results In total, 25 cities across Asia were estimated to be at risk of receiving at least one YF viraemic traveller during 2016. At their average temperatures, we estimated the probability of autochthonous transmission to be <50% in all cities, which was primarily due to the limited number of estimated introductions that year. Conclusion Despite the rise in air travel, we found low support for travel patterns between YF endemic countries and Asia resulting in autochthonous transmission during 2016. This supports the historic absence of YF in Asia and suggests it could be due to a limited number of introductions in previous years. Future increases in travel volumes or YF incidence can increase the number of introductions and the risk of autochthonous transmission. Given the high proportion of asymptomatic or mild infections and the challenges of YF surveillance, our model can be used to estimate the introduction and outbreak risk and can provide useful information to surveillance systems.
Issue Date: 1-Apr-2021
Date of Acceptance: 20-Jan-2021
URI: http://hdl.handle.net/10044/1/87073
DOI: 10.1093/jtm/taab015
ISSN: 1195-1982
Publisher: Oxford University Press (OUP)
Journal / Book Title: Journal of Travel Medicine
Volume: 28
Issue: 3
Copyright Statement: © International Society of Travel Medicine 2021. Published by Oxford University Press.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permitsunrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Wellcome Trust
Medical Research Council
Medical Research Council (MRC)
Funder's Grant Number: 213494/Z/18/Z
MR/R015600/1
MR/R015600/1
Keywords: Tropical Medicine
1103 Clinical Sciences
1117 Public Health and Health Services
1506 Tourism
Publication Status: Published
Article Number: ARTN taab015
Online Publication Date: 2021-01-28
Appears in Collections:Faculty of Medicine
School of Public Health



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