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YELLOW FEVER Yellow fever is a viral disease that has caused large epidemics in Africa and the Americas It can be recognized from historic texts stretching back 400 years Infection causes a wide spectrum of disease from mild symptoms to severe illness and death The yellow in the name is explained by the jaundice that affects some patients Although an effective vaccine has been available for 60 years the number of people infected over the last two decades has increased and yellow fever is now a serious public health issue again Cause The disease is caused by the yellow fever virus which belongs to the flavivirus group In Africa there are two distinct genetic types called topotypes associated with East and West Africa South America has two different types but since 1974 only one has been identified as the cause of disease outbreaks Symptoms The virus remains silent in the body during an incubation period of three to six days There are then two disease phases While some infections have no symptoms whatsoever the first acute phase is normally characterized by fever muscle pain with prominent backache headache shivers loss of appetite nausea andor vomiting Often the high fever is paradoxically associated with a slow pulse After three to four days most patients improve and their symptoms disappear However 15 enter a toxic phase within 24 hours Fever reappears and several body systems are affected The patient rapidly develops jaundice and complains of abdominal pain with vomiting Bleeding can occur from the mouth nose eyes andor stomach Once this happens blood appears in the vomit and faeces Kidney function deteriorates this can range from abnormal protein levels in the urine albuminuria to complete kidney failure with no urine production anuria Half of the patients in the toxic phase die within 10-14 days The remainder recover without significant organ damage Yellow fever is difficult to recognize especially during the early stages It can easily be confused
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