Division of Disease Control and Health Protection

For June 10, 1999

Yellow fever is an acute viral disease of varying severity [1]. The causative agent is the yellow fever virus, genus Flavivirus. Signs and symptoms include chills, fever, headache, vomiting, and muscle pain. Some cases may experience bleeding from the gums and nose, and vomiting of blood. Jaundice may occur, and 20 to 50% of jaundiced cases are fatal. The incubation period is three to six days.

Yellow fever presently occurs in portions of South America and Africa. Two forms of yellow fever exist: the urban and the sylvatic/jungle [2]. Although two forms are clinically and etiologically identical, their epidemiology is different. Urban yellow fever is an epidemic viral disease of humans transmitted from infected to susceptible persons by the bite of Aedes aegypti mosquitoes. Ae. aegypti mosquitoes breed in containers such as jars, barrels, and tires. Sylvatic yellow fever is an enzootic viral disease transmitted among non-human primate hosts by various mosquito vectors. Sylvatic yellow fever usually occurs in forested areas.

By the early 1900s, Ae. aegypti was found in the United States and every other county in the Western Hemisphere except Canada [3]. Ae. aegypti is still found in Florida. Since viremic humans are the source of infection for yellow fever transmitted by Ae. aegypti, it is possible that infected travelers returning from abroad could cause an outbreak of yellow fever in the United States [4]. Aedes albopictus, the Asian "tiger mosquito," is also found in the United States and it is a competent laboratory vector of the yellow fever virus [5]. However, there is no evidence that Ae. albopictus has served as a vector of any cases of any human disease in the United States [6]. Ae. albopictus was found in Florida in 1986 [7].

Yellow fever was not uncommon in Florida in the 1800s. Epidemics occurred in 1857 in Jacksonville and Fernandina in 1877 [8]. In 1887, Key West, Tampa, and Plant City experienced epidemics. Jacksonville was once again struck by yellow fever in 1888. Approximately 5000 individuals developed the disease and more than 400 died [8]. The epidemic of 1888 was the final impetus for establishing the State Board of Health in 1889 [8, 9]. Florida’s first State Health Officer, Dr. Joseph Y. Porter, played an important role in the prevention and control of yellow fever in Florida [9].

The last documented Ae. aegypti-borne yellow fever epidemic in the Western Hemisphere occurred in Trinidad in 1954 [2]. The last reported case of yellow fever in Florida occurred in 1918 [10].

Yellow fever is one of the three internationally quarantinable diseases. The International Health Regulations require mandatory reporting of cases to the World Health Organization. A vaccine is available and vaccination is required for certain international travelers [2].

"Recommendations for the Use of Lyme Disease Vaccine-Recommendations of the Advisory Committee on Immunization Practices (ACIP)," was published by the Centers for Disease Control and Prevention (CDC) in the June 4, 1999, issue of the MMWR.

"The number of annually reported cases of Lyme disease in the United States has increased approximately 25-fold since national surveillance began in 1982; during 1993-1997, a mean of 12,451 cases annually were reported by states to the Centers for Disease Control and Prevention (CDC, unpublished data, 1998). The summary statement of the new recommendations is as follows:

The American Public Health Association's (APHA) 127th Annual Meeting and Exposition will be held on November 7-11, 1999, in Chicago, Illinois. The theme of the meeting is "Celebrating a Century of Progress in Public Health." More than 900 sessions have been planned and over 12,000 health professionals are expected to attend.

Details about the meeting were printed in the May issue of APHA's publication 'The Nation's Health' and will be reprinted in the June through September issues, as well as in the 'American

Journal of Public Health.' Individuals registering before September 1, 1999, will receive the 'early bird' registration rate of $225 for members, $355 for nonmembers.

Travel-Related Vaccine Preventable Illnesses' is the title of the tropical medicine conference on November 27-28, 1999, in Washington, DC. This course is sponsored by the American Society of Tropical Medicine and Hygiene (ASTMH) in cooperation with the American Committee on Clinical Tropical Medicine and Travelers' Health, and immediately precedes the ASTMH annual meeting.

The course will consider the use, indications, adverse events, efficacy, and cost effectiveness of vaccines such as those used to protect against hepatitis A & B, Japanese encephalitis, yellow fever, rabies, typhoid, meningococcal disease, anthrax, and plague, among others.

Surveillance of Vaccine-Preventable Diseases, a live, interactive videoconference, will be broadcast by CDC on December 2, 1999. Guidelines for vaccine-preventable surveillance, case investigation, and outbreak control will be the focus of the three-and-a-half hour videoconference. Continuing education credits will be available.

"The soundest long-term solution for the management of bats that enter buildings and cause a nuisance problem or present a public health hazard is by batproofing the structure. Chemical toxicants do not solve house bat problems and may create worse ones. This manual describes batproofing techniques that will provide effective and acceptable alternatives for dealing with house bat problems and hazards. Recent declines in bat populations and greater appreciation of the ecological importance of bats have identified the need for sound management strategies that will encourage bat conservation while protecting human health and solving nuisance problems."

When the State Board of Health began to establish County Health Departments in the early 1930’s, there was little published material that staff could use for reference and guidance. One of the most interesting and informative volumes in our archives is A Manual for Health Officers by J. Scott MacNutt, A.B., S.B., published by John Wiley and Sons, Inc. London (Stanhope Press, F.H. Glison Company. Boston, USA) in 1915. This 650-page book covers a wide range of medical, scientific and administrative information related to public health principles and practices at that time. Some excerpts from the chapter on "Communicable Diseases" which describes Epidemiology and the Investigation of Epidemics follow: