Public health priority: Urgent.
PHU response time: Respond to cases on day of notification. Enter confirmed cases on NDD within 1 working day.
Case management: Notify the Communicable Diseases Branch. Determine source of infection.
Contact management: Unimmunised contacts who shared an exposure with the case should be placed under surveillance.
Quarantine: Yellow fever is subject to the Biosecurity Act 2015. From June 2016, international yellow fever vaccination certificates presented at Australia’s border are accepted even if the vaccination was given more than ten years ago
To identify cases and prevent infection of mosquitoes in susceptible areas (e.g. Northern Queensland).
Only a confirmed case should be notified.
A confirmed case requires either:
Yellow fever virus-specific IgM detected in the absence of IgM to other relevant flaviviruses, in the absence of vaccination in the preceding 3 months.
Confirmation of laboratory results by a second arbovirus reference laboratory is required in the absence of travel history to areas with known endemic or epidemic activity.
A clinically compatible illness.
History of travel to a yellow fever endemic country in the week preceding onset of illness.
Yellow fever is to be notified by:
Only confirmed cases should be entered onto NCIMS. Yellow fever is subject to the Commonwealth Biosecurity Act 2015.
The Yellow Fever virus, a Flavivirus.
Urban yellow fever is transmitted from person to person by the Aedes aegypti mosquito. Jungle yellow fever is a zoonosis transmitted among non-human hosts (mainly monkeys) by various forest mosquitoes that may also bite and infect humans. Aedes aegypti do not live in NSW. Rarely, yellow fever can follow as an idiosyncratic reaction to the yellow fever vaccination.
The typical incubation period is 3 to 6 days. The blood of cases is infective for mosquitoes shortly before onset of fever and up to five days after onset.
The usual clinical presentation is as an acute viral disease of short duration and varying severity. The mildest cases are clinically indeterminate; typical attacks are characterised by sudden onset, fever, chills, headache, backache, generalised muscle pain, prostration, nausea and vomiting. The classic triad of jaundice, haemorrhage and pronounced albuminuria is present only in a small number of severe cases.
On same day of notification begin follow-up investigation and notify the Communicable Disease Branch of the details of the case.
Within 1 working day of notification enter confirmed cases on NCIMS.
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Identify the source of the infection, such as a location visited and exposures during recent overseas travel, and vaccination history.
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission and the reason for and duration of quarantine. Provide the Yellow Fever fact sheet.
Standard precautions. Prevent access to the patient by mosquitoes for 5 days after onset (care for case in a screened room, or using a mosquito net and insect spray).
None usually required.
Any unimmunised person who has travelled through a Yellow Fever-endemic country with the case.
Contacts should be placed under surveillance.
Advise susceptible contacts (or parents/guardians) of the risk of infection and the reason for and duration of quarantine. Provide the Yellow Fever fact sheet.
Unimmunised travellers are routinely placed under quarantine surveillance on entry into Australia by Biosecurity officers for 6 days since last staying overnight in a country where yellow fever may be present. During this period they are required to notify the Chief Quarantine Medical Officer if suffering from a febrile illness.
Note that in June 2016 the requirements for yellow fever vaccination were changed.
The Australian Government has adopted the World Health Organization amendment to the International Health Regulations (2005) regarding the period of protection afforded by yellow fever vaccination, and the term of validity of the certificate. The period of protection and term of validity has changed from 10 years to the duration of the life of the person vaccinated. This means that international yellow fever vaccination certificates presented at Australia’s border will be accepted even if the vaccination was given more than ten years ago.