The evolutionary origins of yellow fever are most likely African. [1] [2] Phylogenetic analyses indicate that the virus originated from East or Central Africa, with transmission between primates and humans, and spread from there to West Africa. [3] The virus as well as the vector Aedes aegypti , a mosquito species, were probably brought to the western hemisphere and the Americas by slave trade ships from Africa after the first European exploration in 1492. [4] However, some researchers have argued that yellow fever might have existed in the Americas during the pre-Columbian period as mosquitoes of the genus Haemagogus , which is indigenous to the Americas, have been known to carry the disease. [5]
The first outbreaks of disease that were probably yellow fever occurred in the Windward Islands of the Caribbean, on Barbados in 1647 and Guadeloupe in 1648. [6] Barbados had undergone an ecological transformation with the introduction of sugar cultivation by the Dutch. Plentiful forests present in the 1640s were completely gone by the 1660s. By the early 18th century, the same transformation related to sugar cultivation had occurred on the larger islands of Jamaica, Hispaniola, and Cuba. Spanish colonists recorded an outbreak in 1648 on the Yucatán Peninsula of Mexico that may have been yellow fever. The illness was called xekik (black vomit) by the Maya.
At least 25 major outbreaks followed in North America, such as in 1793 in Philadelphia, where several thousand people died, more than nine percent of the total population. The American government, including President George Washington, had to flee the city, which was the capital of the United States at the time. In 1878, about 20,000 people died in an epidemic which struck the towns of the Mississippi River Valley and its tributaries. The last major outbreak in the US occurred in 1905 in New Orleans. Major outbreaks also occurred in Europe in the 19th century in Atlantic ports following the arrival of sailing vessels from the Caribbean, most often from Havana. [7] Outbreaks occurred in Barcelona, Spain, in 1803, 1821, and 1870. In the 1870 outbreak, 1,235 fatalities were recorded of an estimated 12,000 cases. [8] Smaller outbreaks occurred in Saint-Nazaire in France, Swansea in Wales, and in other European port cities, following the arrival of vessels carrying the mosquito vector. [9] [10]
The first mention of the disease by the name "yellow fever" occurred in 1744. [11] Many famous people, mostly during the 18th through the 20th centuries, contracted and then recovered from, or died of, yellow fever.
The yellow fever epidemic of 1793 struck during the summer in Philadelphia, Pennsylvania, where the highest fatalities in the United States were recorded. The disease probably was brought by refugees and mosquitoes on ships from Saint-Domingue. It rapidly spread in the port city, in the crowded blocks along the Delaware River. About 5,000 people died, ten percent of the population of 50,000. The city was then the national capital, and the national government left the city, including President George Washington. Philadelphia, Baltimore, and New York suffered repeated epidemics in the 18th and 19th centuries, as did other cities along the East and Gulf Coasts. [12]
At the time, the known solution to recovery was found to be long and tedious as it was expected that patients needed to consume bitters and country air away from the metropolitan area in order to recover. [13] Yet the average citizen typically sought medical help from the Pennsylvania Hospital. [13] Year after year starting in 1793, yellow fever returned to major cities along the east coast including Philadelphia leaving investigators stagnant in regard to progress made in the search for the cause of yellow fever. [14] Yellow fever's prevalence during this era killed over 10,000 people starting in 1793 where nearly 5,000 people died, striking again in 1797 tallying about 1,500 people, and again the next year in 1798 killing 3,645 people. [14]
With the spread of yellow fever in 1793, physicians of the time used the increase number of patients to increase the knowledge in disease as the spread of yellow fever, helping differentiate between other prevalent diseases during the time period as cholera and typhus were current epidemics of the time as well. [13] As doctors and people of interest investigated the cause of yellow fever, two main hypotheses derived from the confusing data they collected. [14] The first was that the disease is contagious, as the disease is spread through the contact of people, as ships from the already infected Caribbean Islands had spread to major cities. [14] The second hypothesis was that the disease derived from local sources; doctors proposed that contact with these sources caused the sickness rather than contact with people with the disease, as yellow fever seemed to be prevalent in major cities and less effective in rural areas. [14]
The majority of the British soldiers sent to Haiti in the 1790s died of disease, chiefly yellow fever. [15] [16] There has been considerable debate over whether the number of deaths caused by disease was exaggerated. [17]
In 1802–1803, an army of forty thousand sent by First Consul Napoleon Bonaparte of France to Saint-Domingue to suppress the Haitian Revolution mounted by slaves, was decimated by an epidemic of yellow fever (among the casualties was the expedition's commander and Bonaparte's brother-in-law, Charles Leclerc). Some historians believe Napoleon intended to use the island as a staging point for an invasion of the United States through Louisiana (then newly regained by the French from the Spanish.). [18] [16] Others believe that he was most intent on regaining control of the lucrative sugar production and trade in Saint-Domingue. Only one-third of the French troops survived to return to France, and in 1804 the new republic of Haiti declared its independence.[ citation needed ]
Nearly 700 people in Savannah, Georgia, died from yellow fever in 1820, including two local physicians who lost their lives caring for the stricken. [19] An outbreak on an immigrant ship with Irish natives in 1819 led to a passage of an act to prevent the arrival of immigrant ships, which did not prevent the epidemic where 23% of the deaths were of Irish descent. [20] Several other epidemics followed, including 1854 [21] and 1876. [22]
The 1853 outbreak claimed 7,849 residents of New Orleans. The press and the medical profession did not alert citizens of the outbreak until the middle of July, after more than one thousand people had already died. The New Orleans business community feared that word of an epidemic would cause a quarantine to be placed on the city, and their trade would suffer. In such epidemics, steamboats frequently carried passengers and the disease upriver from New Orleans to other cities along the Mississippi River.[ citation needed ]
The epidemic was dramatized and featured in the plot of the 1938 film Jezebel , starring Bette Davis.[ citation needed ]
Yellow fever was a threat in New Orleans and south Louisiana virtually every year, during the warmest months. Among the more prominent victims were: Spanish colonial Governor Manuel Gayoso de Lemos (1799); the first and second wives (d. 1804 and 1809) and young daughter (1804) of territorial Governor William C. C. Claiborne; one of New Orleans' most important early city planners Barthelemy Lafon (1820), architect Benjamin Henry Latrobe and one of his sons (1820, 1817, respectively), who were in New Orleans building the city's first waterworks; Jesse Burton Harrison (1841), a young lawyer and author; [23] Confederate Brig. Gen. Young Marshall Moody (1866); architect James Gallier, Jr. (1868); and Confederate Lt. Gen. John Bell Hood and his wife and daughter (1879).
The steamship, Benjamin Franklin sailing from Saint Thomas in the West Indies and carrying persons infected with the virus arrived in Hampton Roads in southeastern Virginia on 6 June 1855. [25] [26] During the outbreak, the Norfolk Naval Hospital patient register, recorded a total of 587 fever cases (see thumbnail) admitted between the date of 25 July and 10 November 1855. The hospital staff calculated the total fever deaths as 208. [27] The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of Norfolk and Portsmouth. The Howard Association, a benevolent organization, was formed to help coordinate assistance in the form of funds, supplies, and medical professionals and volunteers, who poured in from many other areas, particularly the Atlantic and Gulf Coast areas of the United States. [28]
Bermuda suffered four yellow fever epidemics in the 1800s, both mosquito-borne and via visiting ships, which in total claimed the lives of 13,356 people, including military and civilian population. During the 1864 epidemic, a Dr. Luke Pryor Blackburn, from Halifax, Nova Scotia, visited the island several times, to assist the local medical community on account of his knowledge of the disease. When he left in October 1864, he left behind some trunks of soiled clothing that were to have been sent to him in Canada. Fortunately, the trunks were located and the contents destroyed.[ citation needed ]
It became evident that Dr. Blackburn's visits had been financed by the Confederacy and that a certain Union informer had been offered $60,000 to distribute Dr. Blackburn's trunks of soiled clothing to Union cities including Boston, Philadelphia, Washington, and Norfolk. One trunk also went to New Bern, which was identified as having brought yellow fever to that city, claiming the lives of 2,000 people.[ citation needed ]
Blackburn was arrested and tried, but acquitted owing to lack of evidence, other than hearsay by witnesses, meaning that the culprit trunks could not be located. In 1878, he went on to fight yellow fever in Kentucky, where he had set up practice in Louisville and was eventually elected governor.[ citation needed ]
The 1867 yellow fever epidemic claimed many casualties in the southern counties of Texas, as well as in New Orleans. The deaths in Texas included Union Maj. Gen. Charles Griffin, Margaret Lea Houston (Mrs. Sam Houston), and at least two young physicians and their family members.[ citation needed ]
In 1878, a severe yellow fever epidemic swept through the lower Mississippi Valley.[ citation needed ]
The French effort to build a Panama Canal was damaged by the prevalence of endemic tropical diseases in the Isthmus. Although malaria was also a serious problem for the French canal builders, the numerous yellow fever fatalities and the fear they engendered made it difficult for the French company to retain sufficient technical staff to sustain the effort. Since the mode of transmission of the disease was unknown, the French response to the disease was limited to care of the sick. The French hospitals contained many pools of stagnant water, such as basins underneath potted plants, in which mosquitoes could breed. The numerous deaths eventually led to the failure of the French company licensed to build the canal, resulting in a massive financial crisis in France. [29]
Rift Valley fever (RVF) is a viral disease of humans and livestock that can cause mild to severe symptoms. The mild symptoms may include: fever, muscle pains, and headaches which often last for up to a week. The severe symptoms may include: loss of sight beginning three weeks after the infection, infections of the brain causing severe headaches and confusion, and bleeding together with liver problems which may occur within the first few days. Those who have bleeding have a chance of death as high as 50%.
Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains—particularly in the back—and headaches. Symptoms typically improve within five days. In about 15% of people, within a day of improving the fever comes back, abdominal pain occurs, and liver damage begins causing yellow skin. If this occurs, the risk of bleeding and kidney problems is increased.
Dengue fever is a mosquito-borne disease caused by dengue virus, prevalent in tropical and subtropical areas. It is frequently asymptomatic; if symptoms appear they typically begin 3 to 14 days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin itching and skin rash. Recovery generally takes two to seven days. In a small proportion of cases, the disease develops into severe dengue with bleeding, low levels of blood platelets, blood plasma leakage, and dangerously low blood pressure.
Chikungunya is an infection caused by the Alphavirus chikungunya (CHIKV). The disease was first identified in 1952 in Tanzania and named based on the Kimakonde words for "to become contorted".
A cordon sanitaire is the restriction of movement of people into or out of a defined geographic area, such as a community, region, or country. The term originally denoted a barrier used to stop the spread of infectious diseases. The term is also often used metaphorically, in English, to refer to attempts to prevent the spread of an ideology deemed unwanted or dangerous, such as the containment policy adopted by George F. Kennan against the Soviet Union.
Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human illnesses. VHFs may be caused by five distinct families of RNA viruses: the families Filoviridae, Flaviviridae, Rhabdoviridae, and several member families of the Bunyavirales order such as Arenaviridae, and Hantaviridae. All types of VHF are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in many cases. Some of the VHF agents cause relatively mild illnesses, such as the Scandinavian nephropathia epidemica, while others, such as Ebola virus, can cause severe, life-threatening disease.
The o'nyong'nyong virus (ONNV) was first isolated by researchers at the Uganda Virus Research Institute in Entebbe, Uganda, during a large outbreak of a disease in 1959 that resembled dengue fever. ONNV is a togavirus, genus Alphavirus, is closely related to the chikungunya and Igbo Ora viruses, and is a member of the Semliki Forest antigenic complex. The name was given to the disease by the Acholi tribe during the 1959 outbreak. The name comes from the Nilotic language of Uganda and Sudan and means "weakening of the joints". The virus can infect humans and may cause disease.
Oropouche fever is a tropical viral infection which can infect humans. It is transmitted by biting midges and mosquitoes, from a natural reservoir which includes sloths, non-human primates, and birds. The disease is named after the region where it was first discovered and isolated in 1955, by the Oropouche River in Trinidad and Tobago. Oropouche fever is caused by the Oropouche virus (OROV), of the Bunyavirales order of viruses.
Chikungunya is a mosquito-borne alpha virus that was first isolated after a 1952 outbreak in modern-day Tanzania. The virus has circulated in forested regions of sub-Saharan African in cycles involving nonhuman primate hosts and arboreal mosquito vectors. Phylogenetic studies indicate that the urban transmission cycle—the transmission of a pathogen between humans and mosquitoes that exist in urban environments—was established on multiple occasions from strains occurring on the eastern half of Africa in non-human primate hosts. This emergence and spread beyond Africa may have started as early as the 18th century. Currently, available data does not indicate whether the introduction of chikungunya into Asia occurred in the 19th century or more recently, but this epidemic Asian strain causes outbreaks in India and continues to circulate in Southeast Asia.
During the 1793 yellow fever epidemic in Philadelphia, 5,000 or more people were listed in the register of deaths between August 1 and November 9. The vast majority of them died of yellow fever, making the epidemic in the city of 50,000 people one of the most severe in United States history. By the end of September, 20,000 people had fled the city, including congressional and executive officials of the federal government. Most did not return until after the epidemic had abated in late November. The mortality rate peaked in October before frost finally killed the mosquitoes and brought an end to the outbreak. Doctors tried a variety of treatments but knew neither the origin of the fever nor that the disease was transmitted by mosquitoes.
Stubbins Ffirth (1784–1820) was an American trainee doctor notable for his unusual investigations into the cause of yellow fever. He theorized that the disease was not contagious, believing that the drop in cases during winter showed that it was more likely a result of the heat and stresses of the summer months. While correct in noting that yellow fever was significantly more prevalent in summer, Ffirth's explanation proved to be incorrect. It was a full six decades after his death that a breakthrough would be made, with Cuban scientist Carlos Finlay discovering the link to mosquitoes carrying the disease.
Zika virus is a member of the virus family Flaviviridae. It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus. Its name comes from the Ziika Forest of Uganda, where the virus was first isolated in 1947. Zika virus shares a genus with the dengue, yellow fever, Japanese encephalitis, and West Nile viruses. Since the 1950s, it has been known to occur within a narrow equatorial belt from Africa to Asia. From 2007 to 2016, the virus spread eastward, across the Pacific Ocean to the Americas, leading to the 2015–2016 Zika virus epidemic.
Jean Charles Faget was a medical doctor born on June 26, 1818, in New Orleans. He is best known for the Faget sign—a medical sign that is the unusual combination of fever and bradycardia. The sign is an important diagnostic symptom of yellow fever.
The 2013–2014 chikungunya outbreak represented the first recorded outbreak of the disease outside of tropical Africa and Asia. In December 2013, the first locally transmitted case of chikungunya in the Americas was detected in Saint Martin. Shortly after the first case the disease began to spread rapidly throughout the Caribbean region. By the end of the year, it had spread to Martinique and Guadeloupe, with suspected cases in Saint Barthélemy. By the end of January 2014, cases had been confirmed in Saint Barthélemy, as well as the British Virgin Islands, Dominica, and French Guiana. On the basis of 4,000 confirmed cases and over 30,000 suspected cases, the Caribbean Public Health Agency (CARPHA) declared a Caribbean-wide epidemic of the virus in early May. By the end of May, four cases of chikungunya had been confirmed in Florida. By July 2014 there were an estimated 355,000 cases in the Caribbean. By August 2014, 25 Caribbean countries had confirmed at least one case. The epidemic was over by 2015.
Diseases and epidemics of the 19th century included long-standing epidemic threats such as smallpox, typhus, yellow fever, and scarlet fever. In addition, cholera emerged as an epidemic threat and spread worldwide in six pandemics in the nineteenth century.
In October 2013, there was an outbreak of Zika fever in French Polynesia, the first outbreak of several Zika outbreaks across Oceania. With 8,723 cases reported, it was the largest outbreak of Zika fever before the outbreak in the Americas that began in April 2015. An earlier outbreak occurred on Yap Island in the Federated States of Micronesia in 2007, but it is thought that the 2013–2014 outbreak involved an independent introduction of the Zika virus from Southeast Asia. Investigators suggested that the outbreaks of mosquito-borne diseases in the Pacific from 2012 to 2014 were "the early stages of a wave that will continue for several years", particularly because of their vulnerability to infectious diseases stemming from isolation and immunologically naive populations.
On 20 January 2016, the health minister of Angola reported 23 cases of yellow fever with 7 deaths among Eritrean and Congolese citizens living in Angola in Viana municipality, a suburb of the capital of Luanda. The first cases were reported in Eritrean visitors beginning on 5 December 2015 and confirmed by the Pasteur WHO reference laboratory in Dakar, Senegal in January. The outbreak was classified as an urban cycle of yellow fever transmission, which can spread rapidly. A preliminary finding that the strain of the yellow fever virus was closely related to a strain identified in a 1971 outbreak in Angola was confirmed in August 2016. Moderators from ProMED-mail stressed the importance of initiating a vaccination campaign immediately to prevent further spread. The CDC classified the outbreak as Watch Level 2 on 7 April 2016. The WHO declared it a grade 2 event on its emergency response framework having moderate public health consequences.
The Yellow Fever Commission was a research team of the United States Army which researched treatment for yellow fever.
The 1870 Barcelona yellow fever epidemic was an epidemic that took place in the Spanish city of Barcelona in 1870.
In 1878, a severe yellow fever epidemic swept through the lower Mississippi Valley.