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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (4) : 527-530     DOI: 10.1007/s11684-016-0487-2
Yellow fever and Hajj: with all eyes on Zika, a familiar flavivirus remains a threat
Qanta A. Ahmed1,Ziad A. Memish2,3()
1. Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Winthrop University Hospital; State University of New York (SUNY) at Stony Brook, NY 11790, USA
2. Ministry of Health, Riyadh 11514, Kingdom of Saudi Arabia
3. College of Medicine, Alfaisal University, Riyadh 11533, Kingdom of Saudi Arabia
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Hajj is among the world’s largest mass gatherings, drawing between 2 and 3.5 million Muslims from 183 nations annually to perform pilgrimage in Mecca, Saudi Arabia. Infectious disease outbreaks can be imported both into the Hajj population and exported internationally by returning pilgrims. The domestic Saudi population can also be at risk of outbreaks traveling amid this mass migration. With yellow fever reported for the first time in China following the infection of expatriate Chinese workers in Angola and a full blown outbreak underway in wider West Africa, the prospect of yellow fever outbreaks in Asia threatens to impact Saudi Arabia, both during and beyond the Hajj season. With global focus trained on Zika, the rising threat of yellow fever cannot be overlooked. Strategies to mitigate risk to Saudi Arabia and the global population are thereby suggested.

Keywords yellow fever      mass gathering      Saudi Arabia      Hajj      Zika virus     
Corresponding Authors: Ziad A. Memish   
Just Accepted Date: 15 September 2016   Online First Date: 17 October 2016    Issue Date: 01 December 2016
URL:     OR
Yellow fever virus Zika virus
Causative virus YF virus
Zika virus
Single stranded RNA Single stranded RNA
Non-human host Forest-dwelling non-human primate Non-human primate (Rhesus monkey)
Vector Aedes mosquitos Aedes mosquitos
Incubation period 3?6 days 3?12 days
Geographic distribution Tropical rain forests of Africa and South America Africa, the Pacific Islands, South-east Asia, large part of South/Central America, a number of islands in the Caribbean, including Puerto Rico, the Virgin Islands, and Mexico
Human-to-human transmission Breast feeding
Exposure to infected blood/organs
Mosquito bites
From a pregnant woman to her fetus
Sexual contact
Blood transfusion
Clinical features Asymptomatic
Mild febrile illness Severe disease with jaundice and hemorrhage
Contact with tears
Asymptomatic (80%)
Mild febrile illness: headache; arthralgia; myalgia; conjunctivitis; fever; vomiting; maculopapular rash; prostration; edema of extremities
Complications Liver failure, renal failure, DIC Congenital microcephaly, Guillain Barrie syndrome, meningoencephalitis, acute myelitis
Mortality (%) 20?50 0
Diagnostic test Virus isolation, viral antigen in tissue, viral RNA in blood and tissue (RT-PCR), serology Viral RNA in blood (RT-PCR), serology
Prevention Vaccine
Mosquito prevention measure
No vaccine
Mosquito prevention measure
Tab.1  Comparison between yellow fever and Zika virus
Fig.1  Map of Saudi Arabia indicating all (sea, air, and land) ports of entry for Hajj.
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