During the first four weeks of 2018, a rapid increase in the number of confirmed human cases of yellow fever was observed in the states of Rio de Janeiro, São Paulo, and Minas Gerais. From 1 July 2017 through 16 February 2018, 464 confirmed human cases of yellow fever have been reported in Brazil, including 154 deaths. Confirmed cases were reported in São Paulo (181 cases, including 53 deaths), Minas Gerais (225 cases, including 76 deaths), and Rio de Janeiro (57 cases, including 24 deaths) states and in the Federal District (1 fatal case). Unlike the previous seasonal period, the current seasonal period has been characterized by more cases reported in São Paulo and Rio de Janeiro states along with the occurrence of cases in areas near large cities.
In São Paulo State, 57% of the confirmed cases were likely to have been infected in Mairiporã Municipality (a rural area located 15km north of São Paulo Municipality). In Rio de Janeiro State, 45% of the confirmed cases were among residents of Valença and Teresópolis municipalities; the latter is located 96km from Rio de Janeiro City. Likely places where infections occurred for all of the confirmed cases correspond to areas with documented epizootics in non-human primates. In Minas Gerais, 47% of the confirmed cases reside in municipalities located south and southeast of the city of Belo Horizonte, where no human cases were detected during the outbreak in the 2016/2017 seasonal period.
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Two laboratory-confirmed cases of yellow fever (in France and in the Netherlands) have been reported among unvaccinated travellers who stayed in Brazil, in municipalities considered at-risk for yellow fever as described in the international travel health recommendations on the basis of the virus circulation, the distribution of yellow fever vectors and animal reservoirs. In addition, two laboratory-confirmed cases were reported in Argentinian citizens, likely to have been infected in Ilha Grande, municipality of Angra do Reis, state of Rio de Janeiro, and Isla Bella, state of São Paulo Brazil (both municipalities are known to be at risk for yellow fever). Furthermore, as of 26 February, three confirmed cases of yellow fever (two fatal) have been reported in Chilean citizens likely to also have been infected in Ilha Grande, municipality of Angra do Reis, Rio de Janeiro state, Brazil.