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Shrivastava SR, Shrivastava PS, Ramasamy J. Preventing the introduction of yellow fever in disease-free nations: A global appeal. Ann Trop Med Public Health 2016;9:365-6
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Shrivastava SR, Shrivastava PS, Ramasamy J. Preventing the introduction of yellow fever in disease-free nations: A global appeal. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Aug 14];9:365-6. Available from: https://www.atmph.org/text.asp?2016/9/5/365/190211
Yellow fever is a viral hemorrhagic disease transmitted by the bites of an infected Aedes mosquito.  The disease predominantly affects human and monkeys, with the virus being capable of producing major outbreaks among the 900 million at-risk people across 44 nations in the endemic tropical areas of the Africa and the Latin America. , In fact, the current global estimates suggest that every year almost 85,000-170,000 cases and 60000 deaths are being reported.  Even though the trends of the disease burden suggest that the number of cases has reduced in the last decade, still the disease has a case fatality rate of around 50% among the untreated seriously affected patients. ,,
The Aedes mosquito is responsible for the propagation of the disease in the domestic, semi-domestic (predominantly common in African region), and wild regions.  Further, imported cases have been reported in disease-free nations (like France, Spain, etc.), and this is predominantly due to the presence of favorable conditions in many nonendemic areas to the introduction and spread of disease. , In fact, despite the condition never been reported in the Asian region till date, it is very much at risk due to the presence of ideal environmental conditions in the region.  At the same time, the disease remains a potential threat to the travelers visiting the regions which are endemic for the disease. 
Further, as most of the cases clinically present with symptoms similar to any hemorrhagic fever, an establishment of the diagnosis of the disease is quite difficult.  Only serological tests can conclusively diagnose the disease. Nevertheless it requires a highly trained laboratory staff and specialized logistics for the same. , From the treatment perspective, no specific management approach has been recommended, and only supportive care is advocated, which is rarely available in low-resource settings. 
Moreover, the epidemiological distribution of cases, both regarding number or place would have been much more serious, without the presence of a safe, affordable, and highly effective (single dose conferring lifelong immunity) vaccine. , In fact, vaccination has been acknowledged as the single most key approach for the prevention of disease, and has been recommended in high-risk areas (viz. poor vaccine coverage, or for the immediate control of outbreaks), and for the travelers visiting endemic areas. , Further, it has been estimated that the vaccine coverage should be within the range of 60-80% to prevent the emergence of any outbreak through herd immunity. 
In an attempt to prevent the introduction of the disease in yellow fever free areas (Asia), all the travelers, especially coming from Africa or Latin America region should carry a valid certificate of yellow fever vaccination. , In addition, measures directed toward mosquito control play a defining role in preventing any major outbreak in urban areas, till the vaccination takes effect.  Further, prompt detection of the cases and initiation of a prompt response by conducting emergency vaccination sessions is crucial for controlling outbreaks. ,
To improve the response against the disease, measures such as strengthening of the surveillance, establishing at least one laboratory in each of the high-risk nations to enable prompt diagnosis, developing a framework for conducting outbreak response investigations, maintaining a constant supply of the vaccines, and improving vaccination coverage in endemic regions, has been advocated. ,,, In addition, a Yellow Fever Initiative has been launched which envisages for the introduction of the vaccine in the routine immunization at 9 months of age and improve surveillance and outbreak response capacity of the high-risk nations. ,,
To conclude, though yellow fever remains confined to the specific region currently, all recommendations about vaccine administration and strengthening of international cooperation should be explored to prevent the spread of the disease across the world.
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