Yellow Fever Reemergence Risk in the Guiana Shield: a Comprehensive Review of Cases Between 1990 and 2022

Purpose of Review The aim of this study was to compile all cases of yellow fever (YF) recorded in the Guiana Shield (GS), a region located on the northeastern shore of South America. Recent Findings Yellow fever causes several deaths in French Guiana during the last years. In this context, we wanted to know if it was due to a lack of vaccination or a reemergence of YF as in Brazil and if it was the same trouble in the neighborhood countries. Summary People living in or returning from the GS with YF-compatible symptoms confirmed by reverse transcriptase polymerase chain reaction between 1990 and 2022 were included. In French Guiana (FG), patients were identified through results from the National Reference Center for Arboviruses at the Pasteur Institute in FG and hospital medical charts. For the other countries, medical literature and the WHO database were reviewed. Public health and infectious diseases specialists were solicited to identify unknown and unpublished cases. Nine patients were identified in the study period: five in FG, two in Venezuela, one in Suriname, one in Brazil, including six autochthonous people, Guiana Shield native, and three tourists. The case fatality rate was 7/9 (78%) within 8 days (range: 7-11 days). The M/F sex ratio was 6/3 (2). They had severe liver involvement progressing to multivisceral failure in 89% of cases. Only the two native Amerindian patients in FG had previously benefited from a YF vaccination in childhood and/or for more than 10 years. In conclusion, the sylvatic cycle of the YF virus is likely to persist in this region. Absence of vaccination or unknown immunization status was documented in most patients (78%). The mortality rate of this case series was high thus highlighting the need to strengthen vaccination coverage for the population and travelers to the GS.