SEVERE INFECTIONS

• There may be a short period of recovery. Later, fever returns and the patient’s condition detoriates rapidly with development of liver and kidney failure.
• Sudden onset of fever of 40°C and chills.
• Severe headache and backaches without loins and limb pains.
• Nausea and vomiting with abdominal pain. Abdominal pain is continuous.
• Patient is dehydrated with dry tongue with halitosis.
• Yellow colouration on the conjuctiva which deepens with the appearance of jaundice on the skin.
• Bradycardia, despite increasing temperature (facets signs).
• The patient vomits, altered blood (coffee ground) or back vomit or fresh blood with maelena and diarrhoea which may be present.
• Bleeding may take place from the eyes, nose, mouth, bladder, rectum, and other organs.
• Heavy proteinuria with little urine output and presence of grannular cests, RBCs, Hb in urine.
• Death occurs with increasing proteinuria, haemorrhage, rising pulse, hypotension and oliguria.

Diagnosis & Investigations

• Serology (IgM ELISA): Detects yellow fever-specific antibodies.
• Polymerase Chain Reaction (PCR): Identifies viral RNA in blood samples.
• Liver Function Tests: Elevated liver enzymes (AST, ALT), bilirubin. Also listed as Liver function tests (LFTs).
• Complete Blood Count (CBC): Leukopenia, thrombocytopenia.
• Renal Function Tests (RFTs).

Management & Treatment

• No specific antiviral therapy available.
• Supportive care:
  • Intravenous fluids for hydration.
  • Pain and fever management with paracetamol (avoid NSAIDs due to bleeding risk).
  • Monitoring of liver and kidney function.
• Hospitalization for severe cases.

MANAGEMENT OF YELLOW FEVER AIMS

• To limit the spread of the disease.
• Isolate the patient under the mosquito net and always from other people. Do not refer if not very ill to limit the spread.
• Management of fever.
• Manage pain, headache, myalhia with complete bed rest and analgesics.
• Manage dehydration and halitosis; give plenty of fluids to reduce fever and increase urine output.
• Good oral hygiene but take care of not triggering bleeding.
• Avoid rough and hot things in the mouth.
• Avoid drugs due to liver and kidney failure.
• Control any external bleeding.
• Restrict movement in cases of central nervous system involvement. Restrict movement until fully recovered.
• Notify the DDHS immediately.
• Apply the nursing care of patient in isolation.
• Early case findings and reporting.
• Immunization.

Advice before discharging patient home:

• Sleep under mosquito nets.
• Take plenty of fluids with high glucose level.
• Report back in care of any complication.

Complications

• Jaundice.
• Renal failure.
• GIT bleedings.
• Anaemia.
• Meningo-encephalitis.

Prevention & Control

• Yellow Fever Vaccination:
  • A single dose provides lifelong immunity.
  • Recommended for all individuals in endemic areas, including travelers.
• Vector Control:
  • Use of insecticide-treated mosquito nets (ITNs).
  • Elimination of mosquito breeding sites (stagnant water removal).
  • Spraying using insectcides.
  • Use of mosquito nets.
• Personal protective measures:
  • Use of mosquito repellants.
  • Wearing clothes that fully cover one’s body.
  • People moving from a holo endemic areas to an endemic area should sleep in well screened housing.
• Surveillance and Rapid Response:
  • Monitoring outbreaks and immediate response to cases.
  • Quarantine measures in high-risk areas.
• CONTROL MEASURES:
  • Patients should be isolated as their blood and body products may contain virus particles.

VACCINE USE

Target groups include:

• Persons Living or Traveling in Endemic Areas.
• Laboratory Personnel.

Relevance to Midwifery Practice

• Vaccination of Pregnant Women: Generally, yellow fever vaccine is contraindicated in pregnancy unless there is a high risk of exposure.
• Educate expectant mothers on vector control methods.
• Managing Pregnant Women with Yellow Fever:
  • Supportive treatment to prevent complications.
  • Monitoring for hepatic and renal dysfunction.
  • Management of hemorrhagic complications and ensuring safe delivery.