W O R L D H E A L T H O R G A N I Z A T I O N
ONTTED NATIONS
8 OCT. 195^ I ORGANISATION MONDIALE DE LA SANTÉ
NATIONS UNIES
CaniITTEE ON
D I T S R I ' I A T I G : A L Q U - A R A Î T T K E
26 October 1954
Seccn^ Se33ion ORIGINAL: ENGLISH
CONSIDERATION OF THE YELLOî' FEVER PROVISIONS OF THE BITERl^ATIONAL SAIIITARY REGUUTIONS
TilTH A VIElï TO A RE VISION
YTorking paper submitted by the Chairman
I t i s now recognized that there are two d i s t i n c t types o f Y e l l o w Fever i n humans, not d i f f e r i n g i n t h e i r c l i n i c a l f e a t u r e s but of q u i t e d i s t i n c t
epidemiolofTical • h a r a c t e r i s t i e s ,
from man t o man by the domestic d w e l l i n g mosquito - the Aëdes A e g y p t i , Yeilcw f e v e r i n man so t r a n s m i t t e d can assume epidemic p r o p o r t i o n s , depending on the d e n s i t y o f p o p u l a t i o n and o f the mosquito v e c t o r .
The other type i s the so c a l l e d nJungle" Yellm F e - ^ r , i n which man plays QTÙy an i n c i d e n t a l p a r t . The v i r u s i s t r a n s m i t t e d to mammalian i n l i a b i t a n t s o f the j u n g l e , e . g . monkeys, by a sylvsui mosquito v e c t o r , and i t i s only when man i s i n c l o s e contact with, the jungle t h a t ha may c o n t r a c t the disease by being b i t t e n by a v e c t o r i n f e c t e d by f e e d i n g on an i n f e c t e d jungle mammal such as the monkey. This type o f Yellow Fever i s not epidemic and unless A^des Aegypti o r other v e c t o r i s present i n h i s residence the disease cannot be t r a n s m i t t e d from man to other members of h i s f a m i l y r e s i d i n g w i t h h i m .
Turning t o the p r a c t i c a l i m p l i c a t i o n s of these two d i s t i n c t e p i d e m i o l o g i c a l e n t i t i e s i t i s at once obvious t h a t although urban Yellow Fever when present i s an immediate and d i r e c t menace by i n t e r n a t i o n a l t r a n s p o r t to other c o u n t r i e s vjhere c o n d i t i o n s permit o f the development o f Yellow Fever, Jvingle Yellow Fever i s not by any means so great a menace, though i t i s a p o t e n t i a l menace, and- should be given due c o n s i d e r a t i o n i n drawing up r e g u l a t i o n s f o r the c o n t r o l o f the spread o f epidemic d i s e a s e . No mention of Jungle Y e l l o w Fever i s made i n the present I n t e r n a t i o n a l S a n i t a r y R e g u l a t i o n s .
The f i r s t , the o l a s s i c Y e l l o w Fever found i n urban areas i s t r a n s m i t t e d
îaVCT/60,54 Rev, 1
I t i s considered- that t h i s defect should b« remedied and tha R e £ , u l a t i 3 n d modified accordingly. To do this necessitates i n the f i r s t place a rn-.-i€Trr
of tlio d e f i n i t i o n s i n tho present eculations, and i n p a r t i c u l a r the d e f m i t i ns r e l a t i n g t " F i r s t Cc.se'S "F.yer", "Infected L . c a l Area" and
"r-'ill vr Fevar .Zndemic i r e a " ,
One vcrv imp-rtant questi n I K vrtiether fr-ra the p - i n t of viovr ^f
p r a c t i c a l and practicable q.'arantino ad d n i s t r a t i o n applied t - i n t e r n a t i . n a l t r r . f f i c , i t i s nocessar^ t - tal;e i n t acc unt areac whero ovidence f the -Drcsence f the '-irus i n the re^i te r recent past i s sh rm by i,!!..iunity
tests i n hui-aans vrhercas there i s n c l i n i c a l evidence î y e l l o ,r f e v e r i n the l^c?.l inliabitants. To include such areas has the e f f e c t . f c.ndemning them as infected alin;:st i n perpetuity unless sane term to a p e r i . d '. f apparant i n f a c t i v i t y can Ise devised.
F i n a l l y a revisi-^n -^f the t e r is f A r t i c l e 70 i n r e l a t i r n t the
d e l l n e a t i - n of receptive areas sowiiis t- be i n d i c a t e d . The present .oeth .d ' embracing a large number f c - j n t r i c s vAero ASdes Aeeypti e x i s t s Tcut - .tiere the virus cann-t ustablish i t s e l f s^e^is a l t gether too cumbers..me.
SUGGESTED rCVISION OF T2. Y X L ^ . - F B T E R PROVISIOÎ^S OF T.JS ^''-^
IlITERMATK^AL S A l t l T A R / RSGULATIOÎiS - : • a*/*irT
. - »
DSFLTTIŒ:^ " '
"e ideoiic" - .Replace e x i s t i n g d e f i n i t i r n by : • ' '
"leans an qxtensi n f the i n f e c t i o n : f a quarantinable disease by a
m u l t i p l i e a t i ;n ( f cases i n a l - c a l area." -•
i i f i r s t case" - Suppress this d e f m i t i - n .
"f•;-or" - Suppress t h i s d c f x n i t i . n .• • o. ^.
^^is£ectedJ^l_aToa^^ - Replace e x i s t i n g definition'by :
"I'cajis -
(a) a 1 c a l area where thor^ i s a n-inp. rted case • f placue, choler»
-r smallpox; -'r
;'b) a l o c a l aroa i/here a, case of ye3-lov f e v e r occurs e i t h e r ( i ) i n the presence of Aedes a e g y p t i , or
( i i ) i n the absence o f ..edes ae^^yptij or
( i i i ) vhen there i s reasonable b i o l o g i c a l or p a t h o l o g i c a l evidence t o b e l i e v e t h a t y e l l o v f e v e r v i r u s e:d.sts i n man or some other v e r t e b r a t e or arthropod host,
. ( c ) a l o c a l area where there i s an epidemic of typhus or r e l a p s i n g f e v e r j c r
(d) a l o c a l area voiere plague i n f e c t i o n among rodents e r i s t s on l a n d or on c r a f t -, h i e h are p a r t of an equipment of a p * r t . "
'•ye.Llrv-fever endemic zone'' - Delete t h i s d e f i n i t i o n ,
" y e l l o w - f e v e r r e c e p t i v e a-r_ea,''- Delete t l i i s d e f i n i t i o n . M T I C L E o
A r t i c l e 6 - Replace e.id.sting a r t i c l e by j
"1. The h e a l t h a d m i n i s t r a t i o n f o r a t e r r i t o r y i n wliich an i n f e c t o d l a c a l area i s s i t u a t e d s h a l l i n f o r m t h o Org?.nization when t h a t l o c a l area i s
f r e o from i n f o c t i o n ,
2. I f a h e a l t h a d m i n i s t r a t i o n n o t i f i e s the O r g a n i z a t i o n t h a t a yellov/- f o v e r i n f e c t e d l o c a l area of c a t e - o r y (b) ( i ) i s f r e o from i n f e c t i o a , tha O r g a n i z a t i o n may d e c l a r o tlie area as f r e e i f i t i s s a t i s f i e d t h a t t h e Aëdes a e g y p t i index has been maintrdned below l)i, throughout a p e r i i d «f
one y e a r (S months) immediately preceding t h o n o t i f i c a t i o n and t h a t no human case has been d i s c o v e r e d tlirouflhout t h a t sarœ p o r i o d .
3. I f a h e a l t h a d m i n i s t r a t i o n n o t i f i e s the O r g a n i z a t i o n t h a t a yell«w- f e v o r i n f e c t e d l o c a l area o f cato-crjr (b) ( i i ) i s f r o e from i n f e c t i o n , tlie O r g a n i z a t i o n may d e c l a r e t h e l o c a l aroa as f r e e i f i t i s s a t i s f i e d t h a t nc human ease has beon d i s c o v e r e d throughcut a p e r i o d of ona y e a r (6 months) i;Ti,.,ediately p r e c e d i n g the n o t i f i c a t i o n .
4. Any Iccal area i n f e c t e d m t h a quarantinable disease other than yoll^\<' fever may be considered as f r e e f r . m i r i ' e c t i . n vrhen a l l measures -f prophy- l a x i s have been taken and maint£dned t^. prevent the recurrence . f the disease cr i t s spread tc other areas, and when -
(a) i n the case of plague, cholera, smallpox, typhus, or r e l a p s i n g fever, a period r.f tme equal to tv;ice the incubati n period of the disease, as hereinafter provided, has elapsed since the l a s t caso i d e n t i f i e d has died, recovered or been i s o l a t e d , and i n f -
• e c t i - n from that disease has net occurred i n any other l o c a l area i n the v i c i n i t y , provided that, i n the case plague Td.th rcdent plague als'< present, the paricd s p e c i f i e d under sub-parajraph (b) O'f t h i s para!-,raph has elapsed;
(b) i n the case : f rcdynt plague, one month has elapsed a f t o r suppression f the cpizo. t i c
A r t i c l e 20 - Delete " i n a yiilIon-fever fendomic zone or" and replace by:
" i n or adjacent to a yoll^of-fuvor ii^fJctod l o c a l area or i n " .
A r t i c l e 20 (2) - Delete " i n a ye 11 ..vr-fever onde-.iie zo.ne" and replace by:
" i n -.>r adjacent to a y e l l ' w - f e v e r iri"ected I c c a l area".
A r t i c l e 20 (3) - Delete " i n a y e l l o;.'--fever endemic z.:ne" and replace by:
" i f i or adjacent t-o a yellow-favor i n f e c t a d 1 c a l aroa".
A r t i e l o 70 - delate and replace by : , 3
" A r t i c l e 7^' - para. 1
" A l l t c r r i t r r i e s cr parts . f t e r r i t o r i e s n^/'t being yelL,w-faver infected l o c p l areas, which l i e w i t h i n l a t i t u d e 35^' N and 30° S of the equator and aro bol-w an a l t i t u d e of "x" metres, s h a l l be regarded as f o m i r ^ a yallow- fcvor roccptivc Z' no wherein y e l l c . / f e v e r d^.os not e x i s t but 7/hore conditions
- 5 -
w o u l d permit cf the devcl-pmcnt of tho d i s e a s e i f i n t r o d u c e d . Nevertheless the T'orld Health Assembly may, w i t h tho c ncurrunc>j c f the h(.alth r.c^ministrat- i o n s concernod rem ve t e r r i t o r i e s or p a r t s - f t e r r i t . r i e s l y i n g ^n.tllin
t h i s zone e i t h e r a l t o g e t h e r c r soas: n a l l y and uay, under the sanu c n d i t i o n s , add t e r i i t o r i e s c r p a r t s of t e r r i t o r i e s l y i n g c u t s i d e t h i s z.ne.
Any l o c a l a r e a l y i n g w i t h i n tho y e l l - w - f e v o r r e o o p t i v e z:ne v-'lxLch beccmcs i n f e c t o d i s a u t o m a t i c a l l y removed t h e r e f r c m u n t i l i s ceases to be
i n f e c t e d i n accordance m t h the terras of A r t i c l e 6.
p a r a . 2 - The O r g a n i z a t i o n s h a l l n o t i f y a l l h e a l t h a d T i i n i s t r a t i o n s
of t e r r i t o r i e s or p a r t s . f t e r r i t o r i e s excluded frum or i n c r p o r a t o d i n t o t h i s zone, "
