Yellow fever- Rx

Q: What is the mainstay of treatment for yellow fever? - select one

A) IgG monoclonal antibody

B) Ribavirin 

C) Sofosbuvir 

D) Plasma exchange

E) Supportive care  

Answer: E

Unfortunately, most treatment options for yellow fever are either in the experimental stage or are ineffective.

Yellow fever can have a very dreaded course with septic shock, Metabolic acidosis, and Multi-system organ failure. The mainstay of treatment is supportive.

Ribavirin is active against the yellow fever virus but requires very high concentrations, which are extremely hard to achieve clinically. Sofosbuvir is still considered experimental.

Plasma exchange can be tried, but the evidence is very weak.

TY014 (an engineered anti-yellow fever virus human immunoglobulin (Ig)G monoclonal antibody) is also experimental. Similarly, hyperimmune globulin or monoclonal antibody carries very weak evidence of success.

#ID

#Shock

References/further readings:

1. Ho YL, Joelsons D, Leite GFC, et al. Severe yellow fever in Brazil: clinical characteristics and management. J Travel Med 2019; 26.

2. Sbrana E, Xiao SY, Guzman H, et al. Efficacy of post-exposure treatment of yellow fever with ribavirin in a hamster model of the disease. Am J Trop Med Hyg 2004; 71:306.

3. Rezende IM, Mendonça DC, Costa TA, et al. Sofosbuvir Off-label Treatment of Yellow Fever Patients During an Outbreak in Brazil, 2018: A Cohort Study. Open Forum Infect Dis 2024; 11:ofae312.

4. Ho YL, Nukui Y, Villaça PR, et al. Intensive Therapeutic Plasma Exchange-New Approach to Treat and Rescue Patients with Severe Form of Yellow Fever. Trop Med Infect Dis 2025; 10.

5. Low JG, Ng JHJ, Ong EZ, et al. Phase 1 Trial of a Therapeutic Anti-Yellow Fever Virus Human Antibody. N Engl J Med 2020; 383:452.