Summary
Definition
History and exam
Key diagnostic factors
- history of residence in, or recent travel to, endemic area
- lack of yellow fever immunization
- history of mosquito bite
- fever
- constitutional symptoms
- conjunctival injection
- relative bradycardia (Faget sign)
- biphasic illness
- hemorrhagic diathesis
- signs of renal failure
- signs of hepatic failure
- jaundice
Other diagnostic factors
- hypotension
- abdominal pain, vomiting, and lethargy
Risk factors
- residence in, or recent travel to, endemic area
- lack of immunization
- mosquito bite
- travel during rainy and early dry seasons
Diagnostic tests
1st tests to order
- CBC
- liver function tests
- coagulation screen
- reverse transcription polymerase chain reaction (RT-PCR)
- serology
Tests to consider
- ECG
- histopathology
Emerging tests
- virus isolation
- isothermal nucleic acid amplification assays
Treatment algorithm
all patients
Contributors
Authors
William A. Messer, MD, PhD
Associate Professor of Medicine
Department of Molecular Microbiology and Immunology
Division of Infectious Diseases
Oregon Health & Science University
Portland
OR
Disclosures
WAM declares that he has no competing interests.
Acknowledgements
Dr William A. Messer would like to gratefully acknowledge Dr Philip A. Yeon and Dr Helmut Albrecht, previous contributors to this topic.
Disclosures
PAY and HA declares that he has no competing interests.
Peer reviewers
Carlos Franco-Paredes, MD, MPH
Assistant Professor
Emory University
TravelWell Clinic
Emory University Hospital Midtown
Atlanta
GA
Disclosures
CFP declares that he has no competing interests.
Andrea K. Boggild, MSc, MD, DTMH, FRCPC
Clinical Assistant
Tropical Diseases Unit
Division of Infectious Diseases
Department of Medicine
Toronto General Hospital
University Health Network
Toronto
Canada
Disclosures
AKB declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Centers for Disease Control and Prevention. CDC Yellow Book 2026: health information for international travel. Travel-associated infectious and diseases - yellow fever. Apr 2025 [internet publication].Full text
Centers for Disease Control and Prevention. Yellow fever virus: clinical features and diagnosis of yellow fever. Nov 2025 [internet publication].Full text
World Health Organization. WHO guidelines for clinical management of arboviral diseases. 2025 [internet publication].Full text
Staples JE, Bocchini JA Jr, Rubin L; Centers for Disease Control and Prevention (CDC). Yellow fever vaccine booster doses: recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:647-650.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dengue fever
- Malaria
- Zika virus infection
More DifferentialsGuidelines
- Yellow fever outbreak toolbox
- Yellow fever vaccine information for healthcare providers
More Guidelines
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