Yellow fever (YF) is a re-emerging viral zoonosis caused by the Yellow Fever virus (YFV), affecting humans and non-human primates (NHP). YF is endemic in South America and Africa, being considered a burden for public health worldwide despite the availability of an effective vaccine. Acute infectious disease can progress to severe hemorrhagic conditions and has high rates of morbidity and mortality in endemic countries. In 2016, Brazil started experiencing one of the most significant YF epidemics in its history, with lots of deaths being reported in regions that were previously considered free of the disease. Here, we reviewed the historical aspects of YF in Brazil, the epidemiology of the disease, the challenges that remain in Brazil’s public health context, the main lessons learned from the recent outbreaks, and our perspective for facing future YF epidemics.

Yellow fever (YF) disease is a viral infection caused by Orthoflavivirus flavi (YFV). YFV is transmitted by hematophagous daytime-biting mosquitoes, predominantly Haemagogus spp. and Sabethes spp. in the sylvatic cycles, and Aedes spp. in urban cycles. In this work, we correlated vaccination coverage with the occurrence and spread of the disease throughout Brazil during the years 2016–2018. The Vale do Mucuri and Vale do Rio Doce regions in Minas Gerais state had the highest number of reported cases. Despite being considered areas with vaccine recommendation since 2008, these regions had less than 60% and 70% vaccination coverage in 2016. The outbreak of YF in Brazil has shown that surveillance for emerging diseases should be constant, especially in relation to the national immunization program. In this study, we observed that low vaccination coverage and the lack of public policies aimed at this region with low population development may have an impact on the reemergence of YF.