Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Suspected yellow fever with organ failure
Fever after exposure in sub-Saharan Africa or tropical South America followed by jaundice, bleeding, shock, renal injury, encephalopathy or recurrent fever after brief improvement may be severe yellow fever.
Action: Isolate from mosquitoes, use ABCDE and critical-care organ support, avoid medicines that worsen bleeding, contact infection specialists, UKHSA health protection and RIPL immediately, notify suspected disease, and arrange reference sampling without delaying care.
Synopsis
Recognise severe yellow fever, notify and test safely, and deliver an itinerary-led travel consultation that balances vaccine benefit, certificate requirements and serious adverse-event risk.
Yellow fever is a mosquito-borne flavivirus transmitted in parts of sub-Saharan Africa and tropical South America through sylvatic, intermediate and urban cycles.
Initial illness causes abrupt fever, severe headache, myalgia, nausea, relative bradycardia and conjunctival injection; most patients then improve.
A minority enter a toxic phase after brief remission with recurrent fever, jaundice, bleeding, shock, kidney injury, myocarditis and encephalopathy.
Key red flags
Jaundice, haematemesis, melaena, mucosal bleeding, oliguria, hypotension or confusion after a compatible journey indicates toxic-phase yellow fever.
Acute febrile phase
Abrupt fever, chills, severe headache, backache, myalgia, nausea, vomiting and conjunctival injection begin after a short incubation.
Investigation priorities
01
Immediate malaria testingFirst step
Exclude a common, rapidly fatal and treatable cause of fever after travel.
02
First-line severity panelFirst line
Quantify hepatic, renal, haematological and metabolic injury and guide organ support.
Management branches
ILL TRAVELLERStabilise and test in parallel
Fever, jaundice or haemorrhagic features follow travel in a yellow-fever risk area.
Use ABCDE, isolate from mosquitoes, obtain the severity panel and urgent malaria films, and manage hypoglycaemia, shock, bleeding and organ failure immediately.
Contact infection specialists, the local health-protection team and RIPL before reference sampling; provide precise countries, dates, mosquito exposure and vaccination history.
COADMINISTERPlan other vaccines and timing
Yellow-fever vaccine is needed alongside routine or travel vaccines.
Key medicines
Yellow-fever 17D vaccine (Stamaril)Give one 0.5 mL dose by the licensed subcutaneous route, or intramuscular route where appropriate under official recommendations, at an approved Yellow Fever Vaccination Centre.
ParacetamolUse standard adult oral or intravenous dosing within the product maximum, reducing or avoiding it when severe hepatic dysfunction makes usual dosing unsafe.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.