Could Yellow Fever Virus Cause a Zika-like Epidemic in the Americas?

Yellow fever virus (YFV), a close relative of Zika virus and transmitted by the same type of mosquito, is the cause of an often-fatal viral hemorrhagic fever and could spread via air travel from endemic areas in Africa to cause international epidemics. The recent reemergence and spread of YFV in Africa and Asia and the dire shortage of YFV vaccine have called attention to the potential public health threat of yellow fever and the need for specific measures to prevent infection and control spread of the virus and its mosquito carrier. These measures are clearly presented in a short communication and accompanying editorial published in Vector-Borne and Zoonotic Diseases, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers, and are available free on the Journal website until Aug. 26, 2016.

In the article "Yellow Fever Remains a Potential Threat to Public Health," Pedro Vasconcelos, Ministry of Health, Ananindeua, Brazil, and Thomas Monath, NewLink Genetics Corp., state that urban epidemics caused by the spread of Aedes aegypti mosquitoes are currently of great concern due mainly to increasing urbanization, climate change, and air travel, which has put more than 130 countries infested with the mosquito and more than 4 billion people at risk of yellow fever. The authors describe the most recent YFV epidemic in Angola and the reasons for the lack of sufficient vaccine stockpiles. They propose actions to increase vaccine availability and the need for new approaches to combat Aedes aegypti mosquitoes, especially in urban environments.

"As we have recently seen with West Nile, chikungunya, and Zika viruses, vector-borne and zoonotic diseases continue to be a significant and unpredictable threat to mankind," says Stephen Higgs, PhD, editor-in-chief of Vector-Borne and Zoonotic Diseases, and director of the Biosecurity Research Institute at Kansas State University. "Despite studies of yellow fever that span over more than 100 years, we still lack critical understanding and resources to combat these diseases. The number of cases of yellow fever in several African countries continues to increase despite a major vaccination campaign. We are also seeing travel-related cases in the People's Republic of China. Elsewhere, yellow fever cases have been reported in Brazil, Chad, Colombia, Ghana, Guinea and Peru."

Source: Mary Ann Liebert, Inc./Genetic Engineering News

Yellow Fever cases on the rise in West Africa - Urbanization and shortage of vaccines are leading to the largest yellow fever outbreaks in 30 years.

The cover of a certificate that confirms the holder has been vaccinated against yellow fever. Source: https://en.wikipedia.org/wiki/Yellow_fever

Yellow Fever outbreaks are ongoing in Angola, with exported cases to the Democratic Republic of Congo, Kenya, and China. According to a recent situation report released by the World Health Organization, over 4,000 suspected cases and hundreds of deaths have been reported, mostly from Angola. The epidemic started in December 2015 and despite extensive vaccination efforts, there is ongoing transmission in the Angolan capital of Luanda- a foci of the current outbreak.

Mosquito control during the construction of the Panama Canal. t Source: Field Museum Archives, https://commons.wikimedia.org/wiki/File:
Mansprayingkeroseneoil.jpg

Yellow fever virus (YFV) is a species of flavivirus, meaning it is related to Zika virus, dengue virus, West Nile virus and several other viruses that are known to cause human outbreaks. These viruses are transmitted through the bite of an infected arthropod (usually a mosquito or tick species) and can infect not only humans, but an array of mammal and other animal species. Yellow fever’s name comes from the jaundiced (yellow) appearance that infected humans get– this is accompanied by fever, shivers, and headache. If the infection advances to a second, more serious, stage there is a 50% chance of death without treatment. There is no cure for yellow fever, but treatments that address the symptoms, such as rehydration, can improve patient outcomes.

Yellow fever virus is not a new public health threat. For centuries, yellow fever caused massive mortality in port cities when the vector and infected humans migrated to suitable regions. The virus originated in Africa, but was brought to the Americas 300-400 years ago along with the slave trade.

As one example, the Panama Canal was delayed due to Yellow Fever and malaria outbreaks – over 20,000 workers died from these diseases, and the completion was only possible due to massive investment in mosquito control to curb transmission and reduce morbidity and mortality. This was achieved by spraying oil into ponds and water-filled trenches to destroy breeding habitats of mosquitoes.

The virus is now endemic in many countries in South America and Africa. The distribution is largely determined by the presence and range of suitable vectors- it can be transmitted by several Aedes and Haemagogus species, and the urban Aedes aegypti is particularly suitable for maintaining human cycles. While Aedes mosquitoes are present in Asia, the absence of Yellow Fever in Asian countries is thought to be related to lower introduction rates during the peak of the slave trade.

Yellow fever virus is maintained in sylvatic cycles and sporadically emerges in human populations. The last large epidemic of Yellow Fever was in 1986, when an outbreak in Nigeria infected an estimated 116,000 and killed 24,000 people.

Cases of Yellow Fever. Summary of cases of yellow fever reported to the World Health Organization between 1974 and 2014. . Data from WHO Global Health Observatory Data, figure from ECDC

Vaccination against yellow fever provideslife-long immunity to infection. The vaccines are relatively cheap ($2) and can be administered to most people over 9 months of age. However around 80% of the population must be vaccinated to provide herd immunity and reduce the likelihood of outbreaks.

Unfortunately, in many endemic regions, vaccination rates are low. Although there has been a fast response, vaccination campaigns in Angola will face the inevitable issue of supply – it’s estimated that only 80 million vaccines are made annually, and this recent epidemic is quickly using up these doses. The World Health Organization’s Strategic Advisory Group of Experts (SAGE) has been reviewing evidence for using 1/5 of the normal dose. This strategy, known asfractional dosing, does not guarantee lifelong protection but would protect from yellow fever for at least 12 months and allow scaling up of the number of individuals vaccinated in emergency situations.

However, even though 8 million people have been vaccinated in Angola, there is stillpersistent transmission. This may be because population density is so high in urban areas where transmission is occurring. Infrastructure has a hard time keeping up with this rapid migration to cities, and poor sanitation and weak public services exacerbates the conditions creating an ideal environment for YFV transmission. Aedes mosquitoes often breed in closed containers, which can be found in areas where there is little access to drinking water and where there is poor sanitation. Mosquitoes are happy to breed in leftover garbage that accumulates rain water and receptacles used for storing drinking water.

Map of Yellow Fever Virus. This global map represents endemic areas of Yellow Fever Virus (red) and areas where the virus may be present (orange). Source: https://commons.wikimedia.org/wiki/File:Fievre_jaune.png

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Currently, an additional seven countries (Brazil, Chad, Colombia, Ethiopia, Ghana, Peru and Uganda) are reporting yellow fever cases that are not related to Angola. While the Angolan outbreak has led to some exported cases, particularly to neighbouring DRC, these other countries have developing outbreaks that warrant surveillance. Another outbreak on the scale of Angola could lead to more deaths due to vaccine supplies running low.

At this time, the outbreaks are viewed as critical national public health issues, but are not believed to be a Public Health Emergency of International Concern (PHEIC) . Priorities should be increasing vaccination, vector control, and case management in areas where transmission persists. Migrant workers and travellers in affected regions should also be vaccinated to prevent spread of the virus. Countries and areas with strong travel links to affected countries and with a local vector, such as China, should implement outbreak preparedness by improving surveillance and stockpiling emergency vaccinations.

NIH launches early-stage yellow fever vaccine trial

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has begun an early-stage clinical trial of an investigational vaccine designed to protect against yellow fever virus. The Phase 1 study is evaluating whether an experimental vaccine developed by the Danish biopharmaceutical company Bavarian Nordic is safe, tolerable and has the potential to prevent yellow fever virus infection.

“Yellow fever has recently re-emerged as a major public health threat in parts of Africa.”

—Anthony S. Fauci, M.D.,Director, NIAID

Yellow fever virus is found in tropical and subtropical areas in South America and Africa. It caused an estimated 84,000 to 170,000 severe cases of disease and 29,000 to 60,000 deaths in 2013, according to the World Health Organization (WHO). The virus is transmitted to people primarily through the bite of infected female Aedes aegypti mosquitoes. Mild cases of infection can cause fever, back pain, headache, nausea, vomiting, fatigue and weakness. Most people recover, but approximately 15 percent of those infected develop severe disease manifested as yellow eyes and skin (jaundice), hemorrhage and shock, resulting in potentially fatal kidney, liver or heart conditions.

“Yellow fever has recently re-emerged as a major public health threat in parts of Africa. Although a vaccine exists to prevent this serious disease, it is currently in short supply, and it is not recommended for certain populations, such as pregnant women and people older than 60 years,” said NIAID Director Anthony S. Fauci, M.D. “We must develop new options for preventing this terrible disease.”

As of July 21, 2016, the WHO has reported a total of 3,682 suspected yellow fever cases with 361 deaths in the African country of Angola. Meanwhile, another 1,798 suspected cases have been reported in the Democratic Republic of The Congo (DRC), including 85 deaths. Cases with links to Angola have also been reported in Kenya and China.

More than 105 million people in Africa have been vaccinated against yellow fever in mass campaigns since 2006, according to the WHO. Despite this success, vaccine supplies are limited. In addition, in very rare cases, the current yellow fever vaccine can produce severe adverse complications, such as neurologic side effects, multiple organ system dysfunction and death. For this reason, the vaccine should not be given to infants, the elderly, pregnant women and those with compromised immune systems.

Bavarian Nordic’s experimental yellow fever vaccine, dubbed MVA-BN-YF, is based on the company’s proprietary MVA-BN platform, which uses an attenuated (weakened) version of the Modified Vaccinia Ankara (MVA) virus as a vaccine vector to carry yellow fever virus genes into the body. According to Bavarian Nordic, more than 7,600 people, including 1,000 individuals who are immunocompromised, have been safely vaccinated with MVA-BN-based vaccines.

The placebo-controlled, double-blinded clinical trial will enroll 90 healthy men and women ages 18 to 45 who have never been infected with a flavivirus, the family of viruses that includes yellow fever virus, West Nile virus, dengue and Zika virus, among others. Participants will be divided into six groups: One will receive the currently licensed yellow fever vaccine (15 participants) and five groups (15 participants each) will receive the investigational Bavarian Nordic vaccine, either with or without an adjuvant, a substance that is added to a vaccine to increase the body's immune response to the vaccine. The investigational vaccine will be administered intramuscularly while the licensed yellow fever vaccine will be administered subcutaneously. Trial participants will receive one or two doses of vaccine or placebo, separated by a month.

Previous laboratory and animal studies have suggested that combining MVA-BN with ISA 720, an experimental immune-boosting adjuvant that has been used in prior clinical trials, induces a strong immune response after a single dose of vaccine. One goal of the study will be to assess whether two doses of unadjuvanted vaccine or a single dose of ISA 720 adjuvanted vaccine could provide protection against yellow fever.

The multi-site clinical trial will be conducted by NIAID-funded Vaccine and Treatment Evaluation Units (VTEUs) at the University of Iowa in Iowa City and Saint Louis University in Missouri. Emory Vaccine Center in Decatur, Georgia will assist in evaluating data. 

Additional details about the trial can be found at ClinicalTrials.gov using the identifier NCT02743455.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Latest WHO report for Yellow Fever - July 2016

Jul 15, 2016

GENEVA, Switzerland - World Health Organization issued the latest yellow fever situation report today.

Summary:

Angola: 3625 suspected cases

In Angola, as of 8 July 2016 a total of 3625 suspected cases have been reported, of which 876 are confirmed. The total number of reported deaths is 357, of which 117 were reported among confirmed cases. Suspected cases have been reported in all 18 provinces and confirmed cases have been reported in 16 of 18 provinces and 80 of 125 reporting districts.

Mass reactive vaccination campaigns first began in Luanda and have now expanded to cover most of the other affected parts of Angola. Recently, the campaigns have focused on border areas. Despite extensive vaccination efforts circulation of the virus persists.
Eleven reactive and pre-emptive mass vaccination campaigns are ongoing in several districts in Benguela, Huambo, Huila, Kwanza Norte, Kwanza Sul, Lunda Norte and Uige provinces. Six other mass vaccination campaigns are nearing completion. Mop-up campaigns are being implemented in parts of the provinces of Cunene, Lunda Norte, Uige and Zaire.

Democratic Republic of the Congo: 1798 suspected cases
Other than an increase in the number of suspected cases recently reported, there are no updates regarding the epidemiological situation in the Democratic Republic of The Congo (DRC). For the last three weeks the national laboratory in DRC has been unable to confirm or discard any suspected cases of yellow fever due to technical issues. According to the latest available information (as of 11 July), the total number of notified suspected cases is 1798, with 68 confirmed cases (as of 24 June) and 85 reported deaths. Cases have been reported in 22 health zones in five of 26 provinces. Of the 68 confirmed cases, 59 were imported from Angola, two are sylvatic (not related to the outbreak) and seven are autochthonous.

In DRC, surveillance efforts have increased and vaccination campaigns have centred on affected health zones in Kinshasa and Kongo Central. Reactive vaccination campaigns will start on 20 July, in Kisenso health zone in Kinshasa province and in Kahemba, Kajiji and Kisandji health zones in Kwango province.

The risk of spread

Two additional countries have reported confirmed yellow fever cases imported from Angola: Kenya (two cases) and People's Republic of China (11 cases). These cases highlight the risk of international spread through non-immunised travellers.

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) are currently reporting yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

Vaccination

WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, is under consideration as a short-term measure, in the context of a potential vaccine shortage in emergencies.

Risk assessment

The outbreak in Angola remains of high concern due to:

Persistent local transmission despite the fact that approximately 15 million people have been vaccinated;

Local transmission has been reported in 12 highly populated provinces including Luanda.

The continued extension of the outbreak to new provinces and new districts.

High risk of spread to neighbouring countries. As the borders are porous with substantial cross-border social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present;

Risk of establishment of local transmission in other provinces where no autochthonous cases are reported;

High index of suspicion of ongoing transmission in hard-to-reach areas like Cabinda;

In DRC, the outbreak has spread to three provinces. Given the limited availability of vaccines, the large Angolan community in Kinshasa, the porous border between Angola and DRC, and the presence and the activity of the vector Aedes in the country, the outbreak might extend to other provinces, in particular Kasai, Kasai Central and Lualaba.

The virus in Angola and DRC is largely concentrated in main cities; however, there is a high risk of spread and local transmission to other provinces in both countries. In addition, the risk is high for potential spread to bordering countries, especially those classified as low-risk (i.e. Namibia, Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow fever.
Some African countries (Chad, Ghana, Guinea, Republic of Congo and Uganda) and some countries in South America (Brazil, Colombia and Peru) have reported cases of yellow fever in 2016. These events are not related to the Angolan outbreak, but there remains a need for vaccines in those countries, which poses additional strain on the limited global yellow fever vaccine stockpile.

New Government Yellow Fever Vaccination Center coming up in Nagpur - Daga Hospital

Nagpur: The state government would be setting up a vaccination centre for yellow fever in city at Daga Hospital. Except for Mumbai and Pune, there is no yellow fever vaccination centre in Maharashtra.

The public health secretary Sujata Saunik, who was in city for a court hearing, visited the Daga hospital to finalize the details of the project. She told TOI that Nagpur was emerging as an international connection for flights and was fast growing into a city with high outflow of tourists to 43 countries in South America, South Africa and certain African countries that require the vaccination before visit there, the state had deemed it necessary to start a centre in city.

"Though we are yet to get a formal letter from Union ministry of health and family welfare, it has given a nod for the centre on May 19. Department has not fixed the cost for the vaccine but it will be available at subsidized rates which will be at least one fifth to one sixth the cost of that available in private set up," said Saunik.

The public health department acting director Dr Mohan Jadhav told TOI, the department had sent a proposal to Central government in May end for starting the yellow fever vaccination centre at three places-- Nagpur, Aurangabd and an additional centre at Pune. "Since we desired to have the centre first at Nagpur, the centre granted us the same. The others too will be sanctioned soon," he said.

Daga hospital has been chosen for setting up the centre as it is a women and child hospital and has all the necessary facilities for all types of vaccination. Dr Jadhav said that the WHO in its recent guidelines had included China in the list of countries requiring yellow fever vaccination as the country had reported 11 cases of imported yellow fever till April this year. Two cases were reported from April 4 and 12.

The yellow fever vaccination is required 10-15 days before reaching the destination country. Travellers from Nagpur generally go to Mumbai for taking vaccine. The vaccination was otherwise available at only one private centre and would cost anything from Rs4000 to Rs 8000.

Traveling to Ivory Coast from India, with family. What vaccines are needed in addition to Yellow Fever?

Q: Hello Dr
I will be travelling to Abidjan(ivory Coast) with my wife and 2kids of age 6year and 8 months. In 2-3weeks of time. I know yellow fever is must. Is there any other recommendations as well? 
I am planning to get yfv from ur Noida center. What kind of certificate will be provided? Is it valid from immigration point of view?

A: Please read our FAQs for more details about the validity of the Yellow Fever Certification.

There are a few other vaccines recommended for Ivory Coast, but they are for personal protection, and not legally mandatory.
These include,
Typhoid, Hepatitis A, Hepatitis B, MMR, Tetanus, Rabies etc.
You can get more details by calling our Helpline or emailing us,
Warm regards

15 Million to Be Vaccinated to Contain Yellow Fever Outbreak in DRC & Angola

Lisa Schlein

July 07, 2016 1:15 PM

GENEVA—

The World Health Organization is leading a mass yellow fever vaccination campaign in central Africa to prevent the national and international spread of this deadly disease.  The campaign, which begins this month, aims to vaccinate 15.5 million people in Angola and the Democratic Republic of Congo.

A yellow fever outbreak began late last year in the Angolan capital, Luanda and spread quickly throughout the country. The disease also spread to neighboring Democratic Republic of Congo.

The two-month vaccination campaign is being held in advance of the next rainy season in September, when mosquitos come out and transmission goes up.

Bruce Aylward is WHO executive director of Outbreaks and Health Emergencies.  He says this outbreak is particularly dangerous because it is occurring in large cities.

He says massive outbreaks of yellow fever can occur in urban settings because mosquitos can rapidly infect thousands of people.

“With that explosive spread and the number of cases, you can see very high mortality rates," he said. "These can be very dangerous, destabilizing events; but, the other concern is when urban outbreaks take off in these areas, there is a risk then of international spread of this virus.”

Aylward says two cases were reported in Kenya and 11 cases were brought to China by Chinese men who had been working in Angola.  Yellow fever is endemic in 47 countries, 33 of them in Africa. Most of the rest are in South America.

FILE - A researcher holds a container of female Aedes aegypti mosquitoes at the Biomedical Sciences Institute at Sao Paulo University in Brazil.

Yellow fever is an acute viral disease that in the worst cases, can cause liver damage that begins to turn the skin yellow.  The mosquito that transmits the virus is the Aedes Aegypti, the same one that transmits the Zika virus.  Since the mosquito also exists in Asia, Aylward warns the potential for creating an international crisis exists.

Aylward, however, tells VOA the prognosis for containing the geographical spread is good.

“This is not like Ebola or not like Zika, for which we do not have a vaccine, of course. This is a disease for which we have a vaccine and for which there is a vaccination requirement under the International Health Regulations for yellow fever," he said. "So, again a big part of our work with the countries at risk of the disease is to ensure that they have a vaccination of traveler policy.”

Latest WHO figures show more than 3,500 suspected and over 860 confirmed cases of yellow fever in Angola, with 355 deaths.  In DRC, there are over 1,300 suspected and 68 confirmed cases, with 75 deaths.

The cost of the mass yellow fever campaign is expected to be $34 million. 

Aylward says the WHO will launch an appeal for $20 million in the coming days, with Angola and DRC covering the rest.

Source

Shortage of syringes hampers Congo's fight against yellow fever

A shortage of syringes is hampering plans to vaccinate people in Democratic Republic of Congo against a yellow fever epidemic despite the arrival of more than one million doses of vaccine, health officials said on Tuesday.

Congo's government declared a yellow fever epidemic last month in the capital Kinshasa and two other provinces near the border with Angola.

The World Health Organization (WHO) says some 1,400 suspected cases of the hemorrhagic virus in Congo have resulted so far in 82 deaths and is particularly concerned about conditions in Kinshasa, a city of 12 million with poor health services and a climate conducive to mosquitoes.

The disease has killed 350 people in Angola since December.

The WHO plans to begin a vaccination campaign in the province of Kwango near the Angolan border on July 20 but the U.N. body's spokesman in Congo, Eugene Kabambi, said the country had only about four million syringes but needed 10 million.

Kabambi said some 1.08 million vaccine doses had arrived in Kinshasa in recent days, but declined to say when he thought more syringes might be delivered.

Health officials are reluctant to begin the vaccination campaign in only one zone in densely-populated Kinshasa for reasons of public safety and order.

"If we only organize in Kisenso, there will be huge crowds coming to Kisenso to obtain the vaccine and that could become unmanageable," Kabambi said, referring to the first zone officials plan to target in the capital city. "So we're going to wait a little to obtain more (syringes)."

GLOBAL VACCINE SHORTAGE

The global stockpile of yellow fever vaccine stands at about 6 million doses after having been depleted twice this year to immunize people in Angola, Uganda and Congo. The current method for making vaccines, using chicken eggs, takes a year.

Health officials plan to administer a fifth of the standard dose in Kinshasa due to the shortage of the vaccine. The lower dosage provides temporary protection against the disease but does not confer lifelong immunity.

More than one million people were vaccinated in Kinshasa during a campaign from May 26-June 4 in two health zones. But the effort was hampered by disorganization as residents of other districts flocked to the vaccination sites, preventing many local residents from receiving the injection.

Kabambi said other regions along the Angolan border would eventually be vaccinated, depending on how many more doses are made available, in order to create an "immune buffer".

(Reporting By Aaron Ross; Editing by Nellie Peyton and Gareth Jones)

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17 travellers turned back or quarantined in Jamaica over yellow fever worry

KINGSTON, Jamaica, Tuesday June 28, 2016 – Nine passengers who flew into Jamaica yesterday were refused entry, while another eight were quarantined because of yellow fever concerns.

The 17 were among travellers who flew into the island from Trinidad & Tobago and Panama and were unable to produce evidence that they were vaccinated against the virus, according to the Jamaica Gleaner newspaper.

It quoted Minister of Health Dr. Christopher Tufton as confirming that five of the passengers arrived on Caribbean Airlines from the twin-island republic and they were all sent back home, while the other 12 came in from Panama. Of those 12, four were refused entry and the other eight quarantined.

Tufton said Jamaica has to take the threat of yellow fever seriously. Yellow fever is an acute viral disease transmitted by infected mosquitoes. Symptoms include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue, and according to the World Health Organization (WHO), a small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within seven to 10 days.

Earlier this month, the Jamaica government issued a statement indicating that all travellers over the age of one year who arrive in Jamaica from countries where there is risk of yellow fever transmission – including those passengers transiting those countries – would be required to produce a valid certificate to show they have been vaccinated.

It said it was taking the step to prevent the importation of the virus into Jamaica where the disease does not occur but where the mosquito vector and human hosts are present.

“Failure to produce a valid yellow fever vaccination certificate at a Jamaican point of entry may lead to refusal of entry, or quarantine until the traveller’s certificate is produced,” the government advised.

The countries for which the certificate is required for entry into Jamaica are based on a WHO advisory. Those countries are: Angola, Argentina, Benin, Bolivia, Brazil, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Ecuador, Equatorial Guinea, Ethiopia, French Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Guyana, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Panama, Paraguay, Peru, Senegal, Sierra Leone, South Sudan, Suriname, Togo, Trinidad and Tobago, Uganda and Venezuela.

Source

Comment: If you are traveling to West Indies, make sure that your Yellow Fever Vaccination Certificate is up to date. Given the recent Yellow Fever cases in Angola and Congo, it is important that Indian travelers remain on guard and do not get fake certificates or travel without Yellow Fever Vaccination