Yellow fever (YF), an arboviral
infection of major
public health importance in
Brazil, is associated with high
mortality and high
epidemic potential. We analysed confirmed YF cases from the National
Surveillance System from 1998-2002 and assessed
risk factors for
death among hospitalised
patients. Variables assessed included age,
gender, clinical signs and
laboratory findings. A
logistic regression model was used to identify independent predictors of
death among hospitalised
patients. From 1998-2002, among 2117 suspected YF cases reported to
Brazil's Ministry of
Health, 251 (11.9%) had confirmed YF, of whom 217 (86.5%) were hospitalised and the
case fatality rate was 44.2%. Factors associated with higher
mortality in univariate
analysis included
male gender (
relative risk (RR) 1.96, 95% CI 1.17-2.28), age 40 years (RR 2.61, 95% CI 1.25-5.45),
jaundice (RR 2.66, 95% CI 2.12-3.35),
serum aspartate aminotransferase (AST) 1200IU/l (RR 1.84, 95% CI 1.23-2.74),
alanine aminotransferase 1500IU/l (RR 2.09, 95% CI 1.38-3.17), total
bilirubin 7.0mg/dl (RR 2.33, 95% CI 1.44-3.78), direct
bilirubin 5.0mg/dl (RR 2.29, 95% CI 1.33-3.94) and
blood urea nitrogen 100mg/dl (RR 5.77, 95% CI 1.43-23.22). In
multivariate analysis, elevated AST and
jaundice remained independently associated with higher
mortality. These findings suggest that selected clinical and
laboratory indicators may help clinicians recognise potentially fatal cases of YF...(AU)