Colombia Declares National Yellow Fever Emergency, 45.3% Fatality Rate Already Reported, Travel Restrictions Contemplated

Colombia’s government has declared a national health emergency in response to the active circulation of the yellow fever virus in several regions and the potential for its spread to urban centers. The measure aims to safeguard public health, contain the virus’s propagation, and mitigate its potential effects.

Health authorities are urgently calling on everyone in Colombia to get vaccinated against yellow fever starting at nine months of age, including individuals over 59 years old. Between September 2024 and now, 75 confirmed cases and 34 deaths have been reported nationwide, representing a cumulative fatality rate of 45.3%.

Confirmed cases are distributed across nine departments: Tolima (59 cases), Putumayo (7), Nariño (2), Caquetá (2), Huila (1), Vaupés (1), Cauca (1), Meta (1), and Caldas (1). Fatalities associated with the disease have been recorded in eight departments: Tolima (23 deaths), Putumayo (5), Caquetá (1), Nariño (1), Caldas (1), Cauca (1), Huila (1), and Meta (1).

Yellow fever is a viral illness transmitted through the bite of infected mosquitoes. Initial symptoms within the first 24 hours can include fever, headache, and general malaise. In the subsequent 72 hours, symptoms often intensify with gastrointestinal manifestations such as vomiting, diarrhea, and abdominal pain. From the fifth day onwards, signs like jaundice (yellowing of the skin and eyes) and bleeding may occur, which can be fatal in unvaccinated individuals. The disease is highly preventable through vaccination, with a reported fatality rate ranging between 40% and 50%.

Colombia is implementing an urgent, free, door-to-door vaccine program to prevent the gruesome disease from spreading via mosquitos.

Since September 2024, the National Government has implemented a series of strategic actions to control the spread of yellow fever and protect public health:

• Intensified Vaccination Strategy: The age range for immunization has been expanded to include individuals from 9 months of age and older, with mass mobilization efforts in affected municipalities.
• Strengthened Epidemiological Surveillance: Over 20 rapid response teams have been deployed for active community case finding and field investigations. Entomovirological, pathological, and laboratory surveillance has also been reinforced through the national reference laboratory of the National Health Institute (Instituto Nacional de Salud).
• Expanded Primary Care: More than 100 Basic Health Care Teams (Equipos Básicos de Atención en Salud – EBAS) have been activated in municipalities with confirmed virus presence.
• Coordination with Health Promotion Entities (EPS) and Vaccination Networks: Health Promotion Entities (Entidades Promotoras de Salud – EPS) have been instructed to establish and operate vaccination teams in coordination with the public and private healthcare network in all affected territories.
• Territorial Coordination through Unified Command Posts (PMU): Twenty-two PMU sessions have been held in the department of Tolima, one in Caldas, and one at the national level, involving local, departmental, and national authorities. Additionally, an extraordinary session of the Risk Management Committee was convened in Huila.
• National Communication and Education Campaign: An information and education strategy has been activated to promote vaccination, self-care, and vector control nationwide.
• Clear Technical Guidelines for the Health System: Circulars with precise instructions for all actors in the national and territorial health system have been issued, disseminated, and technically supported.

The outbreak has demonstrated a progressive expansion, particularly in areas of the Amazon basin, the Magdalena River valley, and departments such as Meta, within a short period. Cases have also emerged in territories with no historical records of the disease, such as the municipality of Neira in Caldas, located in the coffee-growing region.

While urban transmission of yellow fever has not been reported in Colombia since 1929, there is a potential risk of re-emergence due to the frequent entry of individuals into enzootic areas—where the virus circulates in its sylvatic cycle through Sabethes and Haemagogus mosquito species—and their subsequent movement to urban zones below 2,200 meters above sea level, inhabited by urban cycle transmitting species such as Aedes aegypti and Aedes albopictus.

Epidemiological monitoring has identified cases in populated centers and urban peripheries of municipalities with low population density, indicating a risk of expansion into larger urban centers. Given this scenario, vaccination remains the most effective tool for controlling yellow fever. Analysis of fatal cases has shown that the deceased individuals were unvaccinated, underscoring the urgency of increasing vaccination coverage. Territorial entities must prioritize immunization of the entire population over 9 months of age in high-risk municipalities and strengthen the intensification strategy in the rest of the country.

The Minister of Health and Social Protection (Ministerio de Salud y Protección Social), Dr. Guillermo Alfonso Jaramillo, stated, “With the declaration of the yellow fever emergency, we are intensifying actions to protect the entire population. Our Basic Health Teams, totaling more than 10,000, continue to travel to vaccinate all people in the most remote areas of the country, especially in high-risk zones. The vaccine is free, safe, and administered in a single dose, at least 10 days before entering risk areas.”

The Minister also added that door-to-door campaigns, vaccination drives in educational institutions, transportation terminals, military and police facilities, and other collective spaces will be strengthened. Furthermore, mosquito control measures will be reinforced, and immediate access to healthcare services without barriers will be guaranteed.

Considering the above, and within the framework of the declared health emergency, the following measures are adopted at the national level to contain the yellow fever outbreak, protect the lives of the population, and ensure a coordinated response from the health system:

• Mass Vaccination: A national mass mobilization will commence in high-risk municipalities and extend to the rest of the national territory. The vaccine is free, safe, administered in a single dose, and should be received 10 days before entering risk areas. Strategies will include door-to-door campaigns and vaccination in educational institutions, transportation terminals, military and police facilities, and other collective spaces.
• Integrated Vector (Mosquito) Control: Actions to control mosquitoes in homes, communities, healthcare facilities, and high-traffic areas such as market squares and terminals will be intensified. Mosquito nets will also be distributed in high-risk rural areas.
• Immediate Deployment of Basic Health Teams and Rapid Response Teams: These teams will play a crucial role in case identification, community education, epidemiological monitoring, and vaccine administration, bringing services closer to the most vulnerable and hard-to-reach populations.
• Centralized Management of Health Services: Regional Emergency and Disaster Centers (Centros Reguladores de Urgencias y Emergencias – CRUE) will assume control of the availability of Intensive Care Units (ICU) and patient transfers.
• Obligations of Health Promotion Entities (EPS): EPS are required to allocate all necessary technical and financial resources through their public, private, and mixed networks to guarantee vaccination, prevention, and care for their entire affiliated population. Prior authorization from EPS for the provision of health services is not required.
• National Hospital Alert: A yellow hospital alert is activated throughout the public, private, and mixed healthcare network nationwide. This will be elevated to orange alert in municipalities with human cases and, if justified, to red alert, based on the analysis conducted by the territorial entity with the support of the Ministry of Health and the National Health Institute.
• Mobility Restrictions: Local authorities may implement access restrictions to areas with active virus transmission, following established protocols and in coordination with police forces. The protection of medical personnel during these operations will be guaranteed.
• Requirement of International Vaccination Certificate for Travelers: In compliance with the International Health Regulations, international travelers entering the country may be required to present a yellow fever vaccination certificate. The vaccine must have been administered at least 10 days before entering risk areas. (This measure will be adjusted based on World Health Organization (WHO) recommendations to avoid impacting tourism and trade).
• Culture of Prevention: Citizens are urged to adopt self-care measures, eliminate mosquito breeding sites in their surroundings, and seek timely vaccination. In particular, residents of municipalities located below 2,200 meters above sea level are advised to use insect repellent, mosquito nets, and clothing that covers the skin as personal protection measures against the yellow fever transmitting mosquito.
• Risk Management Committees: Departmental, district, and municipal territorial entities located in high-risk areas will convene risk management committees to adopt comprehensive control and risk management plans.

The director of the National Health Institute, Diana Marcela Pava, reiterated the duty to protect the health and lives of Colombians. “The measure to declare a health emergency was subjected to a rigorous risk assessment exercise, which is an internationally validated process to establish the level of risk the country is facing,” explained the director, adding that “thanks to this exercise, the measures announced by the Ministry of Health were taken.”

The Vice Minister of Public Health, Jaime Urrego, stated, “This emergency has a preventive emphasis. The vaccine saves lives, and this emergency reminds us that we must take extreme precautions. There are two key points: the change in the behavior of the disease and the risk of urbanization, especially in municipalities below 2,200 meters where we must vaccinate the entire population. We are not seeking to generate fear but to act jointly with experts to stop yellow fever.”

The General Secretary of the Ministry of Health, Rodolfo Salas, affirmed, “Colombia is a social state governed by the rule of law, where the right to life and health prevails. According to Article 69 of Law 1753 of 2015, the Ministry of Health and Social Protection is the competent governing body to declare a health emergency in the event of epidemics that endanger the public health of the country. This virus is showing rapid transmission, so we call on the competent authorities to take the necessary measures to prevent its spread.”

The Ministry of Health and Social Protection calls for the shared responsibility of all actors in the health system, territorial authorities, and the community in general to confront this emergency and protect lives.

Information for Travelers and Individuals in Risk Areas:

Yellow fever is transmitted by the bite of infected Aedes and Haemagogus mosquitoes. These mosquitoes typically bite during the day. For travelers and residents in areas below 2,200 meters above sea level, especially those in the departments with reported cases, the following precautions are recommended:

• Vaccination: The yellow fever vaccine is highly effective and provides lifelong protection with a single dose. It is recommended to receive the vaccine at least 10 days before traveling to or residing in risk areas. The vaccine is available free of charge in affected municipalities for individuals over 9 months of age.
• Insect Repellent: Use insect repellent containing DEET.  Follow the instructions on the product label.  
• Protective Clothing: Wear long-sleeved shirts, long pants, socks, and shoes when outdoors, especially during peak mosquito biting times.
• Mosquito Nets: Use mosquito nets (bed nets), especially if sleeping outdoors or in unscreened accommodations. Permethrin-treated nets offer additional protection.
• Eliminate Mosquito Breeding Sites: Regularly empty and clean containers that can hold water, such as flowerpots, tires, buckets, and pet water dishes, around your home to prevent mosquito breeding.
• Seek Medical Attention: If you develop symptoms such as fever, headache, body aches, nausea, vomiting, or jaundice, especially after being in a risk area, seek medical attention immediately. Early diagnosis and supportive care can improve outcomes.
• International Travel Requirements: Travelers entering Colombia from countries with a risk of yellow fever transmission may be required to present an international certificate of vaccination against yellow fever, as per the International Health Regulations. It is advisable to check the latest requirements before traveling. Similarly, travelers departing from Colombia to certain countries may also need proof of vaccination.

The current health emergency underscores the importance of vaccination and preventive measures to mitigate the risk of yellow fever transmission in Colombia. Residents and travelers in affected areas should adhere to the recommendations of health authorities to protect themselves and prevent further spread of the virus.

Photos © Loren Moss