Approach
As specific antivirals for yellow fever are not available, supportive care is the mainstay of therapy for clinical disease.[15][2][16][42]
Empiric ribavirin therapy
Ribavirin may be given if a viral hemorrhagic fever is suspected until yellow fever is confirmed, either clinically or by a laboratory, as it has some efficacy in other viral hemorrhagic fevers.[13]
However, as ribavirin has been found to be ineffective for yellow fever in monkey studies, it is discontinued once yellow fever has been confirmed.[43]
Supportive therapy
Patients should be hospitalized for supportive care and observation when possible. This involves rest, maintaining nutrition and preventing hypoglycemia; using nasogastric suction to prevent gastric distension and aspiration; giving H2 antagonists (to prevent gastric bleeding); treating hypotension with fluid replacement and vasoactive drugs; giving oxygen; correcting acidosis; treating bleeding complications with fresh frozen plasma; providing hemodialysis for renal failure; and treating secondary infection with antibiotics.[2] Analgesics/antipyretics are recommended for pain and fever; however, nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, should be avoided due to the increased risk of bleeding in these patients.
Critically ill patients (i.e., those with multiorgan failure, severe hemorrhagic complications, and/or refractory hypotension) require intensive care monitoring.
The above recommendations are based on clinical experience, but have not been evaluated in clinical studies.[2]
Patients should be isolated/protected from further mosquito exposure (e.g., staying indoors) for up to 5 days following onset of fever to break the transmission cycle.
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