Severe Yellow Fever: Treatment After Initial Fluid Resuscitation Fails to Restore Perfusion
This page addresses management of severe yellow fever in hospitalised patients when initial intravenous crystalloid resuscitation has not achieved adequate perfusion — specifically when capillary refill time remains prolonged and perfusion targets are not met, in the absence of liver failure.
Clinical scenario
Severe yellow fever requiring hospitalisation, with an ongoing need for intravenous fluid treatment and without liver failure. Severity is determined by clinical evaluation, including assessment for warning signs and existing complications.
Why this line is reached — prior treatment failure
The preceding step was intravenous resuscitation with crystalloid fluid. This protocol is indicated when that approach has not achieved the target of improved perfusion — specifically when capillary refill time remains longer than 3 seconds, indicating that the first-line fluid strategy did not restore circulatory adequacy.
Next-line approach (partial overview)
When crystalloid resuscitation has been insufficient, the next protocol step involves investigational antiviral therapy that is currently available only within a structured clinical trial framework — specific agents, eligibility criteria, and the applicable framework are detailed in the full protocol.
Clinical goal: Viral clearance — absence of yellow fever viraemia.
References
Severe disease: those patients who clinicians assess as requiring hospitalization based on a clinical evaluation which includes assessment for the presence of warning signs and existing complications.
WHO recommends the use of monoclonal immunoglobulin TY014 for the treatment of patients with suspected or confirmed yellow fever only in research settings.
WHO recommends the use of sofosbuvir in the treatment of patients with suspected or confirmed yellow fever only in research settings.
Experimental human challenge (phase I) of healthy subjects demonstrated no viraemia in 8 individuals given the TY014 and the yellow fever vaccine, but detectable virus in 2 individuals receiving placebo.
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