Febbre gialla: come si contrae, sintomi e vaccino
Che cos’è la febbre gialla?
La febbre gialla è una malattia infettiva, presente in alcune aree tropicali, causata da un arbovirus (famiglia Flaviviridae) trasmessa all’uomo da zanzare. Si presenta come un virione sferico di circa 49 nm di diametro;il genoma è costituito da una singola molecola di RNA. I quadri clinici sono variabili; nelle forme più gravi è tipica la presenza di ittero, emorragie, proteinuria.
Quali sono i Paesi a rischio di febbre gialla?
L’infezione è endemica nelle aree umide (foreste tropicali) dell’Africa subsahariana e dell’America centro-meridionale. La trasmissione è mediata da zanzare del genere Haemagogus e Sabethes in America meridionale e Aedes in Africa. Il serbatoio può essere rappresentato sia dall’uomo sia dai primati. Da un punto di vista epidemiologico si distingue un ciclo urbano e ciclo silvestre. Nel primo, la anzara si infetta pungendo l’uomo durante la fase viremica (i primi 3 giorni di infezione). Nel secondo caso si tratta di un’infezione enzootica che coinvolge primati infetti. In Africa la trasmissione avviene soprattutto durante la stagione delle piogge e l’inizio della stagione secca nella savana. Una volta infetta, la zanzara rimane tale per il resto della vita trasmettendo l’infezione alle uova.
Quali sono i sintomi della febbre gialla ?
Dopo un periodo di incubazione di 3-6 giorni, la febbre gialla esordisce in modo brusco con:
- Temperatura elevata (39-40°C)
- Brividi
- Cefalea
- Rachialgia
- Nausea
- Vomito
In poche ore subentra la fase rossa, caratterizzata da:
- Aspetto rosso acceso del volto
- Iniezione congiuntivale
- Epistassi
- Bradicardia relativa (segno di Faget)
- Oliguria
- Febbre persistente di tipo continuo
La fase rossa coincide con la viremia e si esaurisce in 3 giorni. Segue una fugace remissione dei sintomi che perdura per non più di 24 ore e che prelude alla fase gialla, che compare pertanto al quarto- quinto giorno di malattia ed è dominata dalla comparsa di:
- Ittero
- Manifestazioni emorragiche (epistassi, gengivorragie, ematemesi, melena e oliguria. La temperatura si eleva e permane di tipo continuo intorno ai 40° C .
- Può comparire danno miocardico con ipocinesia grave.
- Nei casi favorevoli il paziente si avvia a gurigione senza reliquati dopo 12-14 giorni.
- L’exitus può subentrare per insufficienza epatica, renale o miocardica grave.
Terapia
Non esiste una terapia specifica. Un trattamento sintomatico può alleviare i sintomi della malattia, quali deidratazione e febbre. Dieta liquida ricca in idrati di carbonio e in proteine.
Prevenzione e vaccinazione
Oltre alla bonifica ambientale (lotta alle zanzare) e all’isolamento del paziente, la prevenzione della febbre gialla si fonda sulla vaccinazione. Si utilizza un (YF-17D) che, dopo un’unica somministrazione sottocute, conferisce immunità protettiva per almeno 10 anni. Non contiene alluminio. Il vaccino è abitualmente ben tollerato e sono rare le complicanze neurologiche.
Molto raramente è possibile sviluppare reazioni gravi, se non addirittura mortali.
Queste includono:
- Una reazione allergica, con difficoltà a respirare o a deglutire (anafilassi).
- Un edema del cervello, del midollo spinale o dei tessuti circostanti (encefalite o meningite).
- La sindrome di Guillain-Barré, una malattia rara del sistema nervoso nella quale il sistema immunitario danneggia le cellule nervose causando debolezza muscolare e, talvolta paralisi.
- Una disfunzione o insufficienza di un organo interno.
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- Vaccinazione febbre gialla
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