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The vaccine for YF is considered safe and effective, but intervention strategies need to be optimised; one of the tools for this is mathematical modelling. We refine and expand an existing modelling framework for Africa to account for transmission in South America. We fit to YF occurrence and serology data. We then estimate the subnational forces of infection for the entire endemic region. Finally, using demographic and vaccination data, we examine the impact of vaccination activities. We estimate that there were 109,000 (95% credible interval [CrI] [67,000\u2013173,000]) severe infections and 51,000 (95% CrI [31,000\u201382,000]) deaths due to YF in Africa and South America in 2018. We find that mass vaccination activities in Africa reduced deaths by 47% (95% CrI [10%\u201377%]). This methodology allows us to evaluate the effectiveness of vaccination and illustrates the need for continued vigilance and surveillance of YF.<\/jats:p>","DOI":"10.7554\/elife.64670","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T20:01:36Z","timestamp":1615838496000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.64670","source":"Crossref","is-referenced-by-count":144,"title":["The global burden of yellow fever"],"prefix":"10.7554","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-9081","authenticated-orcid":true,"given":"Katy AM","family":"Gaythorpe","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arran","family":"Hamlet","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6462-7185","authenticated-orcid":true,"given":"K\u00e9vin","family":"Jean","sequence":"additional","affiliation":[{"name":"Ma\u00eetre de conf\u00e9rences, Laboratoire MESuRS - Cnam Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Garkauskas Ramos","sequence":"additional","affiliation":[{"name":"Secretariat for Health Surveillance, Brazilian Ministry of Health, Brasilia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Cibrelus","sequence":"additional","affiliation":[{"name":"World Health Organisation, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tini","family":"Garske","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Ferguson","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4374","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"bib1","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1093\/infdis\/jiz379","article-title":"Yellow fever vaccine: the conundrum of 2 doses, one dose, or One-Fifth dose to induce and maintain protective immunity","volume":"221","author":"Barrett","year":"2020","journal-title":"The Journal of Infectious Diseases"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1186\/1756-3305-7-338","article-title":"Global temperature constraints on aedes aegypti and ae. albopictus persistence and competence for dengue virus transmission","volume":"7","author":"Brady","year":"2014","journal-title":"Parasites & Vectors"},{"key":"bib3","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1590\/S0037-86822011005000024","article-title":"Dynamic behavior of sylvatic yellow fever in Brazil (1954-2008)","volume":"44","author":"C\u00e2mara","year":"2011","journal-title":"Revista Da Sociedade Brasileira De Medicina Tropical"},{"key":"bib4","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1093\/cid\/ciy777","article-title":"What\u2019s Old Is New Again: The Re-emergence of Yellow Fever in Brazil and Vaccine Shortages","volume":"68","author":"Chen","year":"2019","journal-title":"Clinical Infectious Diseases"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1186\/s12985-019-1176-y","article-title":"Serological evidence of Flavivirus circulation in human populations in northern Kenya: an assessment of disease risk 2016-2017","volume":"16","author":"Chepkorir","year":"2019","journal-title":"Virology Journal"},{"key":"bib6","volume-title":"Viz Hub. 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