Phantom Menace: Dengue and Yellow Fever in Asia

The Absence of Yellow Fever in Asia: History, Hypotheses, Vector Dispersal, Possibility of YF in Asia, and Other Enigmas

“…Although James, like Carter, did not entirely agree with Manson's warning and discounted the possibility of YF spread to India because of the long distances from the Americas, he thought that eastern parts of Asia, such as Hong Kong and Singapore, were vulnerable and also recommended India to reduce vector populations. Furthermore, he proposed that British India Medical Service officers be stationed at the Panama Canal, Hong Kong and Singapore for monitoring the occurrence of YF to enable rapid communication with all concerned authorities in Asia [20,34]. His justification of negligible threat to India due to logistics, however, was disputed by others because YFV could survive for long periods aboard ships by cycling between mosquitoes and humans.…”

“…At the 1932 Conference in Cape Town, South Africa, India negotiated with Anglo-Egyptian Sudan and governments of West Africa for Sudan to serve as a "buffer zone" to prevent introduction of YF [33]. At the conference, Wilbur A. Sawyer of the RF suggested that the mountainous lake region of East Africa was apparently serving as a natural barrier against the spread of YF to the East [34], only to find out shortly that the region had been already YF endemic [35].…”

“…Naturally, it aroused a suspicion of YF, but the etiology was not identified. However, because of this episode, quarantine regulations in Hong Kong were later amended to cover YF [34].…”

“…To this proposal, Manson suggested the Netherlands to initiate a diplomatic negotiation first with the USA and later with colonial powers in Asia. As a result of a chain of negotiations, Britain, the Netherlands, Germany, France, and Portugal began a communication regarding establishment of anti-YF measures in the region [34]. Prohibition of importing YFV for any reason including research among all countries was instituted through gentleman's agreement in early 1930s.…”

“…In 1923, Cornelis Bonne in Suriname conceived a hypothesis that prior experience with a dengue-like illness would modulate the severity of YF [34]. This was received favorably in the Dutch East Indies where dengue was prevalent [45].…”