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The Geographical Distribution of Immunity to Yellow Fever in Man in South America¹

1. The reported incidence of yellow fever is no safe index of its occurrence in endemic zones.

2. Although visible urban and maritime outbreaks may decline and even cease entirely for a time, there is a vast, previously silent reservoir of infection in the interior of South America.

3. Yellow fever infection due to Aëdes aegypti has been much more widespread in the interior of Northeast Brazil than was believed, even though this area had long been under special observation. Aegypti-transmitted fever in this area did not spontaneously disappear following the organization of antiaegypti campaigns in the principal centers of population.

4. Yellow fever endemicity, instead of being limited to the coast of Northeast Brazil as was believed, extends to all of Brazil except a few of the southern states, to Bolivia, Paraguay, Peru, Ecuador, Colombia, and Venezuela, involving many districts in which Aëdes aegypti does not exist.

5. Widely varying percentages of immunes have been found in proved endemic regions, depending upon whether transmission is due to Aëdes aegypti or occurs in the absence of this mosquito.

6. There is no evidence of recent yellow fever outbreaks in any of the important Pacific or Caribbean ports of South America.

¹ This report gives the results for South America (Brazil, Paraguay, Bolivia, Chile, Peru, Ecuador, Colombia, Venezuela, British Guiana, Dutch Guiana, and French Guiana) of the world survey of yellow fever immunity distribution begun in 1931 by the International Health Division of The Rockefeller Foundation with the coöperation of the governments concerned (1, 2, 3, 4, 5, 6).

The immunity survey of South America has not been the work of an individual or of a small group of individuals but represents the combined efforts of many colleagues who have travelled extensively throughout the continent collecting sera for examination and of the groups of laboratory workers in the New York and Bahia yellow fever laboratories who have been responsible for the testing of these sera. The field collections have been greatly facilitated by the whole-hearted collaboration of national and colonial authorities, public health officials, teachers, and others who have disinterestedly aided in this work. Special mention must be made of the continued support given to these studies by Drs. F. F. Russell and W. A. Sawyer, under whose direction they have been made during the period 1931 to 1936.