A yellow flag on the horizon: The looming threat of yellow fever to North America.

• Recent yellow fever outbreaks in Africa and Brazil have brought this virus back to the spotlight. • Yellow fever outbreaks have revealed important limitations of the current vaccination system. • There has been a global expansion of arboviruses like dengue, chikungunya and zika. • Arboviral outbreaks due to Aedes mosquitoes have occurred in North America and Europe in this decade. • Unless preventive measures are implemented, yellow fever might soon reach North America and Europe. Yellow fever virus historically was a frequent threat to American and European coasts. Medical milestones such as the discovery of mosquitoes as vectors and subsequently an effective vaccine significantly reduced its incidence, in spite of which, thousands of cases of this deathly disease still occur regularly in Sub-Saharan Africa and the Amazonian basin in South America, which are usually not reported. An urban outbreak in Angola, consecutive years of increasing incidence near major Brazilian cities, and imported cases in China, South America and Europe, have brought this virus back to the global spotlight. The aim of this article is to underline that the preventive YFV measures, such as vaccination, need to be carefully revised in order to minimize the risks of new YFV outbreaks, especially in urban or immunologically vulnerable places. Furthermore, this article highlights the diverse factors that have favored the spread of other Aedes spp.-associated arboviral diseases like Dengue, Chikungunya and Zika, to northern latitudes causing epidemics in the United States and Europe, emphasizing the possibility that YFV might follow the path of these viruses unless enhanced surveillance and efficient control systems are urgently initiated. [ABSTRACT FROM AUTHOR]