Revisiting the Status of Yellow Fever Epizootics and Its Surveillance in South America: New Non-Human Primates, Spillover and Ecological Drivers.

Abstract

Yellow fever (YF) remains a re-emerging vector-borne zoonotic disease in tropical regions of the Americas despite the availability of an effective vaccine. In South America, the virus is maintained through a jungle transmission cycle involvingandmosquitoes and non-human primates (NHPs), which act as amplifying hosts and key epidemiological sentinels. This narrative review examines the current status of YF epizootics in South America, with a focus on the role of NHPs in viral circulation, early detection, and spillover risk to human populations. We synthesize recent evidence on epizootic patterns across endemic countries, the differential susceptibility of neotropical primates, and the ecological and environmental drivers influencing transmission, including deforestation, habitat fragmentation, and human encroachment into forested areas. In addition, we analyze current surveillance strategies, including wildlife monitoring, entomological and genomic surveillance, and their integration within a One Health framework. This review highlights that YF epizootics are expanding geographically and are closely linked to environmental change and human-ecosystem interactions. Strengthening integrated, multidisciplinary surveillance systems is essential to improve early detection, guide vaccination strategies, and prevent human outbreaks. These findings underscore the critical importance of operationalizing the One Health approach to enhance preparedness and response to YF in South America.