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Epidemiology and Incubation Period of Jaundice Following Yellow Fever Vaccination¹

1. Spatial and temporal grouping of cases of jaundice in certain barracks and units among troops having received common YFV at approximately the same time points towards a communicable disease rather than one caused by "icterogenic" vaccine.

2. Similar grouping of cases in units that received mildly "icterogenic" YFV at an earlier period tends to substantiate communicability.

3. A 36-fold increase in attack rate in the unvaccinated population over the preepidemic rate during the major epidemic adds to the probability of communicability of jaundice.

4. There is significant evidence of an incubation period ranging from 2 to 4 weeks with a mode and mean of 3.2 weeks, a standard deviation of ±0.72, and a coefficient of variation of 22.5 per cent.

5. YFV used on certain Army posts appears to have had the property of predisposing its recipients to the communicable disease referred to as jaundice. The property varied in degree among the several lots of YFV.

6. The mode of transmission of jaundice is not ascertained but the common finding of personal association suggests dissemination by droplet or physical passage from hand to mouth. Flies may act as mechanical vectors. Carriers and individuals, inapparently infected, probably play important rôles in the epidemiology of jaundice.

7. The interval of time between administration of YFV and the epidemic appearance of jaundice cannot be called an "incubation period" properly since it is not directly related to the incubation of an infectious agent.

8. It is likely that all cases of jaundice at Camp "Baker", whether they did or did not receive YFV, had a common etiology although proof must await isolation of an etiological agent and the establishment of a specific diagnostic test.

¹ Forwarded to the Surgeon General, U. S. Army on September 20, 1943 requesting publication.

² Major, Medical Corps, A.U.S. Now, Dep't. of Medicine, Univ. of Chicago.