{
  "abstract": "Background\n\nYellow fever (YF) reemerged in Colombia's Andean region during 2024-2025, outside the country's historically recognized endemic areas. We characterized critically ill adults admitted during this outbreak and described clinical features, organ dysfunction, supportive care, and in-hospital outcomes.Methods\n\nWe conducted a prospective observational cohort study of consecutive adults with reverse transcription polymerase chain reaction (RT-PCR)-confirmed YF admitted to the national referral intensive care unit in Ibagué, Tolima, Colombia, from March through September 2025. Clinical, laboratory, complication, intervention, and outcome data were prospectively captured using a standardized case report form.Results\n\nSixty-one patients were analyzed; 22 died (36.1%). Non-survivors had lower platelet counts and fibrinogen and higher INR, aminotransferases, lactate dehydrogenase, and creatinine at ICU admission. Shock, acute kidney injury, acute respiratory distress syndrome, disseminated intravascular coagulation, and severe bleeding were more frequent among non-survivors. Prior YF vaccination was self-reported by 10 patients (16.4%).Conclusions\n\nSevere YF in this Andean outbreak was characterized by hepatic-coagulation abnormalities and multisystem organ dysfunction. The occurrence of critical illness outside historically recognized endemic areas supports surveillance and vaccination strategies that can adapt to changing epidemiological risk.",
  "abstract_shown": true,
  "affiliations": [
    "Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chía, Colombia.",
    "Clinical and Translational Medicine Research Group, Critical Physiology Subdivision, Intensive Care Department, Hospital Federico Lleras Acosta, Ibagué, Colombia.",
    "School of Medicine, Faculty of Health Sciences, Universidad del Tolima, Ibagué, Colombia.",
    "Biosciences PhD Program, School of Engineering, Universidad de La Sabana, Chía, Colombia.",
    "Department of Critical Care Medicine, Clínica Keralty, Ibagué, Colombia.",
    "Doctorado en Ciencias Clínicas, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia.",
    "School of Medicine, Universidad Salud Colombia, Ibagué, Colombia.",
    "Department of Critical Care Medicine, Clínica Universidad de La Sabana, Chía, Colombia.",
    "Department of Critical Care Medicine, Extracorporeal Life Support Unit, Fundación Clínica Shaio, Bogotá, DC, Colombia.",
    "Department of Pediatric Nephrology, Fundación Valle del Lili, Cali, Colombia.",
    "ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, UK."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3,
        4
      ],
      "name": "Alex Julián Forero-Delgadillo",
      "orcid": "0000-0003-2924-5151"
    },
    {
      "affs": [
        0,
        1,
        2,
        4,
        5,
        6
      ],
      "name": "Jeison Andrés Morales-Olivera",
      "orcid": "0000-0002-4076-9127"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Paula O Narvaez-Ramirez",
      "orcid": "0000-0001-9099-646X"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Natalia Sanabria-Herrera",
      "orcid": "0009-0003-3790-4740"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Valeria Aguirre Gutierrez",
      "orcid": "0009-0003-5846-8781"
    },
    {
      "affs": [
        0
      ],
      "name": "Lina F Martinez-Lemus",
      "orcid": "0009-0007-4295-168X"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Cristian C Serrano-Mayorga",
      "orcid": "0000-0001-8344-0535"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Diana Catalina Ramírez-Reyes"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Juan Diego Melo-Pedraza",
      "orcid": "0009-0005-7631-2283"
    },
    {
      "affs": [
        1,
        2,
        4
      ],
      "name": "Julián Celis-Guzmán",
      "orcid": "0000-0002-5793-4803"
    },
    {
      "affs": [
        1,
        4
      ],
      "name": "Gustavo González-Varona",
      "orcid": "0009-0002-1968-5145"
    },
    {
      "affs": [
        5,
        8
      ],
      "name": "Henry Robayo-Amortegui",
      "orcid": "0000-0003-4613-1703"
    },
    {
      "affs": [
        9
      ],
      "name": "Jessica María Forero",
      "orcid": "0000-0002-6526-757X"
    },
    {
      "affs": [
        0
      ],
      "name": "Erwin Hernandez",
      "orcid": "0000-0002-7189-5863"
    },
    {
      "affs": [
        0
      ],
      "name": "Ingrid G Bustos",
      "orcid": "0000-0002-6540-2815"
    },
    {
      "affs": [
        10
      ],
      "name": "Sara Duque",
      "orcid": "0000-0002-6616-8354"
    },
    {
      "affs": [
        10
      ],
      "name": "Esteban Garcia-Gallo",
      "orcid": "0000-0002-8030-9985"
    },
    {
      "affs": [
        0,
        7,
        10
      ],
      "name": "Luis F Reyes",
      "orcid": "0000-0003-1172-6539"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/erqmp2qef9gn4.bib",
  "cited_by": 0,
  "doi": "10.1093/ofid/ofag636",
  "fulltext_url": "https://europepmc.org/articles/PMC13684397",
  "id": "erqmp2qef9gn4",
  "issns": [
    "2328-8957"
  ],
  "landing_url": "https://europepmc.org/article/MED/42909258",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Mosquito-borne diseases and control"
    ]
  ],
  "openalex": "W7223082297",
  "pdf_url": "https://europepmc.org/articles/PMC13684397?pdf=render",
  "pmcid": "PMC13684397",
  "pmid": "42909258",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/erqmp2qef9gn4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42909258",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42909258"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Mosquito-borne diseases and control",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Characterization of an Unusual Severe Yellow Fever Outbreak in the Colombian Andean Region.",
  "title_text": "Characterization of an Unusual Severe Yellow Fever Outbreak in the Colombian Andean Region.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/erqmp2qef9gn4",
  "venue": "Open forum infectious diseases",
  "versions": []
}