1793 Philadelphia yellow fever epidemic Philadelphia forced evacuation of certain neighborhoods and placed refugees in supervised camps. After the epidemic, the city inspected all houses and destroyed those it deemed unhealthy. American doctors did not identify the vector of yellow fever until the late nineteenth century. In 1881 Carlos Finlay, a Cuban doctor, argued that mosquito bites caused yellow fever; he credited Rush's published account of the 1793 epidemic for giving him the idea. He said that Rush had written: "Mosquitoes (the usual attendants of a sickly autumn) were uncommonly numerous..." In the late 1880s, Finlay's theories were confirmed in Cuba by experiments of the
Yellow fever vaccine of age. Those travelling to areas where the disease occurs should also be immunized. Additional doses after the first are generally not needed. Yellow fever vaccine is generally safe. This includes in those with HIV infection but without symptoms. Mild side effects may include headache, muscle pains, pain at the injection site, fever, and rash. Severe allergies occur in about eight per million doses, serious neurological problems occur in about four per million doses, and organ failure occurs in about three per million doses. It is likely safe in pregnancy and therefore recommended among those who will be potentially exposed.