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Yellow Fever QA

Questions and Answers About Yellow Fever Vaccine and Recent Reports of Associated Severe Illness

(Information for Healthcare Providers)

(Further information can be found at MMWR 2001;50:343-5.)

Q. What were the clinical manifestations of the rare but severe illness recently reported in recipients of yellow fever vaccine?

A. The seven persons who were reported with severe multisystemic illness after yellow fever vaccination exhibited the following:

Onset: Within 5 days after yellow fever vaccination.

Symptoms, signs, laboratory findings: Fever, lymphocytopenia, thrombocytopenia, mild to moderate elevation of hepatocellular enzymes, hypotension, and respiratory failure occurred in all patients. Most of the patients also had headache, confusion, vomiting, myalgias, renal failure requiring hemodialysis, hyperbilirubinemia, and severe metabolic acidosis.

Q. Have these reports changed the indications or contraindications for yellow fever vaccination that are reported in the 2002 Advisory Committee on Immunization Practice (ACIP) recommendations?

A. No. Severe illnesses following yellow fever vaccination are rare. By contrast, in Africa and South America, the World Health Organization estimates that 200,000 cases of yellow fever occur each year. During the same period when five post-vaccination severe illnesses were reported in travelers, four unvaccinated European and American travelers died of yellow fever following travel to South America and West Africa.

People traveling to areas where yellow fever occurs should still be vaccinated. However, yellow fever vaccine should only be considered for persons without contraindications who are traveling to areas of yellow fever risk within Africa and South America. For further recommendations, please review the detailed information provided on the CDC Summary of Health Information for International Travel and CDC Yellow Fever Disease and Vaccine Information Web sites.

Q. If there are no changes in the recommendations, what effect will these recent reports have?

A. The potential association between yellow fever vaccine and subsequent severe multisystemic illness has initiated further investigation.

Healthcare providers are encouraged to report cases of febrile illness potentially caused by yellow fever vaccination to the CDC/FDA Vaccine Adverse Events Reporting System (VAERS) by one of the following methods:

  1. Submitting a report online at https://secure.vaers.org/VaersDataEntryintro.htm
  2. Printing a VAERS Form About PDF (23K) and faxing or mailing it using information at http://www.vaers.org/contact.htm
  3. Calling 1-800-822-7967

Persons who develop a fever

will be prioritized by VAERS for further evaluation.

Note: Because local healthcare providers need to be involved in the evaluation, reports cannot be accepted directly from individual patients.

Q. Are different brands of the yellow fever vaccine safer than others?

A. To date, there is no evidence that the two available types of yellow fever vaccine (17D-204 and 17DD strains) differ in their safety profiles. Rare systemic reactions have been reported following receipt of each vaccine strain.

Q. If a patient develops fever or other illness after receiving yellow fever vaccine, what steps should be taken?

A. If a person develops an acute febrile illness after receiving yellow fever vaccine, he/she should be evaluated by a healthcare provider and treated for other potential causes.

If no other diagnosis is clearly present, healthcare providers are encouraged to report cases of febrile illness potentially caused by yellow fever vaccination to the CDC/FDA Vaccine Adverse Events Reporting System (VAERS) by one of the following methods:

  1. Submitting a report online at https://secure.vaers.org/VaersDataEntryintro.htm
  2. Printing a VAERS Form About PDF (23K) and faxing or mailing it using information at http://www.vaers.org/contact.htm
  3. Calling 1-800-822-7967

Persons who develop a fever

will be prioritized by VAERS for further evaluation.

Note: Because local healthcare providers need to be involved in the evaluation, reports cannot be accepted directly from individual patients.

References

  Chan RC, Penney DJ, Little D, et al. Hepatitis and death following vaccination with 17D-204 yellow fever vaccine. Lancet 2001;358:121-2.
 
  Martin M, Tsai TF, Cropp B, Chang GJ, et al. Fever and multisystem organ failure associated with 17D-204 yellow fever vaccination: a report of four cases. Lancet 2001;358:98-104.
  Vasconcelos PF, Luna EJ, Galler R, et al. Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases. Lancet 2001;358:91-7.
 
Centers for Disease Control and Prevention. Notice to readers: Fever, jaundice, and multiple organ system failure associated with 17D-derived yellow fever vaccination, 1996–2001. MMWR 2001;50:343-5.
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