Travel Medicine / Vaccination / Immunization Expert Forum
Yellow Fever Vaccine
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Questions in the Travel Medicine forum are answered by Dr. Philip D Parks, affiliated with Harvard School of Public Health. Topics covered include disease prevention, finding a doctor abroad, food and water safety, illness and injury abroad, mosquito and tick protection, resources for travelers, traveling with children or pets, traveling with special needs, vaccinations and immunizations.

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Yellow Fever Vaccine

Hi Doc!

I have to get a yellow fever vaccine before i travel to Africa on April 2.  I need to get it soon (today or tomorrow).  I am somewhat nervous about getting the vaccination.  I see there are some particularly severe potential side effects: i.e., viscerotropic disease and neurotropic disease.  

I am 29 years old and live in Florida, USA.  To my knowledge, I dont have any thymus disorders or immosuppresive disorders.  I have a very mild cold (perhaps just a scratchy throat).  I am otherwise in pretty good condition.  

Are my concerns warranted?  Can you please explain the risks of serious side effects for yellow fever vaccine and if there is any possibility for getting these side effects with my presumptively low-risk profile (age, health, etc.)?  If so, can you please quantify that?

Thanks!!!

J
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Hello J,

In general, the yellow fever vaccine poses very low risk to otherwise healthy persons.

Are you female or male? According to your profile, you are male. However, just to be safe, if you are female and there is a chance that you are or could be pregnant, then pay special attention to the section on the CDC website regarding pregnancy. Also, discuss this with your healthcare provider.

From the CDC Website, specific risks are quantified below:


http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm

"Vaccine Safety and Adverse Reactions
Common adverse reactions
Reactions to yellow fever vaccine are generally mild; 10%–30% of vaccinees report mild systemic adverse events. Reported events typically include low-grade fever, headache, and myalgias that begin within days after vaccination and last 5–10 days. Approximately 1% of vaccinees temporarily curtail their regular activities because of these reactions.

Severe adverse reactions
Hypersensitivity

Immediate hypersensitivity reactions, characterized by rash, urticaria, bronchospasm, or a combination of these, are uncommon. Anaphylaxis after yellow fever vaccine is reported to occur at a rate of 1.8 cases per 100,000 doses administered.

Yellow fever vaccine–associated neurologic disease (YEL-AND)

YEL-AND represents a conglomerate of different clinical syndromes, including meningoencephalitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, bulbar palsy, and Bell palsy. Historically, YEL-AND was seen primarily among infants as encephalitis, but more recent reports have been among people of all ages.

The onset of illness for documented cases is 3–28 days after vaccination, and almost all cases were in first-time vaccine recipients. YEL-AND is rarely fatal. The incidence of YEL-AND in the United States is 0.8 per 100,000 doses administered. The rate is higher in people aged ≥60 years, with a rate of 1.6 per 100,000 doses in people aged 60–69 and 2.3 per 100,000 doses in people aged ≥70 years.

Yellow fever vaccine–associated viscerotropic disease (YEL-AVD)

YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in multiple organs and often leading to multisystem organ failure and death. Since the initial cases of YEL-AVD were published in 2001, more than 50 confirmed and suspected cases have been reported throughout the world.

YEL-AVD appears to occur after the first dose of yellow fever vaccine, rather than with booster doses. The onset of illness for YEL-AVD cases averaged 3 days (range, 1–8 days) after vaccination. The case-fatality ratio for reported YEL-AVD cases is 65%. The incidence of YEL-AVD in the United States is 0.4 cases per 100,000 doses of vaccine administered. The rate is higher for people aged ≥60 years, with a rate of 1.0 per 100,000 doses in people aged 60–69 years and 2.3 per 100,000 doses in people aged ≥70 years."

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this Medhelp.org posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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