Yellow Fever: Adverse Reactions and Risks

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Yellow fever vaccination can lead to severe adverse reactions like anaphylaxis, neurotropic disease, and viscerotropic disease. These reactions can range from immediate hypersensitivity to rare but serious outcomes such as meningitis and multiple system organ failure. The mortality rate associated with yellow fever infection is high, emphasizing the importance of vaccination but also highlighting the risks involved. Travelers need to be aware of the potential adverse events and take necessary precautions.

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YELLOW FEVER What s the difference? WELL -DOCUMENTED ADVERSE REACTIONS

Reported in 2016 1 SEVERE REACTION Immediate Hypersensitivity or Anaphylaxis Adverse reactions to general vaccines: 0.13 per 100,000 doses 33 anaphylaxis reports (25.1 million doses) Reaction time: immediately up to the next day

Reported in 2010: YF Serious adverse events: 4.7 per 100,000 doses distributed 0.8 1.8 anaphylaxis per 100,000 doses 8.3 per 100,000 in 60 years of age 3 SEVERE REACTIONS Immediate Hypersensitivity or Anaphylaxis YEL-AND Vaccine-associated neurotropic disease YEL-AVD Vaccine-associated viscerotropic disease Reaction time: 30 minutes up to 45 days.

VACCINE- ASSOCIATED NEUROTROPIC DISEASE Serious but rarely fatal 1990 2006 29 cases of YF AND 9 meningoencephalitis (neurotropic disease) (5-24 days to onset) 8 Gullain Barr Syndrome (GBS) (7-27 days to onset) 3 Acute Disseminated Encephalomyelitis (ADEM) (7-20 days to onset) 1 Bulbar palsy 8 insufficient data to classify Symptom onset 3 28 days All cases reported in first-time recipients 53 year old male: fatality 9 days post vax . Undiagnosed HIV 56 year old male: longitudinal myelitis. Onset 45 days post vax YEL AND: 0.4 0.8 per 100,000 60 years = 1.6 per 100,000 70 years = 1.1 to 2.3 per 100,000

VACCINE- ASSOCIATED VISCEROTROPIC DISEASE YEL-AVD first described in 2001 Febrile multiple organ system failure that mimics naturally acquired YF 57 cases reported from 14 countries as of Feb 2010. Onset from vaccination 3 days (1-8 days) Time from vaccination to death 10 days (7-30 days) 65% fatality All cases reported in first-time recipients YEL-AVD: 0.3 0.4 per 100,000 doses 60 years 1.4 1.8 per 100,000 70 years 2.3 3.2 per 100,000 doses Older age History of thymus disease

OUTCOME Died 3 days after admission to hospital, 9 days after vax Undiagnosed thymoma 60 years of age www.cdc.gov/mmwr/preview/mmwrhtml/mm6410a5.htm

Discuss the overall risk for travel- associated YFV disease High mortality when YFV does occur Vaccine requirements per International Health Regulations Contraindications or precautions for vaccination Risk for serious adverse events following YF vaccine administration TIME WITH TRAVELERS Personal Protective Measures Avoid mosquito bites Proper use of Insect repellent Wearing permethrin-impregnated clothing Staying in accommodations with screened or air-condition room Use of bed nets

International Certificate of Vaccination or Prophylaxis REQUIREMENT Complete in every detail Provide a signed and dated letter on letterhead stationary clearly stating the contraindication Signed with official YF stamp Medical Contraindications to Vaccination Reasons other than medical contraindications are not acceptable for exemption from vaccination The medical waiver may not be accepted by the destination country

Quarantined for up to 6 days Requirements are mandatory; to prevent importation and transmission of YFV within a given country State and territorial health departments have the authority to designate nonfederal vaccination centers and to issue YF vaccination stamps to those centers OTHER TOPICS OF DISCUSSION Quarantined (somewhere!) Denied Entry Possibly revaccinated at point of entry (with something!) The certificate is only valid 10 days after the vaccine has been administered Didn t get the memo and the potential for remuneration

THE DIFFERENCE ASSESSMENT AND TEACHING AEDES AEGYPTI MOSQUITO Potential for 3 serious adverse events Travel consultation Mosquito prevention Health insurance while away Personal Protection Other health concerns Diabetes Heart Disease