Yellow fever primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Primary Prevention

In 1937 Max Theiler working at the Rockefeller Foundation developed a vaccine for yellow fever that gives a ten-year or more immunity from the disease and effectively protects people traveling to affected areas, while at the same time being a means to control the disease. Woodcutters working in tropical areas should be particularly targeted for vaccination. Insecticides, protective clothing, and screening of houses are helpful but not always sufficient for mosquito control; people should always use an insecticide spray while in certain areas. In affected areas mosquito control methods have proven effective in decreasing the number of cases. Recent studies have noted the increase in the number of areas affected by mosquito-borne viral infections and have called for further research and funding for vaccines.^,

Vaccination

Indications

• Persons 9 months of age or older traveling to or living in a country that requires yellow fever vaccination for certain travelers. Check with your health-care provider.

• Persons 9 months of age or older traveling to a country that does not require yellow fever vaccination but is located in an area where the risk of yellow fever is known to exist. Check with your health-care provider.

Information about known or probable infected areas is available from the World Health Organization (http://www.who.int), the Pan American Health Organization (http://www.paho.org), and CDC (http://www.cdc.gov/travel).

If you continue to live or travel in yellow fever-endemic areas, you should receive a booster dose of yellow fever vaccine after 10 years. Yellow fever vaccine may be given at the same time as most other vaccines.

Contraindications

• Persons who have ever had a life-threatening allergic reaction to eggs, chicken, gelatin or to a previous yellow fever vaccine.
• Infants younger than 9 months of age. For infants 6 to 8 months of age who cannot avoid travel to a yellow fever area, discuss vaccination with their doctor. Under no circumstances should infants younger than 6 months of age be vaccinated.
• Pregnant women and nursing mothers should avoid or postpone travel to a yellow fever area. If travel cannot be avoided, discuss vaccination with your doctor.
• Check with your doctor before getting yellow fever vaccine if: you have a history of allergy to eggs, chicken, or gelatin; you have HIV/AIDS or another disease that affects the immune system; you have been under treatment for 2 weeks or longer with drugs that affect the immune system, such as steroids; you have any kind of cancer; you are taking cancer treatment with X-rays or drugs; your thymus gland has been removed, or if you have a history of problems with your thymus, such as myasthenia gravis, DiGeorge syndrome, or thymoma.
• If you are 65 or older, discuss with your physician the risks and benefits of vaccination in the context of your risk for exposure to yellow fever virus based on your destination.
• If you cannot get the vaccine because of a medical reason and proof of yellow fever vaccination is required for your travel, your doctor can give you a waiver letter. When planning to use a waiver letter, you should also obtain specific advice from the embassy of the country or countries you plan to visit.
• If you cannot get the vaccine, discuss with your doctor other ways to prevent yellow fever.

Risks of Vaccine

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Reactions are less likely to occur after a booster dose of yellow fever vaccine than after the first dose.

Mild Problems

• soreness, redness, or swelling where the shot was given
• fever
• aches
• If these problems occur, they usually begin soon after the shot and last for 5-10 days. In studies, they occurred in as many as 25% of vaccine recipients.

Severe Problems

• Life-threatening allergic reaction (approximately 1 reported per 131,000 doses).
• Severe nervous system reactions (approximately 1 reported per 150,000-250,000 doses).
• Life-threatening severe illness with major organ system failure (approximately 1 reported per 200,000-300,000 doses, or 1 reported per 40,000-50,000 doses in people 60 years of age and older). More than half of the people who suffer these side effects die.

Moderate or Severe reaction

• Look for any unusual condition, such as a high fever, behavior changes, or flu-like symptoms that occur 1-30 days after vaccination. Signs of an allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat, or dizziness within a few minutes to a few hours after the shot.
• Call a doctor, or get the person to a doctor right away.
• Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
• Ask your health care provider to file a Vaccine Adverse Event Reporting System (VAERS) form if you have any reaction to the vaccine. Or call VAERS yourself at 1-800-822-7967, or visit their website at http://vaers.hhs.gov.

The National Vaccine Injury Compensation Program

In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed. For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at http://www.hrsa.gov/vaccinecompensation.

References

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