Yellow fever primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

the two ways to prevent yellow fever is vaccination and vector control. Yellow fever vaccine is recommended for persons aged ≥9 months who are traveling to or living in areas at risk for yellow fever virus transmission in South America andAfrica. Yellow fever vaccine may be required for entry into certain countries. The best way to prevent mosquitoborne diseases, including yellow fever, is to avoid mosquito bites.

Vaccination

Yellow fever vaccine is a live-virus vaccine which has been used for several decades. A single dose protects against disease for 10 years or more. If a person is at continued risk of infection, a booster dose is recommended every 10 years.

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.^,

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.

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 and Precautions for Vaccination

Contraindications	Precautions
Allergy to vaccine component Age <6 months Symptomatic HIV infection or CD4 T-lymphocytes <200/mm3 (or <15% of total in children aged <6 years)1 Thymus disorder associated with abnormal immune-cell function Primary immunodeficiencies Malignant neoplasms Transplantation Immunosuppressive and immunomodulatory therapies	Age 6–8 months Age ≥60 years Asymptomatic HIV infection and CD4 T-lymphocytes 200–499/mm3 (or 15%–24% of total in children aged <6 years)1 Pregnancy Breastfeeding

Adverse Reactions

• Reactions to yellow fever vaccine are generally mild and include headaches, myalgia (muscle aches), and low-grade fevers.
• There have been reports of rare but serious events following yellow fever vaccination.
• These events include anaphylaxis (life-threatening allergic reaction), yellow fever vaccine-associated viscerotropic disease (YEL-AVD, disease affecting certain internal organs), and yellow fever vaccine-associated neurologic disease (YEL-AND, disease affecting the nervous system).

Vector Control

Use Insect Repellent

• When you go outdoors, use an EPA-registered insect repellent such as those containing DEET, picaridin, IR3535, or oil of lemon eucalyptus on exposed skin.
• Even a short time outdoors can be long enough to get a mosquito bite.

Wear Proper Clothing to Reduce Mosquito Bites

• When weather permits, wear long-sleeves, long pants and socks when outdoors.
• Mosquitoes may bite through thin clothing, so spraying clothes with repellent containing permethrin or another EPA-registered repellent will give extra protection.
• Clothing pre-treated with permethrin is commercially available.
• Mosquito repellents containing permethrin are not approved for application directly to skin.

Be Aware of Peak Mosquito Hours

• The peak biting times for many mosquito species is dusk to dawn.
• However, Aedes aegypti, one of the mosquitoes that transmits yellow fever virus, feeds during the daytime.
• Take extra care to use repellent and protective clothing during daytime as well as during the evening and early morning.
• Staying in accommodations with screened or air-conditioned rooms, particularly during peak biting times, will also reduce risk of mosquito bites.

References

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