Yellow fever vaccine dose

Yellow Fever VIS

Current Edition Date: 3/30/2011

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What You Need to Know

What is yellow fever?

Yellow fever is a serious disease caused by the yellow fever virus. It is found in certain parts of Africa and South America.

Yellow fever is spread through the bite of an infected mosquito. It cannot be spread person to person by direct contact.

People with yellow fever disease usually have to be hospitalized. Yellow fever can cause:

  • fever and flu-like symptoms
  • jaundice (yellow skin or eyes)
  • bleeding from multiple body sites
  • liver, kidney, respiratory and other organ failure
  • death (20% – 50% of serious cases)

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How can I prevent yellow fever?

Yellow fever vaccine

Yellow fever vaccine can prevent yellow fever.

Yellow fever vaccine is given only at designated vaccination centers.

After getting the vaccine, you should be given a stamped and signed “International Certificate of Vaccination or Prophylaxis” (yellow card). This certificate becomes valid 10 days after vaccination and is good for 10 years.

You will need this card as proof of vaccination to enter certain countries. Travelers without proof of vaccination could be given the vaccine upon entry or detained for up to 6 days to make sure they are not infected.

Discuss your itinerary with your doctor or nurse before you get your yellow fever vaccination. Consult your health department or visit CDC’s travel information website to learn yellow fever vaccine requirements and recommendations for different countries.

Other preventive measures

Another way to prevent yellow fever is to avoid mosquito bites by:

  • staying in well-screened or air-conditioned areas,
  • wearing clothes that cover most of your body,
  • using an effective insect repellent, such as those containing DEET.

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Yellow fever vaccine

Yellow fever vaccine is a live, weakened virus. It is given as a single shot. For people who remain at risk, a booster dose is recommended every 10 years.

Yellow fever vaccine may be given at the same time as most other vaccines.

Who should get yellow fever vaccine?

  • Persons 9 months through 59 years of age traveling to or living in an area where risk of yellow fever is known to exist, or traveling to a country with an entry requirement for the vaccination.
  • Laboratory personnel who might be exposed to yellow fever virus or vaccine virus.

Information for travelers can be found online through CDC travel, the World Health Organizationexternal icon, and the Pan American Health Organizationexternal icon.

You should not donate blood for 14 days following the vaccination, because there is a risk of transmitting the vaccine virus through blood products during that period.

Who should not get yellow fever vaccine?

  • Anyone with a severe (life-threatening) allergy to any component of the vaccine, including eggs, chicken proteins, or gelatin, or who has had a severe allergic reaction to a previous dose of yellow fever vaccine should not get yellow fever vaccine. Tell your doctor if you have any severe allergies.
  • Infants younger than 6 months of age should not get the vaccine.
  • Tell your doctor if:
    • You have HIV/AIDS or another disease that affects the immune system.
    • Your immune system is weakened as a result of cancer or other medical conditions, a transplant, or radiation or drug treatment (such as steroids, cancer chemotherapy, or other drugs that affect immune cell function).
    • Your thymus has been removed or you have a thymus disorder, such as myasthenia gravis, DiGeorge syndrome, or thymoma.

    Your doctor will help you decide whether you can receive the vaccine.

  • Adults 60 years of age and older who cannot avoid travel to a yellow fever area should discuss vaccination with their doctor. They might be at increased risk for severe problems following vaccination.
  • Infants 6 through 8 months of age, pregnant women, and nursing mothers should avoid or postpone travel to an area where there is risk of yellow fever. If travel cannot be avoided, discuss vaccination with your doctor.

If you cannot get the vaccine for medical reasons, but require proof of yellow fever vaccination for travel, your doctor can give you a waiver letter if he considers the risk acceptably low. If you plan to use a waiver, you should also contact the embassy of the countries you plan to visit for more information.

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What are the risks from yellow fever vaccine?

A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely low.

Mild problems

Yellow fever vaccine has been associated with fever, and with aches, soreness, redness or swelling where the shot was given.

These problems occur in up to 1 person out of 4. They usually begin soon after the shot, and can last up to a week.

Severe problems

  • Severe allergic reaction to a vaccine component (about 1 person in 55,000).
  • Severe nervous system reaction (about 1 person in 125,000).
  • Life-threatening severe illness with organ failure (about 1 person in 250,000). More than half the people who suffer this side effect die.

These last two problems have never been reported after a booster dose.

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What if there is a serious reaction?

What should I look for?

  • Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

  • If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
  • Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.

VAERS is only for reporting reactions. They do not give medical advice.

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How can I learn more?

  • Ask your doctor.
  • Contact your local or state health department.
  • Contact the Centers for Disease Control and Prevention (CDC):
    • Call 1-800-232-4636 (1-800-CDC-INFO)
    • Visit CDC’s website at:
      Traveler’s Health
      Yellow Fever
      Yellow Fever Vaccination

Many Vaccine Information Statements are available in español and other languages. See http://www.immunize.org/visexternal icon.

Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite http://www.immunize.org/vis/vis_spanish.aspexternal icon

Vaccine Information Statement (Interim)
Yellow Fever Vaccine (3/30/2011)

Office Use Only

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By Michael Le Page

Cancer doctor Martin Gore may have died as the result of yellow fever vaccine

Institute of Cancer Research/The Royal Marsden

On 10 January, renowned cancer doctor Martin Gore of the Royal Marsden Hospital in London died of organ failure shortly after getting the yellow fever vaccine, according to the Times newspaper. This has led to concern about the vaccine’s safety, particularly for older people – Gore was 67. Here’s what we know:

What is yellow fever?
It’s a mosquito-borne virus found in Africa, South America and the Caribbean. People infected with the virus develop flu-like symptoms. About 85 per cent of people recover but in 15 per cent it damages the liver and kidneys, causing internal bleeding that is often fatal. In recent years there have been a series of outbreaks in Africa, leading to a vaccine shortage. There are also fears the virus could spread to Asia.

Did the yellow fever vaccine cause Gore’s death?
We don’t know, contrary to some reports. The case should now go to the agency responsible for vaccine safety in the UK, the Medicines and Healthcare products Regulatory Agency, which will determine if the vaccine was the cause of death.

Could the vaccine have killed him?
Yes, although it is exceedingly unlikely. The yellow vaccine is a live vaccine – a harmless variant of the wild virus. In around 1 in 250,000 people, according to the US Centers for Disease Control (CDC), it causes “yellow fever vaccine-associated viscerotropic disease” – serious damage to internal organs.

How many people have died as a result of the vaccine?
Of the hundreds of millions given the yellow fever vaccine since it was introduced in 1936, there have been just 62 confirmed cases and 35 deaths from vaccine-associated viscerotropic disease, according to a 2016 study. It’s likely that cases have been missed in poor countries, but because the condition is so serious it is unlikely to go unnoticed in rich countries.

Are there other risks of having the vaccine?
About one person in 55,000 experiences a severe allergic reaction to a vaccine component and one person in 125,000 experiences severe nervous system reaction. So overall the risk of serious side effects is very low, but still higher than other vaccines, where the risk is typically one in several million, says Ron Behrens of the London School of Hygiene & Tropical Medicine.

Read more: A yellow fever epidemic has hit central Africa. Is Asia next?

Are older people more vulnerable?
Yes, it appears people aged over 55 are several times more likely to develop vaccine-associated viscerotropic disease than younger people, although the overall risk remains very low. According to a 2013 paper, vaccination of older people should be based on a careful risk-benefit analysis.

So should people get the vaccine?
Behrens thinks all travellers – whatever their age – should weigh the risks of vaccination versus the risks of getting the disease, and decide for themselves, although in some countries it is mandatory for entry. He points out that people travelling to countries like Kenya, where there have been no cases of yellow fever for decades, are often still advised to get vaccinated. Yet in this case the risks of vaccination may outweigh the benefits.

But isn’t it selfish not to get vaccinated?
It is if you live in a country where a disease is spreading. But travellers visiting an area for a week or two are very unlikely to get ill and spread yellow fever to others. Cases in returning travellers are extremely rare, says Behrens. “In this case, the vaccination is for your own benefit.”

What causes yellow fever vaccine-associated viscerotropic disease?
We don’t know. The leading hypothesis is that a few rare individuals have little defence against the vaccine strain of the virus, so it does as much damage as the wild virus.

Can it be prevented?
In theory, a vaccine that does not contain a live virus might prevent all cases of vaccine-associated viscerotropic disease. A 2010 paper called for the replacement of the current yellow fever vaccine for this reason, and a number of new vaccines are already being tested. But establishing the safety and efficacy of new vaccines takes time and money.

More on these topics:

  • vaccines

Yellow Fever Vaccine

Yellow fever is a serious disease caused by a virus that is spread through the bite of an infected mosquito. Yellow fever can cause fever and flu-like illness, jaundice (yellowing of the eyes and skin), liver failure, lung failure, kidney failure, vomiting of blood, and possibly death.

Yellow fever vaccine is recommended for people who plan to live in or travel to areas where yellow fever is known to exist, or those who are otherwise at high risk of coming into contact with the virus.

This vaccine is used to help prevent yellow fever in adults and children who are at least 9 months old. The vaccine works by exposing you to a small dose of the virus, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.

You should receive the vaccine at least 10 days prior to your arrival in an area where you may be exposed to the virus.

This vaccine is also recommended for people who work in a research laboratory and may be exposed to yellow fever virus through needle-stick accidents or inhalation of viral droplets in the air.

Like any vaccine, the yellow fever vaccine may not provide protection from disease in every person.

You should not receive a booster vaccine if you had a life threatening allergic reaction after the first shot.

You should not receive this vaccine if you have ever had a life-threatening allergic reaction to a yellow fever vaccine, or if you have:

  • an allergy to gelatin, eggs, or chicken proteins;
  • cancer, leukemia, or lymphoma;
  • a weak immune system caused by disease (such as cancer or HIV), or by taking certain medicines such as steroids;
  • a disorder such as myasthenia gravis;
  • a disease or tumor of the thymus gland, or if your thymus has been surgically removed; or
  • if you have received a transplant.

If you have a high risk of exposure to yellow fever, you may need to receive the vaccine even if you have an allergy to eggs or chicken products. Your doctor can give you the vaccine in several small doses to avoid an allergic reaction.

In special cases, a doctor or health official may determine that a child between 6 and 9 months old should receive a yellow fever vaccine. Children younger than 6 months old should not receive this vaccine.

To make sure yellow fever vaccine is safe for you, tell your doctor if you have ever had:

  • a seizure;
  • a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine);
  • a bleeding or blood clotting disorder such as hemophilia;
  • Guillain Barré syndrome; or
  • an allergy to latex.

You can still receive a vaccine if you have a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.

It is not known whether yellow fever vaccine will harm an unborn baby. However, if you are at a high risk for infection with yellow fever during pregnancy, your doctor should determine whether you need this vaccine.

You should not receive this vaccine if you are breast-feeding a baby.

Yellow fever

Vaccine

The 17D vaccine, which is based on a live, attenuated viral strain, is the only commercially available yellow fever vaccine. It is given as a single subcutaneous (or intramuscular) injection. Yellow fever vaccine is highly effective (approaching 100%). All individuals aged 9 months or older and living in countries or areas at risk should receive yellow fever vaccine.

Precautions and contraindications

With the exception of very rare cases of vaccine-associated neurotropic and viscerotropic disease (see below), the 17D vaccine is generally considered to be safe. Contraindications include severe hypersensitivity to egg antigens and severe immunodeficiency. Conditions and treatments considered to be severely immunocompromising include: primary immunodeficiencies, thymus disorder, symptomatic HIV infection or CD4 T-cell values 200>

Noting that yellow fever vaccine is a live vaccine, a riskbenefit assessment should be undertaken for all pregnant and lactating women. In areas where YF is endemic, or during outbreaks, the benefits of YF vaccination are likely to far outweigh the risk of potential transmission of vaccine virus to the fetus or infant. Pregnant women and nursing mothers should be counselled on the potential benefits and risks of vaccination so that they may make an informed decision about vaccination. Lactating women should be advised that the benefits of breastfeeding far outweigh alternatives. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed.

The YF vaccine is contraindicated in infants under 6 months of age and is not recommended for those aged 6–8 months, except during epidemics when the risk of YFV transmission may be very high.

Viscerotropic disease: Vaccine-associated viscerotropic disease is a recently described adverse event that on very rare occasions has occurred after the first immunization with the yellow fever 17D vaccine. Onset is within 10 days of vaccination and the pathological process is characterized by severe multi-organ failure and an overall case–fatality rate in excess of 60%. Known risk factors include a history of thymus disease (e.g. thymoma or thymectomy) and age ≥60 years. In the USA the risk of contracting viscerotropic disease after YF vaccination for persons over 70 years of age is estimated to be 2.4 cases/100 000 vaccine doses.

Neurotropic disease: Increased incidence of vaccine-associated neurotropic disease (e.g. meningoencephalitis, acute disseminated encephalomyelitis and Guillain–Barré syndrome) has been reported in infants under 6 months of age and in vaccine recipients aged 60 years and older. The reported rate of vaccine-associated neurotropic disease in travellers from the United States and Europe ranges between 0.13 and 0.8 per 100 000 doses.

Yellow fever vaccination is required for travellers to certain countries and is recommended for all travellers to countries or areas with risk of yellow fever transmission (see Country list and Annex 1).

While yellow fever vaccination should be encouraged as a key prevention strategy, it is important to screen travel itineraries and carefully evaluate the potential risk of systemic illness after yellow fever vaccination. Great care should be exercised not to prescribe yellow fever vaccination to individuals who are not at risk of exposure to infection, based on an accurate assessment of the travel itinerary. Although vaccination is generally not recommended for travellers going to areas where the risk of exposure is low, any risk (e.g. as a result of prolonged travel or heavy exposure to mosquito bites) should be weighed against individual risk factors for vaccineassociated adverse events (e.g. altered immune status).

Type of vaccine: Live, attenuated

Number of doses: One dose of 0.5 ml

Boosters: A single dose of YF vaccine is sufficient to confer sustained lifelong protective immunity against YF disease; a booster dose is not necessary for protection but may still be required by some countries. Adjustments of the provisions for the duration of validity of certificates under the IHR are ongoing.

Contraindications: Infants aged less than 6 months; history of severe allergy to egg or to any of the vaccine components, or hypersensitivity to a previous dose of the vaccine; thymoma or history of thymectomy, immunodeficiency from medication, disease or symptomatic HIV infection

Adverse reactions: Rarely, neurological (encephalitis) or multi-organ failure resembling wild-type yellow fever.

Before departure: International certificate of vaccination becomes valid 10 days after vaccination.

Recommended for: All travellers to countries and areas with risk of yellow fever transmission and when required by countries.

Special precautions:Not recommended for infants aged 68 months, except during epidemics when the risk of YF virus transmission may be very high. The risks and benefits of vaccination in this age group should be carefully considered before vaccination. The vaccine should be avoided during pregnancy or breastfeeding. However, pregnant or nursing women may be vaccinated during epidemics or if travel to a country or area at risk of transmission is unavoidable.

Fractional Yellow Fever Vaccine Dose Remains Protective After a Decade

A new study shows a fractional dose of yellow fever vaccine is not just a good stop-gap measure, but can actually provide long-term protection.
Yellow fever is an incurable, highly fatal acute hemorrhagic viral disease spread by mosquitoes. It gets its name from the fact that in some patients, the disease is accompanied by jaundice. Other symptoms include fever, headaches, muscle pain, fatigue, and vomiting. According to the World Health Organization (WHO), as many as half of the people who become infected with the virus will die from it. The virus is currently endemic in Africa, Central America, and South America.
The good news is that there is a highly effective vaccine that can prevent yellow fever. The bad news is that vaccine supplies are often lacking in affected areas. Thus, when an outbreak occurs, local officials are frequently left scrambling to find sufficient vaccine supplies.
Investigators from the Leiden University Medical Center, in the Netherlands, wanted to know whether the strategy of providing fractional doses—one-fifth of the normal amount—was a good long-term strategy for dealing with vaccine shortages.
In findings published last week, the team followed up with a group of patients who had received fractional doses 10 years ago.
The results were encouraging—the patients remained protected.
First author Anna H.E. Roukens, MD, PhD, of Leiden University Medical Center, told Contagion® that at the time the patients were given the fractional dose, it was not yet clear how long the protection might last or whether a booster might be needed. However, in the intervening years, it’s become clear that the fractional dose provides long-term coverage.
Thirty-nine of 40 people who received fractional doses still had protective levels of yellow fever-neutralizing antibodies after a decade. That’s virtually identical to the 34 of 35 people who still had protection after receiving full doses.
“We were actually not surprised by the results, as we had already demonstrated that the fractional dose was noninferior to the standard dose a year after vaccination,” she said. “The immune response is unlikely to change after this period, and so to us, the response after a year equals the response after 10 years and more.”
Those findings are good news for patients in the Democratic Republic of Congo (DRC), one of the most recent countries where the fractional-dose strategy was widely used to control an outbreak.
Back in 2016, yellow fever broke out in Angola and the DRC. In the latter country, public health officials adopted a strategy that called for 10.5 million at-risk individuals to be vaccinated against the disease. The problem? The WHO had only 5.8 million doses available. In response, Congolese officials decided to ration the vaccine, giving patients just 0.1 ml of the vaccine instead of the standard 0.5 ml dose.
According to an August New England Journal of Medicine article discussing the event, the rationing strategy is effective because a typical vaccine dose far exceeds the amount of vaccine the WHO says is necessary to protect someone. On average, commercially available vaccines have between 12,874 and 43,651 international units (IU). The WHO suggests vaccines have at least 1000 IUs.
“In principle, the quantity of vaccine virus in fractional doses of standard vaccine would therefore still exceed the WHO’s minimum requirement,” Kirsten Vannice, PhD, MHS, of the US Centers for Disease Control and Prevention, and colleagues wrote.
Still, Dr. Vannice, writing this summer, said additional research is needed to confirm the efficacy of the strategy, including larger studies. And although the Dutch study demonstrates the long-lasting efficacy of fractional doses, it was also based on just 75 study enrollees, less than half of the 155 people who initially enrolled in the study and were given the vaccine.
The study, “Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial,” was published December 4 in the Annals of Internal Medicine.

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Reactions to Yellow Fever Vaccine

Reactions to yellow fever vaccine are generally mild and include headaches, muscle aches, and low-grade fevers. Rarely, people develop severe, sometimes life-threatening reactions to the yellow fever vaccine, including:

  • Allergic reaction, including difficulty breathing or swallowing (anaphylaxis)
  • Swelling of the brain, spinal cord, or the surrounding tissues (encephalitis or meningitis)
  • Guillain-Barré syndrome, an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis.
  • Internal organ dysfunction or failure

If you recently received the yellow fever vaccination and develop fever, headache, tiredness, body aches, vomiting, or diarrhea, see your healthcare provider.

Some people may have an increased risk of developing a reaction to the vaccine, but may still benefit from being vaccinated. These people, or their guardians, should talk to a healthcare provider about getting vaccinated:

  • Between 6 and 8 months old
  • Over 60 years old
  • Pregnant
  • Breastfeeding

To learn more about reactions to the yellow fever vaccine and who should or should not receive it, visit the Vaccine Information Statement page.

Yellow Fever Vaccine, Live suspension for injection

What is this medicine?

YELLOW FEVER VACCINE, LIVE (YEL oh FEE ver vax EEN) is used to prevent infection from yellow fever virus. The vaccine is recommended if you travel to parts of the world where yellow fever is common.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): STAMARIL, YF-Vax

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • active infection with fever

  • cancer

  • HIV or AIDS

  • immune system problems

  • myasthenia gravis

  • recent or ongoing radiation therapy

  • thymectomy

  • an unusual or allergic reaction to vaccines, eggs, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

This medicine is for injection under the skin. It is given by a health care professional in a hospital or clinic setting.

A copy of the Vaccine Information Statements will be given before each vaccination. Read this sheet carefully each time. The sheet may change frequently.

Talk to your pediatrician regarding the use of this medicine in children. While this vaccine may be prescribed for children as young as 9 months of age for selected conditions, precautions do apply. This vaccine is not for infants under 9 months of age.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply.

What may interact with this medicine?

  • chloroquine

  • immune globulin

  • medicines for organ transplant

  • medicines to treat cancer

  • other vaccines

  • some medicines for arthritis

  • steroid medicines like prednisone or cortisone

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

This vaccine, like all vaccines, may not fully protect everyone.

Report any side effects that are worrisome to your doctor right away.

After getting the vaccine, you will be given a signed international certificate (yellow card) as proof of receiving the vaccine. The certificate is good for 10 years.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • breathing problems

  • confusion, trouble speaking or understanding

  • seizures

  • trouble walking

  • unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • fever

  • headache

  • pain, redness, or irritation at site where injected

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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