Yellow fever vaccine

Vaccination is the primary means of preventing yellow fever. The yellow fever vaccine offers a high level of protection, with seroconversion rates of 95% or higher for both adults and children. The duration of immunity is at least 10 years and probably lifelong. The serological response to yellow fever vaccine is not inhibited by simultaneous administration of BCG, diphtheria, pertussis, tetanus, measles and poliomyelitis vaccines. Reactions to yellow fever vaccine are generally mild. It can be given to asymptomatic patients infected with HIV but should not be given to symptomatic HIV-infected persons or other immuno-suppressed individuals. For theoretical reasons, yellow fever vaccine is not routinely recommended for pregnant women; however, there is no evidence that vaccination of a pregnant woman is associated with abnormal effects on the fetus. In an outbreak, the risk of disease would outweigh the small theoretical risk to the fetus from vaccination. Recommendations regarding yellow fever vaccination are summarized in Table 2.33.

Table 2.33 Yellow fever vaccination recommendations

Age

All individuals over 6 months of age and the members of a high-risk population should receive the vaccine; in some countries the vaccine is part of the national EPI programme and is given at the same time as measles vaccine

Dosage

A single dose of 0.5 ml

Route

Deep subcutaneous injection using a new sterile disposable needle (23 gauge) and syringe for each individual

Side effects

Some 5% of individuals develop a low-grade fever, headache or myalgia within the first 10 days after vaccination

Immediate hypersensitivity reactions with rash, urticaria or asthma occur in less than 1 per million individuals and usually among those with known egg allergy Serious adverse reactions are extremely rare: 22 cases of encephalitis have been reported to WHO since 1945, in relation to over 200 million doses of 17D yellow fever vaccine given worldwide. Most of those affected were children under 4 months of age

Contraindications

Children under 6 months of age, pregnancy, and symptomatic HIV-infected persons or other immunosuppressed individuals

Instructions for carers or recipients

The individual should be told that a low-grade fever, headache or myalgia may occur within the first 10 days after vaccination, and that if any other condition develops they should seek medical attention

Records

Each individual should receive a certificate as a record of vaccination; each individual's name should be recorded in an appropriate vaccine register

Storage

Live attenuated 17D yellow fever vaccine is heat-sensitive, and should be transported and stored either frozen or at a temperature of 4-8 °C

Reconstitution

Reconstitute with the diluent that accompanies the vaccine; follow the instructions given on the vial; always check that the vaccine is within its expiry date prior to reconstitution

Storage once reconstituted

Reconstituted vaccine is very unstable and should ideally be discarded within 1 hour, although it can last for 6 hours if kept cool

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