YELLOW FEVER VACCINE INJ

Clinical Criteria Summary

Recommended for travelers traveling to or living in areas at risk for yellow fever transmission in South America and Africa
May be required for entry into certain countries
Prevention is critical to lower disease risk and mortality due to the absence of specific antiviral treatment

Acute hypersensitivity to a prior dose of YF vaccine or any of its components
Severely immunosuppressed individuals
Thymic disorders with abnormal immune function (e.g., myasthenia gravis, thymoma)
Women who are breastfeeding an infant younger than 9 months of age

Severe allergic reactions: Patients should be monitored for 15 minutes
YF vaccine associated viscerotropic disease: Age greater than 60 years is a risk factor
YF vaccine associated neurotropic disease: Age greater than 60 years and immunosuppression are risk factors
Should not be administered intravascular, intramuscular or intradermal
Syncope
Testing for hypersensitivity can be considered for those with egg hypersensitivity
Rate of seroconversion is reduced in those with HIV infection; documentation of protective antibody is recommended before travel
Pregnancy
Lactation: Vaccine-associated neurotropic disease has been reported in infants less than one month of age who were exclusively breastfed by vaccinated mothers
Increased risk of severe adverse events in individuals 60 years of age or older

Common: Fever, headache, backache, myalgias, injection site inflammation
Severe/Uncommon: Hypersensitivity reactions (including anaphylaxis), YF vaccine associated neurologic disease (meningoencephalitis or Guillain-Barre), YF vaccine associated viscerotropic disease (mimics yellow fever, can result in multi-organ failure and death)

Reconstitute freeze-dried, lyophilized live-attenuated strain (17D) with supplied sodium chloride diluent
Allow mixture to sit for 1-2 minutes before swirling carefully until uniform
Using aseptic technique and a separate needle and syringe, withdraw 0.5 mL
Administer as a 0.5 mL subcutaneous injection to the upper-outer triceps
Must be given within 60 minutes of reconstituting the vial
Protective antibodies take 7-10 days to develop; international certificates are valid beginning 10 days after vaccination date

Other live-attenuated viral vaccines: Should be given at the same time or at least 30 days apart
Oral typhoid vaccine and inactivated vaccines: Can be administered at any time relative to YF vaccine
PPD testing: Should be performed before or on the same day as YF vaccine, or 4 or more weeks after

General protection is long-lasting; routine booster requirement was removed per 2014 WHO policy (travelers should verify specific entry requirements)
ACIP recommends an additional dose(s) for:
Women who were pregnant when first vaccinated (receive 1 additional dose)
Hematopoietic stem cell transplant recipients vaccinated prior to transplantation (receive additional post-transplant dose before next travel; must be sufficiently immunocompetent)
HIV+ patients (booster every 10 years if no contraindications or precautions exist)
Travelers who received initial vaccination at least 10 years ago and are at higher risk (e.g., prolonged stay in an endemic area)

Document date of vaccination, product name, lot number, expiration date, injection site, and name of person administering the vaccine
Document any precautions or contraindications and planned travel destinations
Report adverse events to VA ADERS as a MedWatch report
Serious adverse events are defined as: death or life-threatening events; hospitalization or prolongation of an existing hospitalization; persistent or significant incapacity/substantial disruption of normal life functions; congenital anomaly/birth defect; or medical/surgical intervention needed to prevent death, life-threatening event, hospitalization, disability, or congenital anomaly

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