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{{Yellow fever}}
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==Overview==
==Overview==
The two methods to prevent yellow fever are 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 and Africa.  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.


==Primary Prevention==
==Vaccination==
==Vaccination==
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. [[Insecticide]]s, 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.<ref>{{cite web|url=http://www.epa.gov/pesticides/health/mosquitoes/mosquitojoint.htm#programs |title= Joint Statement on Mosquito Control in the United States from the U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control and Prevention (CDC) |accessmonthday= June 25 |accessyear=2006 |date= 2000-05-03| |format=PDF |publisher=Environmental Protection Agency |}}</ref>
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.
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.<ref name=Pugachev_2005>{{cite journal | author=Pugachev KV, Guirakhoo F, Monath TP | title=New developments in flavivirus vaccines with special attention to yellow fever | journal=Curr Opin Infect Dis | year=2005 | pages=387-94 | volume=18 | issue=5 | id=PMID 16148524}}</ref><sup>,</sup><ref name=Petersen_2005>{{cite journal | author=Petersen LR, Marfin AA | title=Shifting epidemiology of Flaviviridae | journal=J Travel Med | year=2005 | pages=S3-11 | volume=12 Suppl 1 | id={{PMID|16225801}} }}</ref>


====Indications====
====Indication====
*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.
*People aged ≥9 months who are traveling to or living in [[Yellow fever primary prevention#Countries with Increased Risk of Yellow Fever|areas with risk for yellow fever virus]] transmission in South America and Africa.
*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.
====Vaccine Administration====
*For all eligible people, a single injection of reconstituted vaccine should be administered subcutaneously.
*'''Name: 17D yellow fever vaccine'''
*''' Trade Name: YF-Vax®'''
*'''Dose: 0.5 mL²'''
*'''Route: SC'''
*The International Health Regulations (IHR) published by the World Health Organization (WHO) require revaccination at 10-year intervals.
* Recommendations for storage of yellow fever vaccine include the following:
:* The vaccine should be transported and stored between +2°C (35°F) and+8°C (46°F).
:* Manufacturer's recommendations for vaccine storage must be observed.
:* The vaccine should not be used after the expiration date printed on the vial.
* Since YF-VAX® does not contain a preservative, all reconstituted vaccine and containers must be appropriately discarded if they are not used within 1 hour. This includes the multi-dose (5-dose) vials.


====Contraindications and Precautions for Vaccination====
====Contraindications and Precautions for Vaccination====
Line 39: Line 48:
|}
|}


====Risks of Vaccine====
====Adverse Reactions====
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.  
*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, 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).


=====Mild Problems=====
{| style="border: 0px; font-size: 85%; margin: 3px; width:900px;" align=center
*soreness, redness, or swelling where the shot was given
|valign=top|
*fever
|+
*aches
! style="background: #4479BA; color:#FFF;  width: 400px;" |  Yellow fever vaccine–associated neurologic disease (YEL-AND)
*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.  
! style="background: #4479BA; color:#FFF;  width: 400px;" |  Yellow fever vaccine–associated viscerotropic disease (YEL-AVD)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
*YEL-AND represents a conglomerate of different clinical syndromes, including meningoencephalitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, and rarely, bulbar and Bell palsies.
*Historically, YEL-AND was seen primarily among infants as encephalitis, but more recent reports have been among people of all ages.
*The onset of illness for documented cases is 3–28 days after vaccination, and almost all cases were in first-time vaccine recipients.
*YEL-AND is rarely fatal. The incidence of YEL-AND in the United States is 0.8 per 100,000 doses administered.
*The rate is higher in people aged ≥60 years, with a rate of 1.6 per 100,000 doses in people aged 60–69 years and 2.3 per 100,000 doses in people aged ≥70 years.
| style="padding: 5px 5px; background: #F5F5F5;" |
*YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in multiple organs and often leading to multisystem organ failure and death.
*Since the initial cases of YEL-AVD were published in 2001, >60 confirmed and suspected cases have been reported throughout the world.
*YEL-AVD has been reported to occur only after the first dose of yellow fever vaccine; there have been no reports of YEL-AVD following booster doses.
*The median time from YF vaccination until symptom onset for YEL-AVD cases was 4 days (range, 0–8 days).
*The case-fatality ratio for all reported YEL-AVD cases worldwide is 63%. The incidence of YEL-AVD in the United States is 0.4 cases per 100,000 doses of vaccine administered.  
*The rate is higher for people aged ≥60 years, with a rate of 1.0 per 100,000 doses in people aged 60–69 years and 2.3 per 100,000 doses in people aged ≥70 years.
|-
| style="padding: 0px 5px; background: #F5F5F5;" colspan=2| Adapted from CDC <ref>{{cite web|url=http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/yellow-fever| title= CDC Yellow Book 2014. Chapter 3 Infectious Diseases Related To Travel - Yellow Fever}}</ref>
|}
===Countries with Increased Risk of Yellow Fever===
{|
|valign=top|
{| style="float:right; border: 0px; font-size: 85%; margin: 3px; width:400px;"
|valign=top|
|+'''Countries with risk of yellow fever virus (YFV) transmission'''
! style="background: #4479BA; color:#FFF;  width: 400px;" colspan=2 |  Africa
! style="background: #4479BA; color:#FFF;  width: 200px;" |  Central and South America
|-
| style="padding: 5px 5px; background: #F5F5F5; width: 180px;" |
* Angola
* Benin
* Burkina Faso
* Burundi
* Cameroon
* Central African Republic
* Chad†
* Congo
* Côte d’Ivoire
* Democratic Republic of the Congo†
* Equatorial Guinea
* Ethiopia†
* Gabon
* Gambia
* Ghana
| style="padding: 5px 5px; background: #F5F5F5; width: 180px;" |
* Guinea
* Guinea-Bissau
* Kenya†
* Liberia
* Mali†
* Mauritania†
* Niger†
* Nigeria
* Rwanda
* Senegal
* Sierra Leone
* Sudan†
* South Sudan
* Togo
* Uganda
| style="padding: 5px 5px; background: #F5F5F5;" |
* Argentina†
* Bolivia†
* Brazil†
* Colombia†
* Ecuador†
* French Guiana
* Guyana
* Panama†
* Paraguay
* Peru†
* Suriname
* Trinidad and Tobago†
* Venezuela†
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=3 |<small>†These countries are not holoendemic (only a portion of the country has risk of yellow fever transmission).  <br>Table adapted from CDC <ref name=CDC>{{cite web| url=http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/yellow-fever| title= CDC Travelers' Health - Chapter 3: Infectious Diseases Related To Travel - Yellow Fever}}</ref></small>
|}
|<br>


=====Severe Problems=====
|valign=top|
*Life-threatening allergic reaction (approximately 1 reported per 131,000 doses).
<br>
*Severe nervous system reactions (approximately 1 reported per 150,000-250,000 doses).
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align=center
*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.
|valign=top|
 
|+
=====Moderate or Severe reaction=====
! style="background: #4479BA; color:#FFF;  width: 400px;" colspan=2 |  Countries that require proof of yellow fever vaccination from all arriving travelers
*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.
| style="padding: 5px 5px; background: #F5F5F5; width: 180px;" |
*Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
* Angola
*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.
* Benin
* Burkina Faso
* Burundi
* Cameroon
* Central African Republic
* Congo, Repubic of the
* Côte d’Ivoire
* Democratic Republic of Congo
* French Guiana
| style="padding: 5px 5px; background: #F5F5F5; width: 180px;" |
* Gabon
* Ghana
* Guinea-Bissau
* Liberia
* Mali
* Niger
* Rwanda
* São Tomé and Príncipe
* Sierra Leone
* Togo
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=3 |<small>Table adapted from CDC <ref name=CDC>{{cite web| url=http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/yellow-fever| title= CDC Travelers' Health - Chapter 3: Infectious Diseases Related To Travel - Yellow Fever}}</ref></small>
|}
|}


==Vector Control==
==Vector Control==
[[Insecticide]]s, 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.<ref>{{cite web|url=http://www.epa.gov/pesticides/health/mosquitoes/mosquitojoint.htm#programs |title= Joint Statement on Mosquito Control in the United States from the U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control and Prevention (CDC) |accessmonthday= June 25 |accessyear=2006 |date= 2000-05-03| |format=PDF |publisher=Environmental Protection Agency |}}</ref>


====Use Insect Repellent====
====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.
* 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.  
* Even a short time outdoors can be long enough to get a mosquito bite. <ref name=CDCPrev>{{cite web|url=http://www.cdc.gov/yellowfever/prevention/index.html| title= CDC Prevention of Yellow Fever}}</ref>
 
====Wear Proper Clothing to Reduce Mosquito Bites====
====Wear Proper Clothing to Reduce Mosquito Bites====
*When weather permits, wear long-sleeves, long pants and socks when outdoors.  
*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.  
*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.  
*Clothing pre-treated with [[permethrin]] is commercially available.  
*Mosquito repellents containing [[permethrin]] are not approved for application directly to skin.
*Mosquito repellents containing [[permethrin]] are not approved for application directly to skin.<ref name=CDCPrev>{{cite web|url=http://www.cdc.gov/yellowfever/prevention/index.html| title= CDC Prevention of Yellow Fever}}</ref>


====Be Aware of Peak Mosquito Hours====
====Be Aware of Peak Mosquito Hours====
Line 75: Line 184:
*However, [[Aedes aegypti]], one of the mosquitoes that transmits yellow fever virus, feeds during the daytime.  
*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.  
*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.
*Staying in accommodations with screened or air-conditioned rooms, particularly during peak biting times, will also reduce risk of mosquito bites.<ref name=CDCPrev>{{cite web|url=http://www.cdc.gov/yellowfever/prevention/index.html| title= CDC Prevention of Yellow Fever}}</ref>


==References==
==References==
Line 82: Line 191:
[[Category:Disease]]
[[Category:Disease]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Infectious disease]]
 
[[Category:Viral diseases]]
[[Category:Viral diseases]]
[[Category:Flaviviruses]]
[[Category:Flaviviruses]]

Latest revision as of 19:30, 18 September 2017

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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 methods to prevent yellow fever are 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 and Africa. 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.

Indication

Vaccine Administration

  • For all eligible people, a single injection of reconstituted vaccine should be administered subcutaneously.
  • Name: 17D yellow fever vaccine
  • Trade Name: YF-Vax®
  • Dose: 0.5 mL²
  • Route: SC
  • The International Health Regulations (IHR) published by the World Health Organization (WHO) require revaccination at 10-year intervals.
  • Recommendations for storage of yellow fever vaccine include the following:
  • The vaccine should be transported and stored between +2°C (35°F) and+8°C (46°F).
  • Manufacturer's recommendations for vaccine storage must be observed.
  • The vaccine should not be used after the expiration date printed on the vial.
  • Since YF-VAX® does not contain a preservative, all reconstituted vaccine and containers must be appropriately discarded if they are not used within 1 hour. This includes the multi-dose (5-dose) vials.

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, 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).
Yellow fever vaccine–associated neurologic disease (YEL-AND) Yellow fever vaccine–associated viscerotropic disease (YEL-AVD)
  • YEL-AND represents a conglomerate of different clinical syndromes, including meningoencephalitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, and rarely, bulbar and Bell palsies.
  • Historically, YEL-AND was seen primarily among infants as encephalitis, but more recent reports have been among people of all ages.
  • The onset of illness for documented cases is 3–28 days after vaccination, and almost all cases were in first-time vaccine recipients.
  • YEL-AND is rarely fatal. The incidence of YEL-AND in the United States is 0.8 per 100,000 doses administered.
  • The rate is higher in people aged ≥60 years, with a rate of 1.6 per 100,000 doses in people aged 60–69 years and 2.3 per 100,000 doses in people aged ≥70 years.
  • YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in multiple organs and often leading to multisystem organ failure and death.
  • Since the initial cases of YEL-AVD were published in 2001, >60 confirmed and suspected cases have been reported throughout the world.
  • YEL-AVD has been reported to occur only after the first dose of yellow fever vaccine; there have been no reports of YEL-AVD following booster doses.
  • The median time from YF vaccination until symptom onset for YEL-AVD cases was 4 days (range, 0–8 days).
  • The case-fatality ratio for all reported YEL-AVD cases worldwide is 63%. The incidence of YEL-AVD in the United States is 0.4 cases per 100,000 doses of vaccine administered.
  • The rate is higher for people aged ≥60 years, with a rate of 1.0 per 100,000 doses in people aged 60–69 years and 2.3 per 100,000 doses in people aged ≥70 years.
Adapted from CDC [1]

Countries with Increased Risk of Yellow Fever

Countries with risk of yellow fever virus (YFV) transmission
Africa Central and South America
  • Angola
  • Benin
  • Burkina Faso
  • Burundi
  • Cameroon
  • Central African Republic
  • Chad†
  • Congo
  • Côte d’Ivoire
  • Democratic Republic of the Congo†
  • Equatorial Guinea
  • Ethiopia†
  • Gabon
  • Gambia
  • Ghana
  • Guinea
  • Guinea-Bissau
  • Kenya†
  • Liberia
  • Mali†
  • Mauritania†
  • Niger†
  • Nigeria
  • Rwanda
  • Senegal
  • Sierra Leone
  • Sudan†
  • South Sudan
  • Togo
  • Uganda
  • Argentina†
  • Bolivia†
  • Brazil†
  • Colombia†
  • Ecuador†
  • French Guiana
  • Guyana
  • Panama†
  • Paraguay
  • Peru†
  • Suriname
  • Trinidad and Tobago†
  • Venezuela†
†These countries are not holoendemic (only a portion of the country has risk of yellow fever transmission).
Table adapted from CDC [2]


Countries that require proof of yellow fever vaccination from all arriving travelers
  • Angola
  • Benin
  • Burkina Faso
  • Burundi
  • Cameroon
  • Central African Republic
  • Congo, Repubic of the
  • Côte d’Ivoire
  • Democratic Republic of Congo
  • French Guiana
  • Gabon
  • Ghana
  • Guinea-Bissau
  • Liberia
  • Mali
  • Niger
  • Rwanda
  • São Tomé and Príncipe
  • Sierra Leone
  • Togo
Table adapted from CDC [2]

Vector Control

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.[3]

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. [4]

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.[4]

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.[4]

References

  1. "CDC Yellow Book 2014. Chapter 3 Infectious Diseases Related To Travel - Yellow Fever".
  2. 2.0 2.1 "CDC Travelers' Health - Chapter 3: Infectious Diseases Related To Travel - Yellow Fever".
  3. "Joint Statement on Mosquito Control in the United States from the U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control and Prevention (CDC)" (PDF). Environmental Protection Agency. 2000-05-03. Unknown parameter |accessmonthday= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  4. 4.0 4.1 4.2 "CDC Prevention of Yellow Fever".


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