Individuals aged 60 years and older
Vaccination can be given to those aged 60 years and older following risk assessment and if certain precautions are observed
For most people, serious yellow fever vaccine related adverse events are rare. While vaccine associated neurologic disease (YEL-AND) and vaccine associated viscerotropic disease (YEL-AVD) are described, these are rare adverse events that have occurred at a rate of 0.8 cases (YEL-AND) and 0.3 cases (YEL-AVD) for every 100,000 doses of YF vaccine distributed (US data) [1].
Individuals who are aged 60 years and older are at increased risk for YF vaccine associated adverse events, and this risk appears to increase with increasing age.
For those aged 60 years and older, these serious adverse events have occurred at a rate of approximately:
- 2.2 cases for every 100,000 doses distributed for YEL-AND and
- 1.2 cases for every 100,000 doses distributed for YEL-AVD (US data) [1,2]
To date almost all cases of YEL-AND reported worldwide, occurred in first time vaccine recipients. Laboratory confirmed YEL-AVD has only occurred in individuals receiving the vaccine for the first time [2].
When considering vaccination of a traveller who is aged 60 years and older, a comprehensive risk assessment should be undertaken.
Risk assessment should balance:
- the risk of the vaccine (see information above) with
- the risk of acquiring YF at the destination (actual risk may be difficult to determine)
Discussion should also include whether there is a certificate requirement (under International Health Regulations) by any country to be visited.
Travellers should be encouraged to make an informed decision regarding vaccination against YF. Travel to endemic areas without YF vaccination should be discouraged; where vaccination is not advised on medical grounds it may sometimes be prudent to consider a change to the planned itinerary to avoid the risk of disease.
Aged 60 years or older and visiting areas with risk of yellow fever transmission
In people aged 60 years or older, due to a higher risk of life-threatening side effects, the vaccine should be given only when there is a significant and unavoidable risk of acquiring yellow fever infection, such as travel to an area where there is a current or periodic risk of yellow fever transmission [3, 4]. See yellow fever vaccine recommendation maps which should be used together with the description of risk given in the Country Information pages on TravelHealthPro.
Aged 60 years or older and visiting areas with low potential for exposure to yellow fever virus
People aged 60 years or older should not be given the vaccine due to a higher risk of life-threatening side effects if the vaccine is generally not recommended at their destination (i.e areas described as having low potential for yellow fever virus exposure) [3, 4]. See yellow fever vaccine recommendation maps which should be used together with the description of risk given in the Country Information pages on TravelHealthPro.
Where YF vaccination is contraindicated on medical grounds (or considered inadvisable), and where travel to a country with a YF certificate requirement will go ahead, a Medical Letter of Exemption from YF vaccination can be considered.
Resources
- NaTHNaC Yellow fever vaccination information sheet for travellers (currently under review)
References
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Lindsey NP, Rabe IB, Miller ER et al. Adverse event reports following yellow fever vaccination, 2007-13. J. Trav Med. Jul 4 2016;23 (5), [Accessed 19 October 2021]
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US Centers for Disease Control and Prevention. Yellow Fever. In: Health Information for International Travel. 2020 [Accessed 19 October 2021]
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World Health Organization. International travel and health. Vaccination requirements and recommendations for international travellers; and malaria situation per country. 2022 edition. 19 November 2022 [Accessed 2 December 2022]
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MHRA, PHE, NaTHNaC, HPS Yellow fever vaccine: stronger precautions in people with weakened immunity and those aged 60 years or older November 21, 2019 [Accessed 19 October 2021]