14 Jun 2016

Individuals aged 60 years and older

Age alone is not considered a contraindication to YF vaccination, and vaccination can be given to those aged 60 years and older following risk assessment and as long as certain precautions are observed Individuals aged 60 years and older
In general, all persons who are travelling to yellow fever (YF) risk areas (see maps of yellow fever vaccine recommendations for Africa and the Americas) should be offered YF vaccination unless there are medical contraindications. Age alone (where travel is to a YF risk area) is not considered a contraindication to YF vaccination, and vaccination can be given to those aged 60 years and older following risk assessment and as long as 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 0.4 cases (YEL-AVD) for every 100,000 doses of YF vaccine distributed (US data) [1, 2].
 
Individuals who are aged 60 years and older appear to be at increased risk for these vaccine associated adverse events, and this risk appears to increase with increasing age.
 
60 years and older, these serious adverse events have occurred at a rate of approximately:
 
  • 1.8 cases for every 100,000 doses distributed for YEL-AND and
  • 1.4 cases for every 100,000 doses distributed for YEL-AVD [US data] [2].
 
These reactions are unlikely to occur in persons who have been previously vaccinated with YF vaccine; to date, YEL-AVD has only occurred in individuals receiving the vaccine for the first time [3].
 
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 in order to avoid the risk of disease.
 
Where YF vaccination is contraindicated (or considered inadvisable) on medical grounds, 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.
 
NaTHNaC has produced a yellow fever vaccination information sheet for travellers which may be helpful as the risks and benefits of vaccination are discussed. 
 

Resources

  • NaTHNaC Yellow fever vaccination information sheet for travellers (currently unavailable)
  1. Kitchener S. Viscerotropic and neurotropic disease following vaccination with the 17D yellow fever vaccine, ARILVAX ((R)). Vaccine 2004; 22:2103-5.
  2. Lindsey NP, Schroeder BA, Miller ER et al. Adverse event reports following yellow fever vaccination. Vaccine 2008; 26 (48):6077-6082.
  3. Centers for Disease Control and Prevention (CDC). Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2010;59(RR-7):1-27

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