22 Jun 2016
YEL-AND and YEL-AVDYellow fever vaccine associated neurotropic disease (YEL-AND) and yellow fever vaccine associated viscerotopic disease (YEL-AVD)
Cases of YEL-AND are estimated to occur in 0.8 cases per 100,000 doses distributed, and for YEL AVD, 0.4 cases per 100,000 doses distributed [1, 2]. For individuals who are aged 60 years and older, the risk increases several fold to approximately 1.8 cases per 100,000 doses for YEL-AND and 1.4 cases per 100,000 doses for YEL-AVD .
Yellow fever vaccine associated neurotropic disease (YEL-AND)
The clinical presentation begins four to 23 days (median 14 days) following receipt of vaccine, with fever and headache that can progress to encephalitis, or an autoimmune demyelinating disease with peripheral or central nervous involvement. Most patients will completely recover. Almost all cases have occurred in those receiving the vaccine for the first time with no underlying YF immunity.
Yellow fever vaccine associated viscerotropic (YEL-AVD)
The clinical presentation begins two to eight days (median four days) following vaccination, with fever, malaise (generally feeling unwell), headache, and myalgia (muscle pain) that progress to hepatitis, hypotension (low blood pressure), and multi-organ failure. Death has occurred in more than 60 percent of reported cases. YEL-AVD has been reported to occur only in those receiving the vaccine for the first time, there have been no reports of YEL-AVD following booster dose .
YFVCs, or others involved in the care of a person presenting with suspected adverse event following YF vaccination, are encouraged to report the event in a timely manner to the authorities listed in Management and reporting adverse events.
- Lindsey NP, Schroeder BA, Miller ER et al. Adverse event reports following yellow fever vaccination. Vaccine 2008; 26 (48):6077-6082.
- Kitchener S. Viscerotropic and neurotropic disease following vaccination with the 17D yellow fever vaccine, ARILVAX (R). Vaccine 2004; 22:2103-5.
- Gershman M.D. Staples J.E. CH3 Yellow fever in US Centres for Disease Control (CDC) Health Information for International Travel, ‘Yellow book’ 2016.
Guidelines on clinical procedures
- Medical letter of exemption
- International Certificate of Vaccination or Prophylaxis (ICVP)
- Record keeping and consent