Stamaril: Live Yellow fever vaccine

Yellow fever vaccine is live attenuated vaccine. This vaccine is produced by Sanofi Pasteur.

It is given to prevent yellow fever disease. Yellow fever disease is caused by yellow fever virus which is RNA virus and it is spread by mosquito bite. It is found in Sub-Saharan Africa and South America. Travelers planning to visit countries in these regions should get this vaccine. Travelers planning to visit endemic countries should get the yellow fever vaccine and certificate before visiting those countries.

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How is Stamaril Yellow fever vaccine available?

Yellow fever vaccine is available as lyophilized powder in a vial containing live attenuated virus and diluent for dilution in a pre filled sterile syringe may or may be with needle with it.

It is available in 1, 5 or 10 doses packets as needed.

How is Stamaril Yellow fever vaccine prepared?

Yellow fever vaccine, sterile water for injection is mixed with lyophilized powder. The needle should be attached to the syringe of sterile water. The water is pushed into the vial of lyophilized powder. The mixture is agitated gently to mix the content. The care should be taken while doing the procedure that sterilizers and disinfectant should not touch the vial. The care should be taken to avoid the needle prick while mixing the contents. The mixture is sucked back into the syringe.

How the Stamaril Yellow fever vaccine can be given?

Yellow fever vaccine vaccine can be given either by subcutaneous route or intra-muscular route. All the safety injection precautions need to be taken while giving injection. The disinfectant applied to skin should be evaporated completely before giving the injection. The disposables after use of injection should be discarded as per biomedical waste management protocols. The vaccine if expired should be discarded and not used. The expired vaccines need to be discarded as per biomedical waste management protocols.

At what age Stamaril Yellow fever vaccine is given?

Yellow fever vaccine is given at age above 6-9 months in those in endemic areas.

Travelers visiting endemic areas should get this vaccine preferably 10 days before travel to endemic areas.

The effect of vaccine lasts at least for 10 years.

Boosters may be needed if initial dose is ineffective due to some condition or immunity obtained by vaccine wanes in case.

What if someone has missed Yellow fever vaccine dose?

Above 6-9 months Yellow fever vaccine can be given at any age before 10 days of travel to endemic area and if the there are no contra-indication.

How does Stamaril Yellow fever vaccine works?

Yellow fever vaccine contains live attenuated virus of Yellow fever disease. Live attenuated means these are live virus but they lack capacity to cause disease though they have capacity to infect. When these viruses are injected by vaccine they infect the person who got the injection. They multiply in the body of the host. The immunity of the host recognizes these viruses. The immunity develops mechanism to fight these viruses. In this process the body also develops the memory immunity. When the real infection of these diseases occur the body rapidly increases the immune response and the disease is prevented. This is active form of immunization.

What are the side effects of the Yellow fever vaccine?

Side effects of Yellow fever vaccine are usually milder when compared to the diseases it cause. Common side effects are:

· Fever may come and usually lasts for 1-3 days and it can be easily controlled by oral medications like paracetamol at home. In some patients it may last for 5-10 days.

· Skin rash which looks like measles disease can appear in few days after vaccination. This rash is usually milder and short lasting than measles disease.

· Pain, swelling and redness at injection site. This may come after injection and may last for 1-3 days. It usually subsides by its own or by simple measures like local cold fomentation.

· Symptoms of upper respiratory tract infection like cold and running nose. In some cases can cause bronchospasm

· Nervousness and crying.

· Like all other vaccine anaphylaxis reaction may come after this vaccination though it is very rare. The facility at which vaccination is given should be ready to manage the anaphylaxis with necessary equipments and skilled personnel.

· Yellow fever vaccine-associated neurologic disease (YEL-AND): YELAND represents a conglomerate of different clinical syndromes, including meningoencephalitis, Guillain-Barre syndrome, acute disseminated encephalomyelitis, bulbar palsy, and Bell palsy. This can occur in one patient after every 1 lakh doses administered. It is generally reversible. Extremely rarely fatal.

· Yellow fever vaccine-associated viscerotropic disease (YEL-AVD): YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in multiple organs and often leading to multi-organ failure death. This reaction occurs in 2 patients when 1 lakh doses of vaccine administered.

What cautions are needed with Yellow fever vaccine?

· The facility to management anaphylaxis should be ready while giving Yellow fever vaccine.
· The caution should be taken in those who are allergic to egg or chicken poreteins or neomycin.
· The vaccine should not be given to those who are allergic to any of its components.
· This is live vaccine so cannot be used in pregnancy.
· The caution should be taken in immmunocompromised patients. The vaccine is used in them if benefit outweighs the risks.
· The vaccine is avoided in those with active TB disease or those in intensive phase of the TB-treatment.
· Biomedical waste management guidelines are to be followed like all other vaccinations.
· The vaccine is stored as per mentioned on packet by the manufacturer.
· The vaccine should be used with caution in breast feeding mothers considering risk to benefit ratio.
· Special caution should be taken in those above 60 years of age.

To whom Stamaril Yellow fever vaccine is contraindicated?

· This vaccine is contraindicated in those with stage 3 or stage 4 HIV AIDS disease.
· This vaccine is contraindicated those who are severely immunocompromized.
· Those who are pregnant.
· Those who are allergic to any of its component and eggs, chicken proteins and neomycin.
· Age < 6 months
· Symptomatic human immunodeficiencyvirus (HIV) infection or CD4
· T-lymphocytes < 200 cells/mm3 (or<15% of total in children aged <6years)
· Thymus disorder associated with abnormal immune-cell function
· Primary immunodeficiencies
· Malignant neoplasms
· Transplantation
· Immunosuppressive and
· immunomodulatory therapies

Countries which are endemic to the Yellow fever disease:

· Africa:Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo, and Uganda.

· Americas:Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, and Venezuela.

Yellow fever vaccine certificate for travelers:

Travelers visiting countries listed above should have valid certificate.
Certificate once issued is valid for entire life for visit to all countries in given list.
Currently, valid IHR international certificates of vaccination are now automatically valid for life of the traveler indicated.
Nothing needs to be modified in the certificate; indeed under the IHR, any changes, deletions, erasures, or additions may cause a certificate to be rendered invalid.

In India:

Any traveler (except infants <9 months old) arriving by air or sea without a certificate is detained in isolation for up to 6 days if that person:
Arrives within 6 days of departure from an area with risk of YFV transmission
Has been in such an area in transit (except those passengers and members of flight crews who, while in transit through an airport in an area with risk of YFV transmission, remained in the airport during their entire stay and the health officer agrees to such an exemption)
Arrives on a ship that started from or touched at any port in an area with risk of YFV transmission up to 30 days before its arrival in India, unless such a ship has been disinfected in accordance with the procedure recommended.
Arrives on an aircraft that has been in an area with risk of YFV transmission and has not been disinfected in accordance with the Indian Aircraft Public Health Rules, 1954, or as recommended by the WHO.

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