Yellow fever vaccine is live attenuated vaccine. 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.

How is Yellow fever vaccine available?

Yellow fever vaccine is available as lyophilized powder and sterile water for dilution in different vials.

How is 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 buck into the syringe.

How the 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 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.

What if someone has missed Yellow fever vaccine dose?

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

How does Yellow fever vaccine works?

Yellow fever vaccine contains live attenuated virus of Yellow fever disease. Live attenuated means these are live viruses but they lack the capacity to cause disease though they have the capacity to infect. When these viruses are injected by a 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. Immunity develops a mechanism to fight these viruses. In this process, the body also develops memory immunity. When the real infection of these diseases occurs the body rapidly increases the immune response and the disease is prevented. This is the active form of immunization.

What are the side effects of the Yellow fever vaccine?

Side effects of this vaccine are usually milder when compared to the diseases it causes. 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 a few days after vaccination. This rash is usually milder and short-lasting than measles disease.
  • Pain, swelling, and redness at the injection site. This may come after injection and may last for 1-3 days. It usually subsides on its own or by simple measures like local cold fomentation.
  • Symptoms of upper respiratory tract infection like a cold and running nose. In some cases can cause bronchospasm
  • Nervousness and crying.
  • Like all other vaccines, anaphylaxis reactions may come after this vaccination though it is very rare. The facility at which vaccination is given should be ready to manage anaphylaxis with the necessary equipment 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 manage anaphylaxis should be ready while giving this vaccine.
  • Caution should be taken in those who are allergic.
  • The vaccine should not be given to those who are allergic to any of its components.
  • This is a live vaccine so cannot be used in pregnancy.
  • Caution should be taken in immunocompromised patients. The vaccine is used in them if the benefit outweighs the risks.
  • The vaccine is avoided in those with active TB disease or those in the intensive phase of the TB-treatment.
  • Biomedical waste management guidelines are to be followed like all other vaccinations.
  • The vaccine is stored as mentioned on a packet by the manufacturer.
  • The vaccine should be used with caution in breastfeeding mothers considering the risk to benefit ratio.
  • Special caution should be taken in those above 60 years of age.

To whom Yellow fever vaccine is contraindicated?

  • This vaccine is contraindicated in those with stage 3 or stage 4 HIV AIDS disease.
  • This vaccine is contraindicated for those who are severely immunocompromised.
  • Those who are pregnant.
  • Those who are allergic to any of its components.
  • Age < 6 months
  • Symptomatic human immunodeficiency virus (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 the countries listed above should have a valid certificate.
  • Certificate once issued is valid for entire life for a visit to all countries in the given list.
  • Currently, valid IHR international certificates of vaccination are now automatically valid for the 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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