Formulary
Yellow fever vaccine: Indications, Dosing, Side Effects and Interactions
For yellow fever vaccine Yellow fever vaccine is a live attenuated vaccine.
MedNext Academy | 6 min read
Yellow fever vaccine: Indications, Dosing, Side Effects and Interactions
For yellow fever vaccine Yellow fever vaccine is a live attenuated vaccine.
Drug action
For yellow fever vaccine Yellow fever vaccine is a live attenuated vaccine.
Indications and dose
**Immunisation against yellow fever for yellow fever vaccine**
- **Child 6-8 months (administered on expert advice)** (By deep subcutaneous injection): Infants under 9 months should be vaccinated only if the risk of yellow fever is high and unavoidable (consult product literature or local protocols).
- **Child 9 months-17 years** (By deep subcutaneous injection): 0.5 mL for 1 dose.
Cautions
Important safety information For yellow fever vaccine MHRA/CHM advice (updated November 2019): Yellow fever vaccine: stronger precautions in people with weakened immunity and in those aged 60 years or older In adults: The yellow fever vaccine ( Stamaril ) has been associated with the very rare, life-threatening reactions viscerotropic disease (YEL-AVD) and neurotropic disease (YEL-AND), which both resemble yellow fever infection. It must not be given to patients who have had a thymectomy, who are taking immunosuppressive or immunomodulating biological drugs, or who have a first-degree family history of YEL-AVD or YEL-AND following vaccination that was unrelated to a known medical risk factor. In patients aged 60 years and older, the vaccine should only be administered when there is a significant and unavoidable risk of acquiring yellow fever infection. It must only be administered by healthcare professionals specifically trained in the benefit-risk evaluation of yellow fever vaccine. Healthcare professionals must inform patients and carers about the early signs and symptoms of YEL-AVD and YEL-AND, and advise them to seek urgent medical attention if they occur; the manufacturer's patient information leaflet should also be provided. Healthcare professionals administering vaccines should consult information in the YF Vaccine Centre code of practice and strengthen protocols and checklists to avoid inappropriate administration. MHRA/CHM advice (updated November 2019): Yellow fever vaccine: stronger precautions in people with weakened immunity In children: The yellow fever vaccine ( Stamaril ) has been associated with the very rare, life-threatening reactions viscerotropic disease (YEL-AVD) and neurotropic disease (YEL-AND), which both resemble yellow fever infection. It must not be given to patients who have had a thymectomy, who are taking immunosuppressive or immunomodulating biological drugs, or who have a first-degree family history of YEL-AVD or YEL-AND following vaccination that was unrelated to a known medical risk factor. It must only be administered by healthcare professionals specifically trained in the benefit-risk evaluation of yellow fever vaccine. Healthcare professionals must inform patients and carers about the early signs and symptoms of YEL-AVD and YEL-AND, and advise them to seek urgent medical attention if they occur; the manufacturer's patient information leaflet should also be provided. Healthcare professionals administering vaccines should consult information in the YF Vaccine Centre code of practice and strengthen protocols and checklists to avoid inappropriate administration. MHRA/CHM advice: Yellow fever vaccine ( Stamaril ): new pre-vaccination checklist (November 2021) In adults: A standardised pre-vaccination checklist has been introduced to ensure the yellow fever vaccine is indicated for the intended travel destination and to enable vaccinators to identify existing contra-indications or precautions in individuals before vaccination. Healthcare professionals are reminded to adhere to the contra-indications (for example, in people with immunosuppression or thymus dysfunction or thymectomy) and precautions (in people aged 60 years or older, and pregnant or breast-feeding women) as this is essential to reduce the risk of very rare but potentially fatal adverse reactions. The new checklist should be used in vaccination consultations to ensure systematic evaluation of benefits and risks for individual travellers, this however is not a replacement for the full travel health risk assessment by a qualified practitioner and additional checklists or materials that may also be used prior to vaccination, depending on clinical guidance. Patients and carers should be provided with the patient information leaflet and advised to seek emergency medical attention if they develop signs or symptoms of a severe reaction following vaccination. MHRA/CHM advice: Yellow fever vaccine ( Stamaril ): new pre-vaccination checklist (November 2021) In children: A standardised pre-vaccination checklist has been introduced to ensure the yellow fever vaccine is indicated for the intended travel destination and to enable vaccinators to identify existing contra-indications or precautions in individuals before vaccination. Healthcare professionals are reminded to adhere to the contra-indications (for example, in people with immunosuppression or thymus dysfunction or thymectomy) and precautions (in infants aged 6 months to 9 months, and pregnant or breast-feeding females) as this is essential to reduce the risk of very rare but potentially fatal adverse reactions. The new checklist should be used in vaccination consultations to ensure systematic evaluation of benefits and risks for individual travellers, this however is not a replacement for the full travel health risk assessment by a qualified practitioner and additional checklists or materials that may also be used prior to vaccination, depending on clinical guidance. Patients and carers should be provided with the patient information leaflet and advised to seek emergency medical attention if they develop signs or symptoms of a severe reaction following vaccination.
Contraindications
For all vaccines, live Contra-indications, further information Impaired immune response UKHSA advises severely immunosuppressed patients should not be given live vaccines (including those with severe primary immunodeficiency). Contra-indications For yellow fever vaccine Children under 6 months; history of thymus dysfunction; thymectomy
Side effects
For all vaccines, general Common or very common Abdominal pain; appetite decreased; arthralgia; diarrhoea; dizziness; fatigue; fever; headache; lymphadenopathy; malaise; myalgia; nausea; skin reactions; vomiting Uncommon Hypersensitivity Side-effects For all vaccines, live Common or very common Abdominal pain; arthralgia; diarrhoea; fever; headache; myalgia; nausea; skin reactions; vomiting Uncommon Dizziness Side-effects For yellow fever vaccine Common or very common Asthenia; crying (in children); drowsiness (in children); irritability (in children) Rare or very rare Rhinitis; yellow fever vaccine-associated neurotropic disease; yellow fever vaccine-associated viscerotropic disease Frequency not known Angioedema; influenza like illness; paraesthesia Side-effects, further information Very rare vaccine-associated adverse effects may occur, such as viscerotropic disease (yellow-fever vaccine-associated viscerotropic disease, YEL-AVD), a syndrome which may include metabolic acidosis, muscle and liver cirrhosis, and multi-organ failure. Neurological disorders (yellow fever vaccine-associated neurotropic disease, YEL-AND) such as encephalitis have also been reported. These very rare adverse effects usually occur after the first dose of yellow fever vaccine in those with no previous immunity. Increased risk of fatal reactions reported in patients aged 60 years and older and those who are immunosuppressed.
Pregnancy
For all vaccines, live UKHSA advises live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection, but where there is a significant risk of exposure to disease the need for vaccination may outweigh any possible risk to the fetus. Termination of pregnancy following inadvertent immunisation is not recommended. Pregnancy For yellow fever vaccine Live yellow fever vaccine should not be given during pregnancy because there is a theoretical risk of fetal infection. Pregnant women should be advised not to travel to areas at high risk of yellow fever. If exposure cannot be avoided during pregnancy, then the vaccine should be given if the risk from disease in the mother outweighs the risk to the fetus from vaccination.
Breast feeding
For all vaccines, live Although there is a theoretical risk of live vaccine being present in breast milk, vaccination is not contra-indicated for women who are breast-feeding when there is significant risk of exposure to disease. Breast feeding For yellow fever vaccine Avoid; seek specialist advice if exposure to virus cannot be avoided.
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Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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