Yellow fever

Minor against infectious are not valid reasons Immunisationillnesses without fever or systemic upset disease to postpone immunisation. If Yellow Fever immunisation should be postponed until they Chapter 35 an individual is acutely unwell,avoid confusing the differential diagnosis of have fully recovered. This is to

Precautions

Update

any acute illness by wrongly attributing any sign or symptoms to the adverse effects of the vaccine.

People sentence to read: p.448 Pregnancy section, 4thover 60 years of age The risk for neurologic and viscerotropic adverse events increases with age (see below). The risk assessment needs to take account of this. Pregnancy
Yellow fever vaccine should not be given to pregnant women because of the theoretical risk of fetal infection from the live virus vaccine. Pregnant women should be advised not to travel to a high-risk area. When travel is unavoidable, the risk from the disease and the theoretical risk from the vaccine have to be assessed on an individual basis. WHO states that the vaccine may be considered after the sixth month of pregnancy and should be administered if the destination risk is high (WHO, 2004). WHO states that vaccination against yellow fever may be considered in early pregnancy depending upon the risk (WHO, 2012). Two studies in which pregnant women have been vaccinated demonstrated no adverse fetal outcomes (Nasidi et al., 1993; Tsai et al., 1993), but transplacental transmission has occurred in early pregnancy (Tsai et al., 1993). A slightly increased risk of spontaneous abortion in women vaccinated in early fever Yellow pregnancy has been suggested (Nishioka et al., 1998). Antibody titres following vaccination are lower in pregnant women (Nasidi et al., 1993). Women who continue to be at risk once the pregnancy is completed should be Tattevin P, Depatureaux AG, Chapplain JM et al. (2004) Yellow fever vaccine is safe and revaccinated. effective in HIV-infected patients. AIDS 18: 8257.
Tsai TF, Paul vaccinationMC and Letson GW (1993) Congenital yellow fever virus Inadvertent R, Lynberg during early pregnancy is not an indication for infection after immunization in pregnancy. J Infect Dis 168: 15203.

termination (Monath, 2004). p.454 References, 4th reference to be replaced et al. (2001) Serious adverse events associated with with: Vasconcelos PF, Luna EJ, Galler R
yellow fever 17DD vaccine in Brazil: a report of two cases. Lancet 358: 917. Breast-feeding World is no evidence of harm to International Travel and Health. the breastThere Health Organization (2004) the baby from vaccination of Vaccination Requirements and Health Advice.is a theoreticalHealth Organization, p 210. feeding mother. While there Geneva: World risk that yellow fever vaccine virus

Yellow fever July 2012 Yellow fever July 2012

is excreted in breast milk, vaccination should be considered in cases where World Health Organization (2012) International Travel and Health. Vaccine Preventable Diseases and Vaccines. Geneva: World Health Organization, p136.
Zanotto PM, Gould EA, Gao GF et al. (1996) Population dynamics of flaviviruses revealed by molecular Chapter 35 v1_1 Green Bookphylogenies. Proc Natl Acad Sci USA 93: 54853. 448

Amended 5 July 2012