Yellow fever virus: Difference between revisions

Revision as of 20:24, 16 September 2020

Background

Microbiology

RNA virus and member of the Flaviviridae family

Epidemiology

Worldwide, about 200,000 cases and 30,000 deaths annually

Clinical Manifestations

Spectrum of illness from asymptomatic to fatal
Acute illness starts with fever, chills, headache, backache, myalgias, arthralgias, nausea, vomiting, photophobia, mild jaundice, and epigastric pain
After the acute illness subsides, about 85% of infections are resolved, and 15% progress
In those who progress, a brief remission of hours to days is followed by return of symptoms with progression to renal failure, hemorrhage, and thrombocytopenia

Vaccine-Related Disease

Yellow fever vaccine-associated neurotropic disease, which includes meningoencephalitis, Guillain-Barré syndrome, and acute bulbar palsy
Yellow fever vaccine-associated viscerotropic disease, which causes multi-organ failure similar to wildtype virus

	YEL-AND	YEL-AVD
Incubation period	7 to 21 days	2 to 5 days
Rate	0.8 per 100,000 doses	1 per 100,000 doses
Risk factors	age <6 months age >60-70 years	age >60 years thymus disease
Prognosis	full recovery	65% mortality

Management

Supportive care

Prevention

A live attenuated vaccine strain is available
Contraindications
- Allergy to any component of the vaccine
- Infants less than 6 to 9 months of age, due to the high risk of neurotropic disease following immunization
- People age 60 years and older, due to the high risk of adverse events following immunization
  - Booster doses may stll be given, if indicated
- Pregnancy and breastfeeding
- Thymus disease, including thymoma, thymectomy, and myasthenia gravis, given the high risk of viscerotropic disease
- Moderate or severe acute illness
Vaccination can cause YF vaccine-associated neurotropic disease and YF vaccine-associated viscerotropic disease

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-* RNA virus and member of the [[Flaviviridae]] family
+*RNA virus and member of the [[Flaviviridae]] family
-== Prevention ==
+=== Epidemiology ===
+* Worldwide, about 200,000 cases and 30,000 deaths annually
-* Vaccination can cause [[Yellow fever vaccine-associated neurotropic disease|YF vaccine-associated neurotropic disease]] and [[Yellow fever vaccine-associated viscerotropic disease|YF vaccine-associated viscerotropic disease]], primarily in older people
+== Clinical Manifestations ==
+* Spectrum of illness from asymptomatic to fatal
+* Acute illness starts with fever, chills, headache, backache, myalgias, arthralgias, nausea, vomiting, photophobia, mild jaundice, and epigastric pain
+* After the acute illness subsides, about 85% of infections are resolved, and 15% progress
+* In those who progress, a brief remission of hours to days is followed by return of symptoms with progression to renal failure, hemorrhage, and thrombocytopenia
+=== Vaccine-Related Disease ===
+* [[Yellow fever vaccine-associated neurotropic disease]], which includes [[meningoencephalitis]], [[Guillain-Barré syndrome]], and acute bulbar palsy
+* [[Yellow fever vaccine-associated viscerotropic disease]], which causes multi-organ failure similar to wildtype virus
+{| class="wikitable"
+!
+![[Yellow fever vaccine-associated neurotropic disease|YEL-AND]]
+![[Yellow fever vaccine-associated viscerotropic disease|YEL-AVD]]
+|-
+|Incubation period
+|7 to 21 days
+|2 to 5 days
+|-
+|Rate
+|0.8 per 100,000 doses
+|1 per 100,000 doses
+|-
+|Risk factors
+|age <6 months
+age >60-70 years
+|age >60 years
+thymus disease
+|-
+|Prognosis
+|full recovery
+|65% mortality
+|}
+== Management ==
+* Supportive care
+==Prevention==
+*A live attenuated vaccine strain is available
+*Contraindications
+**Allergy to any component of the vaccine
+**Infants  less than 6 to 9 months of age, due to the high risk of [[Yellow fever vaccine-associated neurotropic disease|neurotropic disease]] following immunization
+**People age 60 years and older, due to the high risk of adverse events following immunization
+***Booster doses may stll be given, if indicated
+**Pregnancy and breastfeeding
+**Thymus disease, including [[thymoma]], [[thymectomy]], and [[myasthenia gravis]], given the high risk of [[Yellow fever vaccine-associated viscerotropic disease|viscerotropic disease]]
+**Moderate or severe acute illness
+*Vaccination can cause [[Yellow fever vaccine-associated neurotropic disease|YF vaccine-associated neurotropic disease]] and [[Yellow fever vaccine-associated viscerotropic disease|YF vaccine-associated viscerotropic disease]]
 [[Category:Flaviviridae]]