Yellow fever virus: Difference between revisions
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*RNA virus and member of the [[Flaviviridae]] family |
*RNA virus and member of the [[Flaviviridae]] family |
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| − | === |
+ | ===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 |
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| − | == |
+ | ==Management== |
| − | * |
+ | *Supportive care |
==Prevention== |
==Prevention== |
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| − | *A live attenuated vaccine strain is available |
+ | *A live attenuated vaccine strain is available, with a single dose provided at least decades of and possibly life-long immunity |
| + | *Antibodies develop within 28 days |
||
*Contraindications |
*Contraindications |
||
**Allergy to any component of the vaccine |
**Allergy to any component of the vaccine |
||
| + | **Immunocompromised state, including HIV with CD4 <200 or <15%, B-cell deficiency (except isolated [[IgA deficiency]], [[IgG subclass deficiency]], and [[specific antibody deficiency]]), and combined B- and T-cell deficiency |
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| − | **Infants |
+ | **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 |
**People age 60 years and older, due to the high risk of adverse events following immunization |
||
***Booster doses may stll be given, if indicated |
***Booster doses may stll be given, if indicated |
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**Thymus disease, including [[thymoma]], [[thymectomy]], and [[myasthenia gravis]], given the high risk of [[Yellow fever vaccine-associated viscerotropic disease|viscerotropic disease]] |
**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 |
**Moderate or severe acute illness |
||
| + | *Booster doses |
||
| + | **No longer routinely indicated |
||
| + | **May be indicated if the original dose was given when the recipient was unlikely to mount a full immune response |
||
| + | ***Vaccinated during pregnancy, while on immunosuppressants, or other immunocompromise like HIV |
||
| + | ****One-time booster for most, and booster every 10 years for HIV |
||
| + | ***Hematopoietic stem cell transplant since last vaccination |
||
| + | ****One-time full dose |
||
| + | ***Last dose was fractional, given improperly, undocumented, or underdocumented |
||
| + | ****One-time full dose |
||
| + | **May be indicated for individuals at particularly high risk of exposure |
||
| + | ***Travel to an area experiencing an outbreak |
||
| + | ***Frequent or prolonged travel to areas with high endemicity, particularly West Africa |
||
| + | ***One-time booster if 10 or more years since primary vaccination |
||
| + | **May be indicated for individuals with regular and ongoing exposure |
||
| + | ***Laboratory workers working on yellow fever virus |
||
| + | ***Booster every 10 years unless antibody titres confirm ongoing immunity |
||
*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]] |
*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]] |
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Latest revision as of 20:38, 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, with a single dose provided at least decades of and possibly life-long immunity
- Antibodies develop within 28 days
- Contraindications
- Allergy to any component of the vaccine
- Immunocompromised state, including HIV with CD4 <200 or <15%, B-cell deficiency (except isolated IgA deficiency, IgG subclass deficiency, and specific antibody deficiency), and combined B- and T-cell deficiency
- 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
- Booster doses
- No longer routinely indicated
- May be indicated if the original dose was given when the recipient was unlikely to mount a full immune response
- Vaccinated during pregnancy, while on immunosuppressants, or other immunocompromise like HIV
- One-time booster for most, and booster every 10 years for HIV
- Hematopoietic stem cell transplant since last vaccination
- One-time full dose
- Last dose was fractional, given improperly, undocumented, or underdocumented
- One-time full dose
- Vaccinated during pregnancy, while on immunosuppressants, or other immunocompromise like HIV
- May be indicated for individuals at particularly high risk of exposure
- Travel to an area experiencing an outbreak
- Frequent or prolonged travel to areas with high endemicity, particularly West Africa
- One-time booster if 10 or more years since primary vaccination
- May be indicated for individuals with regular and ongoing exposure
- Laboratory workers working on yellow fever virus
- Booster every 10 years unless antibody titres confirm ongoing immunity
- Vaccination can cause YF vaccine-associated neurotropic disease and YF vaccine-associated viscerotropic disease
