Risk Groups for Yellow Fever Vaccine-Associated Viscerotropic Disease (YEL-AVD)

Authors

Stephen J. Seligman, Department of Microbiology and Immunology, New York Medical College, 15 Dana Road, Valhalla, NY 10595, United States. Electronic address: stephen_seligman@nymc.edu.

Author Type(s)

Faculty

DOI

10.1016/j.vaccine.2014.08.051

Journal Title

Vaccine

First Page

5769

Last Page

75

Document Type

Article

Publication Date

10-7-2014

Keywords

Risk groups, Vaccine, Viscerotropic, Yellow fever

Disciplines

Medicine and Health Sciences

Abstract

Although previously considered as the safest of the live virus vaccines, reports published since 2001 indicate that live yellow fever virus vaccine can cause a severe, often fatal, multisystemic illness, yellow fever vaccine-associated viscerotropic disease (YEL-AVD), that resembles the disease it was designed to prevent. This review was prompted by the availability of a listing of the cumulative cases of YEL-AVD, insights from a statistical method for analyzing risk factors and re-evaluation of previously published data. The purpose of this review is to identify and analyze risk groups based on gender, age, outcome and predisposing illnesses. Using a passive surveillance system in the US, the incidence was reported as 0.3 to 0.4 cases per 100,000. However, other estimates range from 0 to 12 per 100,000. Identified and potential risk groups for YEL-AVD include elderly males, women between the ages of 19 and 34, people with a variety of autoimmune diseases, individuals who have been thymectomized because of thymoma, and infants and children ≤11 years old. All but the last group are supported by statistical analysis. The confirmed risk groups account for 77% (49/64) of known cases and 76% (32/42) of the deaths. The overall case fatality rate is 66% (42/64) with a rate of 80% (12/15) in young women, in contrast to 50% (13/26) in men ≥56 years old. Recognition of YEL-AVD raises the possibility that similar reactions to live chimeric flavivirus vaccines that contain a yellow fever virus vaccine backbone could occur in susceptible individuals. Delineation of risk groups focuses the search for genetic mutations resulting in immune defects associated with a given risk group. Lastly, identification of risk groups encourages concentration on measures to decrease both the incidence and the severity of YEL-AVD.

Recommended Citation

Seligman, S. J. (2014). Risk Groups for Yellow Fever Vaccine-Associated Viscerotropic Disease (YEL-AVD). Vaccine, 32 (44), 5769-75. https://doi.org/10.1016/j.vaccine.2014.08.051