From the Guidelines
Prevention of yellow fever primarily relies on vaccination, which is the most effective strategy, and individuals traveling to or living in endemic areas should receive the vaccine, unless they are immunosuppressed, in which case alternative strategies such as holding immunosuppressive therapy for vaccination may be considered 1. The yellow fever vaccine is a live attenuated vaccine that provides lifelong immunity after a single dose for most people.
Key Points
- Vaccination is recommended for anyone 9 months or older traveling to or living in areas where yellow fever is endemic, particularly in parts of Africa and South America 1.
- Other prevention methods include avoiding mosquito bites by using insect repellents containing DEET, wearing long-sleeved shirts and pants, staying in accommodations with screens or air conditioning, and using bed nets treated with insecticide.
- There is no specific antiviral treatment for yellow fever once infected, and treatment is supportive, focusing on managing symptoms, which may include rest, fluids to prevent dehydration, pain relievers like acetaminophen for fever and pain (avoiding aspirin and NSAIDs due to bleeding risk), and hospitalization for severe cases.
- In hospital settings, patients may receive intravenous fluids, dialysis for kidney failure, blood transfusions for severe bleeding, and respiratory support if needed.
- Yellow fever can be severe and potentially fatal, with symptoms progressing from fever, headache, and muscle pain to jaundice, bleeding, and organ failure in some cases, which is why prevention through vaccination is so crucial.
Special Considerations
- The yellow fever vaccine should be avoided in patients who are immunosuppressed, and in travels or patients in endemic areas at very high risk, patients and their providers may consider holding immunosuppressive therapy for vaccination 1.
- The typical requirement for doing this would be to hold for a sufficient time to allow for the medication to wash out and its biologic effect to dissipate depending on half-life, then vaccinate, and then wait 2–4 weeks before resuming medication 1.
From the Research
Prevention of Yellow Fever
- The primary prevention method for yellow fever is vaccination, which has been available since 1937 2, 3, 4, 5.
- The live, attenuated yellow fever 17D vaccine provides highly effective and durable immunity against the disease 3.
- A single dose of the vaccine is sufficient to confer sustained life-long protective immunity, and a booster dose is not necessary 5.
- Travel health practitioners should conduct individualized assessments of the risks and benefits of yellow fever vaccination to identify potential contraindications, such as a history of thymoma or thymus dysfunction, AIDS, and individuals receiving immunosuppressive drugs 2.
Treatment Options for Yellow Fever
- There is no effective treatment for yellow fever, making vaccination an important preventive intervention in endemic areas 2.
- Treatment for yellow fever is primarily focused on managing symptoms and supporting the patient's immune system 6.
Risks and Benefits of Yellow Fever Vaccination
- The vaccine can cause rare but serious adverse events, such as neurotropic and viscerotropic disease, which can be fatal 3, 4.
- The risk of vaccine-related illness and death should be weighed against the risk of natural infection with yellow fever, taking into account factors such as destination, season, and individual risk factors 3.
- The World Health Organization (WHO) recommends the use of yellow fever vaccination in accordance with its position paper, which summarizes the WHO position on the use of YF vaccination 5.