From the Guidelines
Transplant patients who have received the yellow fever vaccine should be closely monitored for potential adverse reactions, particularly yellow fever vaccine-associated viscerotropic disease (YEL-AVD), due to their increased risk of vaccine-related complications. The management and monitoring of these patients should prioritize minimizing the risk of YEL-AVD and other adverse reactions. According to the guidelines from the Infectious Diseases Society of America (IDSA) 1, live vaccines, including the yellow fever vaccine, should generally not be administered to immunocompromised persons, such as transplant patients, due to the risk of vaccine-related complications. However, if a transplant patient has already received the yellow fever vaccine, they should be monitored daily for at least 30 days post-vaccination for signs of YEL-AVD, including fever, myalgia, headache, hypotension, jaundice, or signs of multi-organ dysfunction. Laboratory monitoring should include complete blood counts, liver function tests, and renal function tests twice weekly for the first two weeks, then weekly for an additional two weeks 1. Immunosuppression should be carefully managed, avoiding significant increases in immunosuppressive medications during this period if possible. If signs of YEL-AVD develop, immediate hospitalization is necessary with supportive care, possible reduction in immunosuppression (balanced against rejection risk), and consideration of intravenous immunoglobulin (IVIG) at 400-500 mg/kg daily for 3-5 days. Antiviral medications like ribavirin may be considered in severe cases, though evidence for their efficacy is limited. The risk of YEL-AVD is higher among persons receiving their first yellow fever vaccination, and all cases reported thus far have occurred among such persons 1. Therefore, a careful risk-benefit assessment should be made before administering the yellow fever vaccine to transplant patients, and alternative measures to prevent yellow fever, such as avoiding travel to endemic areas or using insecticide-treated clothing and gear, should be considered. In cases where vaccination is deemed necessary, close monitoring and prompt treatment of any adverse reactions are crucial to minimizing the risk of complications. The IDSA guidelines emphasize the importance of careful consideration and monitoring in the administration of live vaccines to immunocompromised individuals, including transplant patients 1.
From the Research
Management and Monitoring Recommendations
For a transplant patient who has received the yellow fever vaccine, the following management and monitoring recommendations can be considered:
- Close monitoring for signs of yellow fever disease, such as fever, nausea, vomiting, diarrhea, polyarthralgia, and thrombocytopenia 2
- Regular laboratory tests to assess liver function and viral load 2
- Monitoring for potential adverse events associated with the vaccine, such as meningoencephalitis and invasive or disseminated disease 3
- Counseling on the contraindications of the yellow fever vaccine and the risks associated with its use in immunosuppressed patients 4, 5
Considerations for Transplant Patients
Transplant patients who have received the yellow fever vaccine should be aware of the following:
- The vaccine is contraindicated in immunosuppressed patients due to the risk of life-threatening side effects 4, 5
- The risk of developing yellow fever disease after vaccination is higher in immunosuppressed patients 2
- The use of live attenuated virus vaccines, including the yellow fever vaccine, is still contraindicated for immunocompromised patients, such as transplant recipients 6
Clinical Outcomes
Studies have reported varying clinical outcomes for transplant patients who have received the yellow fever vaccine, including: