Risks of Transmitting Yellow Fever Vaccine Through Sexual Contact to Someone with Autoimmune Disease
There is no documented risk of transmitting yellow fever vaccine virus through sexual contact to someone with an autoimmune disease, though general precautions are recommended due to the theoretical risk of viral transmission during the viremic period. 1
Understanding Yellow Fever Vaccine and Autoimmune Disease Risks
The yellow fever vaccine is a live-attenuated vaccine that typically causes a low-level viremia in recipients 4-7 days post-vaccination as anti-yellow virus IgM antibodies develop 2. This viremia typically resolves within a week as the immune response develops.
Key Considerations for Autoimmune Disease Patients
- Individuals with autoimmune diseases are generally advised to avoid receiving the yellow fever vaccine themselves 2
- The EULAR (European League Against Rheumatism) 2020 recommendations specifically state that yellow fever vaccination should be generally avoided in patients with autoimmune inflammatory rheumatic diseases (AIIRD) 2
- Autoimmune disease appears to be a potential risk factor for yellow fever vaccine-associated viscerotropic disease (YEL-AVD), a rare but serious adverse event 2
Transmission Risk Through Sexual Contact
While there is no specific data on sexual transmission of yellow fever vaccine virus:
- No documented cases of person-to-person transmission of yellow fever vaccine virus through sexual contact exist in the medical literature 1
- Unlike some other live vaccines (such as oral polio vaccine), yellow fever vaccine has not shown evidence of casual transmission between individuals 1
- The viremic period (when virus may be present in blood) typically lasts only 4-7 days post-vaccination 2
Recommended Precautions
For sexual partners where one has received yellow fever vaccine and the other has an autoimmune disease:
- General hygiene measures are recommended for the first 2-4 weeks after vaccination 1
- Consider barrier protection (condoms) during the potential viremic period (first 1-2 weeks after vaccination) as a precautionary measure, especially if the autoimmune disease partner is on immunosuppressive medications
- The risk is theoretical rather than documented, but caution is warranted given the potential serious complications of yellow fever vaccine virus in immunocompromised individuals 2
Special Considerations
- The level of immunosuppression in the person with autoimmune disease is an important factor - those on high-dose immunosuppressive medications may warrant more caution 1
- Individuals with a history of thymectomy or thymus disorders have specific contraindications to yellow fever vaccine themselves, suggesting potential higher risk if exposed 2
- Nine (16%) of 57 persons with reported cases of YEL-AVD had a history of autoimmune disease, suggesting autoimmune disease may be a risk factor for serious adverse events if directly exposed to the vaccine virus 2
While the risk of transmission through sexual contact appears minimal, using barrier protection during the first 1-2 weeks after vaccination represents a reasonable precaution for partners with autoimmune disease, particularly those on immunosuppressive therapy.