What are the requirements for the yellow fever vaccine?

Yellow Fever Vaccine Requirements

Yellow fever vaccine is required for persons aged ≥9 months who are traveling to or living in areas at risk for YFV transmission in South America and Africa, and must be administered at an approved vaccination center with documentation provided through an International Certificate of Vaccination or Prophylaxis (ICVP). 1

Vaccination Requirements and Documentation

• The yellow fever vaccine is recommended for travelers to endemic regions in South America and Africa, with specific country requirements available through the CDC 1
• The vaccine must be administered at least 10 days before entering an endemic area to ensure immunity 1, 2
• Documentation through an ICVP (yellow card) is mandatory, which must be:
  • Completed in every detail
  • Signed by the provider
  • Validated with the official yellow fever vaccination center stamp 1
• Incomplete or inaccurate documentation may result in travelers being:
  • Quarantined for up to 6 days
  • Denied entry
  • Possibly revaccinated at point of entry 1

Validity and Timing

• The certificate of vaccination becomes valid 10 days after administration and remains valid for 10 years 1
• When a booster dose is administered within the 10-year period, the certificate is valid immediately from the day of the most recent vaccination 1
• Studies show that approximately 21.7% of travelers receive the vaccine less than 10 days before departure, with those traveling to Africa more likely to be late (32.7%) compared to South America (10.8%) 2

Administration Requirements

• Yellow fever vaccines must be administered at an approved vaccination center 1
• In the United States, state and territorial health departments designate nonfederal vaccination centers and issue yellow fever vaccination stamps 1
• The vaccine is administered as a 0.5 mL dose subcutaneously 3
• The 17D-204 yellow fever vaccine is a freeze-dried, live attenuated vaccine that should be stored at 2-8°C 3
• After reconstitution with normal saline, the vaccine must be used within 1 hour 3

Medical Exemptions and Contraindications

• Medical providers may issue a waiver of yellow fever vaccination if medically contraindicated 1
• The waiver should include:
  • Completed "Medical Contraindications to Vaccination" section of the ICVP
  • Signed and dated letter on letterhead stationary clearly stating the contraindication
  • Official yellow fever vaccination center stamp 1
• The vaccine is contraindicated in severely immunocompromised individuals due to risk of complications 4

Special Populations

• Age restrictions: The vaccine is recommended for persons aged ≥9 months 1
• Some countries do not require an ICVP for infants younger than certain ages (e.g., <6 months, <9 months, or <1 year, depending on the country) 1
• Older adults (≥60 years) represent approximately 17% of vaccine recipients and require careful evaluation due to potentially increased risk of adverse events 5

Public Health Impact

• Yellow fever causes an estimated 200,000 cases and 30,000-51,000 deaths annually worldwide 6, 7
• The case fatality rate for severe yellow fever is approximately 50% 6
• Mass vaccination activities in Africa have reduced deaths by 47% 7

Common Pitfalls to Avoid

• Last-minute vaccination decisions (43.2% of late vaccinations) 2
• Incomplete documentation on the ICVP 1
• Failure to verify country-specific requirements before travel 1
• Not allowing sufficient time (minimum 10 days) for immunity development before travel 1, 2
• Not obtaining vaccination from an officially designated center 1

Following these requirements is essential not only for legal entry into countries requiring yellow fever vaccination but also for protecting travelers from a potentially fatal disease with no specific treatment.