Yellow Fever Vaccination Guidelines
Yellow fever vaccination requires a single subcutaneous injection of 0.5 mL of reconstituted vaccine that provides long-lasting immunity, with revaccination recommended every 10 years for those at continued risk of exposure. 1
Administration Requirements
- Yellow fever vaccine must be administered at an approved Yellow Fever Vaccination Center 2
- Vaccinees should receive an International Certificate of Vaccination or Prophylaxis (ICVP) that is:
- Completed properly
- Signed by the administering clinician
- Stamped with the official stamp of the vaccination center 1
- The vaccine should be administered within 1 hour of reconstitution 1
- Once reconstituted, multidose vials should be maintained at 35°F–46°F (2°C–8°C), and remaining doses used or discarded within 1 hour 1
Dosage and Immunity Duration
- A single 0.5 mL dose administered subcutaneously is sufficient for most individuals 1
- While International Health Regulations formally require revaccination every 10 years, evidence suggests immunity persists for decades and may be lifelong 2, 3
- If the date of most recent vaccination cannot be determined and the patient requires vaccination, a booster dose should be administered 1
- Recent evidence shows that 94% of healthy adults in non-endemic settings maintain seroprotection even 10-60 years after vaccination 3
Special Populations and Contraindications
Contraindications:
- Severe hypersensitivity to vaccine components, including egg proteins
- Age <6 months (high risk of vaccine-associated neurologic disease)
- Thymus disorders
- Primary immunodeficiencies
- Malignant neoplasms
- Transplantation recipients
- HIV with CD4 counts <200/mm³ or <15% of total lymphocytes for children <6 years 1
Precautions (require risk-benefit assessment):
- Age 6-8 months (if travel to endemic area is unavoidable)
- Adults ≥60 years (higher risk of serious adverse events with first-time vaccination)
- Pregnancy
- Breastfeeding
- HIV with CD4 counts 200-499/mm³ or 15-24% of total lymphocytes for children <6 years
- Family history of vaccine-associated adverse events 1
Adverse Events
- Most reactions are mild: headaches, myalgia, low-grade fever for 5-10 days after vaccination 2
- Serious adverse events are rare but include:
- Yellow fever vaccine-associated neurotropic disease (YEL-AND)
- Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) 1
- All vaccinees should be observed for at least 15 minutes post-vaccination 1
- Patients should be advised about potential allergic reaction symptoms and to seek immediate medical care if these develop 1
Special Considerations
Co-administration with other vaccines:
- Inactivated vaccines can be administered simultaneously or at any time before/after yellow fever vaccine 1
- Other live viral vaccines should be given either simultaneously or separated by 30 days 1
Blood donation:
- Vaccinees should defer blood donation for 2 weeks after receiving yellow fever vaccine 1
Medical waivers:
- For individuals with contraindications who must travel to endemic areas, healthcare providers should:
- Complete the Medical Contraindications to Vaccination section of the ICVP
- Provide a signed and dated exemption letter
- Emphasize protective measures against mosquito bites 1
Special Population Considerations
- Children: Lower seroprotection rates (47%) observed in children vaccinated at 9-23 months when measured 10+ years later 3
- Older adults: Despite concerns about immunosenescence, a study of travelers vaccinated at age ≥60 found 100% remained seropositive 10 years after vaccination 4
- HIV patients: Lower seroprotection rates (61%) observed 10+ years after vaccination 3
Yellow fever vaccination remains one of the most effective preventive measures against this potentially fatal disease, with a single dose providing robust protection for most individuals.