Yellow Fever Vaccine Cases, Mark Gershman - ISTM

Would You Vaccinate ThisTraveler?Yellow Fever Vaccine Case StudiesMark Gershman, MDTravelers’ Health BranchCenters for Disease Control and PreventionAtlanta, Georgia, U.S.A.Case 1 49 year old male – no prior YF vaccination History of rheumatoid arthritis for 5 years Treated with infliximab (200 mg IV every 8weeks) Other medications — ibuprofen as needed forpain No other significant medical history He plans a 3 week business/leisure trip to Côted’Ivoire,leaving 5 months from today.Case 2 32 year old woman – no prior YF vaccination She has a healthy 2 month old infant boywhom she has exclusively breastfed since birth She will depart in 3 weeks for a month long tripwith her baby to Manaus,Brazil She plans to attend her sister’s wedding and tovisit relatives in several rural villages nearbyNational Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and QuarantineCase 3 61 year old man Healthy – no prior YF vaccination Leaving in 1 month for 2 week trip to Ethiopia He plans to do business and visit friends Plans to spend time in Addis Ababa and nearbyvillagesSupplemental InformationVaccine Contraindication* Condition in a vaccine recipient thatincreases the risk for a serious adversereaction Vaccine should not be administeredwhen a contraindication is present*General Recommendations on Immunization: Advisory Committee on ImmunizationPractices (ACIP), MMWR, Vol. 60, No. 2, Jan. 28, 2011

Vaccine Precaution* Condition in a vaccine recipient that• Might increase the risk for a serious adverseevent (SAE)Or• Might compromise the ability of the vaccine toproduce immunity Must carefully weigh benefit of protectionfrom vaccine versus risk for SAE Consider deferring vaccine*General Recommendations on Immunization: Advisory Committee on ImmunizationPractices (ACIP), MMWR, Vol. 60, No. 2, Jan. 28, 2011Contraindications to Yellow FeverVaccine Administration (WHO)* Allergy to any vaccine component Age < 6 months Symptomatic HIV infection Thymoma or history of thymectomy Immunodeficiencies from medication or disease*International Travel and Health, 2011, WHO, Geneva, SwitzerlandPrecautions to Yellow Fever VaccineAdministration (WHO)* Age 6-8 months Pregnancy Breastfeeding*International Travel and Health, 2011, WHO, Geneva, SwitzerlandContraindications to Yellow FeverVaccine Administration (U.S.)* Allergy to any vaccine component Age < 6 months Symptomatic HIV infection or CD4 + count < 200/mm 3 Thymus disorder associated with abnormal immune cellfunction Primary immunodeficiencies Malignant neoplasms Transplantation Immunosuppressive and immunomodulatory therapiesPrecautions to Yellow Fever VaccineAdministration (U.S.)* Age 6-8 months Asymptomatic HIV infection and CD4 + count200-499/mm 3 Pregnancy BreastfeedingYellow Fever Vaccination Decision Making — CONTRAINDICATIONSNo vaccination.Patient presentsDiscourage travelYESto YF endemicfor YF vaccinationarea.YF VaccineRECOMMENDED?NOWaiverYESContraindicationYESCONTRAINDICATIONpresentYF Vaccinepresent?REQUIRED?No vaccination.YESDiscourage travelNO YF Vaccineto YF endemicarea.RECOMMENDED?NONONo vaccinationYESVaccinateNO YF vaccinePRECAUTIONREQUIRED and/orpresent?RECOMMENDED?• *Yellow Fever Vaccine: Recommendations of the Advisory Committee on ImmunizationPractices (ACIP), MMWR, Vol.59, July 30, 2010• Blue font indicates Contraindication details not listed by WHO• *Yellow Fever Vaccine: Recommendations of the Advisory Committee on ImmunizationPractices (ACIP), MMWR, Vol.59, July 30, 2010• Blue font indicates Precaution details not listed by WHOYESSeePrecautionflow chartNONo vaccinationMark Gershman MD, CDC, Atlanta, GA, USAMay 2013

Yellow Fever Vaccination Decision Making — PRECAUTIONSPatient presentsfor YF vaccinationCONTRAINDICATIONpresent?YESSeeContraindicationflow chartYESNo vaccination.Consider vaccination.Discourage travelWeigh YF disease riskto YF endemicversus vaccine risk.area.NOYF VaccineRECOMMENDED?YESNOWaiverContraindicationpresent PRECAUTIONpresent?YESYF VaccineREQUIRED?NOYF VaccineRECOMMENDED?YESConsider vaccination.Weigh YF disease riskversus vaccine risk.NONOYF vaccineREQUIRED and/orRECOMMENDEDYESVaccinateNo vaccinationNONo vaccinationMark Gershman MD, CDC, Atlanta, GA, USAMay 2013