The Australian Immunisation Handbook 10th Edition 2013

Vaccine-associated neurotropic adverse events
Yellow fever vaccine-associated neurotropic disease (YF-AND) is rare. 18
At least 25 cases of meningoencephalitis following yellow fever
vaccination have been reported. 7 However, 15 of these cases occurred in
the 1950s in infants ≤7 months of age. Following recommendations in
the early 1960s not to vaccinate young infants, the incidence of vaccineassociated
meningoencephalitis declined considerably. 7 Nevertheless,
these adverse events, albeit very rare, still occur in adults; the risk is
greater in persons ≥60 years of age. 16,17
Vaccine-associated viscerotropic adverse events
Recently, an apparently very rare (and often fatal) complication, yellow fever
vaccine-associated viscerotropic disease (YF-AVD), characterised by multiorgan
system failure, has been recognised following yellow fever vaccination. It
appears that overwhelming infection with the 17D vaccine virus is responsible
for these viscerotropic adverse events. 7,18
Vaccine-associated viscerotropic adverse events do not appear to be caused by
altered virulence of the vaccine virus, but rather appear to be related to host
factors. Although cases have occurred in younger persons, it is apparent that the
risk is increased with advanced age, particularly in those aged ≥60 years. 16,17,19
Another host factor associated with an increased risk of a viscerotropic adverse
event is pre-existing thymus disease. Published reports of YF-AVD cases have
indicated that 4 of the 27 reported cases had a history of thymic tumour and
thymectomy, both uncommon conditions. 18,22
4.23.12 Public health management of yellow fever
Yellow fever is a notifiable and quarantinable disease in all states and territories
in Australia.
Further instructions about the public health management of yellow fever,
including management of cases of yellow fever and their contacts, should
be obtained from state/territory public health authorities (see Appendix 1
Contact details for Australian, state and territory government health authorities and
communicable disease control).
4.23.13 Variations from product information
The product information states that pregnancy is a contraindication to the yellow
fever vaccine. The ATAGI recommends instead that pregnant women who insist
on travelling to endemic countries should be vaccinated.
The product information suggests that a 0.1 mL test dose of yellow fever vaccine
can be used intradermally to assess an individual with suspected allergy to the
vaccine. The ATAGI instead recommends that (with the exception of Q fever
vaccine) test doses should never be used.
References
A full reference list is available on the electronic Handbook or website
www.immunise.health.gov.au
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4.23 YELLOW FEVER