title: Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) and corticosteroid therapy: eleven United States cases, 1996-2004.
abstract: During 1996 through 2004, 29 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been reported worldwide; 17 were fatal. Stress-dose corticosteroid (SDS) therapy has recently been found to improve survival among patients with septic shock but benefit for the treatment of YEL-AVD patients in septic shock is unknown. We retrospectively reviewed medical records of 11 U.S. YEL-AVD cases reported to the Vaccine Adverse Event Reporting System (VAERS) from 1996 through 2004. Four of 11 case-patients received SDS; 3 of these 4 (75%) survived. Seven patients did not receive SDS and 2 (29%) survived. Altered mental status was documented on admission for 5 of the 11 patients; 4 of these 5 did not receive SDS and died, whereas one received SDS and survived. The use of stress-dose steroids might be a factor that influenced the survival of these YEL-AVD patients and should be further evaluated in the management of both YEL-AVD and wild-type yellow fever septic shock.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. cvellozzi@cdc.gov
authors.forename: Claudia
authors.initials: C
authors.lastname: Vellozzi
authors.forename: Tarissa
authors.initials: T
authors.lastname: Mitchell
authors.forename: Elaine
authors.initials: E
authors.lastname: Miller
authors.forename: Christine G
authors.initials: CG
authors.lastname: Casey
authors.forename: Rachel Barwick
authors.initials: RB
authors.lastname: Eidex
authors.forename: Edward B
authors.initials: EB
authors.lastname: Hayes
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015004:Yellow Fever / Q000517:prevention & control; D022341:Yellow Fever Vaccine / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D022341:Yellow Fever Vaccine