[Yellow fever vaccination in non-immunocompetent patients].
Any person travelling in countries where yellow fever (YF) is endemic and without presenting contra-indication for the vaccination against YF may be vaccinated. This vaccination can very rarely induce a potentially lethal neurotropic or viscerotropic disease. In severely immunodeficient patients, the vaccination is contra-indicated because postvaccinal encephalitis may occur after the vaccination, due to vaccine strain pathogenecity. It is important to evaluate the general health status in elderly individuals before vaccinating because of the increased risk of viscerotropic disease in people of 60 years of age and over. Pregnant women should not be vaccinated, except if departure to an endemic zone is unavoidable. YF vaccinatio is contra-indicated for newborns under six months of age. Solid organ grafts, congenital immunodeficiency, leukemia, lymphoma, cancer, and immunosuppressive treatments are contra-indications for this vaccination. Nevertheless, YF immunization is possible after a bone marrow graft and a two-year period without graft-versus-host disease or immunosuppressive treatment. There is no data to support that immunization of the dono prior to the graft could confer protection against yellow fever to the recipient. Low doses, short courses of corticosteroids either as systemic treatment or intra-articular injections are not contra-indications for YF vaccination. Patients infected with HIV with stable clinical status and T CD4-cel count above 200 cells per millimetre cube may be vaccinated. Thymic diseases, including thymoma and thymectomy, are contra-indications for YF vaccination. Finally, a substantial residual level of antibodies beyond 10 years after the latest vaccination could confer protection, thus avoiding a new vaccination when it is an issue.
Bruyand
M
M
Service de médecine interne et tropicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
Receveur
M C
MC
Pistone
T
T
Verdière
C H
CH
Thiebaut
R
R
Malvy
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D
D000328:Adult; D000368:Aged; D000375:Aging / Q000276:immunology; D000914:Antibodies, Viral / Q000096:biosynthesis; D001327:Autoimmune Diseases / Q000276:immunology; D000075202:Contraindications; D004673:Encephalomyelitis, Acute Disseminated / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes / Q000151:congenital / Q000276:immunology; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011446:Prospective Studies; D014181:Transplantation Immunology; D014611:Vaccination / Q000009:adverse effects*; D022341:Yellow Fever Vaccine / Q000009:adverse effects* / Q000276:immunology; D015005:Yellow fever virus / Q000276:immunology
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D022341:Yellow Fever Vaccine