title: Safety and immunogenicity of yellow fever 17D vaccine in adults receiving systemic corticosteroid therapy: an observational cohort study.
abstract: OBJECTIVE
  To assess the safety and immunogenicity of live attenuated yellow fever (YF) 17D vaccine in adults receiving systemic corticosteroid therapy.
  
  
  METHODS
  All adult travelers on systemic corticosteroid therapy who had received the YF17D vaccine in 24 French vaccination centers were prospectively enrolled and matched with healthy controls (1:2) on age and history of YF17D immunization. Safety was assessed in a self-administered standardized questionnaire within 10 days after immunization. YF-specific neutralizing antibody titers were measured 6 months after vaccination in patients receiving corticosteroids.
  
  
  RESULTS
  Between July 2008 and February 2011, 102 vaccine recipients completed the safety study (34 receiving corticosteroids and 68 controls). The median age was 54.9 years (interquartile range [IQR] 45.1-60.3 years) and 45 participants had a history of previous YF17D immunization. The median time receiving corticosteroid therapy was 10 months (IQR 1-67 months) and the prednisone or equivalent dosage was 7 mg/day (IQR 5-20). Main indications were autoimmune diseases (n = 14), rheumatoid arthritis (n = 9), and upper respiratory tract infections (n = 8). No serious adverse event was reported; however, patients receiving corticosteroids reported more frequent moderate/severe local reactions than controls (12% and 2%, respectively; relative risk 8.0, 95% confidence interval 1.4-45.9). All subjects receiving corticosteroids who were tested (n = 20) had neutralizing antibody titers >10 after vaccination.
  
  
  CONCLUSIONS
  After YF17D immunization, moderate/severe local reactions may be more frequent in patients receiving systemic corticosteroid therapy. Immunogenicity seems satisfactory. Large-scale studies are needed to confirm these results.
authors.affiliation: Paris Descartes University, INSERM, CIC BT505, and AP-HP, Cochin Hospital, CICBT505, Paris, France.
authors.forename: Solen
authors.initials: S
authors.lastname: Kernéis
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
authors.forename: Thierry
authors.initials: T
authors.lastname: Ancelle
authors.forename: Laura
authors.initials: L
authors.lastname: Iordache
authors.forename: Véronique
authors.initials: V
authors.lastname: Naneix-Laroche
authors.forename: Frédéric
authors.initials: F
authors.lastname: Méchaï
authors.forename: Thierry
authors.initials: T
authors.lastname: Fehr
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Leroy
authors.forename: Bertrand
authors.initials: B
authors.lastname: Issartel
authors.forename: Jean
authors.initials: J
authors.lastname: Dunand
authors.forename: Diane
authors.initials: D
authors.lastname: van der Vliet
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wyplosz
authors.forename: Paul-Henri
authors.initials: PH
authors.lastname: Consigny
authors.forename: Thomas
authors.initials: T
authors.lastname: Hanslik
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D018771:Arthralgia / Q000139:chemically induced / Q000276:immunology; D015331:Cohort Studies; D005221:Fatigue / Q000139:chemically induced / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D015004:Yellow Fever / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000009:adverse effects / Q000276:immunology* / Q000627:therapeutic use*; D015005:Yellow fever virus / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D022341:Yellow Fever Vaccine