title: Yellow fever vaccine-associated viscerotropic disease: current perspectives.
abstract: OBJECTIVE
  To assess those published cases of yellow fever (YF) vaccine-associated viscerotropic disease that meet the Brighton Collaboration criteria and to assess the safety of YF vaccine with respect to viscerotropic disease.
  
  
  METHODS
  Ten electronic databases were searched with no restriction of date or language and reference lists of retrieved articles.
  
  
  METHODS
  All abstracts and titles were independently read by two reviewers and data independently entered by two reviewers.
  
  
  RESULTS
  All serious adverse events that met the Brighton Classification criteria were associated with first YF vaccinations. Sixty-two published cases (35 died) met the Brighton Collaboration viscerotropic criteria, with 32 from the US, six from Brazil, five from Peru, three from Spain, two from the People's Republic of China, one each from Argentina, Australia, Belgium, Ecuador, France, Germany, Ireland, New Zealand, Portugal, and the UK, and four with no country stated. Two cases met both the viscerotropic and YF vaccine-associated neurologic disease criteria. Seventy cases proposed by authors as viscerotropic disease did not meet any Brighton Collaboration viscerotropic level of diagnostic certainty or any YF vaccine-associated viscerotropic disease causality criteria (37 died).
  
  
  CONCLUSIONS
  Viscerotropic disease is rare in the published literature and in pharmacovigilance databases. All published cases were from developing countries. Because the symptoms are usually very severe and life threatening, it is unlikely that cases would not come to medical attention (but might not be published). Because viscerotropic disease has a highly predictable pathologic course, it is likely that viscerotropic disease post-YF vaccine occurs in low-income countries with the same incidence as in developing countries. YF vaccine is a very safe vaccine that likely confers lifelong immunity.
authors: Department of Family Medicine, Faculty of Medicine, University of Calgary, Research Office, G012, Health Sciences Centre, Calgary, AB, Canada.
authors: Roger E
authors: RE
authors: Thomas
mesh_terms: D003906:Developing Countries; D006801:Humans; D009102:Multiple Organ Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014611:Vaccination / Q000009:adverse effects* / Q000401:mortality; D022341:Yellow Fever Vaccine / Q000009:adverse effects*
chemical_list: D022341:Yellow Fever Vaccine
keywords: postvaccination severe adverse events; systematic review; viscerotropic disease; yellow fever vaccine