Yellow Fever Vaccine–Associated Viscerotropic Disease among Siblings, São Paulo State, Brazil

Fernandes, Eder Gatti; Pôrto, Victor Bertollo Gomes; Oliveira, Patrícia Mouta Nunes de; Duarte‐Neto, Amaro Nunes; Maia, Maria de Lourdes de Sousa; Lignani, Letícia Kegele; Nogueira, Juliana Silva; Teixeira, Gabriellen Vitiello; Iglezias, Silvia D’Andretta; Blanco, Roberta Morozetti; Sato, Helena Keico

doi:10.3201/eid2903.220989

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Myocarditis and myocardial hemorrhage due to the YFV-17DD strain found in the cases described here are similar, from the histological point of view, to previous reports made by our group in cases of YEL-AVD. 17 , 34 These results corroborate that the vaccine strain can mediate not only severe adverse lesions in the liver and brain, but also in the heart, and, therefore, we suggest awareness regarding cardiovascular symptoms after administration of the 17DD vaccine. Clinical and pathological studies (human and experimental) can deepen this important matter.…”

Section: Discussionsupporting

confidence: 76%

Understanding yellow fever-associated myocardial injury: an autopsy study

Giugni,

Aiello,

Faria

et al. 2023

eBioMedicine

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Section: Discussionsupporting

confidence: 76%

Understanding yellow fever-associated myocardial injury: an autopsy study

Giugni,

Aiello,

Faria

et al. 2023

eBioMedicine

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“…Besides particularly young age [28,202], inborn or functional deficiency in IFN-I signalling [203,204] may contribute to an enhanced individual risk for YEL-AND and YEL-AVD, respectively. Though very few cases have been studied in detail [205], there seems to be a particularly strong link to host genetics [206] and rare immune defects [204,205], similar to other live-attenuated vaccines, such as MMR, oral polio or Bacillus Calmette-Guerin (BCG) vaccine [207]. WHO recommendations [137] (last updated in 2013) and, accordingly, the label of current WHO-prequalified YF vaccines, integrate these general safety concerns in a list of contraindications.…”

Section: Box 3 -General Vaccine Safetymentioning

confidence: 99%

YF17D‐based vaccines – standing on the shoulders of a giant

Sanchez‐Felipe,

Alpizar,

et al. 2024

Eur J Immunol

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SummaryLive‐attenuated yellow fever vaccine (YF17D) was developed in the 1930s as the first ever empirically derived human vaccine. Ninety years later, it is still a benchmark for vaccines made today. YF17D triggers a particularly broad and polyfunctional response engaging multiple arms of innate, humoral and cellular immunity. This unique immunogenicity translates into an extraordinary vaccine efficacy and outstanding longevity of protection, possibly by single‐dose immunization. More recently, progress in molecular virology and synthetic biology allowed engineering of YF17D as a powerful vector and promising platform for the development of novel recombinant live vaccines, including two licensed vaccines against Japanese encephalitis and dengue, even in paediatric use. Likewise, numerous chimeric and transgenic preclinical candidates have been described. These include prophylactic vaccines against emerging viral infections (e.g. Lassa, Zika and SARS‐CoV‐2) and parasitic diseases (e.g. malaria), as well as therapeutic applications targeting persistent infections (e.g. HIV and chronic hepatitis), and cancer. Efforts to overcome historical safety concerns and manufacturing challenges are ongoing and pave the way for wider use of YF17D‐based vaccines. In this review, we summarize recent insights regarding YF17D as vaccine platform, and how YF17D‐based vaccines may complement as well as differentiate from other emerging modalities in response to unmet medical needs and for pandemic preparedness.

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Yellow fever vaccine-associated neurologic and viscerotropic disease: a 10-year case series of the French National Reference Center for Arboviruses with clinical and immunological insights

Le Hir,

Durand,

Boucraut

et al. 2023

Journal of Travel Medicine

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Background Immunization against the Yellow fever virus (YFV) with the 17D live-attenuated vaccine is the most effective way to prevent the disease. However, unexpected severe adverse events can occur. They consist in a neurological disease (YEL-AND), a viscerotropic disease (YEL-AVD), or anaphylaxis. In this article, we describe the epidemiology, clinical and biological features of YEL-AND and YEL-AVD cases reported to the French National Reference Center for Arboviruses (NRCA) in the past 10 years. Methods We conducted a national, retrospective study using the database of the NRCA from June 2012 to June 2022. All patients whose biological samples were sent to the NRCA for detection of YFV by serology and/or RT-qPCR for a suspected vaccine-associated adverse event were included. We collected data by reading medical records and conducted complementary neuro-immunological analysis, followed by a search for autoimmunity against type-1-interferon when samples were available at the NRCA. Results There were 10 cases of YEL-AND and 2 cases of YEL-AVD reported to the NRCA in the past 10 years, which represented an overall incidence of 0.6 for 100 000 doses. 6/12 cases were previously healthy patients (50%, mean age 31 years), and 4/12 cases had cardiovascular comorbidities (42%, mean age 56 years). The majority of YEL-AND had a favourable outcome at 6 months of follow up. 1 YEL-AVD patient passed. In secondary analyses, we evidenced a significant blood-CSF barrier dysfunction, without intrathecal synthesis of immunoglobulin and without argument for a neuron damage. We further detected a significant rate of anti-type-1alpha interferon antibodies in 3/10 tested patients (2 YEL-AND and 1 YEL-AVD). Conclusion YEL-AND and YEL-AVD are rare events that can underlie defect in the innate immunity of apparently healthy or mild comorbid subjects. Outcome was generally favourable in the YEL-AND cases of our series, but still life-threatening or even fatal in the YEL-AVD cases.

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Yellow Fever Vaccine–Associated Viscerotropic Disease among Siblings, São Paulo State, Brazil

Cited by 3 publications

References 29 publications

Understanding yellow fever-associated myocardial injury: an autopsy study

Understanding yellow fever-associated myocardial injury: an autopsy study

YF17D‐based vaccines – standing on the shoulders of a giant

Yellow fever vaccine-associated neurologic and viscerotropic disease: a 10-year case series of the French National Reference Center for Arboviruses with clinical and immunological insights

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