Yellow Fever Vaccine Post-marketing Surveillance in Brazil

Martins, Reinaldo de Menezes; Maia, Maria de Lourdes de Sousa; Santos, Elizabeth Moreira dos; Cruz, Robson Leite de Souza; Santos, Paulo Roberto Gomes dos; Carvalho, Sandra Maria Deotti; Sato, Helena Keiko; Schermann, Maria Teresa; Mohrdieck, Renate; Leal, M; Homma, Akira

doi:10.1016/j.provac.2010.07.012

Cited by 38 publications

(31 citation statements)

References 19 publications

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“…Data from the UK [17] and Australia [27] are consistent, showing the increased risk in the elderly. In Brazil, 38 cases of YEL-AND (35 aseptic meningitis, two GBS, one case of demyelinating disease with optic neuritis) were recorded during a mass vaccination campaign Rio Grande do Sul in 2008-2009 (where surveillance for adverse events was high), a rate (1.1 per 100,000) similar to that in the USA based on 3.6 million doses of 17D vaccine administered for travel [28].…”

Section: Neurologic Adverse Eventsmentioning

confidence: 97%

“…Two famililal clusters each involving two cases have been reported in Brazil, suggesting a genetic basis of susceptibility [28]. In other cases of YEL-AVD, acquired risk factors including immune dysregulation, for example from autoimmune disease, thymic disease [48] or advanced age [17,[24][25][26][27][28], appear to underlie increased susceptibility to YEL-AVD. Autoimmune disease is gaining recognition as a risk factor for YEL-AVD, and may have both inherited and acquired etiologies (see below) [28,49].…”

Section: Viscerotropic Diseasementioning

confidence: 99%

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Review of the risks and benefits of yellow fever vaccination including some new analyses

Monath

2012

Expert Review of Vaccines

126

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The live, attenuated yellow fever (YF) 17D vaccine provides highly effective and durable immunity and is widely used for travelers to and residents of endemic areas of South America and Africa. Neurotropic and viscerotropic serious adverse events associated with these vaccines occur rarely, but YF 17D vaccine-associated viscerotropic disease (YEL-AVD) is notable for its lethality. There appear to be two distinct patterns of risk for YEL-AVD: the first in younger persons, particularly women, with defects in innate immunity, in whom the case-fatality rate is higher; and the second in elderly persons, particularly men with age-related immune senescence and a lower case-fatality rate. From 1990 to the present, the number of cases (n = 31) and deaths (n = 12) from YEL-AVD in travelers has exceeded the reports of YF (n = 6) acquired by natural infection, raising the question whether the risk of vaccination exceeds the benefit in travelers. To provide some guidance on this point, the rate of vaccine-related injury is compared with the rate of naturally acquired disease in a new analysis that estimates the immunologically susceptible denominator population in YF endemic and epidemic areas. For many years, the risk of vaccine-related illness and death was similar to the risk of illness and death from natural infection with YF in South America. Africa posed a substantially higher estimated risk of wild-type YF than vaccine-related injury. Multiple factors should be considered in making decisions about YF vaccination, including specific destination, season of the year, local evidence for YF transmission, likelihood of exposure to vector mosquitoes and individual risk factors for YEL-AVD, with the goal of increasing vaccine coverage for travel to high-risk areas and reducing unnecessary vaccination. Prospects for future, safer vaccines are also described.

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Section: Neurologic Adverse Eventsmentioning

confidence: 97%

Section: Viscerotropic Diseasementioning

confidence: 99%

Review of the risks and benefits of yellow fever vaccination including some new analyses

Monath

2012

Expert Review of Vaccines

126

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“…12 In a study of adverse events during a campaign in Argentina, 13 there was one YEL-AVD confirmed case per 1,943,000 doses administered (0.05/100,000 doses). Including 12 probable cases, the rate increased to 0.6/100,000 doses, 7/12 were in people >50 years old (but risk per age group is not provided), and 9/12 were male.…”

Section: Vaccine-associated Viscerotropicmentioning

confidence: 99%

“…12,41 One possibility is that mothers immune to YF through exposure to wild virus or vaccination could protect their children by passive transmission of antibodies, so lowering adverse events when vaccination starts at 9 months of age. Also, in YF endemic areas, people of African descent predominate, and this population may have been selected for resistance to YF, 42 and possibly to YF 17D virus invasiveness.…”

Section: The Influence Of Flavivirus Heterologous Immunity On Human Vmentioning

confidence: 99%

Serious adverse events associated with yellow fever vaccine

Martins

Leal²,

Homma³

2015

Human Vaccines & Immunotherapeutics

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“…But after the vaccination campaigns in São Paulo and Rio Grande do Sul in 2009, the serious adverse event rates were higher: 0.31 and 0.11 per 100,000 doses, respectively. In Rio Grande do Sul the rate of neurological events (aseptic meningitis and Guillain-Barré syndrome) was 1.1 per 100,000 doses 28 . Also in Rio Grande do Sul, two cases were confirmed of meningitis due to vaccine virus acquired through human breast milk 29 .…”

Section: Safety Of Yellow Fever Vaccinementioning

confidence: 99%