Rare, Fatal Complications of Yellow Fever Vaccination

in Infectious Diseases/Outbreak Watch by

Yellow fever vaccine is recommended to all travelers who are planning a trip to countries endemic for the disease. The vaccine is relatively safe and effective and recently, there have been two isolated reports of a fatal and extremely rare complication arising from the YF vaccine, the Yellow Fever Vaccine associated Viscerotropic Disease (YEL-AVD). The CDC MMWR reported a case in Oregon, USA, and the Outbreak News Blog reported a case from Hong Kong.

YEL-AVD results from the uncontrolled replication of the vaccine virus, finally leading to multi-organ failure and has a reported mortality to the tune of 60%.

FIGURE from CDC Report: Yellow fever virus antigens (red) detected after immunohistochemical staining in tissue samples from various organs* of a patient who died from yellow fever vaccine–associated viscerotropic disease — Oregon, September 2014
* Sample A: myocytes in heart; sample B: fibroblasts in vascular wall in lung; sample C: kupffer cell in liver; sample D: fibroblasts and histiocytes in skin. (Immunoalkaline phosphatase with naphthol fast-red substrate and hematoxylin counterstain. Original magnifications: A = x400; B = x100; C = x400; D = x100.)
The CDC report further states that the risk of YEL-AVD is 0.4 per 100,000 doses of YF vaccine administered. The risk is increases with age: in patients older than 60 years it has a risk of 1/100,000 doses while those that, those who are older than 70 years have a risk of 2.3/100,000 doses administered. Almost a quarter of the first few cases of YEL-AVD that have been reported had a history of thymoma and it is estimated that the increased risk attributable to thyme disease persists even after thyme resection.

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

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