14 Jan 2020

Yellow fever Green Book updated chapter

The updated yellow fever chapter in the Green Book (Immunisation against infectious disease) has been published Yellow fever Green Book updated chapter

On November 21, 2019 the findings of a Commission on Human Medicines (CHM) review of serious and fatal reactions following yellow fever vaccine was published [1]. The CHM concluded that the balance between benefits and risk of yellow fever vaccine remain favourable for most travellers when used as indicated. However, strengthened measures were recommended to minimise the potential risk of rare but serious and fatal adverse events associated with yellow fever vaccination in those with weakened immune systems, and in particular those aged 60 years or older and anyone who has had their thymus removed. For more details please see the report (Commission on Human Medicines, 2019) [1]. 

Yellow Fever Vaccination Centres (YFVCs) in England, Wales and Northern Ireland and Scotland were notified of implications for clinical practice in a Joint Letter from the Medicines and Healthcare products Regulatory Agency, National Travel Health Network and Centre, Public Health England and Health Protection Scotland [2].

Public Health England has updated the yellow fever chapter in Immunisation against infectious disease to reflect the recommendations of the CHM. Additionally, updates to some immunisation procedures are provided.

In addition to established contraindications to this vaccine (i.e. aged less than 6 months, primary or acquired immunodeficiency due to a congenital condition, disease process or treatment, anaphylaxis to a previous dose, egg or any component of YF vaccine), new contraindications to YF vaccine now include: 

  • a history of thymus disorder or thymectomy for any reason including incidental thymectomy (e.g. during cardiac surgery).
  • aged 60 years or older and travelling to areas where yellow fever vaccine is generally not recommended by the World Health Organization (WHO) (see our country information pages for country specific information).
  • a first-degree family history of yellow fever vaccine associated viscerotropic disease (YEL-AVD) or yellow fever vaccine associated neurotropic disease (YEL-AND) following YF vaccination that was not related to a known medical risk factor.

Updates to immunisation procedures include:

  • guidance on intervals between YF and MMR vaccines.
  • guidance on YF revaccination, where the interval between MMR is sub-optimal, for those at ongoing risk. 

Health Professionals and particularly those working in UK YFVCs should read this new chapter in its entirety and ensure this new information is disseminated widely and applied in their clinical practice. Where there is doubt regarding the advice that should be offered, health professionals are recommended to seek specialist advice. 

Our website documents are currently being updated.

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