Abstract
Background: The yellow fever (YF) vaccination is recommended by the WHO for people traveling or living in endemic areas at risk for yellow fever infections in Africa and South America. Although the live attenuated yellow fever vaccine is a safe and efficient vaccine, rare serious adverse events after vaccination have been reported. Case presentation: We present the case of a 74-year-old male with multiorgan failure after yellow fever vaccination for a trip to Brazil. The patient required admission to the intensive care unit with a prolonged stay due to severe organ dysfunction. Five days after the YF vaccination, the patient experienced nausea, vomiting, diarrhea, and general illness. Three days later he sought medical attention and was transferred to the University Hospital Heidelberg with beginning multiorgan failure and severe septic shock, including hypotonia, tachypnea, thrombopenia, and acute renal failure the same day. Within one week after vaccination, antibodies against YF virus were already detectable and progressively increased over the next two weeks. Viral RNA was detected in serum on the day of admission, with a viral load of 1.0 × 105 copies/mL. The YF virus (YFV) RNA was also present in tracheal secretions for several weeks and could be detected in urine samples up to 20 weeks after vaccination, with a peak viral load of 1.3 × 106 copies/mL. After 20 weeks in the ICU with nine weeks of mechanical ventilation, the patient was transferred to another hospital for further recovery. Conclusions: The risk for severe adverse events due to the YF vaccination should be balanced against the risk of acquiring a severe YF infection, especially in elderly travelers.
Highlights
The yellow fever (YF) vaccination is recommended by the WHO for people traveling or living in endemic areas at risk for yellow fever infections in Africa and South America. the live attenuated yellow fever vaccine is a safe and efficient vaccine, rare serious adverse events after vaccination have been reported
YF virus (YFV)-infected people have an asymptomatic course of infection, most patients show symptoms like fever, headache, nausea, muscle pain, backache, vomiting, jaundice, and bleeding from the mouth, nose, eyes, or stomach
yellow fever vaccine associated viscerotropic disease (YEL-AVD) has been estimated at a frequency of about 0.3–0.4 per 100,000 doses distributed in vaccinees [2], and it has been described in the setting of primary vaccination in people without pre-existing YFV immunity
Summary
Yellow fever virus (YFV) is a member of the genus Flavivirus, family Flaviviridae, mainly transmitted by Aedes sp. mosquitoes. An excellent safety profile of the vaccine exists, some severe adverse events following YF-immunization (YFV-AEFI). YEL-AVD has been estimated at a frequency of about 0.3–0.4 per 100,000 doses distributed in vaccinees [2], and it has been described in the setting of primary vaccination in people without pre-existing YFV immunity. The clinical presentation of YEL-AVD includes high-grade fever (≥38 ◦ C for more than 24 h) and other signs such as nausea, vomiting, malaise, myalgia, arthralgia, diarrhea, and dyspnea in the early phase, resembling acute natural YF infection. YEL-AVD patients frequently present jaundice, thrombocytopenia, elevation of hepatic enzymes, total bilirubin, and creatinine. As the disease progresses patients may show cardiovascular instability, hemorrhage, and in some cases respiratory and/or renal failure, resembling wild type YF. We describe a confirmed case of YEL-AVD in a 74-year-old traveler
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