Abstract
The disease yellow fever (YF) is prevented by a live-attenuated vaccine, termed 17D, which has been in use since the 1930s. One dose of the vaccine is thought to give lifelong (35+ years) protective immunity, and neutralizing antibodies are the correlate of protection. Despite being a vaccine-preventable disease, YF remains a major public health burden, causing an estimated 109,000 severe infections and 51,000 deaths annually. There are issues of supply and demand for the vaccine, and outbreaks in 2016 and 2018 resulted in fractional dosing of the vaccine to meet demand. The World Health Organization (WHO) has established the “Eliminate Yellow Fever Epidemics” (EYE) initiative to reduce the burden of YF over the next 10 years. As with most vaccines, the WHO has recommendations to assure the quality, safety, and efficacy of the YF vaccine. These require the use of live 17D vaccine only produced in embryonated chicken eggs, and safety evaluated in non-human primates only. Thus, any second-generation vaccines would require modification of WHO recommendations if they were to be used in endemic countries. There are multiple second-generation YF vaccine candidates in various stages of development that must be shown to be non-inferior to the current 17D vaccine in terms of safety and immunogenicity to progress through clinical trials to potential licensing. The historic 17D vaccine continues to shape the global vaccine landscape in its use in the generation of multiple licensed recombinant chimeric live vaccines and vaccine candidates, in which its structural protein genes are replaced with those of other viruses, such as dengue and Japanese encephalitis. There is no doubt that the YF 17D live-attenuated vaccine will continue to play a role in the development of new vaccines for YF, as well as potentially for many other pathogens.
Highlights
The disease yellow fever (YF) has been prevented by the use of a live-attenuated vaccine, strain 17D, since 1937
We describe the reasons why YF is a re-emerging virus and the current status of the
Others who are more likely to be prescribed precautionary booster doses are those who had their last 17D vaccine more than 10 years prior, who are traveling to endemic areas that are especially higher-risk based on the season, current outbreaks, rural proximity, or if they will be spending a prolonged period of time in that area [61]
Summary
The disease yellow fever (YF) has been prevented by the use of a live-attenuated vaccine, strain 17D, since 1937. Despite the vaccine being very successful, there are still large outbreaks of YF that put pressure on supply and demand for the vaccine. We describe the reasons why YF is a re-emerging virus and the current status of the. 17D vaccine, and speculate on the future of YF vaccines
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