Yellow Fever Vaccine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Yellow Fever Prophylaxis

0.5 mL subcutaneously at least 10 days before travel. Booster doses are recommended every 10 years if there is continued risk of exposure.

Usual Pediatric Dose for Yellow Fever Prophylaxis

>= 9 months: 0.5 mL subcutaneously at least 10 days before travel. Booster doses are recommended every 10 years if there is continued risk of exposure.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Precautions

Yellow fever virus vaccine is contraindicated in immunosuppressed patients due to the risk of encephalitis and other serious adverse reactions or patients with acute hypersensitivity to eggs or egg products (less severe or localized reactions to eggs or feathers are not considered contraindications). Persons who are able to eat eggs or egg products generally may be vaccinated.

Anaphylaxis may occur, even in patients with no previous hypersensitivity to the vaccine ingredients. Gelatin is used as a stabilizer and has caused allergic reactions with other vaccines. The vial stopper contains natural latex rubber which may cause allergic reactions in sensitive patients. Epinephrine and other medications and equipment should be readily available to treat anaphylactic or severe allergic reactions.

Immunosuppressed patients are at increased risk of developing encephalitis and other serious reactions. These patients should not be vaccinated and travel to yellow fever endemic/epidemic areas should be avoided or postponed. If travel is unavoidable, patients should receive vaccination waivers and be advised on methods for avoiding mosquitoes. Family members of immunosuppressed patients may be vaccinated if no contraindications exist.

Patients with asymptomatic HIV infection and adequate immune function should be offered the vaccination if potential exposure to yellow fever virus cannot be avoided. Vaccinees should be monitored for adverse effects. The seroconversion rate may be reduced. Documentation of an adequate antibody response is recommended before travel.

Sensitivity testing:

If a person is suspected of having egg sensitivity, skin testing can be performed before administering the vaccine, as follows:
1. Scratch, prick, or puncture test: Place 1 drop of a 1:10 dilution of vaccine in saline on a superficial scratch, prick, or puncture on the forearm, and evaluate after 15 to 20 minutes. Positive and negative controls should also be used. A wheal 3 mm larger than that of the saline control (usually with erythema) is considered positive. If the results are negative, an intradermal test should be performed.
2. Intradermal test: Inject 0.02 mL of a 1:100 dilution of the vaccine in saline. Positive and negative controls should also be used. A wheal 5 mm or more larger than the saline control (with surrounding erythema) is considered positive.

Desensitization:

If the patient has a history of severe egg sensitivity and has a positive skin test to the vaccine, the individual may be given the vaccine using the desensitization procedure if immunization is imperative. The following successive doses should be administered subcutaneously at 15 to 20 minute intervals:
1. 0.05 mL of 1:10 dilution of the vaccine
2. 0.05 mL of full strength vaccine
3. 0.10 mL of full strength vaccine
4. 0.15 mL of full strength vaccine
5. 0.20 mL of full strength vaccine

The desensitization should be undertaken only if supervised by a physician experienced in the management of anaphylaxis and with necessary emergency equipment immediately available. Epinephrine always must be immediately available to treat unexpected anaphylactic or other allergic reactions.

Infants:

Yellow fever vaccine is contraindicated by the manufacturer in infants < 9 months old due to the risk of encephalitis. Travelers with infants < 9 months should be strongly cautioned against traveling to areas with epidemic yellow fever.

The Advisory Committee on Immunization Practices (ACIP) advises that 6 to 8 month-old infants may be vaccinated only if they must travel to epidemic areas and a high level of protection against mosquito bites is not possible. Physicians should contact the Division of Vector-Borne Infectious Diseases (970-221-6400) or the Division of Global Migration and Quarantine (404-498-1600) at the U.S. Centers for Disease Control for advice on vaccinating infants <9 months old. The ACIP recommends that yellow fever vaccine never be given to infants <6 months of age.

Dialysis

No adjustment recommended

Other Comments

The lyophilized vaccine must be kept frozen to maintain full potency. It cannot be refrozen. Reconstituted vaccine must be used within 1 hour.

Adverse reactions should be reported to the U.S. Department of Health and Human Services Vaccine Adverse Event Reporting System. Reporting forms and information regarding the completion of the form can be obtained at 1-800-822-7967.

The ACIP (Advisory Committee on Immunization Practices) recommends that live-virus vaccines not administered on the same day should be administered at least 30 days apart. There is concern that the vaccine given first could interfere with response to the vaccine given second. ACIP recommends that if two live parenteral vaccines are given less than 28 days apart, the vaccine given second should not be counted as valid and should be repeated at least 4 weeks later.

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