YF-VAX vaccine is contraindicated in anyone with a history of acute hypersensitivity reaction to any components (including gelatin).²² Because the yellow fever virus used in the production of this vaccine is propagated in chicken embryos, YF-VAX vaccine should not be administered to anyone with a history of acute hypersensitivity to eggs or egg products; anaphylaxis may occur. Less severe or localized manifestations of allergy to eggs or to feathers are not contraindications to vaccine administration and do not usually warrant vaccine skin testing (see PRECAUTIONS section, HYPERSENSITIVITY REACTIONS subsection). Generally, persons who are able to eat eggs or egg products may receive the vaccine. ^2,23

Vaccination of infants less than 9 months of age IS CONTRAINDICATED because of the risk of encephalitis, and travel of such persons to rural areas in yellow fever endemic zones or to countries experiencing an epidemic should be postponed or avoided, whenever possible.

IMMUNOSUPPRESSED PATIENTS

Exposure to yellow fever vaccine, which is a live virus vaccine, poses a risk of encephalitis or other serious adverse events to patients with illnesses that commonly result in immunosuppression (eg, acquired immunodeficiency syndrome or other manifestations of human immunodeficiency virus (HIV) infection, leukemia, lymphoma, thymic disease, generalized malignancy), or patients whose immunologic responses are suppressed by drug therapy (eg, corticosteroids, alkylating drugs, or antimetabolites) or radiation. There is evidence suggesting that thymic dysfunction is an independent risk factor for the development of yellow fever vaccine-associated viscerotropic disease, and health care providers should be careful to ask about a history of thymus disorder, including myasthenia gravis, thymoma or prior thymectomy.²⁴

Immunosuppressed subjects should not be immunized, and travel to yellow fever endemic areas should be postponed or avoided. If travel to a yellow fever-infected zone is unavoidable, immunosuppressed patients should be advised of the risk, instructed in methods for avoiding vector mosquitoes, and supplied with vaccination waiver letters by their physicians (see ADVERSE REACTIONS section). Family members of immunosuppressed persons, who themselves have no contraindications, may receive yellow fever vaccine.^2,25

REFERENCES

2. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Yellow Fever Vaccine. 2002. MMWR 2002;51(RR17):1-10.

22. CDC. Vaccine Information Statements (VIS) — Yellow Fever Vaccine [serial online]. Available at: http://www. cdc. gov/nip/publications/VIS/vis-yf. pdf. Accessed September 27, 2004.

23. American Academy of Pediatrics. In: Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 25^th ed. Elk Grove Village, IL: American Academy of Pediatrics 2000;35-38, 174-175.

24. Aventis Pasteur Inc. Data on File — 080601;120104.

25. CDC. Health Information for the International Traveler, 2001-2002. Atlanta:US Department of Health and Human Services, Public Health Service 2001;3-6, 12-21, 154-160, 207-220.

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