Yellow Fever Vaccine
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YF-VAX vaccine is recommended for active immunization of persons 9 months of age and older in the following categories:
Persons Living In Or Traveling To Endemic Areas
While the actual risk for contracting yellow fever during travel is probably low, variability of itineraries and behaviors and the seasonal incidence of disease make it difficult to predict the actual risk for a given individual traveling to a known endemic or epidemic area. Persons greater than or equal to 9 months of age traveling to or living in areas of South America and Africa where yellow fever infection is officially reported at the time of travel should be vaccinated. Vaccination is also recommended for travel outside the urban areas of countries that do not officially report the disease but that lie in a yellow fever endemic zone.
Yellow fever vaccination may be required for international travel. Some countries in Africa require evidence of vaccination from all entering travelers and some countries may waive the requirements for travelers staying less than 2 weeks that are coming from areas where there is no current evidence of significant risk for contracting yellow fever. Some countries require an individual, even if only in transit, to have a valid International Certificate of Vaccination if the individual has been in countries either known or thought to harbor yellow fever virus. The certificate becomes valid 10 days after vaccination with YF-VAX vaccine.2,21
Those laboratory personnel who might be exposed to virulent yellow fever virus or to concentrated preparations of the yellow fever vaccine strain by direct or indirect contact or by aerosols should be vaccinated.2
As with any vaccine, vaccination with YF-VAX vaccine may not protect 100% of individuals (see CLINICAL PHARMACOLOGY section).
DOSAGE AND ADMINISTRATION
For all eligible persons, a single subcutaneous injection of 0.5 mL of reconstituted vaccine (formulated to contain not less than 4.74 log10 PFU throughout the life of the product) should be administered. Immunity develops by the 10th day after primary vaccination.11,25,46
Re-immunization with 17D vaccine is recommended every 10 years for those at continuing risk of exposure and is required by International Health Regulations.23 Revaccination boosts antibody titer, although evidence from several studies suggests that yellow fever vaccine immunity persists for at least 30 to 35 years and probably for life,47 and epidemiologic data suggest that a single infection with wild-type yellow fever virus provides lifelong immunity against illness due to subsequent exposure.
Concomitant Administration With Other Vaccines
Determination of whether to administer yellow fever vaccine and other immunobiologics simultaneously should be made on the basis of convenience to the traveler in completing the desired vaccinations before travel and on information regarding possible interference. Limited data are available related to administration of YF-VAX vaccine with other vaccines. (See PRECAUTIONS section, DRUG INTERACTIONS subsection.) In those specific instances where vaccines may be given concurrently, injections should be administered at separate sites. Where there are no data to support administration of YF-VAX vaccine concurrently with other vaccines, 4 weeks should elapse between sequential vaccinations.2
- Reconstitute the vaccine using only the diluent supplied (0.6 mL vial of Sodium Chloride Injection USP for single dose vial of vaccine and 3 mL vial of Sodium Chloride Injection USP for 5 dose vial of vaccine). Draw the volume of the diluent, shown on the diluent label, into a suitable size syringe and slowly inject into the vial containing the vaccine. Allow the reconstituted vaccine to sit for one to two minutes and then carefully swirl mixture until a uniform suspension is achieved. Avoid vigorous shaking as this tends to cause foaming of the suspension. Do not dilute reconstituted vaccine.
- YF-VAX vaccine is a slight pink-brown suspension after reconstitution. If the product contains extraneous particulate matter or is discolored, do not administer the vaccine.
- SWIRL VACCINE WELL before withdrawing each dose. Administer the single immunizing dose of 0.5 mL subcutaneously using a 5/8- to 3/4-inch long needle23 within 60 minutes of reconstituting the vial.
- Properly dispose of all reconstituted vaccine and containers that remain unused after one hour (eg, sterilized or disposed in red hazardous waste containers).2
If immunization is imperative and the individual has a history of severe egg sensitivity and has a positive skin test to the vaccine, this desensitization procedure may be used to administer the vaccine.
The following successive doses should be administered subcutaneously at 15- to 20-minute intervals:
0.05 mL of 1:10 dilution
0.05 mL of full strength
0.10 mL of full strength
0.15 mL of full strength
0.20 mL of full strength
Desensitization should only be performed under the direct supervision of a physician experienced in the management of anaphylaxis with necessary emergency equipment immediately available.
Vaccine vial, 1 Dose (NDC 49281-915-58) supplied in a package of 5 vials (NDC 49281-915-01).
Diluent vial, 0.6 mL (NDC 49281-912-58) supplied separately in a package of 5 vials (NDC 49281-912-01).
Vaccine vial, 5 Dose (NDC 49281-915-68) supplied in a package of 1 vial (NDC 49281-915-05).
Diluent vial, 3 mL (NDC 49281-912-68) supplied separately in a package of 1 vial (NDC 49281912-03).
YF-VAX vaccine (Yellow Fever Vaccine) in the US is supplied only to designated Yellow Fever Vaccination Centers authorized to issue valid certificates of Yellow Fever Vaccination. Location of the nearest Yellow Fever Vaccination Centers may be obtained from the Centers for Disease Control and Prevention, Atlanta, GA 30333, state or local health departments.
Store at 2° to 8°C (35° to 46°F). DO NOT FREEZE.
Do not use vaccine after expiration date. YF-VAX vaccine does not contain a preservative; therefore, all reconstituted vaccine and containers, which remain unused after one hour must be properly disposed (eg, sterilized or disposed in red hazardous waste containers).2
The following stability information for YF-VAX vaccine is provided for those countries or areas of the world where an adequate cold chain is a problem and inadvertent exposure to abnormal temperatures has occurred. Half-life is reduced from approximately 14 days at 35° to 37°C to 3-4 days at 45° to 47°C.
YF-VAX vaccine is formulated to satisfy the current US potency requirements of not less than 4.74 log10 PFU per 0.5 mL dose throughout the life of the product and meets the minimum requirements of WHO.10
2 Recommendations of the Advisory Committee on Immunization Practices (ACIP). Yellow Fever Vaccine. 2002. MMWR 2002;51(RR17):1-10.
10. Requirements for yellow fever vaccine. WHO Technical Report Series. 1976;594:23-49.
21 World Health Organization (WHO). International Health Regulations (1969) (3rd annotated edition). Geneva 1983:30-65.
23 American Academy of Pediatrics. In:Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics 2000;35-38,174-175.
25 CDC. Health Information for the International Traveler, 2001-2002. Atlanta: US Department of Health and Human Services, Public Health Service 2001;3- 6,12-21,154160,207- 220.
46 ACIP. General Recommendations on Immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR 2002;51(RR02):1-35.
47 Poland JD, et al. Persistence of neutralizing antibody 30-35 years after immunization with 17D yellow fever vaccine. Bull WHO 1981;59(6):895-900.
Manufactured by: Sanofi Pasteur Inc., Swiftwater PA 18370 USA. Revised May 2013
Last reviewed on RxList: 10/14/2014
This monograph has been modified to include the generic and brand name in many instances.
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