G Model
ARTICLE IN PRESS
JVAC-15414; No. of Pages 2
Vaccine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
WHO Report
Vaccines and vaccination against yellow fever: WHO Position Paper, June 2013—Recommendations WHO Immunization, Vaccines and Biologicals, 20 Ave Appia, CH-1211, Geneva, Switzerland
a r t i c l e
i n f o
Article history: Received 30 April 2014 Accepted 7 May 2014 Available online xxx Keywords: Yellow fever Vaccine Position paper WHO
a b s t r a c t This article presents the World Health Organizations (WHO) evidence and recommendations for the use of yellow fever (YF) vaccination from “Vaccines and vaccination against yellow fever: WHO Position Paper – June 2013” published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the use of YF vaccination, in particular that a single dose of YF vaccine is sufficient to confer sustained life-long protective immunity against YF disease. A booster dose is not necessary. The current document replaces the position paper on the use of yellow fever vaccines and vaccination published in 2003 [2]. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO’s Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. © 2014 Published by Elsevier Ltd.
1. General goal and strategy for the use of YF vaccine Yellow fever vaccination is carried out for 3 reasons: to protect populations living in areas subject to endemic and epidemic disease; to protect travellers visiting these areas; and to prevent international spread by minimizing the risk of importation of the virus by viraemic travellers [3]. A single dose of YF vaccine is sufficient to confer sustained lifelong protective immunity against YF disease; a booster dose is not necessary. In view of the ongoing transmission of YF virus, and the proven efficacy and safety of YF vaccination, WHO recommends that all endemic countries should introduce YF vaccine into their routine immunization programmes.
their immunization programmes. In addition, preventive mass vaccination campaigns are recommended for inhabitants of areas at risk of YF where there is low vaccination coverage. Vaccination should be provided to everyone aged ≥9 months in any area with reported cases. Vaccine supply issues need to be considered when planning vaccination campaigns. 2.1.2. Travellers Vaccine should be offered to all unvaccinated travellers aged > 9 months, travelling to and from at-risk areas, unless they belong to the group of individuals for whom YF vaccination is contraindicated.
2. Schedules
3. Special populations, contraindications and precautions
2.1.1. Endemic countries
YF vaccine may be offered to asymptomatic HIV-infected persons with CD4 T-cell counts ≥200 cells/mm3 . Although there are limited data on safety and immunogenicity of YF vaccine when used in HIV-infected children, YF vaccine may be administered to all clinically well children. HIV testing is not a pre-requisite for vaccination.
It is recommended that the YF vaccine be given to children at age 9–12 months at the same time as the measles vaccine in YFendemic countries. All countries with areas at risk of YF disease should establish timelines for the introduction of YF vaccine into http://dx.doi.org/10.1016/j.vaccine.2014.05.040 0264-410X/© 2014 Published by Elsevier Ltd.
Please cite this article in press as: WHO . Vaccines and vaccination against yellow fever: WHO Position Paper, June 2013—Recommendations. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.05.040
G Model JVAC-15414; No. of Pages 2 2
ARTICLE IN PRESS WHO / Vaccine xxx (2014) xxx–xxx
Noting that YF is a live vaccine, a risk-benefit assessment should be undertaken for all pregnant and lactating women. In areas where YF is endemic, or during outbreaks, the benefits of YF vaccination are likely to far outweigh the risk of potential transmission of vaccine virus to the foetus or infant. Pregnant women and nursing mothers should be counselled on the potential benefits and risks of vaccination so that they may make an informed decision about vaccination. Lactating women should be advised that the benefits of breastfeeding far outweigh alternatives. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. The vaccine is contraindicated in children aged
ARTICLE IN PRESS
JVAC-15414; No. of Pages 2
Vaccine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
WHO Report
Vaccines and vaccination against yellow fever: WHO Position Paper, June 2013—Recommendations WHO Immunization, Vaccines and Biologicals, 20 Ave Appia, CH-1211, Geneva, Switzerland
a r t i c l e
i n f o
Article history: Received 30 April 2014 Accepted 7 May 2014 Available online xxx Keywords: Yellow fever Vaccine Position paper WHO
a b s t r a c t This article presents the World Health Organizations (WHO) evidence and recommendations for the use of yellow fever (YF) vaccination from “Vaccines and vaccination against yellow fever: WHO Position Paper – June 2013” published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the use of YF vaccination, in particular that a single dose of YF vaccine is sufficient to confer sustained life-long protective immunity against YF disease. A booster dose is not necessary. The current document replaces the position paper on the use of yellow fever vaccines and vaccination published in 2003 [2]. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO’s Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. © 2014 Published by Elsevier Ltd.
1. General goal and strategy for the use of YF vaccine Yellow fever vaccination is carried out for 3 reasons: to protect populations living in areas subject to endemic and epidemic disease; to protect travellers visiting these areas; and to prevent international spread by minimizing the risk of importation of the virus by viraemic travellers [3]. A single dose of YF vaccine is sufficient to confer sustained lifelong protective immunity against YF disease; a booster dose is not necessary. In view of the ongoing transmission of YF virus, and the proven efficacy and safety of YF vaccination, WHO recommends that all endemic countries should introduce YF vaccine into their routine immunization programmes.
their immunization programmes. In addition, preventive mass vaccination campaigns are recommended for inhabitants of areas at risk of YF where there is low vaccination coverage. Vaccination should be provided to everyone aged ≥9 months in any area with reported cases. Vaccine supply issues need to be considered when planning vaccination campaigns. 2.1.2. Travellers Vaccine should be offered to all unvaccinated travellers aged > 9 months, travelling to and from at-risk areas, unless they belong to the group of individuals for whom YF vaccination is contraindicated.
2. Schedules
3. Special populations, contraindications and precautions
2.1.1. Endemic countries
YF vaccine may be offered to asymptomatic HIV-infected persons with CD4 T-cell counts ≥200 cells/mm3 . Although there are limited data on safety and immunogenicity of YF vaccine when used in HIV-infected children, YF vaccine may be administered to all clinically well children. HIV testing is not a pre-requisite for vaccination.
It is recommended that the YF vaccine be given to children at age 9–12 months at the same time as the measles vaccine in YFendemic countries. All countries with areas at risk of YF disease should establish timelines for the introduction of YF vaccine into http://dx.doi.org/10.1016/j.vaccine.2014.05.040 0264-410X/© 2014 Published by Elsevier Ltd.
Please cite this article in press as: WHO . Vaccines and vaccination against yellow fever: WHO Position Paper, June 2013—Recommendations. Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.05.040
G Model JVAC-15414; No. of Pages 2 2
ARTICLE IN PRESS WHO / Vaccine xxx (2014) xxx–xxx
Noting that YF is a live vaccine, a risk-benefit assessment should be undertaken for all pregnant and lactating women. In areas where YF is endemic, or during outbreaks, the benefits of YF vaccination are likely to far outweigh the risk of potential transmission of vaccine virus to the foetus or infant. Pregnant women and nursing mothers should be counselled on the potential benefits and risks of vaccination so that they may make an informed decision about vaccination. Lactating women should be advised that the benefits of breastfeeding far outweigh alternatives. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. The vaccine is contraindicated in children aged
