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YELLOW FEVER VACCINE-ASSOCIATED VISCEROTROPIC DISEASE (YEL-AVD) AND CORTICOSTEROID THERAPY: ELEVEN UNITED STATES CASES, 1996–2004

CLAUDIA VELLOZZI^*, TARISSA MITCHELL, ELAINE MILLER, CHRISTINE G. CASEY, RACHEL BARWICK EIDEX, EDWARD B. HAYES THE YELLOW FEVER VACCINE SAFETY WORKING GROUP

During 1996 through 2004, 29 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been reported worldwide; 17 were fatal. Stress-dose corticosteroid (SDS) therapy has recently been found to improve survival among patients with septic shock but benefit for the treatment of YEL-AVD patients in septic shock is unknown. We retrospectively reviewed medical records of 11 U.S. YEL-AVD cases reported to the Vaccine Adverse Event Reporting System (VAERS) from 1996 through 2004. Four of 11 case-patients received SDS; 3 of these 4 (75%) survived. Seven patients did not receive SDS and 2 (29%) survived. Altered mental status was documented on admission for 5 of the 11 patients; 4 of these 5 did not receive SDS and died, whereas one received SDS and survived. The use of stress-dose steroids might be a factor that influenced the survival of these YEL-AVD patients and should be further evaluated in the management of both YEL-AVD and wild-type yellow fever septic shock.

Received January 3, 2006. Accepted for publication April 19, 2006.

Acknowledgments: The authors thank Frank Destefano and Francisco Averhoff for their valuable input and revisions of the manuscript.

^* Address correspondence to Claudia Vellozzi, National Immunization Program, Centers for Disease Control and Prevention, MS E-05, 1600 Clifton Rd., Atlanta, GA 30333. E-mail: cvellozzi{at}cdc.gov

Other members of The Yellow Fever Vaccine Safety Working Group include T.L. Smith, Robert Chen, Martin Cetron, Michelle Russell, Jennifer Lehman, Katrin Kohl, and Nicholas Crass (Centers for Disease Control and Prevention), Neil Halsey and Anna Durbin (Johns Hopkins, Bloomberg School of Public Health), Elizabeth Barnett (Boston Universiity School of Medicine), Dirk Teuwen (Sanofi Pasteur), Thomas Monath (Acambis), R. Dana Bradshaw (Department of Defense), and Mary Elizabeth Wilson (Harvard School of Public Health).

Authors’ addresses: Claudia Vellozzi, Centers for Disease Control and Prevention; MS E-05, 1600 Clifton Rd, Atlanta, GA 30333; Telephone: (404) 639-6364, Fax: (404) 639-6258, Email: cvellozzi{at}cdc.gov. Tarissa Mitchell, Boston Combined Residency Program in Pediatrics, Boston Medical Center; One Boston Medical Center Place, Boston, MA 02118-2999; Email: tarissa.mitchell{at}gmail.com. Elaine Miller and Christine G. Casey, Centers for Disease Control and Prevention, MS E-61, 1600 Clifton Rd, Atlanta, GA 30333, Telephone (404) 639-8268, Fax: (404) 639-8834, Email: emiller{at}cdc.gov. Rachel Barwick Eidex, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E03, Atlanta, GA 30333, Telephone: (404) 639-4503, Fax: (404) 639-4441, Email: REidex{at}cdc.gov. Edward B. Hayes, Centers for Disease Control and Prevention, TFCL Bldg TRAIL, Room 1, MS P02, Fort Collins, CO 80521, Telephone: (970) 266-3517, Fax: (970) 221-6476, Email: NHayes1{at}cdc.gov.