Volume 82, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Two cases of yellow fever vaccine-associated viscerotropic adverse events (YEL-AVD) were identified by review of correspondence received at the Centers for Disease Control and Prevention (CDC; Ft. Collins, CO). The cases occurred in Indiana and Maryland in 1973 and 1978, respectively. One patient, a 75-year-old man with multi-organ failure died, and the other, a 31-year-old woman, was hospitalized for 14 days. Onset was 3–6 days after vaccination. The illness was characterized by fever, headache, myalgia, gastrointestinal symptoms, hepatic and renal dysfunction, and (in the fatal case), shock and coagulopathy, compatible with YEL-AVD. Liver pathology showed diffuse, spotty necrosis, acidophilic degeneration, Kupffer cell hyperplasia, and microvesicular fat. No virological confirmation was obtained, so that both cases remain classified as “suspect.” The 1973 case is the earliest record of YEL-AVD; until now, the earliest known case of YEL-AVD had been in 1975 in Brazil, and most subsequent cases have been reported after 1995.


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  1. Theiler M, Smith HH, , 1937. The use of yellow fever virus modified by in vitro cultivation for human immunization. J Exp Med 65: 787800.[Crossref]
  2. Monath TP, Nichols R, Archambault WT, Moore L, Marchesani R, Tian J, Shope RE, Thomas N, Schrader R, Furby D, Bedford P, , 2002. Comparative safety and immunogenicity of two yellow fever 17D vaccines (ARILVAX and YF-VAX) in a phase III multicenter, double-blind clinical trial. Am J Trop Med Hyg 66: 533541.
  3. Martin M, Tsai TF, Cropp CB, Chang G-J, Holmes DA, Tseng J, Shieh W-J, Zaki SR, Al-Sanouri I, Cutrona AF, Ray G, Weld LH, Cetron MS, , 2001. Multisystemic illness in elderly recipients of yellow fever vaccine: report of four cases. Lancet 358: 98.[Crossref]
  4. Vasconcelos PF, Luna EJ, Galler R, Silva LJ, Coimbra TL, Barros VL, Monath TP, Rodigues SG, Laval C, Costa ZG, Vilela MF, Santos CL, Papaiordanou PM, Alves VA, Andrade LD, Sato HK, Rosa ES, Froguas GB, Lacava E, Almeida LM, Cruz AC, Rocco IM, Santos RT, Oliva OF, Brazilian Yellow Fever Vaccine Evaluation Group, 2001. Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases. Lancet 358: 9197.[Crossref]
  5. Chan RC, Penney DJ, Little D, Carter IW, Roberts JA, Rawlinson WD, , 2001. Hepatitis and death following vaccination with 17D-204 yellow fever vaccine. Lancet 358: 121122.[Crossref]
  6. Hayes EB, , 2007. Acute viscerotropic disease following vaccination against yellow fever. Trans R Soc Trop Med Hyg 101: 967971.[Crossref]
  7. Monath TP, Cetron M, Teuwen D, Plotkin S, Orenstein W, Offit P, , Yellow fever , eds. Vaccines. Fifth edition. Saunders Elsevier, 2008, 9591055.
  8. Lindsey NP, Schroeder BA, Miller ER, Braun MM, Hinckley AF, Marano N, Slade BA, Barnett ED, Brunette GW, Horan K, Staples JE, Kozarsky PE, Hayes EB, , 2008. Adverse event reports following yellow fever vaccination. Vaccine 26: 60776082.[Crossref]
  9. Pulendran B, Miller J, Querec TD, Akondy R, Moseley N, Laur O, Glidewell J, Monson N, Zhu T, Zhu H, Staprans S, Lee D, Brinton MA, Perelygin AA, Vellozzi C, Brachman P, Jr Lalor S, Teuwen D, Eidex RB, Cetron M, Priddy F, del Rio C, Altman J, Ahmed R, , 2008. Case of yellow fever vaccine–associated viscerotropic disease with prolonged viremia, robust adaptive immune responses, and polymorphisms in CCR5 and RANTES genes. J Infect Dis 198: 500507.[Crossref]
  10. Barwick R, ; Eidex for the Yellow Fever Vaccine Safety Working Group., 2004. History of thymoma and yellow fever vaccination. Lancet 364: 936.[Crossref]
  11. Engel AR, Vasconcelos PF, MacArthur MA, Barrett AD, , 2004. Characterization of a viscerotropic yellow fever vaccine variant from a patient in Brazil. Vaccine 22: 10731078.[Crossref]
  12. Whittembury A, Ramirez G, Hernández H, Ropero AM, Waterman S, Ticona M, Brinton M, Uchuya J, Gershman M, Toledo W, Staples E, Campos C, Martínez M, Chang GJ, Cabezas C, Lanciotti R, Zaki S, Montgomery JM, Monath T, Hayes E, , 2009. Viscerotropic disease following yellow fever vaccination in Peru. Vaccine 27: 59745981.[Crossref]
  • Received : 02 Jan 2010
  • Accepted : 06 Jan 2010

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