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Defining Risk Groups to Yellow Fever Vaccine-Associated Viscerotropic Disease in the Absence of Denominator Data

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  • Department of Microbiology and Immunology, New York Medical College, Valhalla, New York; Laboratory of Populations, The Rockefeller University, New York, New York and Columbia University, New York, New York; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York; Department of Medicine, Georgetown University, Washington, DC

Several risk groups are known for the rare but serious, frequently fatal, viscerotropic reactions following live yellow fever virus vaccine (YEL-AVD). Establishing additional risk groups is hampered by ignorance of the numbers of vaccinees in factor-specific risk groups thus preventing their use as denominators in odds ratios (ORs). Here, we use an equation to calculate ORs using the prevalence of the factor-specific risk group in the population who remain well. The 95% confidence limits and P values can also be calculated. Moreover, if the estimate of the prevalence is imprecise, discrimination analysis can indicate the prevalence at which the confidence interval results in an OR of ∼1 revealing if the prevalence might be higher without yielding a non-significant result. These methods confirm some potential risk groups for YEL-AVD and cast doubt on another. They should prove useful in situations in which factor-specific risk group denominator data are not available.

Author Notes

* Address correspondence to Stephen J. Seligman, 48 Locust Road, Briarcliff Manor, New York 10510. E-mail: Stephen_seligman@nymc.edu

Financial support: This work was supported in part by U.S. National Science Foundation grants EF-1038337 and DMS-1225529 to JEC and in part by a Howard Hughes Medical Institute grant to J-LC.

Authors' addresses: Stephen J. Seligman, Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, E-mail: stephen_seligman@nymc.edu. Joel E. Cohen, Laboratory of Populations, The Rockefeller University, New York, NY, and Columbia University, New York, NY, E-mail: cohen@mail.rockefeller.edu. Yuval Itan and Jean-Laurent Casanova, St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY, E-mails: yitan@mail.rockefeller.edu and Jean-Laurent.Casanova@mail.rockefeller.edu. John C. Pezzullo, Department of Medicine, Georgetown University, Washington, DC, E-mail: pezzullo@georgetown.edu.

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