Dosing & Uses
Dosage Forms & Strengths
injection [17D-204 strain]
- ≥4.74 log10 plaque-forming units/0.5mL
Yellow Fever
Prophylaxis: 0.5 mL SC ≥10 days before travel
A single, lifetime dose of yellow fever vaccine is sufficient for most people traveling to endemic areas, although some high-risk groups may benefit from a booster dose according to CDC's Advisory Committee on Immunization Practices
MMWR June 19, 2015:64(23);647-650
Booster/additional dose for high-risk groups
- A single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers
-
Additional doses of yellow fever vaccine recommended for
- Women who were pregnant (regardless of trimester) when they received their initial dose of yellow fever vaccine should receive 1 additional dose before their next travel that puts them at risk for yellow fever virus infection
- Persons who received a hematopoietic stem cell transplant after receiving a dose of yellow fever vaccine and who are sufficiently immunocompetent to be safely vaccinated should be revaccinated before their next travel that puts them at risk for yellow fever virus infection
-
Booster dose for high risk after 10 yr
- A booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 yr previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel
- Persons who were infected with HIV when they received their last dose of yellow fever vaccine should receive a dose every 10 yr
- Travelers who plan to spend a prolonged period in endemic areas or those traveling to highly endemic areas such as rural West Africa during peak transmission season or an area with an ongoing outbreak
- Laboratory workers who routinely handle wild-type yellow fever virus should have yellow fever virus–specific neutralizing antibody titers measured at least every 10 yr to determine if they should receive additional doses of the vaccine
- For laboratory workers who are unable to have neutralizing antibody titers measured, yellow fever vaccine should be given every 10 yr as long as they remain at risk
Dosing considerations
- Rate of seroconversion following vaccine administration is reduced in individuals with asymptomatic HIV infection and appears to depend on HIV viral load and CD4 + T-cell count; therefore, documentation of protective antibody response recommended before travel; for discussion of this subject and for documentation of immune response to vaccine where it is deemed essential, contact the CDCat 1-970-221-6400
Dosage Forms & Strengths
injection [17D-204 strain]
- ≥4.74 log10 plaque-forming units/0.5mL
Yellow Fever
>6 months (off-label): 0.5 mL SC x 1 dose ≥10 days before travel
>9 months: 0.5 mL SC x 1 dose ≥10 days before travel
A single, lifetime dose of yellow fever vaccine is sufficient for most people traveling to endemic areas, although some high-risk groups may benefit from a booster dose according to CDC's Advisory Committee on Immunization Practices
MMWR June 19, 2015:64(23);647-650
Booster/additional dose for high-risk groups
- A single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers
Additional doses of yellow fever vaccine recommended for
- Persons who received a hematopoietic stem cell transplant after receiving a dose of yellow fever vaccine and who are sufficiently immunocompetent to be safely vaccinated should be revaccinated before their next travel that puts them at risk for yellow fever virus infection
Booster dose for high risk after 10 yr
- A booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 yr previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel
- Persons who were infected with HIV when they received their last dose of yellow fever vaccine should receive a dose every 10 yr
- Travelers who plan to spend a prolonged period in endemic areas or those traveling to highly endemic areas such as rural West Africa during peak transmission season or an area with an ongoing outbreak
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (14)
- belimumab
belimumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Do not administer live vaccines 30 days before or concurrently with belimumab.
- certolizumab pegol
certolizumab pegol decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Do not give live vaccines concurrently with certolizumab.
- ibrutinib
ibrutinib decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- ifosfamide
ifosfamide decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo. after cessation of immunosuppressive therapy.
- ixekizumab
ixekizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Ixekizumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating ixekizumab, complete all age appropriate immunizations.
- lomustine
lomustine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.
- mechlorethamine
mechlorethamine decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- melphalan
melphalan decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo. after cessation of immunosuppressive therapy.
- methotrexate
methotrexate decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunization with live virus vaccines is generally not recommended.
- onasemnogene abeparvovec
onasemnogene abeparvovec decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Adjust vaccinations to accommodate concomitant corticosteroid administration prior to and following onasemnogene abeparvovec infusion. Avoid live vaccines for at least 1 month when initiating or after high-dose systemic corticosteroid therapy administered for =2 weeks.
- oxaliplatin
oxaliplatin decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo. after cessation of immunosuppressive therapy.
- procarbazine
procarbazine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- secukinumab
secukinumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.
- ustekinumab
ustekinumab decreases effects of yellow fever vaccine by Mechanism: pharmacodynamic antagonism. Contraindicated. Prior initiating therapy, patients should receive all age-appropriate immunizations as recommended by current guidelines. Immunosuppressants also increase risk of infection with concomitant live vaccines.
Serious - Use Alternative (65)
- abrocitinib
abrocitinib decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administration of live vaccines is not recommended during abrocitinib treatment and immediately before or after treatment.
- adalimumab
adalimumab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- alefacept
alefacept decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- anakinra
anakinra decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- anifrolumab
anifrolumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Before initiation, update immunization according to current guidelines.
- antithymocyte globulin equine
antithymocyte globulin equine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- antithymocyte globulin rabbit
antithymocyte globulin rabbit decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- atoltivimab/maftivimab/odesivimab
atoltivimab/maftivimab/odesivimab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Ebola monoclonal antibodies may interfere with immune response of live vaccines. Refer to vaccine guidelines for vaccination timing during and following treatment. .
- axicabtagene ciloleucel
axicabtagene ciloleucel decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid live virus vaccines for at least 6 weeks before initiating lymphodepleting therapy, during axicabtagene ciloleucel treatment, and after treatment until full immune recovery is achieved.
- azathioprine
azathioprine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- baricitinib
baricitinib decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines with baricitinib. Update immunizations in agreement with current immunization guidelines before initiating baricitinib.
- basiliximab
basiliximab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- brexucabtagene autoleucel
brexucabtagene autoleucel decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid live virus vaccines for at least 6 weeks before initiating lymphodepleting therapy, during brexucabtagene autoleucel treatment, and after treatment until full immune recovery is achieved.
- budesonide
budesonide decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- cabazitaxel
cabazitaxel decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Live attenuated vaccines should not be used in patients receiving immunosuppressive therapy. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects.
- canakinumab
canakinumab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ciltacabtagene autoleucel
ciltacabtagene autoleucel decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live virus vaccines is not recommended for at least 6 weeks before starting lymphodepleting chemotherapy, during CAR-T cell treatment, and until immune recovery following treatment. .
- cortisone
cortisone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- cyclosporine
cyclosporine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Avoid live vaccines in immunocompromised patients due to the risk of developing a clinical infection from the live vaccine. Inadequate immune response to the vaccine may also occur in the presence of immunosuppressants. Avoid live vaccines for at least 3 months after cessation of immunosuppressant therapy unless the benefit of vaccine administration outweighs the potential risk.
- deflazacort
deflazacort decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
deflazacort decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids. - dexamethasone
dexamethasone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- dupilumab
dupilumab, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating dupilumab, complete all age appropriate immunizations. Avoid use of live vaccines in patients treated with dupilumab.
- elivaldogene autotemcel
elivaldogene autotemcel, yellow fever vaccine. Either decreases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The safety and effectiveness of vaccination during or following elivaldogene autotemcel treatment have not been studied. Vaccination is not recommended during the 6 weeks preceding myeloablative conditioning, and until hematological recovery following elivaldogene autotemcel treatment. Where feasible, administer childhood vaccinations before myeloablative conditioning. .
- etanercept
etanercept decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- everolimus
everolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- fingolimod
fingolimod decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Avoid live attenuated vaccines during and for 2 months after stopping fingolimod.
- fludrocortisone
fludrocortisone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- glatiramer
glatiramer decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- golimumab
golimumab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- guselkumab
guselkumab, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating guselkumab, complete all age appropriate immunizations. No data available on the ability of live or inactive vaccine to elicit an immune response in patients treated with guselkumab.
- hydrocortisone
hydrocortisone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- idecabtagene vicleucel
idecabtagene vicleucel decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live virus vaccines is not recommended for at least 6 weeks before starting lymphodepleting chemotherapy, during CAR-T cell treatment, and until immune recovery following treatment. .
- infliximab
infliximab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- leflunomide
leflunomide decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- mercaptopurine
mercaptopurine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- methylprednisolone
methylprednisolone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- muromonab CD3
muromonab CD3 decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- mycophenolate
mycophenolate decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ocrelizumab
ocrelizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live-attenuated or live vaccines is not recommended during ocrelizumab treatment and until B-cell repletion.
- ofatumumab SC
ofatumumab SC decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administer all immunizations according to immunization guidelines at least 4 weeks prior to initiation of ofatumumab SC for live or live-attenuated vaccines, and whenever possible.
- ozanimod
ozanimod decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live-attenuated vaccines with ozanimod during treatment and for up to 3 months after discontinuing ozanimod. .
- ponesimod
ponesimod decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live attenuated vaccines at least 1 month before initiating, during, and for 1-2 weeks after treatment. Coadministration with live attenuated vaccines may increase infection risk.
- prednisolone
prednisolone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- prednisone
prednisone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- rilonacept
rilonacept decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- risankizumab
risankizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines. Before starting risankizumab, complete age appropriate immunizations.
- ritlecitinib
ritlecitinib, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid live attenuated vaccines during or shortly before initiating ritlecitinib. No data are available on vaccination response in ritlecitinib treated patients. Before initiating, review patient immunization status (including herpes zoster) and immunize accordingly in agreement with current immunization guidelines.
- rituximab
rituximab, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Safety of immunization with live viral vaccines following rituximab therapy has not been studied and vaccination with live virus vaccines is not recommended.
- rituximab-hyaluronidase
rituximab-hyaluronidase, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Safety of immunization with live viral vaccines following rituximab therapy has not been studied and vaccination with live virus vaccines is not recommended.
- sarilumab
sarilumab, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.
- satralizumab
satralizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. ive vaccines are not recommended during treatment. Administer all immunizations according to immunization guidelines. At least 4 weeks before initiating for live or live-attenuated vaccines.
- siponimod
siponimod decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Pause vaccinations beginning 1 week before initiating siponimod and for 4 weeks after stopping treatment. Coadministration with live attenuated vaccines may increase infection risk.
- sirolimus
sirolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tacrolimus
tacrolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- temsirolimus
temsirolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- teplizumab
teplizumab decreases effects of yellow fever vaccine by Other (see comment). Avoid or Use Alternate Drug. Comment: Administer all age-appropriate vaccinations before starting teplizumab. Live-attenuated vaccines are not recommended within 8 weeks before teplizumab treatment, during treatment, or up to 52 weeks after treatment.
- tildrakizumab
tildrakizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Before initiating tildrakizumab therapy, consider completion of all age appropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with tildrakizumab. No data are available on the response to live or inactive vaccines.
- tisagenlecleucel
tisagenlecleucel decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live virus vaccines is not recommended for at least 6 weeks before starting lymphodepleting chemotherapy, during CAR-T cell treatment, and until immune recovery following treatment. .
- tocilizumab
tocilizumab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tralokinumab
tralokinumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines. Before starting tralokinumab, complete age appropriate immunizations.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- upadacitinib
upadacitinib decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ustekinumab
ustekinumab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Prior initiating therapy, patients should receive all age-appropriate immunizations as recommended by current guidelines. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- vedolizumab
vedolizumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live virus vaccines while receiving vedolizumab; live vaccines may be administered concurrently with vedolizumab only if the benefits outweigh the risks.
- voclosporin
voclosporin decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.
Monitor Closely (6)
- anthrax immune globulin
anthrax immune globulin decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Immune globulin administration may impair the efficacy of live attenuated vaccines. Defer vaccination with live virus vaccines until ~3 months after administration of anthrax IG. Revaccinate people who received anthrax IG shortly after live virus vaccination following 3 months after the administration of anthrax IG.
- belatacept
belatacept decreases effects of yellow fever vaccine by Other (see comment). Use Caution/Monitor. Comment: The use of live vaccines should be avoided during treatment with belatacept. Inform patients that vaccinations may be less effective while they are being treated with belatacept.
- betibeglogene autotemcel
betibeglogene autotemcel, yellow fever vaccine. Other (see comment). Use Caution/Monitor. Comment: Follow institutional guidelines for vaccine administration. Safety of live vaccines during or following treatment not studied. .
- leniolisib
leniolisib decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Live, attenuated vaccinations may be less effective if administered during leniolisib treatment.
- obinutuzumab
obinutuzumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunization with live virus vaccines is not recommended during obinutuzumab treatment and until after B-cell recovery.
- ublituximab
ublituximab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Administer all immunizations according to immunization guidelines at least 4 weeks before initiating ublituximab for live or live-attenuated vaccines and, whenever possible, at least 2 weeks before initiating for non-live vaccines. Vaccination with live virus vaccines is not recommended during treatment and until B-cell repletion. Do not administer live or live-attenuated vaccines to infants of mothers exposed to ublituximab during pregnancy, before confirming recovery of B-cell counts as measured by CD19+ B cells.
Minor (2)
- chloroquine
chloroquine, yellow fever vaccine. Other (see comment). Minor/Significance Unknown. Comment: The prescribing information states: "although chloroquine inhibits replication of yellow fever vaccine in vitro, it does not appear to adversely affect antibody responses to yellow fever vaccine among persons receiving chloroquine" .
- hydroxychloroquine sulfate
hydroxychloroquine sulfate, yellow fever vaccine. Other (see comment). Minor/Significance Unknown. Comment: The prescribing information states: "although chloroquine inhibits replication of yellow fever vaccine in vitro, it does not appear to adversely affect antibody responses to yellow fever vaccine among persons receiving chloroquine" .
Adverse Effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
1-10%
Headache (5-10%)
Chills (5-10%)
Low-grade fever (5-10%)
Myalgia (5-10%)
Frequency Not Defined
Meningoencephalitis
Seizures
Rash
Urticaria
Pain
Warmth
Erythema
Guillain-Barre syndrome
Warnings
Contraindications
Hypersensitivity to any component of the vaccine, including chicken eggs or egg products
Acute or febrile disease
Severe immunosuppression
Immunosuppressed patients (due to malignancy, radiation, or medications)
Infants <6 months (per CDC if exposure to the yellow fever virus is unavoidable)
Infants <9 months (per manufacturer due to risk of encephalitis)
Lactating women providing breastmilk to infants <9 months of age
Cautions
Vial stopper contains natural latex rubber; epinephrine should be available when vaccine
Syncope accompanied by visual disturbances, tonic-clonic movements, or weakness reported with injectable vaccines; syncope can occur following or even before vaccination; procedures should be in place to prevent falling and injury and to manage syncope
Postpone immunization in acute or febrile illness; low-grade fever not a reason to postpone vaccination
Risk of encephalitis may be increased (theoretically) in patients who are immunosuppressed
Following vaccination, wait two weeks before donating blood
Effective immunity may not occur in all vaccinated patients
Malnourished persons may have decreased response to vaccination
Not for intravascular, intramuscular, or intradermal routes
Use a separate, sterile syringe and needle for each patient to prevent transmission of blood-borne infectious agents; do not recap needles; dispose needles and syringes according to biohazard waste guidelines
Severe allergic reactions (eg, anaphylaxis) may occur following administration of the vaccine, even in individuals with no prior history of hypersensitivity to vaccine components; appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of vaccine
Vaccine-associated viscerotropic disease
- Age > 60 years is risk factor for yellow fever vaccine-associated viscerotropic disease (YEL-AVD), which may present as non-specific multi-organ system failure or can be similar to fulminant yellow fever caused by wild-type yellow fever virus, with liver failure and internal bleeding, leading to death
- Available evidence suggests that the occurrence of this syndrome may depend upon undefined host factors, rather than intrinsic virulence of the yellow fever strain 17D vaccine, based on characterization of vaccine viruses isolated from individuals with YEL-AVD; YEL-AVD has been reported to occur only after first dose of yellow fever vaccine
- There have been no reports of YEL-AVD following booster dose; the decision to vaccinate individuals 60 years of age and older needs to weigh risks and benefits of vaccination and risk for exposure to yellow fever virus
Vaccine-associated neurotropic disease
- Age > 60 years and immunosuppression are risk factors for post-vaccinal encephalitis, also known as yellow fever vaccine-associated neurotropic disease (YEL-AND)
- Almost all cases of YEL-AND have been in first-time vaccine recipients; the decision to vaccinate individuals >60 years and
- immunosuppressed individuals needs to weigh risks and benefits of vaccination and risk for exposure to yellow fever virus
Testing for hypersensitivity reactions
- If an individual is suspected of being an egg-sensitive individual, before administering, perform a scratch, prick, or puncture test by placing a drop of a 1:10 dilution of vaccine in physiologic saline on a superficial scratch, prick, or puncture on volar surface of the forearm; positive(histamine) and negative (physiologic saline) controls should also be used; read test after 15 to 20 minutes
- A positive test is a wheal (superficial bump) 3 mm larger than that of the saline control, usually with surrounding erythema; the histamine control must be positive for valid interpretation; if the result of this test is negative, an intradermal (ID) test should be performed
- For intradermal test, inject a dose of 0.02 mL of a 1:100 dilution of the vaccine in physiologic saline; positive and negative control skin tests should be performed concurrently; a wheal 5 mm or larger than negative control with surrounding erythema is considered a positive reaction
Drug interaction overview
- Limited data on interaction with other vaccines
- Measles (Schwartz strain) vaccine, diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP), hepatitis A and hepatitis B vaccines, meningococcal vaccine, Menomune ® A/C/Y/W-135, and typhoid vaccine, Typhim Vi, have been administered with yellow fever vaccine at separate injection sites
- Potential for interference between yellow fever vaccine and rabies or Japanese encephalitis vaccines has not been established
- In a prospective study, persons given 5 cc of commercially available immune globulin did not experience alterations in immunologic responses to yellow fever vaccine
- Although chloroquine inhibits replication of yellow fever vaccine in vitro, it does not appear to adversely affect antibody responses to yellow fever vaccine among persons receiving chloroquine
- Oral Prednisone or other systemic corticosteroid therapy, depending on dose and duration of exposure, may have an immunosuppressive effect on recipients of yellow fever vaccine that potentially decreases immunogenicity and increases risk of adverse events; intra-articular, bursal, or tendon injections with corticosteroids should not constitute an increased hazard to recipients of yellow fever vaccine
Pregnancy
Pregnancy
Not known whether vaccine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; vaccine should be given to a pregnant woman only if clearly needed
Vaccine has not been evaluated in pregnant women; however, based on experience of other yellow fever vaccines, the following findings have been determined for safety and effectiveness
A case-control study of Brazilian women found no significant difference in odds ratio of spontaneous abortion among vaccinated women compared to a similar unvaccinated group
In a separate study in Trinidad, 100 to 200 pregnant females were immunized, no adverse events related to pregnancy were reported; in addition, 41 cord blood samples were obtained from infants born to mothers immunized during first trimester; one of these infants tested positive for IgM antibodies in cord blood; the infant appeared normal at delivery, and no subsequent adverse sequelae of infection were reported; however, this result suggests that transplacental infection with 17D vaccine viruses can occur
In another study involving 101 Nigerian women, the majority of whom (88%) were in the third trimester of pregnancy, none of the 40infants who were delivered in a hospital tested positive for IgM antibodies as a criterion for transplacental infection with vaccine virus; however, the percentage of pregnant women who seroconverted was reduced compared to a non-pregnant control group
Animal data
- Animal reproduction studies have not been conducted
Lactation
Because of potential for serious adverse reactions in nursing infants from vaccine, a decision should be made whether to discontinue nursing or not to administer vaccine, taking into account importance of vaccine to mother
As of July, 2015, three vaccine-associated neurotropic disease cases have been reported worldwide in exclusively breastfed infants whose mothers were vaccinated with yellow fever vaccines, including one case reported after vaccination; all three infants were diagnosed with encephalitis and were < 1 month of age at time of exposure
Because age less than 9 months is a risk factor for yellow fever vaccine-associated neurotropic disease, administration is contraindicated in lactating women who are providing breastmilk to infants <9 months of age; discuss risks and benefits of vaccination with lactating women who are providing breastmilk to infants >9 months of age
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Live, attenuated virus stimulates active immunity to Yellow fever; conveys active immunity via stimulation of production of endogenously produced antibodies
Pharmacokinetics
Onset: 7-10 days
Duration of immunity: 30 yr to life
Administration
SC Preparation
Reconstitute 1 dose vial with 0.6 mL supplied diluent and 5 dose vial with 3 mL supplied diluent
Store refrigerated at 2-8°C (35-46°F); do not freeze
Storage
Store refrigerated at 2-8°C (35-46°F)
Do not freeze
Images
Patient Handout
yellow fever vaccine live (PF) subcutaneous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
