Vaccination Guidelines

Introduction to Vaccines

• The yellow fever vaccine is a live attenuated virus preparation made from the 17D yellow fever virus strain, considered one of the safest and most effective live virus vaccines ever developed, as stated by the American Society of Clinical Oncology 1
• The vaccine is not known to be shed in semen or saliva, and there is no documented risk of transmission through casual contact or intimate relations, according to the American Society of Clinical Oncology guidelines 2

Special Populations and Precautions

• Immunocompromised individuals, pregnant women, infants under 9 months of age, and adults over 60 years receiving their first dose should avoid receiving the vaccine or take precautions, as recommended by the Centers for Disease Control and Prevention 3
• Household contacts of individuals with autoimmune diseases can safely interact with someone who has recently received a yellow fever vaccine, with no special precautions needed, as stated in the MMWR Recommendations and Reports and supported by the European League Against Rheumatism (EULAR) 2020 recommendations 4, 3
• Individuals with autoimmune diseases are generally advised to avoid receiving the yellow fever vaccine themselves due to the potential risk of yellow fever vaccine-associated viscerotropic disease (YEL-AVD), a rare but serious adverse event, as reported in the MMWR Recommendations and Reports and supported by the Annals of the Rheumatic Diseases 4, 3

Comparison with Other Live Vaccines

• The following table compares the shedding risk and precautions needed for different live vaccines:

• The risk of transmission through sexual contact appears minimal, but using barrier protection during the first 1-2 weeks after vaccination represents a reasonable precaution for partners with autoimmune disease, particularly those on immunosuppressive therapy, as stated in the MMWR Recommendations and Reports 3

Healthcare Workers and Patient Contact

• Healthcare workers who receive the yellow fever vaccine do not need to avoid contact with patients, as stated by the MMWR Recommendations and Reports 5
• The vaccine causes a low-level viremia in recipients 4-7 days post-vaccination as anti-yellow virus IgM antibodies develop, which typically resolves within a week as the immune response develops, according to the MMWR Recommendations and Reports 3
• General hygiene measures, such as regular handwashing and avoiding sharing personal items, are recommended for the first 2-4 weeks after vaccination, as suggested by the American Academy of Allergy, Asthma, and Immunology and the European League Against Rheumatism (EULAR) 6, 4

Vaccine Precautions for Household Members

• The following table outlines precautions for household members of individuals with autoimmune diseases:

• Oral polio vaccine is contraindicated for household contacts of immunocompromised individuals due to the risk of transmission and potential for vaccine-associated paralytic polio, as stated by the American Academy of Allergy, Asthma, and Immunology and the European League Against Rheumatism (EULAR) 6, 4
• The medical consensus strongly supports vaccination of household contacts to create a "protective cocoon" around vulnerable individuals with autoimmune disorders, as stated by the American College of Rheumatology and the American Academy of Allergy, Asthma, and Immunology 8, 6