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Fever and multisystem organ failure associated with 17D-204 yellow fever vaccination: a report of four cases

M Martin1, T F Tsai, B Cropp

  • 1Divisions of Global Migration and Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Lancet (London, England)
|July 21, 2001
PubMed
Abstract

Insights

Severe illness and death occurred in older adults following yellow fever vaccination. Vaccine-related virus variants were identified, suggesting a causal link. Yellow fever vaccination is crucial but requires further safety evaluation in elderly populations.

Area of Science:

  • Virology
  • Immunology
  • Public Health

Background:

  • Reports of severe illness post-yellow fever vaccination in elderly individuals prompted investigation.
  • Four cases were identified between 1996 and 1998, all in patients over 63 years old.

Observation:

  • Patients presented with fever, myalgia, headache, and confusion, progressing to severe multisystemic disease.
  • Three of the four patients ultimately died.

Findings:

  • Genomic sequencing identified vaccine-related yellow fever virus variants in patient samples (plasma and cerebrospinal fluid).
  • High antibody responses (≥1:10240) were observed in convalescent serum samples.
  • Immunohistochemical analysis of liver tissue revealed yellow fever virus antigen in Kupffer cells.

Implications:

  • The findings suggest a causal relationship between yellow fever vaccination and severe illness in older adults.
  • Yellow fever vaccination remains critical for disease prevention in endemic regions.
  • Further research is needed to quantify the frequency of these adverse events in the elderly population.

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