eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Yellow Fever: Treatment & Medication

Author: William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
Coauthor(s): Patrick B Hinfey, MD, Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine; Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Contributor Information and Disclosures

Updated: Sep 15, 2009

Treatment

Medical Care

No specific treatment for yellow fever (YF) is noted. Monitor for signs of organ failure and other infections and be prepared to manage them.

  • Supportive care is the mainstay of management.
    • Monitor fluid status and hydrate to maintain organ perfusion.
    • Monitor electrolyte status and promptly correct any abnormalities.
    • Monitor and be prepared to manage organ failure secondary to direct organ injury from yellow fever virus leading to cardiogenic shock, hepatic coma, and renal failure requiring dialysis.
    • Monitor coagulation profile and correct abnormalities. Blood products may be required. Anticipate disseminated intravascular coagulation (DIC).
  • Anticipate secondary bacterial infections, particularly pneumonia.
  • Exclude concurrent malaria.
  • Indicators of poor prognosis include the following:
    • Early onset of bilirubinemia
    • Marked albuminuria
    • Prothrombin time increased by more than 25%
    • Severe hemorrhage
    • Shock
    • Intractable hiccough (hiccup)

Consultations

  • Infectious diseases specialist
    • Additional training in tropical medicine is preferred.
    • Diagnose and manage yellow fever.
    • Diagnose and manage concurrent malaria.
    • Diagnose and manage concurrent tropical disease other than malaria or yellow fever.
  • Critical care specialist
    • Consultation is preferred early in the course of illness in order to anticipate problems.
    • Manage organ failure.
    • Manage hemorrhagic diathesis.
  • Nephrologist, if dialysis is required

Diet

  • Diet is based on the patient's general status, the presence of any organ failure, and the development of a hemorrhagic diathesis.

Activity

  • Activity is based on the patient's general status, the presence of any organ failure, and the development of a hemorrhagic diathesis.

Medication

No specific medication is indicated in the treatment of yellow fever (YF). Medication selection is based on the control of symptoms, secondary infections, and organ failure.

Analgesic and antipyretic agents

Antipyretics should be used only with caution, if at all, because of their metabolic effects on the liver and kidney. Do not use acetaminophen in the presence of hepatic compromise. Do not use ibuprofen in the presence of hepatic or renal compromise.


Acetaminophen (Tylenol, Feverall, Tempra)

Safe, well-tolerated, familiar agent with analgesic and antipyretic properties. Primary mechanism of action for analgesia and antipyresis is inhibition of prostaglandin synthesis. Available as tab, cap, liquid, powder, and supp.

Adult

325-650 mg PO/PR q4-6h prn
Alternative: 1000 mg PO q6h; not to exceed 4 g/d

Pediatric

15 mg/kg PO/PR q4h; not to exceed 2.6 g/d

Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity; hypothermia may occur when used concomitantly with phenothiazines

Documented hypersensitivity; known G-6-PD; hepatic compromise (because of potential for increased injury)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible with overdose or long-term use of high doses; severe or recurrent pain or high or continued fever may indicate serious illness; contained in many OTC products, and their combined use may result in cumulative doses exceeding recommended maximum dose


Ibuprofen (Advil, Motrin)

Drug of choice (DOC) for mild-to-moderate pain; also used to reduce fever. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Adult

200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d

Pediatric

<6 months: Not established
6 months to 12 years: 4-10 mg/kg PO q6-8h
>12 years: Administer as in adults

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor prothrombin time (PT) closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Vaccines

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components, which act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties.


YF vaccine (YF-Vax)

Live, attenuated virus preparation prepared by culturing 17D strain virus in living chick embryo. Immunity may start 7-10 d after vaccination. WHO requires revaccination q10y to maintain travelers' vaccination certificates which are valid in the United States for 10 y beginning 10 d after initial vaccination or revaccination.

Adult

0.5 mL SC at least 10 d before travel; reimmunization recommended q10y

Pediatric

<9 months: Contraindicated
>9 months: Administer as in adults

Cholera and YF vaccinations reduce response to each other and should be administered at least 3 wk apart, if possible (may be administered on same day if not feasible); concurrent hepatitis B vaccination may reduce response expected from YF vaccination and should be administered 1 mo apart, if possible; immunosuppressants, including steroids, or radiation may predispose patients to disseminated infections or insufficient response to immunization; patients may remain susceptible despite immunization

Documented hypersensitivity; age <9 mo, except when in high-risk areas or with immunodeficiency syndrome

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Preservative-free diluents should be used to avoid inactivating vaccine; caution in immunosuppressed patients or patients taking immunosuppressants; delay vaccination with YF vaccine for 8 wk after blood or plasma transfusion; may produce drowsiness, blurred vision, or sensitivity to light (due to dilated pupils); caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity

More on Yellow Fever

Overview: Yellow Fever
Differential Diagnoses & Workup: Yellow Fever
Treatment & Medication: Yellow Fever
Follow-up: Yellow Fever
Multimedia: Yellow Fever
References
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References

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Further Reading

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Keywords

yellow fever, YF, Flaviviridae, tropical infections, viral infections, yellow fever virus, yellow jack, proteinuria, mosquito, disseminated intravascular coagulation, DIC, high temperatures, chills, anxiety, confusion, lethargy, prostration, jaundice, epistaxis, anorexia, epigastric pain, nausea, vomiting, hematemesis, melena, lumbosacral pain, pneumonia, sepsis, infection, treatment, diagnosis

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Contributor Information and Disclosures

Author

William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Glaxo Smith Kline Consulting fee Consulting; Glaxo Smith Kline Honoraria Speaking and teaching

Coauthor(s)

Patrick B Hinfey, MD, Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center
Patrick B Hinfey, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine
Amy J Behrman, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine
Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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