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Pediatric Yellow Fever Treatment & Management

  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 24, 2015
 

Approach Considerations

No specific treatment for yellow fever (YF) is noted. Supportive care is the mainstay of management. Base management decisions on the presence of dehydration, electrolyte imbalance, organ failure, concurrent infections, secondary infections, hemorrhagic diathesis, and generalized symptoms. The managing physician must be thoroughly versed in critical care management to coordinate the various interventions to the maximum benefit of the patient.

Patients who recover do so with minimal end-organ damage. In addition, they develop life-long immunity from further infection with YF virus.

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Supportive Care

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 YF virus that leads to cardiogenic shock, hepatic coma, and renal failure necessitating dialysis.

Monitor the coagulation profile, and correct any abnormalities. Blood products may be required. Anticipate possible disseminated intravascular coagulation (DIC). Also anticipate possible secondary bacterial infections, particularly pneumonia. Exclude concurrent malaria.

If the necessary clinical expertise, monitoring capability, and treatment modalities necessary for managing YF are not available at the current institution, transfer the patient to another institution. Ensure that the patient is stable enough for transfer.

Physicians with experience in pediatric medicine, infectious or tropical diseases, pediatric critical care, and nephrology should be readily available at the institution to which the patient is being transferred. An attending physician at that institution must accept the patient in transfer.

The recommended diet and level of activity are based on the patient’s general status, the presence of any organ failure, and the development of a hemorrhagic diathesis.

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Prevention

Prevention remains the cornerstone to minimizing the risk of yellow fever. Travelers to endemic areas and local populations should be vaccinated. The currently available vaccine confers near lifelong immunity in 95% of patients.[7, 8]

A single, lifetime dose of yellow fever vaccine is sufficient for most people traveling to endemic areas according to the CDC's Advisory Committee on Immunization Practices and the World Health Organization. The CDC also recommends that some high-risk groups may receive a booster dose after 10 years or an additional dose before traveling to an endemic area.[9, 10]

An additional dose is recommended for the following populations:

  • 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

A booster dose is recommended for the following high risk populations after 10 years:

  • A booster dose may be given to travelers who received their last dose of yellow fever vaccine at least 10 y previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel  (bullet) Persons who were infected with HIV when they received their last dose of yellow fever vaccine should receive a dose every 10 y
  • 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 y 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 y as long as they remain at risk
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Contributor Information and Disclosures
Author

David J Cennimo, MD, FAAP, FACP, AAHIVS Assistant Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Director, Disease Processes, Prevention, and Therapeutics, Director, Pediatric Infectious Diseases Fellowship, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, AAHIVS is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Medical Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society, HIV Medicine Association, American Academy of HIV Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

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 Physicians, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Patrick B Hinfey, MD Emergency Medicine Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD is a member of the following medical societies: American Academy of Emergency Medicine, Wilderness Medical Society, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

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, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College 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.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Associate Professor, Education Officer, 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.

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; Novartis Honoraria Speaking and teaching

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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  11. Staples JE, Gershman M, Fischer M. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 Jul 30. 59:1-27. [Medline].

  12. Khromava AY, Eidex RB, Weld LH, et al. Yellow fever vaccine: an updated assessment of advanced age as a risk factor for serious adverse events. Vaccine. 2005 May 9. 23(25):3256-63. [Medline].

  13. Sibailly TS, Wiktor SZ, Tsai TF, et al. Poor antibody response to yellow fever vaccination in children infected with human immunodeficiency virus type 1. Pediatr Infect Dis J. 1997 Dec. 16(12):1177-9. [Medline].

  14. Goujon C, Tohr M, Feuille V. Good tolerance and efficacy of yellow fever vaccine among subjects who are carriers of human immunodeficiency virus. Abstracts, 4th International Conference on Travel Medicine. 1995.

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This female Aedes aegypti mosquito is shown here after landing on a human host. The A aegypti mosquito is a known transmitter of both dengue fever and yellow fever. A aegypti is sometimes referred to as the yellow fever mosquito. The viruses are transferred to the host when bitten by a female mosquito. Image courtesy of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
 
 
 
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