Pediatric Yellow Fever Treatment & Management

Updated: May 04, 2017
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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Treatment

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]

Due to a shortage of yellow fever vaccine (YF-VAX) in 2017, Stamaril yellow fever vaccine is being imported into the United States. Providers should be aware of the vaccine shortage. [11, 12]  

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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