Travel Reference
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Figure 5-3. Distribution of yellow fever in Africa
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Infantslessthansixmonthsoldshouldnotbevaccinatedbecausetheyaremoresuscept-
ible to encephalitis. Preferably, immunization should be delayed until an infant is at least
nine months old. Physicians considering vaccinating infants younger than nine months
old in unusual circumstances should consult with the Division of Vector-Borne Infec-
tious Diseases (phone: 970-221-6400) or the Division of Global Migration and Quarantine
(phone: 404-498-1600) at CDC.
Another serious adverse reaction has recently been described among recipients of yel-
low fever vaccines. This syndrome is now called yellow fever vaccine-associated viscero-
tropic disease (YELAVD). Since 1996, nine cases of this disorder, which resembles natur-
allyacquiredyellowfever,havebeenreportedintheUnitedStates;anadditionalseventeen
caseshavebeenidentifiedworldwideasofOctober2004.AllU.S.casesrequiredintensive
care, and six were fatal. In several individuals from whom tissue samples were available,
viraldisseminationthroughoutthebodywasdemonstrated.Allcasesreportedthusfarhave
occurred in individuals being vaccinated for the first time.
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