Long-Term Protection After Fractional-Dose Yellow Fever Vaccination
Authors: Annelies Wilder-Smith, Alan Barrett, Kirsten Vannice, Joachim Hombach
Journal: Annals of Internal Medicine (2019)

Letters16 July 2019Long-Term Protection After Fractional-Dose Yellow Fever VaccinationAnnelies Wilder-Smith, MD, PhD, Alan Barrett, PhD, Kirsten Vannice, PhD, MHS, and Joachim Hombach, PhDAnnelies Wilder-Smith, MD, PhDInstitute of Public Health, University of Heidelberg, Heidelberg, Germany, and London School of Hygiene and Tropical Medicine, London, United Kingdom (A.W.)Search for more papers by this author, Alan Barrett, PhDUniversity of Texas Medical Branch, Galveston, Texas (A.B.)Search for more papers by this author, Kirsten Vannice, PhD, MHSWorld Health Organization, Geneva, Switzerland (K.V., J.H.)Search for more papers by this author, and Joachim Hombach, PhDWorld Health Organization, Geneva, Switzerland (K.V., J.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0196 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Roukens and colleagues' article (1) with interest. In 2016, the World Health Organization (WHO) endorsed the use of fractional-dose yellow fever vaccination subcutaneously in response to an acute vaccine shortage during a yellow fever outbreak. The rationale for this recommendation was that standard doses of WHO-prequalified yellow fever vaccines are highly potent, with average doses between 12 874 and 43 651 IU—far greater than WHO's recommended minimum of 1000 IU. Some countries have considered the use of fractional-dose vaccination outside of an emergency situation because of vaccine shortages (2), but such use is not yet compliant with ...References1. Roukens AHE, van Halem K, de Visser AW, et al. Long-term protection after fractional-dose yellow fever vaccination: follow-up study of a randomized, controlled, noninferiority trial. Ann Intern Med. 2018;169:761-5. [PMID: 30476963]. doi:10.7326/M18-1529 LinkGoogle Scholar2. Teitelbaum P, Bui YG, Libman M, et al. Fractional dosing of yellow fever vaccine during shortages: perspective from Canada. J Travel Med. 2018;25. [PMID: 30346564] doi:10.1093/jtm/tay098 CrossrefMedlineGoogle Scholar3. Lindsey NP, Horiuchi KA, Fulton C, et al. Persistence of yellow fever virus-specific neutralizing antibodies after vaccination among US travellers. J Travel Med. 2018;25. [PMID: 30346562] doi:10.1093/jtm/tay108 CrossrefMedlineGoogle Scholar4. Campi-Azevedo AC, de Almeida Estevam P, Coelho-Dos-Reis JG, et al. Subdoses of 17DD yellow fever vaccine elicit equivalent virological/immunological kinetics timeline. BMC Infect Dis. 2014;14:391. [PMID: 25022840] doi:10.1186/1471-2334-14-391 CrossrefMedlineGoogle Scholar5. de Menezes Martins R, Maia MLS, de Lima SMB, et al; Collaborative Group for Studies on Duration of Immunity from Yellow Fever Vaccine. Duration of post-vaccination immunity to yellow fever in volunteers eight years after a dose-response study. Vaccine. 2018;36:4112-7. [PMID: 29784469] doi:10.1016/j.vaccine.2018.05.041 CrossrefMedlineGoogle Scholar6. Ahuka-Mundeke S, Casey RM, Harris JB, et al. Immunogenicity of fractional-dose vaccine during a yellow fever outbreak—preliminary report. N Engl J Med. 2018. [PMID: 29443626] doi:10.1056/NEJMoa1710430 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Institute of Public Health, University of Heidelberg, Heidelberg, Germany, and London School of Hygiene and Tropical Medicine, London, United Kingdom (A.W.)University of Texas Medical Branch, Galveston, Texas (A.B.)World Health Organization, Geneva, Switzerland (K.V., J.H.)Note: Dr. Wilder-Smith is a consultant for WHO, Dr. Vannice was on staff at WHO during the development of its policy on fractional-dose vaccination, and Dr. Hombach is a WHO employee.Disclaimer: The views expressed here are those of the authors and do not necessarily represent the decisions or policies of the WHO.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0196. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Protection After Fractional-Dose Yellow Fever Vaccination Anna H.E. Roukens , Karlijn van Halem , Adriëtte W. de Visser , and Leo G. Visser Metrics Cited byYellow Fever in Travelers 16 July 2019Volume 171, Issue 2Page: 145-146KeywordsChildrenDisclosureFeversGlobal healthHIV vaccinesImmunityPopulation statisticsPregnancySafetyVaccines ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...