Drug Interaction:
Interacting drugs- summary
+ Yellow fever vaccine
Cholera vaccine
concurrent cholera and yellow fever vaccinations impair the immune
response to each vaccine. Separate these vaccinations by > 3 weeks
if possible may be administered on the same day if separation is not
feasible.
Hepatitis B vaccine
concurrent vaccination against hepatitis B and yellow fever viruses in
one study reduced the antibody titer expected from yellow fever vaccine.
Separate these vaccinations by 1 month if possible.
Immune globulins
yellow fever vaccine does not interact with American produced immune
globulins, although it may be prudent to maintain an interval of several
weeks between these drugs if time permits.
Preservatives
since yellow fever consists of live virises, reconstitute it with a diluent
that does not contain presrvatives. Preservatives may inactivate
constituent viruses and render the vaccine ineffective.
Yellow Fever vaccine + Immunosuppressants
like all viral vaccines, administeration to patients receiving
immunosuppressants drugs, including steroids or radiation may
predispose patients to disseminated infections or insufficient response
to immunization. They may remain susceptible despite immunization.
Indication:
Immunity against yellow fever: Interacting drugs-
Adverse Reaction:
Frequent
fever or malaise, usually appearing 7 to 14 days after administration (10%) treatment is symptomatic) myalgia, and headache.
Rare
encephalitis has developed in very young infants, only two cases have been reported in the US. One death has been reported.
Anaphylaxis
may occur, even in individuals with no history of hypersenstivity to any vaccine component.
Contra-Indications:
Hypersensitivity to the vaccine or to egg or chick embryo protein, pregnant women, childfen < 6 month (except in high risks areas. Any form of immunodeficency.
Special precautions
Blood /plasma transfusions- defer vaccination with yellow fever vaccine for 8 weeks following blood or plasma transfusions.
Warnings- Immunodeficiency
Do not use in immunodefficient persons, including persons with congenital or acquired immune deficiencies , whether due to genetics, disease or radiation therapy. Contains live viruses. Avoid use in HIV positive persons.
Hypersenstivity-
Yellow fever vaccine is produced inchick embryo. Do not administer to individuals hypersenstive to egg or chick protein.
Perform intradermal skin tests with the vaccine and sterile normal saline as a control on such individuals Immediate hypersensitivity- reactions characterized by rash, urticaria, or asthma are very rare. ( , 1 in 1,000,000 and occur principally in persons with histories of egg allergy. Have epinephrine 1:1000 available.
Pregnancy
Avoid use unless travel to high risk areas are umavoidable.
Lactation- Problems in humans have not been documented.
Children
The same dose is used for children as adults. Do not administer to infants < 6 months of age . unless travel to high risk areas are unavoidable.
Dosages/ Overdosage Etc:
Immunity against yellow fever Dosage
Adults and children
Administer a single immunizing dose of 0.5ml SC.
Missed dose
1. If you miss a dose of this medicine, and remember it on the day it should be taken, take it as directed.
2. However, if you do not remember the mised dose until the next day,take the missed dose at that time and reschedule your every-other-day doses from then.
3. It is important that this vaccine be taken exactly as directed so that it can give you protection against Yellow fever
Patient Information:
1. Advice vaccinated persons to take personal precautions to reduce
exposure to mosquito bites.
2. Travellers should stay in screened or air conditined rooms.
3. Use insecticidal sprays as necessary.
4. Use mosquito repellents and protective clothing to avoid mosquito bites.
Ref - USP PDI Vol II 17th Edition (1997)
YELLOW FEVER VACCINE- SYSTEMIC
1.Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to
Yellow fever vaccine. Also tell your healthcare care professional if you are
allergic to any other substances such as foods,( especially eggs and
chicken),preservatives or dyes.
The yellow fever vaccine available in the U.S. and Canada is grown in
chick embryo cell culture so it may contain egg or chicken protein
2.Pregnancy-
Yellow fever vaccine may cause birth defects . Therefore, it is not
recommended especially in the first 3 months of pregnancy, unless
they are at high risk of getting yellow fever.
Pregnant women who have not been immunized are generally advised
to postpone their travel and vaccination until after giving birth.
3. Breast-feeding-
Yellow fever fever vaccine has not been shown to cause problems in
nursing babies.
4.Children-
Yellow fever vaccine is recommended for children 9 months of age or older,
if they are travelling to,or living in area where there is yellow fever infection, or
if they are travelling to areas that require immunization
( certificate of vaccination).
5. Other medicines-
Before you receive yellow fever vaccine, it especially important that your
doctor know if you have received any of the following-
Treatment with x-rays or medicines that may lower bodys potection against
infection such as those used for organ transplants ( eg cyclosporine) cancer
medicines or corticosteroids - may decrease the useful effects of yellow
fever vaccine
7. Other medical problems-
The presence of other medical problems may affect the use of yellow fever
vaccine. Make sure you tell your doctor if you have any other medical problems
especially-
Immune deficiency condition( or family history of )- the condition may decrease
the useful effect of the vaccine or increase the severity of the infection.
Serious illness with fever- the symptoms of the illness may be confused with
the possible side effects of the vaccine.
Pharmacology/ Pharmacokinetics:
Pharmacology- This vaccine is live attenuated virus preparation prepared by culturing the 17D strain virus in living chick embryo.
Onset of immunity is 7 to 10 days , duration is > 10 years.
Pregnancy and lactation:
Pregnancy
Avoid use unless travel to high risk areas are umavoidable.
Lactation
Problems in humans have not been documented.
Children
The same dose is used for children as adults. Do not administer to infants < 6 months of age, unless travel to high risk areas are unavoidable.
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