Yellow fever vaccine

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Yellow fever vaccine
Barros inaugura linha de producao da vacina de febre amarela (28118409009).jpg
Yellow fever vaccine vials (Brazil)
Vaccine description
TargetYellow fever
Vaccine type Attenuated
Clinical data
Trade names YF-Vax, Stamaril
Other names17D vaccine
AHFS/Drugs.com Monograph
MedlinePlus a607030
Pregnancy
category
Routes of
administration
Subcutaneous injection
ATC code
Legal status
Legal status
Identifiers
ChemSpider
  • none
UNII
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Yellow fever vaccine is a vaccine that protects against yellow fever. [4] Yellow fever is a viral infection that occurs in Africa and South America. [4] Most people begin to develop immunity within ten days of vaccination and 99% are protected within one month, and this appears to be lifelong. [4] The vaccine can be used to control outbreaks of disease. [4] It is given either by injection into a muscle or just under the skin. [4] [5]

Contents

The World Health Organization (WHO) recommends routine immunization in all countries where the disease is common. [4] This should typically occur between nine and twelve months of age. [4] Those traveling to areas where the disease occurs should also be immunized. [4] Additional doses after the first are generally not needed. [6]

The yellow fever vaccine is generally safe. [4] This includes in those with HIV infection but without symptoms. [4] Mild side effects may include headache, muscle pains, pain at the injection site, fever, and rash. [4] Severe allergies occur in about eight per million doses, serious neurological problems occur in about four per million doses, and organ failure occurs in about three per million doses. [4] It appears to be safe in pregnancy and is therefore recommended among those who will be potentially exposed. [4] It should not be given to those with very poor immune function. [7]

Yellow fever vaccine came into use in 1938. [8] It is on the World Health Organization's List of Essential Medicines. [9] [10] The vaccine is made from weakened yellow fever virus. [4] Some countries require a yellow fever vaccination certificate before entry from a country where the disease is common. [4] [5]

Medical uses

A yellow fever vaccination certificate issued by the Soviet Union. Soviet International Certificate of Vaccination or Revaccination Against Yello Fever.jpg
A yellow fever vaccination certificate issued by the Soviet Union.

Targeting

Medical experts recommend vaccinating people most at risk of contracting the virus, such as woodcutters working in tropical areas. [11] Insecticides, protective clothing, and screening of houses are helpful, but not always sufficient for mosquito control; medical experts recommend using personal insecticide spray in endemic areas. [12] In affected areas, mosquito control methods have proven effective in decreasing the number of cases. [13]

Travellers need to have the vaccine ten days prior to being in an endemic area in order to assure full immunity. [14] :45

Duration and effectiveness

For most people, the vaccine remains effective permanently. People who are HIV positive at vaccination can benefit from a booster after ten years. [15]

On 17 May 2013, the World Health Organization (WHO) Strategic Advisory Group of Experts on immunization (SAGE) announced that a booster dose of yellow fever (YF) vaccine, ten years after a primary dose, is not necessary. [16] Since yellow fever vaccination began in the 1930s, only 12 known cases of yellow fever post-vaccination have been identified, after 600 million doses have been dispensed. [17] Evidence showed that among this small number of "vaccine failures", all cases developed the disease within five years of vaccination. [18] This demonstrates that immunity does not decrease with time. [19]

Schedule

The World Health Organization recommends the vaccine between the ages of 9 and 12 months in areas where the disease is common. [4] Anyone over the age of nine months who has not been previously immunized and either lives in or is traveling to an area where the disease occurs should also be immunized. [4]

Side effects

The yellow fever 17D vaccine is considered safe, with over 500 million doses given and very few documented cases of vaccine associated illness (62 confirmed cases and 35 deaths as of January 2019). [20] In no case of vaccine-related illness has there been evidence of the virus reverting to a virulent phenotype.[ medical citation needed ] [21]

The majority of adverse reactions to the 17D vaccine result from allergic reaction to the eggs in which the vaccine is grown. [22] Persons with known egg allergy should discuss this with their physician prior to vaccination. [23] In addition, there is a small risk of neurologic disease and encephalitis, particularly in individuals with compromised immune systems and very young children. The 17D vaccine is contraindicated in (among others) infants between zero and six months, [24] people with thymus disorders associated with abnormal immune cell function, people with primary immunodeficiencies, and anyone with a diminished immune capacity including those taking immunosuppressant drugs. [25]

There is a small risk of more severe yellow fever-like disease associated with the vaccine. This reaction, known as yellow fever vaccine-associated acute viscerotropic disease (YEL-AVD), [26] causes a fairly severe disease closely resembling yellow fever caused by virulent strains of the virus. [27] The risk factors for YEL-AVD are not known, although it has been suggested that it may be genetic. [28] The 2'-5'-oligoadenylate synthase (OAS) component of the innate immune response has been shown to be particularly important in protection from Flavivirus infection. [29] Another reaction to the yellow fever vaccine is known as yellow fever vaccine-associated acute neurotropic disease (YEL-AND). [30]

The Canadian Medical Association published a 2001 CMAJ article entitled "Yellow fever vaccination: be sure the patient needs it". [31] The article begins by stating that of the seven people who developed system failure within two to five days of the vaccine in 1996–2001, six died "including 2 who were vaccinated even though they were planning to travel to countries where yellow fever has never been reported." [32] The article cites that "3 demonstrated histopatholic changes consistent with wild yellow fever virus." [33] The author recommends vaccination for only non-contraindicated travelers (see the articles list) and those travelers going where yellow fever activity is reported or in the endemic zone which can be found mapped at the CDC website cited below. [34] In addition, the 2010 online edition of the Center for Disease Control Traveler's Health Yellow Book states that between 1970 and 2002 only "nine cases of yellow fever were reported in unvaccinated travelers from the United States and Europe who traveled" to West Africa and South America, and 8 of the 9 died. [35] However, it goes on to cite "only 1 documented case of yellow fever in a vaccinated traveler. [36] This nonfatal case occurred in a traveler from Spain who visited several West African countries in 1988". [37]

History

African tropical cultures had adopted burial traditions in which the deceased were buried near their habitation, including those who died of Yellow fever. [38] This ensured that people within these cultures gained immunity through a childhood case of "endemic" yellow fever through acquired immunity. This led to a lasting misperception first by colonial authorities and foreign medical experts that Africans have a "natural immunity" [39] to the illness. In the nineteenth century health provisioners forced abandonment of these traditional burial traditions, leading to local populations dying of yellow fever as frequently as those without such burial customs such as settler populations. [40]

The first modern attempts to develop a yellow fever vaccine followed the opening of the Panama Canal in 1912, which increased global exposure to the disease. [41] The Japanese bacteriologist Hideyo Noguchi led investigations for the Rockefeller Foundation in Ecuador that resulted in a vaccine based on his theory that the disease was caused by a leptospiral bacterium. [41] However, other investigators could not duplicate his results and the ineffective vaccine was eventually abandoned.[ citation needed ]

Another vaccine was developed from the "French strain" of the virus, obtained by Pasteur Institute scientists from a man in Dakar, Senegal, who survived his bout with the disease.[ citation needed ] This vaccine could be administered by scarification, like the smallpox vaccine, and was given in combination to produce immunity to both diseases, but it also had severe systemic and neurologic complications in a few cases. [42] Attempts to attenuate the virus used in the vaccine failed. Scientists at the Rockefeller Foundation developed another vaccine derived from the serum of an African named Asibi in 1927, the first isolation of the virus from a human. [43] It was safer but involved the use of large amounts of human serum, which limited widespread use. [44] Both vaccines were in use for several years, the Rockefeller vaccine in the Western hemisphere and England, and the Pasteur Institute vaccine in France and its African colonies. [45]

In 1937, Max Theiler, working with Hugh Smith and Eugen Haagen at the Rockefeller Foundation to improve the vaccine from the "Asibi" strain, discovered that a favorable chance mutation in the attenuated virus had produced a highly effective strain that was named 17D. [41] Following the work of Ernest Goodpasture, Theiler used chicken eggs to culture the virus. After field trials in Brazil, over one million people were vaccinated by 1939, without severe complications. [8] This vaccine was widely used by the U.S. Army during World War II. [46] For his work on the yellow fever vaccine, Theiler received the 1951 Nobel Prize in Physiology or Medicine. [47] Only the 17D vaccine remains in use today. [4]

Theiler's vaccine was responsible for the largest outbreak of Hepatitis B in history: infecting 330,000 soldiers and giving 50,000 jaundice between 1941 and 1942. [48] At the time, chronic infectious hepatitis was not known, so when human serum was used in vaccine preparation, serum drawn from a chronic Hepatitis B Virus (HBV) carrier would contaminate the Yellow Fever Vaccine. [49] In 1941, researchers at Rocky Mountain Laboratories developed a safer alternative, an "aqueous-base" version of the 17D vaccine using distilled water combined with the virus grown in chicken eggs. [50] Since 1971, screening technology for HBV has been available and is routinely used in situations where HBV contamination is possible including vaccine preparation. [51]

Also in the 1930s, a French team developed the French neurotropic vaccine (FNV), which was extracted from mouse brain tissue. [52] Since this vaccine was associated with a higher incidence of encephalitis, FNV was not recommended after 1961. Vaccine 17D is still in use, and more than 400 million doses have been distributed. Little research has been done to develop new vaccines. Newer vaccines, based on vero cells, are in development (as of 2018). [53] [54] [55]

Manufacture and global supply

Increases in cases of yellow fever in endemic areas of Africa and South America in the 1980s were addressed by the WHO Yellow Fever Initiative launched in the mid-2000s. [56] The initiative was supported by the Gavi Alliance, a collaboration of the WHO, UNICEF, vaccine manufacturers, and private philanthropists such as the Bill & Melinda Gates Foundation. [57] Gavi-supported vaccination campaigns since 2011 have covered 88 million people in 14 countries considered at "high-risk" of a yellow fever outbreak (Angola was considered "medium risk"). As of 2013, there were four WHO-qualified manufacturers: Bio-Manguinhos in Brazil (with the Oswaldo Cruz Foundation), Institute Pasteur in Dakar, Senegal, the Federal State Unitary Enterprise of Chumakov Institute in Russia, and Sanofi Pasteur, the French pharmaceutical company. [58] [59] Two other manufacturers supply domestic markets: Wuhan Institute of Biological Products in China and Sanofi Pasteur in the United States. [60]

Demand for yellow fever vaccine for preventive campaigns has increased from about five million doses per year to a projected 62 million per year by 2014. [61] UNICEF reported in 2013 that supplies were insufficient. Manufacturers are producing about 35 million of the 64 million doses needed per year. [62] Demand for the yellow fever vaccine has continued to increase due to the growing number of countries implementing yellow fever vaccination as part of their routine immunization programmes. [63]

The outbreak of yellow fever in Angola and in the Democratic Republic of Congo in 2016 has raised concerns about whether the global supply of vaccine is adequate to meet the need during a large epidemic or pandemic of the disease. [64] Routine childhood immunization was suspended in other African countries to ensure an adequate supply in the vaccination campaign against the outbreak in Angola. [65] Emergency stockpiles of vaccine diverted to Angola, which consisted of about 10 million doses at the end of March 2016, had become exhausted, [58] [66] but were being replenished by May 2016. [67] However, in August it was reported that about one million doses of six million shipped in February had been sent to the wrong place or not kept cold enough to ensure efficacy, resulting in shortages to fight the spreading epidemic in DR Congo. [68] As an emergency measure, experts suggested fractional dose vaccination, using a fractional dose (1/5 or 1/10 of the usual dose) to extend existing supplies of vaccine. [69] [65] Others have noted that switching manufacturing processes to modern cell-culture technology might improve vaccine supply shortfalls, [60] as the manufacture of the current vaccine in chicken eggs is slow and laborious. [70] On 17 June 2016, the WHO agreed to the use of 1/5 the usual dose as an emergency measure during the ongoing outbreak in Angola and the DR Congo. [63] [71] The fractional dose would not qualify for a yellow fever certificate of vaccination for travelers. Later studies found that the fractional dose was just as protective as the full dose, even 10 years after vaccination. [72]

As of February 2021, UNICEF reported awarded contract prices of ranging from US$ 0.97 to US$ 1.444 per dose under multi-year contracts with various suppliers. [73]

Travel requirements

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Risk countries (WHO designation)
Partial risk countries (WHO designation) Yellow fever risk countries map.svg
  Risk countries (WHO designation)
  Partial risk countries (WHO designation)
Vaccination against yellow fever 10 days before entering this country/territory is required for travellers coming from...
All countries
Risk countries (including airport transfers)
Risk countries (excluding airport transfers)
No requirement (risk country)
No requirement (non-risk country) Yellow fever vaccination travel requirements map.svg
Vaccination against yellow fever 10 days before entering this country/territory is required for travellers coming from...
  All countries
  Risk countries (including airport transfers)
  Risk countries (excluding airport transfers)
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Travellers who wish to enter certain countries or territories must be vaccinated against yellow fever 10 days before crossing the border, and be able to present a vaccination record/certificate at the border checks. [14] :45 In most cases, this travel requirement depends on whether the country they are travelling from has been designated by the World Health Organization as being a 'country with risk of yellow fever transmission'. [74] In a few countries, it does not matter which country the traveller comes from: everyone who wants to enter these countries must be vaccinated against yellow fever. [75] There are exemptions for newborn children; in most cases, any child who is at least 9 months or 1 year old needs to be vaccinated. [76]

Yellow fever vaccination requirements for international travel (July 2019) [76]
Country or territoryStatusVaccination required for travellers coming fromTraveller age
Flag of Albania.svg  Albania No riskRisk countries1 year or older
Flag of Algeria.svg  Algeria No riskRisk countries [note 4] 1 year or older
Flag of Angola.svg  Angola Risk countryAll countries9 months or older
Flag of Antigua and Barbuda.svg  Antigua and Barbuda No riskRisk countries1 year or older
Flag of Argentina.svg  Argentina Risk provinces:
Misiones, Corrientes
No [note 3]
Flag of Aruba.svg  Aruba No riskRisk countries [note 4] 9 months or older
Flag of Australia (converted).svg  Australia No riskRisk countries [note 4] 1 year or older
Flag of the Bahamas.svg  Bahamas No riskRisk countries [note 4] 1 year or older
Flag of Bahrain.svg  Bahrain No riskRisk countries [note 4] 9 months or older
Flag of Bangladesh.svg  Bangladesh No riskRisk countries [note 5] 1 year or older
Flag of Barbados.svg  Barbados No riskRisk countries1 year or older
Flag of Belize.svg  Belize No riskRisk countries [note 5] 1 year or older
Flag of Benin.svg  Benin Risk countryRisk countries [note 5] 1 year or older
Bandera de Bolivia (Estado).svg  Bolivia Risk countryRisk countries1 year or older
Flag of Bonaire.svg  Bonaire No riskRisk countries [note 4] 9 months or older
Flag of Botswana.svg  Botswana No riskRisk countries [note 5] 1 year or older
Flag of Brazil.svg  Brazil Risk countryNo [note 3]
Flag of Brunei.svg  Brunei No riskRisk countries [note 4] 9 months or older
Flag of Burkina Faso.svg  Burkina Faso Risk countryRisk countries [note 5] 9 months or older
Flag of Burundi.svg  Burundi Risk countryRisk countries [note 5] 9 months or older
Flag of Cape Verde.svg  Cabo Verde No riskRisk countries [note 4] 1 year or older
Flag of Cambodia.svg  Cambodia No riskRisk countries [note 4] 1 year or older
Flag of Cameroon.svg  Cameroon Risk countryAll countries9 months or older
Flag of the Central African Republic.svg  Central African Republic Risk countryAll countries9 months or older
Flag of Chad.svg  Chad Risk countryAll countries9 months or older
Flag of the People's Republic of China.svg  China No riskRisk countries [note 5] 9 months or older
Flag of Christmas Island.svg  Christmas Island No riskRisk countries [note 4] 1 year or older
Flag of Colombia.svg  Colombia Risk countryRisk countries [note 4] 1 year or older
Flag of the Republic of the Congo.svg  Congo-Brazzaville Risk countryAll countries9 months or older
Flag of the Democratic Republic of the Congo.svg  Congo-Kinshasa Risk countryAll countries9 months or older
Flag of Costa Rica.svg  Costa Rica No riskRisk countries9 months or older
Flag of Cote d'Ivoire.svg  Côte d'Ivoire Risk countryAll countries9 months or older
Flag of Cuba.svg  Cuba No riskRisk countries [note 4] 9 months or older
Flag of Curacao.svg  Curaçao No riskRisk countries [note 4] 9 months or older
Flag of Dominica.svg  Dominica No riskRisk countries [note 4] 1 year or older
Flag of the Dominican Republic.svg  Dominican Republic No riskRisk countries [note 4] 1 year or older
Flag of Ecuador.svg  Ecuador Risk countryRisk countries [note 4] 1 year or older
Flag of Egypt.svg  Egypt No riskRisk countries [note 4] 9 months or older
Flag of El Salvador.svg  El Salvador No riskRisk countries [note 4] 1 year or older
Flag of Equatorial Guinea.svg  Equatorial Guinea Risk countryRisk countries9 months or older
Flag of Eritrea.svg  Eritrea No riskRisk countries [note 4] 9 months or older
Flag of Eswatini.svg  Eswatini No riskRisk countries [note 5] 9 months or older
Flag of Ethiopia.svg  Ethiopia Risk countryRisk countries [note 4] 9 months or older
Flag of Fiji.svg  Fiji No riskRisk countries [note 4] 1 year or older
Flag of France.svg  French Guiana Risk countryAll countries1 year or older
Flag of French Polynesia.svg  French Polynesia No riskRisk countries [note 4] 9 months or older
Flag of Gabon.svg  Gabon Risk countryAll countries1 year or older
Flag of The Gambia.svg  Gambia Risk countryRisk countries9 months or older
Flag of Ghana.svg  Ghana Risk countryAll countries9 months or older
Flag of Grenada.svg  Grenada No riskRisk countries [note 4] 1 year or older
Flag of France.svg  Guadeloupe No riskRisk countries [note 4] 1 year or older
Flag of Guatemala.svg  Guatemala No riskRisk countries [note 4] 1 year or older
Flag of Guinea.svg  Guinea Risk countryRisk countries9 months or older
Flag of Guinea-Bissau.svg  Guinea-Bissau Risk countryAll countries1 year or older
Flag of Guyana.svg  Guyana Risk countryRisk countries [note 5] 1 year or older
Flag of Haiti.svg  Haiti No riskRisk countries1 year or older
Flag of Honduras.svg  Honduras No riskRisk countries1 year or older
Flag of India.svg  India No riskRisk countries [note 5] 9 months or older
Flag of Indonesia.svg  Indonesia No riskRisk countries9 months or older
Flag of Iran.svg  Iran No riskRisk countries [note 4] 9 months or older
Flag of Iraq.svg  Iraq No riskRisk countries [note 4] 9 months or older
Flag of Jamaica.svg  Jamaica No riskRisk countries [note 4] 1 year or older
Flag of Jordan.svg  Jordan No riskRisk countries [note 4] 1 year or older
Flag of Kenya.svg  Kenya Risk countryRisk countries1 year or older
Flag of Kyrgyzstan (2023).svg  Kyrgyzstan No riskRisk countries [note 4] 1 year or older
Flag of Laos.svg  Laos No riskRisk countriesUnknown
Flag of Lesotho.svg  Lesotho No riskRisk countries [note 4] 6 months or older
Flag of Liberia.svg  Liberia Risk countryRisk countries9 months or older
Flag of Libya.svg  Libya No riskRisk countries1 year or older
Flag of Madagascar.svg  Madagascar No riskRisk countries [note 4] 9 months or older
Flag of Malawi.svg  Malawi No riskRisk countries [note 4] 1 year or older
Flag of Malaysia.svg  Malaysia No riskRisk countries [note 4] 1 year or older
Flag of Maldives.svg  Maldives No riskRisk countries [note 4] 9 months or older
Flag of Mali.svg  Mali Risk countryAll countries1 year or older
Flag of Malta.svg  Malta No riskRisk countries [note 4] 9 months or older
Flag of France.svg  Martinique No riskRisk countries [note 4] 1 year or older
Flag of Mauritania.svg  Mauritania Risk countryRisk countries1 year or older
Flag of France.svg  Mayotte No riskRisk countries [note 4] 1 year or older
Flag of Montserrat.svg  Montserrat No riskRisk countries [note 5] 1 year or older
Flag of Mozambique.svg  Mozambique No riskRisk countries [note 4] 9 months or older
Flag of Myanmar.svg  Myanmar No riskRisk countries [note 4] 1 year or older
Flag of Namibia.svg  Namibia No riskRisk countries [note 4] 9 months or older
Flag of Nepal.svg    Nepal No riskRisk countries [note 4] 1 year or older
Flags of New Caledonia.svg  New Caledonia No riskRisk countries [note 4] 1 year or older
Flag of Nicaragua.svg  Nicaragua No riskRisk countries1 year or older
Flag of Niger.svg  Niger Risk countryAll countries1 year or older
Flag of Nigeria.svg  Nigeria Risk countryAll countries9 months or older
Flag of Niue.svg  Niue No riskRisk countries9 months or older
Flag of North Korea.svg  North Korea No riskRisk countries1 year or older
Flag of Oman.svg  Oman No riskRisk countries [note 4] 9 months or older
Flag of Pakistan.svg  Pakistan No riskRisk countries1 year or older
Flag of Panama.svg  Panama Risk countryRisk countries [note 4] 1 year or older
Flag of Papua New Guinea.svg  Papua New Guinea No riskRisk countries [note 5] 1 year or older
Flag of Paraguay.svg  Paraguay Risk countryRisk countries1 year or older
Flag of Peru.svg  Peru Risk countryNo [note 3]
Flag of the Philippines.svg  Philippines No riskRisk countries [note 4] 1 year or older
Flag of the Pitcairn Islands.svg  Pitcairn Islands No riskRisk countries1 year or older
Flag of Rwanda.svg  Rwanda No riskRisk countries1 year or older
Flag of France.svg  Saint Barthélemy No riskRisk countries [note 4] 1 year or older
Flag of Saint Helena.svg  Saint Helena No riskRisk countries1 year or older
Flag of Saint Kitts and Nevis.svg  Saint Kitts and Nevis No riskRisk countries1 year or older
Flag of Saint Lucia.svg  Saint Lucia No riskRisk countries9 months or older
Flag of France.svg  Saint Martin No riskRisk countries [note 4] 1 year or older
Flag of Saint Vincent and the Grenadines.svg  Saint Vincent and the Grenadines No riskRisk countries1 year or older
Flag of Samoa.svg  Samoa No riskRisk countries [note 4] 1 year or older
Flag of Sao Tome and Principe.svg  São Tomé and Príncipe No riskRisk countries [note 5] 1 year or older
Flag of Saudi Arabia.svg  Saudi Arabia No riskRisk countries [note 4] 1 year or older
Flag of Senegal.svg  Senegal Risk countryRisk countries [note 5] 9 months or older
Flag of Seychelles.svg  Seychelles No riskRisk countries [note 4] 1 year or older
Flag of Sierra Leone.svg  Sierra Leone Risk countryAll countriesUnknown
Flag of Singapore.svg  Singapore No riskRisk countries [note 4] 1 year or older
Flag of Sint Eustatius.svg  Sint Eustatius No riskRisk countries6 months or older
Flag of Sint Maarten.svg  Sint Maarten No riskRisk countries9 months or older
Flag of the Solomon Islands.svg  Solomon Islands No riskRisk countries9 months or older
Flag of Somalia.svg  Somalia No riskRisk countries [note 4] 9 months or older
Flag of South Africa.svg  South Africa No riskRisk countries [note 4] 1 year or older
Flag of South Sudan.svg  South Sudan Risk countryAll countries9 months or older
Flag of Sri Lanka.svg  Sri Lanka No riskRisk countries [note 4] 9 months or older
Flag of Sudan.svg  Sudan Risk countryRisk countries [note 4] 1 year or older
Flag of Suriname.svg  Suriname Risk countryRisk countries [note 4] 1 year or older
Flag of Tanzania.svg  Tanzania No riskRisk countries [note 4] 1 year or older
Flag of Thailand.svg  Thailand No riskRisk countries [note 4] 1 year or older
Flag of Togo.svg  Togo Risk countryAll countries9 months or older
Flag of Trinidad and Tobago.svg  Trinidad and Tobago Risk region:
Trinidad
Risk countries1 year or older
Flag of Uganda.svg  Uganda Risk countryAll countries1 year or older
Flag of the United Arab Emirates.svg  United Arab Emirates No riskRisk countries [note 4] 9 months or older
Flag of Venezuela.svg  Venezuela Risk countryRisk countries [note 4] 1 year or older
Flag of France.svg  Wallis and Futuna No riskRisk countries [note 4] 1 year or older
Flag of Zambia.svg  Zambia No riskRisk countries [note 4] 1 year or older
Flag of Zimbabwe.svg  Zimbabwe No riskRisk countries [note 4] 9 months or older
  1. Also required for travellers having transited (more than 12 hours) through a risk country's airport.
  2. Not required for travellers having transited through a risk country's airport.
  3. 1 2 3 4 The WHO has designated (parts of) Argentina, Brazil and Peru as risk countries, but these countries do not require incoming travellers to vaccinate against yellow fever.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Also required for travellers having transited more than 12 hours through a risk country's airport.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Also required for travellers having transited any time through a risk country's airport.

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The MMRV vaccine combines the attenuated virus MMR vaccine with the addition of the varicella (chickenpox) vaccine. The MMRV vaccine is typically given to children between one and two years of age.

<span class="mw-page-title-main">Mumps vaccine</span> Vaccine which prevents mumps

Mumps vaccines are vaccines which prevent mumps. When given to a majority of the population they decrease complications at the population level. Effectiveness when 90% of a population is vaccinated is estimated at 85%. Two doses are required for long term prevention. The initial dose is recommended between 12 and 18 months of age. The second dose is then typically given between two years and six years of age. Usage after exposure in those not already immune may be useful.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Varicella vaccine</span> Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.

<span class="mw-page-title-main">Hepatitis B vaccine</span> Vaccine against hepatitis B

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.

<span class="mw-page-title-main">Hepatitis A vaccine</span> Vaccine to prevent hepatitis A

Hepatitis A vaccine is a vaccine that prevents hepatitis A. It is effective in around 95% of cases and lasts for at least twenty years and possibly a person's entire life. If given, two doses are recommended beginning after the age of one. It is given by injection into a muscle. The first hepatitis A vaccine was approved in Europe in 1991, and the United States in 1995. It is on the World Health Organization's List of Essential Medicines.

<span class="mw-page-title-main">Hib vaccine</span> Haemophilus influenzae type B vaccine

The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.

<span class="mw-page-title-main">Rabies vaccine</span> Vaccines to prevent rabies in humans and animals

The rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the latent period after exposure to prevent the disease. Transmission of rabies virus to humans typically occurs through a bite or scratch from an infectious animal, but exposure can occur through indirect contact with the saliva from an infectious individual.

Meningococcal vaccine refers to any vaccine used to prevent infection by Neisseria meningitidis. Different versions are effective against some or all of the following types of meningococcus: A, B, C, W-135, and Y. The vaccines are between 85 and 100% effective for at least two years. They result in a decrease in meningitis and sepsis among populations where they are widely used. They are given either by injection into a muscle or just under the skin.

<span class="mw-page-title-main">Tick-borne encephalitis vaccine</span> Vaccine against tick-borne encephalitis

Tick-borne encephalitis vaccine is a vaccine used to prevent tick-borne encephalitis (TBE). The disease is most common in Central and Eastern Europe, and Northern Asia. More than 87% of people who receive the vaccine develop immunity. It is not useful following the bite of an infected tick. It is given by injection into a muscle.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

<span class="mw-page-title-main">Rubella vaccine</span> Vaccine used to prevent rubella

Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated. By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020.

<span class="mw-page-title-main">2016 Angola and DR Congo yellow fever outbreak</span> Disease outbreak in Africa

On 20 January 2016, the health minister of Angola reported 23 cases of yellow fever with 7 deaths among Eritrean and Congolese citizens living in Angola in Viana municipality, a suburb of the capital of Luanda. The first cases were reported in Eritrean visitors beginning on 5 December 2015 and confirmed by the Pasteur WHO reference laboratory in Dakar, Senegal in January. The outbreak was classified as an urban cycle of yellow fever transmission, which can spread rapidly. A preliminary finding that the strain of the yellow fever virus was closely related to a strain identified in a 1971 outbreak in Angola was confirmed in August 2016. Moderators from ProMED-mail stressed the importance of initiating a vaccination campaign immediately to prevent further spread. The CDC classified the outbreak as Watch Level 2 on 7 April 2016. The WHO declared it a grade 2 event on its emergency response framework having moderate public health consequences.

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