INDEXED WORLD HEALTH ORGANISATION ORGANIZATION
VIRAF /71.24
MONDIALE DE LA SANTÉ
ENGLISH ONLY
EXPERT COMMITTEE ON YELLOW FEVER Entebbe. 9-15 March 1971
RECONMENDATIONS REGARDING YELLOW FEVER VACCINATION FOR INTERNATIONAL TRAVEL by P. Brès, M.D. V i r u s Diseases The need f o r s p e c i f y i n g c e r t a i n Important d e t a i l s i n yellow fever v a c c i n a t i o n was expressed Informally by two members of the l 6 t h Session of the Committee on I n t e r n a t i o n a l S u r v e i l l a n c e of Communicable Diseases. I t i s suggested that these s p e c i f i c a t i o n s should be included i n the f i r s t pages of the manual on "Vaccination C e r t i f i c a t e Requirements f o r I n t e r n a t i o n a l T r a v e l " as w e l l as "Yellow Fever V a c c i n a t i o n Centres f o r I n t e r n a t i o n a l T r a v e l " , edited by the Epidemiological S u r v e i l l a n c e of Communicable Diseases u n i t . The f o l l o w i n g t e x t i s submitted t o the members of the Expert Committee on Yellow Fever for amendments o r a d d i t i o n s : I n t e r n a t i o n a l C e r t i f i c a t e s of Vaccination Without any m o d i f i c a t i o n to the t e x t i n "Vaccination C e r t i f i c a t e Requirements f o r International Travel". Yellow fever v a c c i n a t i o n : technique
Transportation and storage; I t i s recommended that a check should be made on whether the vaccine has been transported under proper c o n d i t i o n s of r e f r i g e r a t i o n and immediately stored a t low temperature a f t e r d e l i v e r y to the V a c c i n a t i n g Centre. The vaccine should normally be stored a t a temperature lower than +4°C although higher temperatures may be permitted f o r a short i n t e r v a l . Nevertheless, vaccine stored a t temperatures between 0°C and 4°C may lose a considerable degree of potency during the course of one year. Therefore, i f the vaccine i s to be stored a t t h i s temperature f o r periods of more than three months the vaccine should i n i t i a l l y have a s u f f i c i e n t high t i t r e t o comply with the requirements of potency. Considering that a domestic-type r e f r i g e r a t o r u s u a l l y runs a t a temperature of +10°C, i t would be s a f e r t o store the vaccine i n a deep-freeze cabinet i n which the temperature i s minus 20°C o r lower f o r any period of storage exceeding three months. Rehydration and I n o c u l a t i o n of the vaccine: The vaccine Is rehydrated by adding the quantity o f s t e r i l e s a l i n e recommended by the manufacturing l a b o r a t o r y . This operation should be performed a s e p t i c a l l y , taking care t o obtain a good d i s s o l u t i o n of the d r i e d m a t e r i a l and a very homogenous suspension. The rehydrated vaccine should be kept r e f r i g e r a t e d by p l a c i n g the ampoule i n an i c e d water bath, preserved from d i r e c t s u n l i g h t and discarded one hour a f t e r preparation. 0 . 5 ml i s Inoculated subcutaneously i n a d u l t s or c h i l d r e n . Less than the recommended dose could be dangerous.
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VIR/YF/71. 24 page 2
Contra-indications to vaccination: In addition t o general contra-indications to a ll vaccinations, allergy to egg protein mainly, must be care f ully l ooked for by que s tioni ng ~n asthma, spasmodic coryza, eczema, urticaria or drug sens i tivity. An allergic person m ust be tested with 0.10 ml of the vaccine given intracu t aneously on the anterior part of the forearm. The typical allergic reaction consists of an erythematous area with a 'l'ihl t e papula extending in pseudopoda. Some very sensitive persons may collapse or s how Cl tendency to laryngeal oedema and must be kept temporarily W1der medical surveillance. 1'he erythematous reaction does not contra-indicate the vaccination which is resumed by giving 0.40 ml subcutaneously half an hour later. In the absence of suff i c ient inf ormation relevant to vaccination of pregnant women, this might be considered as a con tra-indic a t i on unless the risk of exposure to yellow fever virus is great. I n inf ec ted areas, health authorities may recommend revaccination be f ore the eXj.li t'y ua t e of t en years. Certificates and records: Certificates are issued as mentioned above and all tlaLa f rom the certificate, including particularly the name of the vaccinator and batch num ber of the vaccine with its expiry date should be entered in a register. Control of vaccination: Each batch of vaccine has passed through pot ency and innocui t y tests in the manufacturing laboratory and in the national control laboratories. The effectiveness of the vaccination may be checked by serological tests i n speciali zed l aboratories.