Yellow Fever vaccine as a requirment for International travel during the adoption process

I am heading to a couple of countries where Yellow Fever vaccine is required. On occassion I have taken my kids on various trips with me to developing nations and feel this is greatly beneficial for them. My 11 year old son would very much like to go with me, but I am pretty worried about giving him a live vaccine... Are there any medical professionals out there with thoughts on the safety of this vaccine (as well as Typhoid and many of the other ones)? Should I just leave him at home for this trip? Am I crazy to think of taking him?

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Yellow Fever vaccine is considered safe, but there have been rare (~0.5/100,000 doses given) complications, which have been severe, including multiorgan system failure, and vaccine associated encephalitis. The risk is 3-4x higher in patients with significant immunodeficiencies and travelers older than 60. More commonly, about 25% of vaccine recipients report a local reaction at the vaccine site, and some develop fever and muscle aches too, that can last for a few days.

On the other hand, yellow fever is also rare, but is potentially fatal. It is a flaviviral infections transmitted through mosquito bites. (Other flaviviruses include West Nile, Dengue, Japanese encephalitis, St. Louis encephalitis, Powassan, and Hepatitis C.) It occurs year-round in both rural and urban areas in sub-Saharan Africa, as well as Central and South America, and countries in this Yellow Fever belt usually require evidence of vaccination for travel into the country. If a traveler is lacking a valid ICVP (International Certificate of Vaccination or Prophylaxis), s/he can be denied entry or quarantined, unless s/he agrees to on-site vaccination or has a medical waiver letter.

I think of vaccines, like home insurance or your AAA membership – you hopefully won’t need it or ever use it, but if a worst case scenario arises, it’s a good thing to have. Yellow Fever is rare, but potentially catastrophic. Serious vaccines side effects are rare, but can be bad as well – it’s up to you and your provider to decide what’s best for you.

Certainly, the basic rule for all international travelers from the U.S. is that they should be fully up-to-date on the U.S. recommended immunizations – such as tetanus, diphtheria, polio, measles, mumps, and rubella. Most children and adolescents have also received pertussis, hepatitis B, H. influenzae B, chicken pox, and S. pneumoniae vaccines. This applies to adult travelers, who are often behind on tetanus and diphtheria shots. One lifetime polio booster is recommended for adults who travel internationally, particularly to areas in Asia and Africa where wild-type polio remains endemic. Adults born in 1957 or later may also require a measles booster. Most adults have not received hepatitis B vaccines, which I would definitely recommend for international travel. Lastly, a newer tetanus/diphtheria booster also containing acellular pertussis is indicated as a (currently one time) booster for those < 65 years old who require a tetanus booster.

Depending on where and how long the traveler is going, would help determine how important the need for other vaccines like Hepatitis A, typhoid, and even Japanese encephalitis. I would encourage you to find a travel clinic or someone with international medicine experience to discuss your travel plans and risks/benefits for these vaccines.

Lastly, Yellow Fever vaccine must be given by a certified provider, which is the only source of the ICVP needed for entry into endemic countries. A relatively comprehensive listing of providing sites can be found at the CDC website at http://www2.ncid.cdc.gov/travel/yellowfever . Bear in mind, there is a relative shortage of single dose Yellow Fever vaccine at this time, so some of the providers are batching visits, or charging more, because they have to use a more expensive multi-dose (10 dose) vial that can only be used that day.

Despite the ominous tone of the CDC travel website, and the yellow fever and yellow fever vaccine info, I still think it’s fine and great, that your 11 year old wants to go, and that you want to take him. As long as you use common sense, and take the usual precautions for travel (concentrating on being careful about what you drink/eat and minimizing insect bites), the odds are both of you would have a great trip with minimal health risks. Good luck and bring me back a souvenir!

Article Source: http://www.adoptiondoctors.com/articles

Paul J Lee, MD Winthrop-University Hospital Pediatric Infectious Diseases and International Adoption Program 120 Mineola Blvd, Suite 210 Mineola, NY 11501 Office: (516) 663-9414 Fax: (516) 663-3793 www.winthrop.org/departments/specialtycenters/international-adoption-program/

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