पीला बुखार टीका

WHO और ICMR के दिशानिर्देशों के अनुसार:

• स्थानिक क्षेत्रों (अफ्रीका/दक्षिण अमेरिका) की यात्रा करने वाले 9 माह से अधिक आयु के सभी व्यक्ति

• जिन देशों में प्रवेश के लिए ICVP अनिवार्य है, वहाँ जाने वाले यात्री

• स्थानिक क्षेत्रों में रहने वाले या कार्यरत व्यक्ति — प्रयोगशाला कर्मी सहित

• भारतीय सशस्त्र बलों के जवान जो अफ्रीकी/दक्षिण अमेरिकी UN मिशनों में तैनात हों

IHR 2005 के अनुसार प्रमाणपत्र टीकाकरण के 10 दिन बाद मान्य होता है और आजीवन वैध रहता है (बूस्टर अनिवार्य नहीं)।

• 6 माह से कम आयु के शिशु (बिल्कुल वर्जित — encephalitis का जोखिम)

• 6–8 माह के शिशु (केवल महामारी के दौरान विशेष अनुमति से)

• अंडे की गंभीर एलर्जी (एनाफिलेक्सिस का इतिहास) — टीका अंडे के भ्रूण में विकसित किया जाता है

• गंभीर प्रतिरक्षा-दमन: HIV (CD4 < 200/µL), अंग प्रत्यारोपण, कीमोथेरेपी, उच्च खुराक स्टेरॉयड

• थाइमस विकार (थाइमोमा, थाइमेक्टॉमी) — YEL-AVD का उच्च जोखिम

• गर्भावस्था — सैद्धांतिक भ्रूण जोखिम (विशेष परिस्थिति में ICMR/WHO अनुमति)

• 60 वर्ष से अधिक आयु — YEL-AND (neurotropic disease) और YEL-AVD (viscerotropic disease) का बढ़ा जोखिम; जोखिम-लाभ मूल्यांकन आवश्यक

सामान्य (10–30%): इंजेक्शन स्थल पर दर्द, लालिमा और सूजन; हल्का बुखार (37.5–38.5°C); सिरदर्द, माँसपेशियों में दर्द (myalgia); थकान — ये प्रतिक्रियाएँ 2–7 दिनों में स्वतः ठीक होती हैं।

असामान्य (1–5%): मध्यम बुखार (>38.5°C), जोड़ों का दर्द, चकत्ते, मतली।

दुर्लभ गंभीर प्रतिकूल प्रभाव:

• YEL-AND (Yellow Fever Vaccine-Associated Neurotropic Disease): 0.4–0.8/1,00,000 खुराक — मेनिंगो-एन्सेफलाइटिस, गिलेन-बैरे सिंड्रोम

• YEL-AVD (Viscerotropic Disease): 0.3–0.5/1,00,000 खुराक — बहु-अंग विफलता, मृत्यु दर ~60%

• एनाफिलेक्सिस: 1.3/1,00,000 — जिलेटिन या अंडा प्रोटीन से

ICMR/MoHFW निर्देश: टीकाकरण के बाद 30 मिनट तक निगरानी अनिवार्य।

• खुराक: 0.5 mL, चमड़े के नीचे (subcutaneous) इंजेक्शन, ऊपरी बाँह (deltoid क्षेत्र)

• प्राथमिक अनुसूची: एकल खुराक, यात्रा से कम से कम 10 दिन पूर्व

• बूस्टर: WHO 2013 — आजीवन सुरक्षा; बूस्टर आवश्यक नहीं (कुछ देश अभी भी 10 वर्षीय बूस्टर माँग सकते हैं)

• सुई: 25G, 5/8 इंच

• भंडारण: 2–8°C; प्रकाश से सुरक्षित; पुनर्गठन (reconstitution) के बाद 1 घंटे के भीतर उपयोग करें

भारत में MoHFW अधिकृत केंद्रों पर ही उपलब्ध — NCDC दिल्ली, कोलकाता बंदरगाह स्वास्थ्य संगठन, चेन्नई PHO आदि।

पीत ज्वर टीका (YF-17D) सबसे प्रभावी टीकों में से एक है:

• सेरोकन्वर्ज़न दर: ≥99% एकल खुराक के 10 दिनों में (neutralizing antibody ≥LNI 0.7)

• सुरक्षा अवधि: WHO Position Paper 2013 — आजीवन प्रतिरक्षा; 30+ वर्ष बाद भी सुरक्षात्मक अनुमापांक (titres) बने रहते हैं

• क्षेत्र प्रभावशीलता: ब्राज़ील (2017–2018 प्रकोप) — एकल खुराक 85–98% प्रभावी

• विषाणु उदासीनीकरण (virus neutralization): 10 वर्ष बाद भी >90% व्यक्तियों में पर्याप्त स्तर

भारतीय यात्रियों के लिए: ICMR अनुशंसा करता है कि स्थानिक क्षेत्रों की हर यात्रा से पूर्व टीकाकरण स्थिति सत्यापित करें। ICVP अब आजीवन मान्य है।

Proper vaccine storage is critical for maintaining potency and efficacy.

• Unopened vaccine (lyophilized powder):

• Temperature: 2°C to 8°C (35°F to 46°F); aim for 5°C (41°F)

• Protection from light: Keep in original packaging

• Duration: Until expiration date on vial

• Freezing: Must not be frozen

Active Ingredient:

Yellow fever virus 17D-204 strain (live, attenuated) – minimum 1000 international units (IU) per 0.5 mL dose (equivalent to ≥4.74 log₁₀ plaque-forming units)

Produced in specified pathogen-free (SPF) chicken embryos, free of avian leukosis virus

Non-medicinal Ingredients (Excipients):

Sorbitol (stabilizer)

Gelatin (stabilizer)

Sodium chloride

L-Histidine hydrochloride

L-Alanine

Potassium chloride

Disodium phosphate dihydrate

Potassium dihydrogen phosphate

Calcium chloride

Magnesium sulfate

Lactose (in some formulations)

Water for injection

Notable absence:

No preservatives (sodium thimerosal or other antimicrobial agents) are added

Physical form:

Lyophilized (freeze-dried) powder supplied in hermetically sealed vials under nitrogen atmosphere

Reconstituted vaccine: slight pink-brown suspension

• अन्य जीवित टीकों (MMR, वेरिसेला, OPV) के साथ: या तो एक ही दिन दें या 4 सप्ताह का अंतराल रखें

• इम्यूनोग्लोबुलिन या रक्त उत्पाद: 2 सप्ताह पहले या 3 माह बाद तक पीत ज्वर का टीका न दें

• प्रतिरक्षा-दमनकारी दवाएँ (methotrexate, biologics, TNF-α inhibitors): टीका वर्जित

• मलेरिया-रोधी दवाएँ (chloroquine, mefloquine): कोई ज्ञात हस्तक्षेप नहीं, सह-प्रशासन सुरक्षित

• निष्क्रिय टीके (हेपेटाइटिस A/B, टाइफाइड इंजेक्शन): कोई प्रतिबंध नहीं, एक ही दिन भिन्न स्थल पर दिए जा सकते हैं

Recommendation: Yellow fever vaccine should be avoided during pregnancy unless travel to a high-risk yellow fever-endemic area is unavoidable and cannot be postponed, and a high level of protection against mosquito bite exposure is not feasible.

Rationale: Wild yellow fever virus can cause severe infection in pregnancy and has been associated with fetal transmission and poor outcomes. However, the live attenuated vaccine virus carries theoretical risk, particularly in the first trimester. Limited data from surveillance of several hundred women who inadvertently received yellow fever vaccine during pregnancy have not demonstrated significant adverse fetal outcomes, suggesting that inadvertent vaccination during pregnancy is not an indication for pregnancy termination. ​

Special considerations:

Seroconversion rates (antibody response) following vaccination are lower in pregnant women compared to non-pregnant individuals; post-immunization serology (blood test to confirm immunity) may be considered ​

Individual risk assessment must carefully weigh the risk of yellow fever infection (which carries substantial maternal and fetal morbidity and mortality) against theoretical vaccine risks

If vaccination is deemed necessary, it should ideally be administered in the second or third trimester, though the vaccine can be given at any stage if infection risk is high ​

Healthcare providers should document the indication for vaccination and counsel women regarding theoretical risks

Women of childbearing potential should be counseled to avoid pregnancy for 2 months following yellow fever vaccination, though data do not support this as a strict requirement

Recommendation: Yellow fever vaccination should generally be avoided in women who are actively breastfeeding, particularly those breastfeeding infants under 9 months of age.

Rationale: Three documented cases of vaccine-strain yellow fever virus transmission through breast milk have been reported, resulting in meningoencephalitis in exclusively breastfed infants whose mothers received yellow fever vaccine during their infants' first month of life. Although the exact mode of transmission has not been definitively established, the risk of vaccination during breastfeeding is considered a precaution rather than an absolute contraindication.

Age 6 months to 9 months:

Vaccination is contraindicated in routine circumstances due to increased risk of vaccine-associated encephalitis (YEL-AND). During the pre-restriction era (1950s), 15 encephalitis cases were reported in infants, with 13 (87%) occurring in infants under 4 months and all cases occurring in infants under 7 months. The risk of YEL-AND is inversely proportional to age in this age group. ​

Vaccination may be considered only when travel to yellow fever-endemic areas is unavoidable and the risk of wild-type yellow fever infection is very high (such as during confirmed epidemics or outbreaks). Expert consultation is mandatory, and a thorough individual risk-benefit assessment must be documented.

Age 9 months to 2 years:

Vaccination is recommended for infants and young children traveling to yellow fever-endemic areas. However, immunogenicity studies demonstrate lower seroprotection rates in children vaccinated before age 2 years:

Seroprotection rate within 5 years post-vaccination: approximately 52% in children vaccinated before age 2 years

This is substantially lower than the >90% seroprotection rate in children vaccinated at age ≥2 years

Booster vaccination in early childhood: Children vaccinated before age 2 years are recommended to receive a reinforcing (booster) dose once they reach age 2 years or older, depending on planned travel to yellow fever-endemic areas. This recommendation is based on evidence of waning seroprotection 3 months to 5 years following primary vaccination in infants. Recent breakthrough infection data suggest this approach may enhance long-term protection. ​

Age ≥9 years to adolescence:

Children in this age group have immunogenicity and safety profiles similar to adults. Standard vaccination schedules and recommendations apply. A single dose provides sustained protective immunity.

General pediatric considerations:

The vaccine is well-tolerated in children

Mild systemic adverse events (fever, headache, myalgia) are reported in 20–40% of younger vaccinees, with rates typically lower in older children than infants

Serious adverse events are rare in children, with the exception of increased risk in the 6–9 months age group

Vaccination in children can be given concurrently with routine immunizations at separate injection sites

Travel-related mosquito bite prevention is essential for all children, especially those too young for vaccination or in the precautionary age groups

Recommendation: Yellow fever vaccination for individuals aged 60 years and older requires individualized risk-benefit assessment. Vaccination should only be administered when there is a significant and unavoidable risk of acquiring yellow fever infection based on travel itinerary and duration in endemic areas.

No specific cases of overdose with yellow fever vaccine have been documented in the medical literature. The vaccine is supplied as a single-dose vial containing 0.5 mL (one dose), and multi-dose vials are used in limited circumstances under strict medical supervision.

• पहली बार टीकाकरण करवाने वाले 60+ वर्ष के व्यक्तियों में YEL-AND/YEL-AVD का मूल्यांकन अनिवार्य

• HIV पॉज़िटिव (CD4 ≥200/µL, स्पर्शोन्मुख): सावधानी से दिया जा सकता है

• स्तनपान कराने वाली माताएँ: शिशु को YEL-AND का सैद्धांतिक जोखिम — यदि संभव हो तो स्थगित करें

• केवल MoHFW अधिकृत पीत ज्वर टीकाकरण केंद्रों पर लगवाएँ — ICVP वहीं जारी होता है

• टीका 2–8°C पर शीत श्रृंखला (cold chain) में संग्रहित करें; पुनर्गठन के 1 घंटे के भीतर उपयोग करें

• एलर्जी इतिहास वाले रोगियों में त्वचा परीक्षण (skin prick test) पर विचार करें