Yellow fever is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America associated with significant morbidity and mortality. The use of a live attenuated vaccine can prevent yellow fever, but vaccine-associated neurologic disease has been reported and is a safety concern. We present the case of a previously healthy 35-year-old active-duty man who received the yellow fever vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis. KEYWORDS Transverse myelitis; yellow fever; yellow fever vaccine-associated neurologic disease Y ellow fever (YF) is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America with significant morbidity and mortality. The World Health Organization estimates that 200,000 cases occur each year. 1,2 YF can result in severe illness with hepatic dysfunction, renal failure, coagulopathy, and shock. 3 Supportive care is the mainstay of therapy, because there is no specific treatment for YF. Primary prevention with the YF vaccine is pivotal in reducing its incidence. The Centers for Disease Control and Prevention recommends YF vaccination for travelers to and residents of endemic areas aged 9 months and older. The YF vaccine was developed in 1937, with over 600 million doses administered to date, and has been described as a safe vaccine with rare cases of serious adverse reactions. 4 YF vaccine-associated neurologic disease has been reported by the Yellow Fever Working Group. Encephalitis, meningoencephalitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis are among the most frequently described neurologic complications. These complications account for 0.4 to 0.8 cases per 100,000 doses, as reported to the Vaccine Adverse Event Reporting System. 5 We present the case of a 35-yearold active-duty man who received the YF vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis.
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