Safety and Immunogenicity of Yellow Fever 17D Vaccine in Adults Receiving Systemic Corticosteroid Therapy: An Observational Cohort Study

Abstract

Objective. To assess the safety and immunogenicity of live attenuated yellow fever (YF) 17D vaccine in adults receiving systemic corticosteroid therapy. Methods. All adult travelers on systemic corticosteroid therapy who had received the YF17D vaccine in 24 French vaccination centers were prospectively enrolled and matched with healthy controls (1:2) on age and history of YF17D immunization. Safety was assessed in a self-administered standardized questionnaire within 10 days after immunization. YF-specific neutralizing antibody titers were measured 6 months after vaccination in patients receiving corticosteroids. ‫؍‬ 14), rheumatoid arthritis (n ‫؍‬ 9), and upper respiratory tract infections (n ‫؍‬ 8). No serious adverse event was reported; however, patients receiving corticosteroids reported more frequent moderate/severe local reactions than controls (12% and 2%, respectively; relative risk 8.0, 95% confidence interval 1.4 -45.9). All subjects receiving corticosteroids who were tested (n ‫؍‬ 20) had neutralizing antibody titers >10 after vaccination. Conclusion. After YF17D immunization, moderate/severe local reactions may be more frequent in patients receiving systemic corticosteroid therapy. Immunogenicity seems satisfactory. Large-scale studies are needed to confirm these results.

International Consensus Document (ICON): Common Variable Immunodeficiency Disorders

“…One study found no effect on responses to yellow fever vaccine. 170 Chronic inhaled steroids did not impair responses to influenza vaccine in another study. 171 …”

Diphtheria, tetanus, poliomyelitis, yellow fever and hepatitis B seroprevalence among HIV1-infected migrants. Results from the ANRS VIHVO vaccine sub-study

“…The VIHVO cohort is restricted to French HIV-infected migrants, which may limit the external validity of our results, as is the case of many vaccinal studies [8][9][10]. Further investigations are thus needed to determine if our conclusions also apply to HIV-infected patients in general or even to all immunocompromised patients, not just those infected by HIV.…”

“…HIV-infected persons may have suboptimal primary and longterm responses to vaccines [8][9][10][11]. Moreover, immigrants may have an incomplete vaccine schedule because of their migratory life course [12].…”

Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review

“…Suppressed HIV viral load at the time of immunisation also influenced durability of neutralising antibodies titres at long-term follow-up [41]. There are no large studies available to assess the efficacy and safety of YFV in non-HIV ICH although available observational data with small numbers of SOT patients and those on long term steroid therapy showed that no major adverse event occurred and neutralizing antibodies were detected with 17-D vaccine [42,43]. A successful vaccine response has also been reported in a patient with allo-HSCT who received primary vaccination 8 years post-transplant [44].…”