Vaccine Administration Decision Making: The Case of Yellow Fever Vaccine

Abstract

Targeted information is necessary but insufficient to change the process of vaccine administration decision making. Providers need additional education to enable them to apply evidence, overcome cognitive decision-making errors, and involve patients in vaccine decisions.

Use of Japanese Encephalitis Vaccine in US Travel Medicine Practices in Global TravEpiNet

“…Healthcare providers must consider a number of factors when deciding whether to administer a travel-related vaccine, including the details of the traveler's itinerary and risk of exposure to disease, vaccine cost, morbidity and mortality of the disease, and potential adverse events after vaccination. 9 Although JE can be a fatal disease with high morbidity, the risk of infection for travelers is low. 10 , 11 A review of published cases of JE in travelers during 1973–2008 estimated the incidence rate for travelers from non-endemic areas to be 0.2 cases per million.…”

International Travel by Persons With Medical Comorbidities: Understanding Risks and Providing Advice

“…Most travelers to YF-endemic countries received YF vaccine; the decision to provide live virus YF vaccines to high-risk persons requires a complicated informed decision-making process to review risks and benefits. 33 Primary care and specialist health care professionals should consider early referral of these complicated patients to experienced travel medicine specialists, as patients themselves may not be aware of the need for a travel medicine consultation. Travel clinic visits need adequate time to address the particular risks faced by high-risk travelers.…”

“…The decision to vaccinate these individuals requires a careful assessment of the risks and benefits and must be made in partnership with an informed traveler. 33 Guidelines recommend that YF vaccine (and other live virus vaccines) should not be given to immunocompromised persons with AIDS-defining conditions, thymic disease, malignant neoplasms, and other conditions. 7,8,11,37 Limited data on YF vaccine use in pregnant women suggest that infection of the fetus is possible and that development of protective antibodies may be trimester dependent.…”

Yellow Fever 17DD Vaccine Virus Infection Causes Detectable Changes in Chicken Embryos

“…Complicating matters, the vaccine is also contraindicated or demands precaution for a number of patients, including: those with allergies to eggs or other vaccine components (which are difficult to identify due to trade secret laws), women who are pregnant or breastfeeding, children less than six months old, individuals older than 60, transplant recipients, patients with AIDS, patients presenting primary immunodeficiency, and immunosuppressed patients with cancer or thymic diseases [ 18 ]. Although the YF vaccine is generally very safe and effective, viscerotropic and neurotropic vaccine-associated diseases have occurred, especially in patients with immunodeficiency or the elderly [ 19 ]. These vaccine-associated diseases can kill up to 65% of affected patients due to the lack of available treatment.…”