University of Saskatchewan, Saskatoon, Saskatchewan S7 N 5A2, Canada.
Vaccine. 2013 Dec 2;31(49):5798-805. doi: 10.1016/j.vaccine.2013.09.030. Epub 2013 Sep 27.
Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a rare and serious adverse event of the yellow fever (YF) vaccine that mimics wild-type YF. Research shows there may be an increased risk of YEL-AVD among the elderly population (≥ 60-65 years old), however this research has yet to be accumulated and reviewed in order to make policy recommendations to countries currently administering the YF vaccine. This paper systematically reviewed all information available on YEL-AVD to determine if there is an increased risk among the elderly, for both travelers and endemic populations. Age-specific reporting rates (RRs) were re-calculated from the literature using the Brighton Collaboration case definition for YEL-AVD and were then analyzed to determine if there was a significant difference between the RRs of younger and older age groups. Two out of the five studies found a significantly higher rate of YEL-AVD among the elderly population. Our findings suggest unexposed elders may be at an increased risk of developing YEF-AVD, however the evidence remains limited. Therefore, our findings for YF vaccination of elderly populations support the recommendations made by the Strategic Advisory Group of Experts (SAGE) in their April 2013 meeting, mainly vaccination of the elderly should be based on a careful risk-benefit analysis.
黄热病疫苗相关内脏疾病（YEL-AVD）是黄热病（YF）疫苗的一种罕见且严重的不良反应，类似于野生型 YF。研究表明，老年人（≥60-65 岁）中 YEL-AVD 的风险可能增加，但尚未对该研究进行积累和审查，以便向目前正在接种 YF 疫苗的国家提出政策建议。本文系统地综述了关于 YEL-AVD 的所有可用信息，以确定旅行者和地方性人群中老年人是否存在更高的风险。使用 Brighton 合作组织对 YEL-AVD 的病例定义，根据文献重新计算了特定年龄组的报告率（RR），然后分析了年轻和老年组之间的 RR 是否存在显著差异。五项研究中有两项发现老年人中 YEL-AVD 的发生率明显更高。我们的研究结果表明，未暴露的老年人可能有更高的罹患 YEF-AVD 的风险，但证据仍然有限。因此，我们关于老年人接种 YF 疫苗的发现支持了战略咨询专家组（SAGE）在 2013 年 4 月会议上提出的建议，主要是老年人的疫苗接种应基于仔细的风险-效益分析。
