Porudominsky Ruben, Gotuzzo Eduardo H
Universidad Peruana Cayetano Heredia, Lima, Peru.
Rev Panam Salud Publica. 2018 Jun 5;42:e75. doi: 10.26633/RPSP.2018.75. eCollection 2018.
To evaluate contraindications and precautions for the yellow fever vaccine (YFV) in risk populations.
A literature review was conducted by searching PubMed for "yellow fever vaccine" and "adverse events" (AEs); 207 studies were found, and 43 of them met the inclusion criteria and were included in a systematic review.
The results for first dose of YFV in elderly patients were conflicting-some showed AEs while some showed benefits. Therefore, precaution and case-by-case decisionmaking for YFV in this population are advised. The same precautions are warranted for YFV in infants 6-8 months, with the vaccine contraindicated in those < 6 months old and safe after 9 months of age. YFV seems safe in the first trimester of pregnancy, and probably throughout gestation, as it was not associated with increased malformations. During breastfeeding, YFV continues to be controversial. The vaccine seems safe in people being treated with immunomodulatory or immunosuppressive therapy, people with immunosuppressive diseases, and solid organ and hematopoietic stem cell transplant patients; in stem cell transplants, however, a booster dose should only be applied once immunity is recovered. HlV-infected patients with a CD4+ count > 200 cells/mm do not have increased risk of AEs from YFV. Egg allergy vaccination protocols seem to provide a safe way to immunize these patients.
YFV safety has been confirmed based on data from many vaccination campaigns and multiple studies. AEs seem more frequent after a first-time dose, mainly in risk groups, but this review evaluated YFV in several of the same risk groups and the vaccine was found to be safe in most of them.
评估风险人群中黄热病疫苗（YFV）的禁忌证和注意事项。
通过在PubMed上搜索“黄热病疫苗”和“不良事件”进行文献综述；共找到207项研究，其中43项符合纳入标准并被纳入系统评价。
老年患者首剂YFV的结果相互矛盾——一些研究显示有不良事件，而另一些则显示有益处。因此，建议对该人群使用YFV时采取预防措施并逐案决策。6至8个月的婴儿使用YFV时也应采取同样的预防措施，6个月以下婴儿禁忌使用该疫苗，9个月龄后使用安全。YFV在妊娠早期似乎是安全的，可能在整个妊娠期都是安全的，因为它与畸形增加无关。在母乳喂养期间，YFV仍然存在争议。该疫苗在接受免疫调节或免疫抑制治疗的人群、患有免疫抑制疾病的人群、实体器官和造血干细胞移植患者中似乎是安全的；然而，在干细胞移植中，只有在免疫力恢复后才能接种加强剂量。CD4+计数>200个细胞/mm的HIV感染患者接种YFV后发生不良事件的风险没有增加。鸡蛋过敏疫苗接种方案似乎为这些患者提供了一种安全的免疫方法。
基于多次疫苗接种活动和多项研究的数据，YFV的安全性已得到证实。首次接种后不良事件似乎更常见，主要发生在风险人群中，但本综述评估了YFV在几个相同风险人群中的情况，发现该疫苗在大多数人群中是安全的。
