Domingo Cristina, Lamerz Judith, Cadar Daniel, Stojkovic Marija, Eisermann Philip, Merle Uta, Nitsche Andreas, Schnitzler Paul
Robert Koch Institute, Centre for Biological Threats and Special Pathogens, 13353 Berlin, Germany.
Department of Internal Medicine IV, University Hospital of Heidelberg, 69120 Heidelberg, Germany.
Vaccines (Basel). 2020 May 26;8(2):249. doi: 10.3390/vaccines8020249.
The yellow fever (YF) vaccination is recommended by the WHO for people traveling or living in endemic areas at risk for yellow fever infections in Africa and South America. Although the live attenuated yellow fever vaccine is a safe and efficient vaccine, rare serious adverse events after vaccination have been reported.
We present the case of a 74-year-old male with multiorgan failure after yellow fever vaccination for a trip to Brazil. The patient required admission to the intensive care unit with a prolonged stay due to severe organ dysfunction. Five days after the YF vaccination, the patient experienced nausea, vomiting, diarrhea, and general illness. Three days later he sought medical attention and was transferred to the University Hospital Heidelberg with beginning multiorgan failure and severe septic shock, including hypotonia, tachypnea, thrombopenia, and acute renal failure the same day. Within one week after vaccination, antibodies against YF virus were already detectable and progressively increased over the next two weeks. Viral RNA was detected in serum on the day of admission, with a viral load of 1.0 × 10 copies/mL. The YF virus (YFV) RNA was also present in tracheal secretions for several weeks and could be detected in urine samples up to 20 weeks after vaccination, with a peak viral load of 1.3 × 10 copies/mL. After 20 weeks in the ICU with nine weeks of mechanical ventilation, the patient was transferred to another hospital for further recovery.
The risk for severe adverse events due to the YF vaccination should be balanced against the risk of acquiring a severe YF infection, especially in elderly travelers.
世界卫生组织建议前往非洲和南美洲黄热病流行地区旅行或居住、有感染黄热病风险的人群接种黄热病疫苗。尽管减毒活黄热病疫苗是一种安全有效的疫苗，但接种后罕见的严重不良事件仍有报道。
我们报告一例74岁男性病例，该患者因前往巴西旅行接种黄热病疫苗后出现多器官功能衰竭。由于严重的器官功能障碍，患者需要入住重症监护病房并长期住院。黄热病疫苗接种五天后，患者出现恶心、呕吐、腹泻及全身不适。三天后他寻求医疗救治，并被转至海德堡大学医院，入院当天即出现多器官功能衰竭和严重感染性休克，包括肌张力减退、呼吸急促、血小板减少及急性肾衰竭。接种疫苗一周内即可检测到抗黄热病病毒抗体，且在接下来的两周内逐渐升高。入院当天血清中检测到病毒RNA，病毒载量为1.0×10拷贝/mL。黄热病病毒（YFV）RNA在气管分泌物中也持续存在数周，接种疫苗后20周内尿液样本中均可检测到，病毒载量峰值为1.3×10拷贝/mL。在重症监护病房治疗20周，机械通气9周后，患者转至另一家医院继续康复治疗。
黄热病疫苗接种导致严重不良事件的风险应与感染严重黄热病的风险相权衡，尤其是在老年旅行者中。
