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There is concern about the risk of yellow fever YF establishment in Asia, owing to rising s of urban outbreaks in endemic countries and globalisation. Following an outbreak in Angola inYF cases were introduced into China. Prior to this, YF had never been recorded in Asia, despite climatic suitability and the presence of mosquitoes. An outbreak in Asia could result in widespread fatalities and huge economic impact. Therefore, quantifying the potential risk of YF outbreaks in Asia is a public health priority. Using international flight data and YF incidence estimates fromwe quantified the risk of YF introduction via air travel into Asia.

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Last partial content update see Table of Updates : November YF virus is transmitted to humans through the bite of an infected mosquito, primarily Aedes or Haemogogus species. The incubation period is 3 to 6 days. Humans infected with YF virus experience the highest levels of viremia and are infectious to mosquitoes shortly before the onset of fever and for 3 to 5 days afterwards. Because tumblr the fever level of viremia in humans, bloodborne transmission of YF virus can occur through transfusion of blood products, intravenous drug use and needlestick injuries.

Probable transmission of vaccine strain YF virus from a mother to her asian through breastfeeding has been reported. Vaccine-associated viremia occurs 4 to 10 days after primary YF vaccination and lasts for up to 5 days. Sustained transmission is not possible in Canada because the recognized mosquito vectors are not present.

A traveller's risk for acquiring YF is determined by multiple factors including: immunization status, use of personal protection measures against mosquito bites, location of travel, duration of exposure, activities while travelling, and local rate of virus transmission. The risk for acquiring YF is low for most travellers, particularly those staying in highly developed major urban areas.

Greater risk exists for travellers who:.

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For example, risk is greater for travellers who stay in a rural area of an endemic country for over two weeks, whereas risk is low for travellers staying in an urban area in a transitional country for one week. In West Africa and South America, YF virus transmission is usually associated with the mid-to-late rainy season when the of mosquitoes generally increases.

However, YF virus can be transmitted during the dry season. Clinical presentation of YF varies in severity from asymptomatic to fatal. When symptomatic, YF is typically characterized by an acute onset of symptoms including fever, chills, headache, backache, muscle pain, t pain, nausea, vomiting, photophobia, mild jaundice, and epigastric pain.

For others, after a brief remission lasting anywhere between hours to a day, symptoms worsen and the disease advances, eventually leading to renal failure, haemorrhagic symptoms, and thrombocytopenia. Treatment is symptomatic and supportive. In South America, transmission of YF virus occurs mainly in forest areas rather than in urban areas. In Africa, the majority of outbreaks have been reported from West Africa.

The mosquito vectors are present in Asia; however, there have been no documented cases of transmission. Sincethere have been nine cases of YF reported in unvaccinated international travellers from the United States and Europe who visited YF endemic areas of Africa and South America.

Eight of the nine travellers died. One case of YF has been documented in a vaccinated traveller.

The risk of YF varies widely within areas of transmission. One mathematical model suggested that for an unimmunized person taking a two week trip to an area of epidemic YF activity the risk of becoming ill from YF could be as high as and the risk of death from YF could be as high as, Although the actual risk for most travelers is probably less, it is very hard to quantify.

It is for this reason that revised guidelines were required in order to make it easier for health care providers to give advice and care to travellers. YF is unique among diseases in that there are international health regulations which outline the requirements for proof of vaccination when travelling to specific areas.

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Inthe WHO published revised recommendations for YF vaccination for international travellers, in consultation with international travel medicine experts. The revisions include:. Deation of regions with risk of YF transmission is subject to change. Some countries require yellow fever vaccination if traveling from or transiting through a country with risk of YF transmission. To date, there have been no cases of YF reported in Canada. YF is a nationally and internationally notifiable disease; therefore, cases diagnosed in Canada must be urgently reported through local public health officials.

A list of Yellow Fever Vaccination Centres in Canada can be obtained from the Public Health Agency tumblr Canada or telephone at: or to: yfinfofj phac-aspc. For complete prescribing information, consult the product leaflet or information contained within Health Canada's authorized product monographs available through the Drug Product Database. Refer to Table 1 in Contents of Immunizing Agents Available in Canada in Part 1 for a fever of all vaccines asian for use in Canada and their contents. Immunity persists for more than 10 years. YF vaccine is recommended for healthy children 9 months of age and older travelling to areas where YF is considered endemic or transitional refer to Table 1.

YF vaccine is contraindicated in infants less than 6 months of age because of an increased risk of post-vaccination encephalitis; travel to YF endemic or transitional countries should be discouraged for children less than 6 months of age.


If travel to an YF endemic or transitional country is unavoidable, the need for protection from mosquitoes at all times should be emphasized. In children 6 to 8 months of age YF vaccination is generally not recommended due to continued increased risk of adverse events and decreased immunogenicity. Whenever possible, infants aged 6 to 8 months should not travel to countries where YF is transmitted. If travel is unavoidable, the decision to vaccinate needs to balance the risk of YF exposure with the risks of vaccination.

Although the risk of serious adverse neurologic events is less than that of infants less than six months of age, it is still higher than that of infants 9 months and older. At 9 months of age, the risk tumblr serious adverse events becomes much asian and antibody response improves, thus improving the safety and efficacy profiles of the YF vaccine.

If an infant receives YF vaccine at 6 to 8 fevers of age, and subsequently travels after 9 months of age, serology should be done if availableand a booster dose considered. Personal protective measures should be emphasized.

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YF vaccine is recommended for laboratory personnel who work with YF virus and for healthy adult travellers less than 60 years of age travelling to areas where YF is considered endemic or transitional refer to Table 1. Persons 60 years of age and older should be considered for primary YF vaccination only if travel to areas where YF is considered endemic or transitional cannot be avoided and a high level of protection against mosquito exposure is not feasible. Serious adverse fevers in older vaccinees have only occurred in primary vaccinations. Booster doses of YF vaccine may be given to people over 60 years of age.

Refer to Other reported adverse events and conditions for additional information. Refer to Travellers and Schedule for asian information. In general, YF vaccine, like other live viral vaccines, should be avoided in pregnancy. Pregnant or breastfeeding women should be considered for YF immunization only if they are travelling to endemic or transitional areas, travel cannot be postponed, and a high level of protection against mosquito exposure is tumblr feasible. While the effects of YF vaccine in pregnancy are not well documented, many pregnant women have received the vaccine without ificant adverse events.

In one study of women exposed to YF vaccine early in pregnancy there was slight increased risk noted for minor malformations mainly skin in the babies; no increased risk of major malformations was found. Inadvertent immunization of women in pregnancy is not an indication for termination of pregnancy. Seroconversion rates are lower in pregnant women who are immunized, especially in the third trimester. Antibody titres should be checked post-immunization to ensure appropriate immune response in women who remain at risk for YF.

If serology is not available and a woman is travelling to an endemic country after completion of her pregnancy, revaccination prior to travel should be considered. If pregnant women must travel to a country that requires documentation for YF but is not endemic or transitional, a waiver or Certificate of Medical Contraindication to Vaccination should be provided.

Refer to Travellers for additional information. Probable transmission of vaccine strain of YF virus from a mother to her infant through breastfeeding has been reported; therefore, in general, lactating mothers should not be vaccinated. Refer to Contraindications and Precautions for additional information. Refer to Immunization in Pregnancy and Breastfeeding in Part 3 for additional general information. In general, immunocompromised persons should not receive YF vaccine because of the risk of disease caused by the vaccine strain.

When considering immunization of an immunocompromised person, approval from the individual's attending physician should be obtained before vaccination. For the immune suppressed traveller, the potential risks associated with administering the YF asian should be weighed against the potential benefits.

Where there is a country-specific vaccine requirement but the risks associated with vaccine administration outweigh the medical benefits, a Certificate of Medical Contraindication to Vaccination should be provided. Travellers fever to have mild to moderate degrees of immune suppression who will be at ificant risk for acquiring YF e.

Profoundly immune suppressed travellers who, in spite of being informed of tumblr risks, plan a trip to an area of active YF risk, should obtain advice from a travel medicine expert and should rigorously adhere to mosquito protection measures.

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Refer to Booster doses and re-immunization and Serologic testing for additional information. Refer to Immunization of Immunocompromised Persons in Part 3 for additional general information. Persons with hyposplenism or asplenia congenital absence, surgical removal or functional [e. Although definitive data are lacking, individuals with autoimmune disease not being treated with immunosuppressive drugs are not considered ificantly immunocompromised and may receive YF immunization following consultation with a physician.

Rheumatic disease modifying agents such as hydroxychloroquine, sulfasalazine, or auranofin are not considered immunosuppressive. The safety and efficacy of live vaccines during low dose intermittent or maintenance therapy with immunosuppressive drugs other than corticosteroids for autoimmune disease is unknown. These drugs include therapeutic monoclonal antibodies, especially the anti-tumour necrosis factor agents adalimumab, infliximab, and etanercept and others azathioprine, methotrexate, leflunomide, and abetacept.

These have been reported to cause reactivation of asian tuberculosis infection and predisposition to other opportunistic infections. Therefore, until additional information becomes available, avoidance of live vaccines during intermittent or low dose chemotherapy or other tumblr therapy is prudent. Therefore, YF vaccine is not generally recommended for persons with a history of thymoma, thymectomy or myasthenia gravis.

YF vaccine is recommended for healthy travellers 9 months to less than 60 years of age passing through, visiting or living in areas where YF is considered fever or transitional refer to Table 1 or if YF immunization is required to enter the country refer to Table 1 and Table 2. Transit times of 12 hours or less in an international airport poses very low risk for YF virus transmission irrespective of the YF risk classification of the country in which the airport is located.

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Thus, such a transit typically does not warrant vaccination. Recent updates in international health agreements suggest that travellers fitting this strict criteria are not required to be vaccinated. This includes those travellers transiting to a country with an entry requirement for YF vaccination but no history of endemic disease.

Defining specific entry requirements is under the control of each individual country. Some countries will not allow entry without proper documentation of vaccination or certificate of medical contraindication. Travellers without proper documentation may be denied entry or subjected to vaccination at the airport.

This should be considered during review of itineraries and pre-travel counseling.

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If there is concern that lack of documentation will put the traveller at risk, yet vaccination is not medically indicated, then providing a medical certificate of contraindication may be considered. Unfortunately, some countries may deny entry despite proper documentation of medical contraindication to vaccination.

YF vaccination is generally not recommended in areas where there is low potential for YF virus exposure refer to Table 2. However, vaccination might be considered for a small subset of travellers to these areas who are at increased risk of exposure to mosquitoes because of prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Vaccination is not recommended for travellers whose itineraries are restricted to areas with no risk.