Yellow Fever Vaccine-Associated Viscerotropic Disease among Siblings, São Paulo State, Brazil

• Published in: Emerging infectious diseases Vol. 29; no. 3; pp. 493 - 500
• Main Authors: Fernandes, Eder Gatti, Gomes Porto, Victor Bertollo, de Oliveira, Patrícia Mouta Nunes, Duarte-Neto, Amaro Nunes, de Sousa Maia, Maria de Lourdes, Lignani, Letícia Kegele, Nogueira, Juliana Silva, Teixeira, Gabriellen Vitiello, Iglezias, Silvia D'Andretta, Blanco, Roberta Morozetti, Sato, Helena Keico
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.03.2023; Centers for Disease Control and Prevention
• Subjects: Adult; Adverse and side effects; adverse events; Analgesics; Antigens; Antigens, Viral; Brazil; Brothers and sisters; Case studies; Complications and side effects; Creatinine; Development and progression; Disease; Drugs; Edema; Enzymes; Epidemics; Families & family life; Fever; Genetic factors; Genomes; Health aspects; Health surveillance; Humans; Hypotension; Immunization; Laboratories; Leukocytes; Liver; Male; Oliguria; Patients; Prevention; Respiratory failure; Siblings; São Paolo; Tazobactam; Thrombocytopenia; Vaccination; Vaccines; Vector-borne diseases; vector-borne infections; Ventilation; Viral vaccines; viscerotropic disease; Vomiting; Yellow fever; Yellow Fever - epidemiology; Yellow Fever Vaccine; Yellow Fever Vaccine–Associated Viscerotropic Disease among Siblings, São Paulo State, Brazil; Brazil; viruses; vector-borne infections; Brazil; yellow fever vaccine; adverse events; São Paolo; viscerotropic disease
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2903.220989

We describe 5 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) in 2 familial clusters during the 2017-2018 yellow fever (YF) vaccination campaign in São Paulo state, Brazil. The first case was that of a 40-year-old white man who died of icterohemorrhagic syndrome, which was confirmed to be YEL-AVD by using real-time reverse transcription PCR to detect 17DD YF vaccine in the liver. Ten years previously, his brother died of a clinically similar disease without a confirmed diagnosis 9 days after YF vaccination. The second cluster included 3 of 9 siblings in whom hepatitis developed in the first week after receiving fractionated doses of YF vaccine. Two of them died of hemorrhagic diathesis and renal and respiratory failure, and 17DD-YF vaccine was detected in serum samples from all patients and in the liver in 1 case. Genetic factors might play a substantial role in the incidence of YEL-AVD.