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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1379-1381
Whether fractional dosing of yellow fever vaccine can be recommended to meet the challenges of the ongoing 2016 West African outbreak and the resulting vaccine shortage?


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication6-Nov-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Whether fractional dosing of yellow fever vaccine can be recommended to meet the challenges of the ongoing 2016 West African outbreak and the resulting vaccine shortage?. Ann Trop Med Public Health 2017;10:1379-81

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Whether fractional dosing of yellow fever vaccine can be recommended to meet the challenges of the ongoing 2016 West African outbreak and the resulting vaccine shortage?. Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 22];10:1379-81. Available from: http://www.atmph.org/text.asp?2017/10/5/1379/196650


Dear Editor,

The Yellow fever is an acute viral hemorrhagic infectious disease, transmitted by the bite of infected Aedes mosquitoes, with the causative virus being endemic across 47 nations of the Africa and Central and South America.[1] The disease is expected to manifest as large outbreaks or epidemics, especially when infected people introduce the virus into areas with large numbers of susceptible populations, either due to the presence of the vector species in great number or in areas with high human density and where people lack immunity due to the lack of vaccination.[1],[2]

To acknowledge the millions of people who are at the risk of acquiring the disease or the potential threat of the spread of the disease to other nations where the disease does not exist through the unimmunized travellers, a special initiative was launched in West Africa in 2006, and in excess of 100 million people were immunized with the vaccine.[1],[3] Infact, no major outbreak of the disease was reported in 2015, but then in January 2016, a major epidemic has been reported in various urban settings of Angola after almost 28 years.[4] However, the bigger concern is that the evidences of local transmission have been reported in the Democratic Republic of Congo (DCR), while imported cases have been observed in China and Kenya.[4] Thus, there is a great need to implement systematic monitoring and ensure prevention of the international spread of the virus to the neighbouring nations.[1],[3],[4]

Moreover, the presence of a safe, affordable and effective vaccine offers an extremely useful option to confer lifelong immunity with a single dose.[2],[3] Further, at times of any outbreak, the affected nations should have an access to vaccine supplies urgently to avoid the disease spread. Therefore, many international welfare agencies are assisting to maintain the global emergency stockpile.[1],[4] However, due to the ongoing disease epidemic, almost 18 million vaccine doses have been distributed in 3 nations (Angola, DCR and Uganda), of which close to 12 million were distributed in Angola alone.[4] Nevertheless, as the disease is even spreading further, and the necessity that almost 80% of the population at risk should be immunized to prevent further disease transmission, the emergency vaccine stocks have been threatened.[1],[4]

However, considering that the production of vaccines take almost close to a year, it is quite difficult to forecast in advance the number of doses required each year to respond to the outbreaks.[2],[3],[4] Already, the manufacturers have started the process of replenishing the stores, and even shipments of vaccines in other endemic nations have been mobilized towards the currently affected nations.[4] In addition, it has been recommended that the administration of one-fifth of the standard vaccine dose will also offer protection against the disease for at least a year.[4] This fractional dosing is a safe and a cost-effective strategy for mass campaigns to respond to the challenge of sudden vaccine shortage only during emergencies, but not in routine immunization.[4],[5] Furthermore, such fractional doses are not approved for travellers, and they have to receive one complete dose of the vaccine.[3],[4] Moreover, there is also a need to strengthen the components of surveillance and risk assessment, case management, social mobilization and risk communication, and vector control.[1],[2]

To conclude, the yellow fever vaccine is one of the most successful prophylactic interventions for controlling disease expansion. Nevertheless, the ongoing outbreak in three nations has placed an excessive demand on vaccine supply to ensure control over the spread of the disease. Thus, fractional dosing remains an effective temporary option to deal with the shortage of vaccines.

Acknowledgement

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health OrganizationYellow fever-Fact sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs100/en. [Last accessed on 2016 Jun 17].  Back to cited text no. 1
    
2.
Monath TP, Woodall JP, Gubler DJ, Yuill TM, Mackenzie JS, Martins RM. Yellow fever vaccine supply: a possible solution. Lancet 2016;387:1599-600.  Back to cited text no. 2
    
3.
Verma R, Khanna P, Chawla S. Yellow fever vaccine: an effective vaccine for travelers. Hum Vaccin Immunother 2014;10:126-8.  Back to cited text no. 3
[PUBMED]    
4.
World Health OrganizationLower doses of yellow fever vaccine could be used in emergencies; 2016. Available from: http://who.int/mediacentre/news/statements/2016/yellow-fever-vaccine/en. [Last accessed 2016 June 19].  Back to cited text no. 4
    
5.
Campi-Azevedo AC, de Almeida Estevam P, Coelho-Dos-Reis JG, Peruhype-Magalhães V, Villela-Rezende G, Quaresma PF. et al. Subdoses of 17DD yellow fever vaccine elicit equivalent virological/immunological kinetics timeline. BMC Infect Dis 2014;14:391.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh R Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196650

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