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Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial.
Ann Intern Med. 2018 12 04; 169(11):761-765.AIM

Abstract

Background

Outbreaks of yellow fever and a frequently depleted vaccine stock increase demand for a dose-sparing strategy. A fractional dose of 17D yellow fever virus (17D-YFV) vaccine has been shown to be noninferior to the standard dose in inducing seroprotection.

Objective

To evaluate whether fractional-dose vaccination can confer long-term immunity.

Design

10-year follow-up of a subgroup of a randomized, controlled, noninferiority trial. (Dutch Trial Register: NTR7094 [current study] and ISRCTN46326316 [original study]).

Setting

The Netherlands.

Participants

Seventy-five of 155 participants in the original trial provided a blood sample for this study. These 75 participants had received primary vaccination with 17D-YFV vaccine 10 years before. Forty received a 0.1-mL fractional dose intradermally, and 35 received the standard 0.5-mL dose subcutaneously.

Measurements

Virus-neutralizing antibody responses were measured by a plaque reduction neutralization test.

Results

Thirty-nine of 40 (98% [95% CI, 89% to 100%]) participants had protective levels of yellow fever-neutralizing antibodies more than 10 years after receiving a fractional dose of 17D-YFV vaccine compared with 34 of 35 (97% [CI, 87% to 100%]) in the standard-dose group.

Limitation

Only 48% of participants from the original trial participated in this study.

Conclusion

Intradermal administration of a one-fifth dose of yellow fever vaccine induced a protective immune response that lasted for 10 years after vaccination. Persons receiving a fractional dose of yellow fever vaccine do not require a booster vaccination for long-term protection against yellow fever.

Primary Funding Source

Leiden University Medical Center and the International Society of Travel Medicine.

Authors+Show Affiliations

Leiden University Medical Center, Leiden, and Maasstad Hospital, Rotterdam, the Netherlands (A.H.R.).Leiden University Medical Center, Leiden, the Netherlands (K.V., A.W.D., L.G.V.).Leiden University Medical Center, Leiden, the Netherlands (K.V., A.W.D., L.G.V.).Leiden University Medical Center, Leiden, the Netherlands (K.V., A.W.D., L.G.V.).

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30476963

Citation

Roukens, Anna H E., et al. "Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial." Annals of Internal Medicine, vol. 169, no. 11, 2018, pp. 761-765.
Roukens AHE, van Halem K, de Visser AW, et al. Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial. Ann Intern Med. 2018;169(11):761-765.
Roukens, A. H. E., van Halem, K., de Visser, A. W., & Visser, L. G. (2018). Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial. Annals of Internal Medicine, 169(11), 761-765. https://doi.org/10.7326/M18-1529
Roukens AHE, et al. Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial. Ann Intern Med. 2018 12 4;169(11):761-765. PubMed PMID: 30476963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Protection After Fractional-Dose Yellow Fever Vaccination: Follow-up Study of a Randomized, Controlled, Noninferiority Trial. AU - Roukens,Anna H E, AU - van Halem,Karlijn, AU - de Visser,Adriëtte W, AU - Visser,Leo G, Y1 - 2018/11/27/ PY - 2018/11/27/pubmed PY - 2019/8/31/medline PY - 2018/11/27/entrez SP - 761 EP - 765 JF - Annals of internal medicine JO - Ann Intern Med VL - 169 IS - 11 N2 - Background: Outbreaks of yellow fever and a frequently depleted vaccine stock increase demand for a dose-sparing strategy. A fractional dose of 17D yellow fever virus (17D-YFV) vaccine has been shown to be noninferior to the standard dose in inducing seroprotection. Objective: To evaluate whether fractional-dose vaccination can confer long-term immunity. Design: 10-year follow-up of a subgroup of a randomized, controlled, noninferiority trial. (Dutch Trial Register: NTR7094 [current study] and ISRCTN46326316 [original study]). Setting: The Netherlands. Participants: Seventy-five of 155 participants in the original trial provided a blood sample for this study. These 75 participants had received primary vaccination with 17D-YFV vaccine 10 years before. Forty received a 0.1-mL fractional dose intradermally, and 35 received the standard 0.5-mL dose subcutaneously. Measurements: Virus-neutralizing antibody responses were measured by a plaque reduction neutralization test. Results: Thirty-nine of 40 (98% [95% CI, 89% to 100%]) participants had protective levels of yellow fever-neutralizing antibodies more than 10 years after receiving a fractional dose of 17D-YFV vaccine compared with 34 of 35 (97% [CI, 87% to 100%]) in the standard-dose group. Limitation: Only 48% of participants from the original trial participated in this study. Conclusion: Intradermal administration of a one-fifth dose of yellow fever vaccine induced a protective immune response that lasted for 10 years after vaccination. Persons receiving a fractional dose of yellow fever vaccine do not require a booster vaccination for long-term protection against yellow fever. Primary Funding Source: Leiden University Medical Center and the International Society of Travel Medicine. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/30476963/Long_Term_Protection_After_Fractional_Dose_Yellow_Fever_Vaccination:_Follow_up_Study_of_a_Randomized_Controlled_Noninferiority_Trial_ L2 - https://www.acpjournals.org/doi/10.7326/M18-1529?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -