Epidemiology and Infection

Risk of fatal adverse events associated with 17DD yellow fever vaccine

C. J. STRUCHINER a1c1, P. M. LUZ a1, I. DOURADO a2, H. K. SATO a3, S. G. AGUIAR a4, J. G. L. RIBEIRO a5, R. C. R. SOARES a6 and C. T. CODEÇO a1
a1 Programa de Computação Científica, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, Brasil, CEP 21045-900
a2 Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brasil
a3 Secretaria de Saúde do Estado de São Paulo, São Paulo, SP, Brasil
a4 Biomanguinhos, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, Brasil, CEP 21045-900
a5 Secretaria de Saúde do Estado de Minas Gerais, Belo Horizonte, MG, Brasil
a6 Programa Nacional de Imunizações, Fundação Nacional de Saúde, Brasília, DF, Brasil

Article author query
struchiner cj   [PubMed][Google Scholar] 
luz pm   [PubMed][Google Scholar] 
dourado i   [PubMed][Google Scholar] 
sato hk   [PubMed][Google Scholar] 
aguiar sg   [PubMed][Google Scholar] 
ribeiro jg   [PubMed][Google Scholar] 
soares rc   [PubMed][Google Scholar] 
codeco ct   [PubMed][Google Scholar] 


Yellow fever (YF), an acute infectious disease, is endemic in the north and central-west of Brazil. This disease can be prevented by the use of a vaccine. In Brazil, four fatal adverse events have been associated with the YF vaccine used in the country (17DD vaccine). We briefly describe the last two fatalities, and estimate the risk of 17DD-associated fatal adverse events under different epidemiological scenarios. Controversies regarding the appropriate denominator that enters the estimation of risk serve as a motivation for each proposed scenario. The statistical procedures used show optimum behaviour when assessing the risk of rare events. Risk estimates vary from 0·043 (95% CI 0·017–0·110) to 2·131 (95% CI 0·109–12·071) fatalities per million doses administered. The robust estimates of the risk of fatal adverse events we present constitute an important element in future risk–benefit analysis and point to the need for good quality vaccine coverage and adverse-events surveillance data to assess the risk of vaccination. Although vaccination of YF endemic regions is necessary to maintain low disease prevalence, preventive administration of YF vaccine to the entire population should be cautiously analysed.

(Accepted April 14 2004)

c1 Dr C. J. Struchiner, Rua Benjamim Batista 22, 202, Jardim Botânico, CEP 22461-120, Rio de Janeiro, RJ, Brasil. (Email: stru@procc.fiocruz.br)