Letter of medical exemption from yellow fever vaccination
There are situations when yellow fever (YF) vaccine should not be given. If a receiving
country requires an International Certificate of Vaccination or Prophylaxis (ICVP) documenting YF vaccination as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption from YF vaccination can be
Medical grounds for exemption exist when there is a:
· Contraindication to YF vaccination: the vaccine poses an unacceptable risk to the
individual and these individuals should never receive YF vaccine, e.g. severe egg
allergy; advanced AIDS.
· Precaution (relative contraindication) to yellow fever vaccination: There are
situations such as vaccination during pregnancy or in persons aged 60 years and
older, where there is a need to be cautious when considering this vaccine. These
situations require detailed risk assessment. YF vaccine can administered with
informed consent, if the risk of YF is determined to be sufficient and unavoidable. In
situations where there is a certificate requirement and vaccination is not given, a
letter of medical exemption can be considered at the discretion of the health
professional signing the letter.
· Situation where there is no risk of disease transmission, but there is a
certificate requirement by the receiving country: In such situations the risk of a
serious vaccine adverse event outweighs the risk of YF disease at the destination. In
these circumstances a letter of medical exemption can be considered at the
discretion of the health professional signing the letter.
International Health Regulations (2005) state that the written reasons in the letter of medical exemption, issued by a supervising clinician, should be taken into account by competent authorities on arrival. In addition, the supervising clinician and competent authorities shall inform such persons of any risk associated with nonvaccination.