As per CDC guidelines , IHRs (International Health Regulations) stipulate that a medical provider may issue a waiver of YF vaccination to a traveler if the provider judges that YF vaccination is medically contraindicated (see Contraindications and Precautions). In this case, the physician should fill out and sign the “Medical Contraindications to Vaccination” section of the ICVP (Figure 4), provide a signed and dated letter on letterhead stationary clearly stating the contraindication, and bearing that center’s official YF vaccination stamp. The provider should inform the traveler of any increased risk for YF infection associated with nonvaccination and how to minimize this risk. Reasons other than medical contraindications are not acceptable for exemption from vaccination. The traveler also should be advised of the possibility that the medical waiver might not be accepted by the destination country.
| TABLE – Contraindications and precautions to yellow fever vaccine administration | |
|---|---|
| Contraindications | Precautions |
| Allergy to vaccine component | Age 6–8 months |
| Age less than 6 months | Age ≥60 years† |
| Symptomatic HIV infection or CD4+ T-lymphocytes <200/mm3 (or <15% of total in children aged <6 years)* | Asymptomatic HIV infection and CD4+ T-lymphocytes 200–499/mm3 (or 15%–24% of total in children aged <6 years)* |
| Thymus disorder associated with abnormal immune function† | Pregnancy |
| Primary immunodeficiencies | Breastfeeding |
| Malignant neoplasms | |
| Transplantation | |
| Immunosuppressive and immunomodulatory therapies† | |
* Symptoms of HIV have been classified (Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents; US Department of Health and Human Services; 2008. Available at http://aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=7&ClassID=1 . Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection; 2009. Available at http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf  .)† New contraindication or precaution since the ACIP’s recommendations for the use of yellow fever vaccine were published in 2002 (CDC. Yellow fever vaccine: recommendations of the Advisory Committee on Immunizations Practices: MMWR 2002;51[No. RR-17]). |
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