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Yellow Fever in Transplantation

  • Transplant and Oncology (M Ison, N Theodoropoulos, and S Pergam, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Yellow fever is an emerging infectious disease, with epidemics occurring in Africa and South America, and poses great concern due to high lethality rates of up to 60% in severe cases, despite the availability of an efficacious vaccine. In this paper, we sought to review the epidemiology, clinical manifestations, diagnosis, prevention strategies, and treatment in overall and in the transplant population.

Recent Findings

Yellow fever control relies mainly on adequate vaccine coverage, and as the yellow fever vaccine is composed of live, attenuated virus, it is contraindicated in the immunosuppressed individuals, including solid organ transplant and hematopoietic stem cell transplant recipients. Therefore, these patients should be preferably vaccinated in the pre-transplant period. There are few case series where vaccine is given to immunocompromised patients that showed a low incidence of adverse effects, although the number of patients in these reports is small. Donors who live in or with recent travel to yellow fever endemic or epidemic areas should be evaluated as to their suitability for donation. There is no specific therapy for infection and supportive treatment in intensive care units is required in severe cases. Recently, liver transplantation has been performed in several severe yellow fever cases, and although it was lifesaving in some, overall, there were high post-transplant mortality rates.

Summary

Yellow fever is still responsible for devastating epidemics, and some particularities pertaining to the transplant population are discussed. Prevention strategies including vaccination in the pre-transplant period and recommendations for donors living or with recent travel to yellow fever high-risk areas are discussed, as well as recent attempts of treatment with liver transplantation in severe cases.

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References

  1. Monath TP. Yellow fever: an update. Lancet Infect Dis. 2001;1(1):11–20.

    Article  CAS  Google Scholar 

  2. Carter HR. Yellow fever: an epidemiological and historical study of its place of origin. Baltimore, Mp., USA, The Williams & Wilkins Company: United States Public Health Service; 1931. p. 332.

  3. Monath TP, Vasconcelos PFC. Yellow fever. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. 2015;64:160–73.

    Article  Google Scholar 

  4. PAHO. Yellow fever 2021 [https://www.paho.org/en/topics/yellow-fever]. Available from: https://www.paho.org/en/topics/yellow-fever.

  5. Chippaux J-P, Chippaux A. Yellow fever in Africa and the Americas: a historical and epidemiological perspective. J Venom Anim Toxins Incl Trop Dis. 2018;24:20.

    Article  Google Scholar 

  6. Barnett ED. Yellow Fever: Epidemiology and Prevention. Clin Infect Dis. 2007;44(6):850–6.

    Article  Google Scholar 

  7. WHO. Yellow Fever 2021

  8. Wang L, Zhou P, Fu X, Zheng Y, Huang S, Fang B, et al. Yellow fever virus: Increasing imported cases in China. J Infect. 2016;73(4):377–80.

    Article  Google Scholar 

  9. Wkly Epidemiol Rec 2017. Yellow fever in Africa and the Americas, 2016 28799735]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28799735.

  10. Ministry of Health. Monitoramento da Situação Epidemiológica da Febre Amarela no Brasil. 2018. [Available from http://portalarquivos2.saude.gov.br/images/pdf/2018/maio/18/Informe-FA-26.pdf. 

  11. Litvoc MN, Novaes CTG, Lopes MIBF. Yellow fever. Rev Assoc Med Bras. 2018;64:106–13.

    Article  Google Scholar 

  12. Johansson MA, Vasconcelos PFC, Staples JE. The whole iceberg: estimating the incidence of yellow fever virus infection from the number of severe cases. Trans R Soc Trop Med Hyg. 2014;108(8):482–7.

    Article  Google Scholar 

  13. Ministry of Health BRAZIL. Manual de manejo clínico da febre amarela www.saude.gov.br/bvs: Ministério da Saúde; 2020 [Available from: http://bvsms.saude.gov.br/bvs/publicacoes/manual_manejo_clinico_febre_amarela.pdf.

  14. Song ATW, Albuquerque LAC. Yellow Fever: Prevention in Transplant Candidates and Emerging Treatment Data for Liver Transplant. Morris MI KC, Wolfe C, editor. Emerging Transplant Infections: Clinical Challenges and Implications; 2020. p.1–16.

  15. Kallas EG, Zanella LGFABD, Moreira CHV, Buccheri R, Diniz GBFD, Castiñeiras ACP, et al. Predictors of mortality in patients with yellow fever: an observational cohort study. Lancet Infect Dis. 2019;19(7):750–8.

  16. Tuboi SH, Costa ZG, da Costa Vasconcelos PF, Hatch D. Clinical and epidemiological characteristics of yellow fever in Brazil: analysis of reported cases 1998–2002. Trans R Soc Trop Med Hyg. 2007;101(2):169–75.

    Article  Google Scholar 

  17. Osório FMF, Cançado GGL, Nardelli MJ, Vidigal PVT, Xavier MAP, Clemente WT. Hepatitis relapse after yellow fever infection: is there another wave? Rev Soc Bras Med Trop. 2020;53:e20200152.

  18. Blandine D, Chirio D, Ponscarme D, Brichler S, Verdière NC, Simon F, et al. Hepatitis rebound after infection with yellow fever virus. Emerg Infect Dis. 2019;25(6):1248–9.

    Article  Google Scholar 

  19. Casadio L, Nastri AC, Malta FM, Araujo J, Silva JB, Salomao J, et al. Late-onset relapsing hepatitis associated with yellow fever. N Engl J Med. 2020;382(21):2059–61.

    Article  Google Scholar 

  20. Rezende IM, Pereira LS, Fradico JRB, Xavier MAP, Alves PA, Campi-Azevedo AC, et al. Late-relapsing hepatitis after yellow fever Viruses. 2020;12:222.

    CAS  Google Scholar 

  21. CDC. Yellow Fever: clinical & laboratory evaluation 2015 [Available from: https://www.cdc.gov/yellowfever/healthcareproviders/healthcareproviders-clinlabeval.html.

  22. Domingo C, Patel P, Yillah J, Weidmann M, Méndez JA, Nakouné ER, et al. Advanced yellow fever virus genome detection in point-of-care facilities and reference laboratories. J Clin Microbiol. 2012;50(12):4054–60.

    Article  Google Scholar 

  23. PAHO. Laboratory diagnosis of yellow fever virus infection 2018 [Available from: https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=guidelines-5053&alias=46877-laboratory-diagnosis-of-yellow-fever-virus-infection&Itemid=270〈=en.

  24. Shope RE, Woodall JP, Rosa AT. The epidemiology of diseases caused by viruses in groups C and Guama (Bunyaviridae); 2019. p. 37–52.

  25. Nassar ES, Chamelet ELB, Coimbra TLM, Souza LTM, Suzuki A, Ferreira IB, et al. Jungle yellow fever: clinical and laboratorial sudies emphasizing viremia on a human case. Rev. Inst. Med. trop. S. Paulo vol.37 no.4 São Paulo; 1995. p. 337–41.

  26. Reusken CBEM, Knoester M, GeurtsvanKessel C, Koopmans M, Knapen DG, Bierman WFW, et al. Urine as sample type for molecular diagnosis of natural yellow fever virus infections. J Clin Microbiol. 2017;55(11):3294–6.

    Article  Google Scholar 

  27. Barbosa CM, Paola ND, Cunha MP, Rodrigues-Jesus MJ, Araujo DB, Silveira VB, et al. Yellow fever virus RNA in urine and semen of convalescent patient. Brazil Emerg Infect Dis. 2018;17(ed2018):176–8.

    Article  Google Scholar 

  28. Domingo C, Charrel RN, Schmidt-Chanasit J, Zeller H, Reusken C. Yellow fever in the diagnostics laboratory. Emerg Microbes Infect. 2018;7:129.

    Article  Google Scholar 

  29. Morris MI, Grossi P, Nogueira ML, Azevedo LS. Arboviruses recommendations for solid-organ transplant recipients and donors. Transplantation. 2018;102(2S Suppl 2):S42-S51.

  30. Morris MI, Kotton CN, Wolfe C. Emerging transplant infections - clinical challenges and implications 2020.

  31. Grobusch MP, van Aalst M, Goorhuis A. Yellow fever vaccination - once in a lifetime? Travel Med Infect Dis. 2017;15:1–2.

    Article  Google Scholar 

  32. Reinhardt B, Jaspert R, Niedrig M, Kostner C, L'age-Stehr J. Development of viremia and humoral and cellular parameters of immune activation after vaccination with yellow fever virus strain 17D: a model of human flavivirus infection. J Med Virol. 1998;56(2):159–67.

  33. Wyplosz B, Burdet C, François H, Durrbach A, Duclos-Vallée JC, Mamzer-Bruneel MF, et al. Persistence of yellow fever vaccine-induced antibodies after solid organ transplantation. Am J Transplant. 2013;13(9):2458–61.

    Article  CAS  Google Scholar 

  34. Monath TP, Cetron MS, Teuwen DE. Yellow fever vaccine. 5ª ed2008. 959–1055 p.

  35. WHO. Detection and investigation of serious adverse events following yellow fever vaccination: WHO; 2008 [Available from: https://www.who.int/publications/i/item/detection-and-investigation-of-serious-adverse-events-following-yellow-fever-vaccination.

  36. Porudominsky R, Gotuzzo EH. Yellow fever vaccine and risk of developing serious adverse events: a systematic review. Rev Panam Salud Publica. 2018;42:e75.

  37. Wieten RW, Goorhuis A, Jonker EFF, Bree GJ, Visser AW, van Genderen PJJ, et al. 17D yellow fever vaccine elicits comparable long-term immune responses in healthy individuals and immune-compromised patients. The Journal of Infection. 2018;72(6).

  38. Croce E, Hatz C, Jonker EF, Visser LG, Jaeger VK, Bühler S. Safety of live vaccinations on immunosuppressive therapy in patients with immune-mediated inflammatory diseases, solid organ transplantation or after bone-marrow transplantation - A systematic review of randomized trials, observational studies and case reports. Vaccine. 2017;35(9):1216–26.

    Article  CAS  Google Scholar 

  39. Azevedo LS, Lasmar EP, Contieri FLC, Boin I, Percegona L, Saber LTS, et al. Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study Transpl Infect Dis. 2012;14(3):237–41.

    Article  CAS  Google Scholar 

  40. Miranda LJC, Agena F, Sartori AMC, David-Neto E, Azevedo LS, Pierrotti LC. Awareness of inadvertent use of yellow fever vaccine among recipients of renal transplant. Transplant Proc. 2020;52(5):1291–3.

    Article  Google Scholar 

  41. Fontbrune FS, Arnaud C, Cheminant M, Boulay A, Konopacki J, Lapusan S, et al. Immunogenicity and safety of yellow fever vaccine in allogeneic hematopoietic stem cell transplant recipients after withdrawal of immunosuppressive therapy. J Infect Dis. 2018;217(3):494–7.

    Article  Google Scholar 

  42. Avelino-Silva VI, Freire MS, Rocha V, Rodrigues CA, Novis YS, Sabino EC, et al. Persistence of Yellow Fever vaccine-induced antibodies after cord blood stem cell transplant. Hum Vaccin Immunother. 2016;12(4):937–8.

    Article  Google Scholar 

  43. Pierrotti LC, Duarte-Neto AN, Song ATW, Ventura CG, David-Neto E, Azevedo LS. Fatal Yellow Fever in a Kidney Transplant Patient. Clin Infect Dis. 2020;70(1):144–8.

    Article  Google Scholar 

  44. Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13529.

  45. Grossi PA. Urban Spread of Flaviviruses: A New Challenge in Solid-organ Transplant Recipients. Clin Infect Dis. 2020;70(1):149–51.

    Article  Google Scholar 

  46. Julander JG, Bantia S, Taubenheim BR, Minning DM, Kotian P, Morrey JD, et al. BCX4430, a novel nucleoside analog, effectively treats yellow fever in a Hamster model. Antimicrob Agents Chemother. 2014;58(11):6607–14.

    Article  Google Scholar 

  47. Sbrana E, Xiao S-Y, Guzman H, Ye M, Rosa APAT, Tesh RB. Efficacy of post-exposure treatment of yellow fever with ribavirin in a hamster model of the disease. The American Journal of Tropical Medicine and Hygiene. 2004;71(3).

  48. Freitas CS, Higa LM, Sacramento CQ, Ferreira AC, Reis PA, Delvecchio R, et al. Yellow fever virus is susceptible to sofosbuvir both in vitro and in vivo. PLoS Negl Trop Dis. 2019;13(1:e0007072).

  49. Figueiredo-Mello C, Casadio LVB, Avelino-Silva VI, Yeh-Li H, Sztajnbok J, Joelsons D, et al. Efficacy of sofosbuvir as treatment for yellow fever: protocol for a randomised controlled trial in Brazil (SOFFA study). BMJ Open. 2019;9((11)e027207).

  50. USNLo M. A Study to Evaluate the Safety, Pharmacokinetics and Antiviral Effects of Galidesivir in Yellow Fever or COVID-19. ClinicalTrialsgov. 2020.

  51. Lu X, Xiao H, Li S, Pang X, Song J, Liu S, et al. Double Lock of a Human Neutralizing and Protective Monoclonal Antibody Targeting the Yellow Fever Virus Envelope. Cell Rep. 2019;26:438–46.

    Article  CAS  Google Scholar 

  52. Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC, et al. High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial. J Hepatol. 2016;64(1):69–78.

    Article  Google Scholar 

  53. Ho Y-L, Joelsons D, Leite GFC, Malbouisson LMS, Song ATW, Perondi B, et al. Severe yellow fever in Brazil: clinical characteristics and management. J Travel Med. 2019;26((5):taz040).

  54. Duarte-Neto AN, Cunha MDP, Marcilio I, Song ATW, Martino RB, Ho Y-L, et al. Yellow fever and orthotopic liver transplantation: new insights from the autopsy room for an old but re-emerging disease. Histopathology. 2019;75(5):638–48.

    Article  Google Scholar 

  55. Ministry of Health BRAZIL. PORTARIA N° 1.173 DOU de 01108118.1: Diário Oficial Imprensa Nacional; 2018 [61].

  56. Sousa MV, Zollner RL, Stucchi RSB, Boin IFSF, Ataide EC, Mazzali M. Yellow fever disease in a renal transplant recipient: Case report and literature review. Transpl Infect Dis. 2019;21(5):e13151.

  57. CDC. Transfusion-related transmission of yellow fever vaccine virus. 2010 Jan. MMWR Morb Mortal Wkly Rep. 2010;59(2):34–7.

  58. Slifka MK, Hammarlund E, Lewis MW, Poore EA, Hanifin JM, Marr KA, et al. Antiviral immune response after live yellow fever vaccination of a kidney transplant recipient treated with IVIG. Transplantation. 2013;95(9):e59-61.

    Article  Google Scholar 

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Authors and Affiliations

  1. Liver and Digestive Organ Transplant Division and LIM-37, Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo (USP), Avenida Doutor Arnaldo, 455, 3rd Floor, São Paulo, SP, Brazil

    Alice T. W. Song

  2. Liver Transplant Group, Faculdade de Medicina, Instituto Alfa de Gastroenterologia Do Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil

    Wanessa Trindade Clemente

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  1. Alice T. W. Song
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  2. Wanessa Trindade Clemente
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Correspondence to Alice T. W. Song.

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Song, A.T.W., Clemente, W.T. Yellow Fever in Transplantation. Curr Infect Dis Rep 23, 18 (2021). https://doi.org/10.1007/s11908-021-00761-2

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