Yellow fever vaccination during the shortage

I’ve told quite a few of my friends and coworkers about my travel plans at this point. From most, I received a positive reaction. But there are always one or two people who think that my international adventures are an attempt at getting myself killed. This could not be further form the truth. If I had a death wish I would not be the proud owner of a 3 month supply of anti-malarials and have an appointment on my calendar for Cholera vaccination**. To this point, let’s talk about my recent hoop-jumping in order to get the one required vaccine for this trip – Yellow Fever (YF).

My cup runneth over (with anti malarials)

**I told my work friend about my Cholera vaccination and he asked me why I needed a vaccine for collards, as in collard greens. There were many laughs had over this one. It is apparently taken orally as a drink (thus I am referring to it as ‘the Cholera milkshake’). Like a good QC person I will provide a sensory evaluation once I get through it. UPDATE: It tastes like alka-seltzer dissolved in salt water.

Why do you need to be vaccinated to go on vacation?

If you haven’t planned an international trip before, you may not know that one of your essential pre-trip tasks is to figure out which diseases you may encounter while abroad. There is no standard list of vaccines for a RTW trip since it’s completely dependent on which countries you plan on visiting. Hence while you won’t be needing anti-malarials while strolling through Paris it might be something to consider when booking your airfare to SE Asia. The more varied your destinations are, the larger the list becomes of ways you can get sick. To make it easier the CDC (yay Atlanta!) has a website where you can select your travel destinations from a drop down list and find out the recommended and required (if any) vaccines for that country. It is super useful.

While I usually start with the CDC site to get a rough idea of how many needles/pills I’m looking at, I’ve always found it best to go to a travel clinic and speak to a travel nurse in person (Passport Health is a popular chain in the US). When you start looking at the individual country pages, you will find that there are very few ‘required’ vaccines but a lot of ‘recommended’ vaccines. Even more confusing, the recommended vaccines may only be recommended for certain regions or certain times of year or for certain activities because otherwise the risk of infection is low. That’s why it’s good to make a list of questions and ask the professionals what they think the risk is. YMMV but I’ve never felt pressured into getting any vaccination I didn’t want and all the travel nurses I’ve met seem to love their jobs and love talking about travel with you.

Of course if money were no object, I would get vaccinated for everything I could – no one wants to get sick and some of these diseases are the ‘this will possibly kill you and it will hurt the entire time you’re dying’ type (rabies comes to mind). But while your vaccines for things like the flu shot are covered by insurance, travel vaccines are (most often) not. I was on the fence about getting vaccinated for Japanese Encephalitis (it’s recommended for a couple countries on my list) but after talking to the travel nurse about the $1000 out-of-pocket price tag and the level of risk, I decided against it (be aware though that there are some outbreaks of JE in India right now though so in some cases the cost is justified).

Why am I getting vaccinated for Yellow Fever?

Yellow Fever is one of the ‘required vaccines’ for several countries in Africa. Even though my itinerary isn’t set in stone, some countries on my theoretical list had YF vaccine requirements. Some places like Angola require YF vaccines for everyone entering the country. Other places like Kenya (which is on my short list) have YF vaccine requirements only if you’re coming from a country that has YF. This is what the CDC’s travel health page for Kenya has to say:

Country entry requirement: The government of Kenya requires proof of yellow fever vaccination if you are traveling from a country with risk of yellow fever (this does not include the US – for complete list, see Countries with risk of yellow fever virus (YFV) transmission.

If you look at the list of countries with risk of YF transmission, you’ll find that Ethiopia (also on my short list) is there. So if I visited Ethiopia and then tried to cross the border into Kenya, I could be denied entrance without proof of YF vaccination. Knowing this, I decided that instead of taking countries off my list before I even left the States I would just go ahead and get vaccinated. Easier said than done.

What is Yellow Fever?

Being a curious person with vague memories of a couple of courses in Epidemiology/Immunology from long ago, I started researching the history of YF and what it does to your body if you’re infected. There were two really awesome resources I would suggest if you (like me) want to know more about it:

  • This Podcast Will Kill You was recommended to me by a Lyft driver a couple weeks ago and I’ve listened to almost every podcast they’ve uploaded to date. Episode 10 of their first season is called Yellow Fever: Is there a Hamilton song about this? and it’s only an hour long. It is excellent – popsci but with tons of depth and history.
  • I found a PBS documentary on Youtube called The Great Fever. It goes into great detail about Yellow Fever outbreaks that occured in the US in the 1800 (almost 20,000 people died in the Mississippi Valley region of the US in 1878. I had no idea that this even happened so it was very interesting as well.

    In short, YF is a viral hemmoragic fever. It’s a virus transmitted by mosquitos that can cause you to bleed internally (I’ll spare the gory details – it’s actually in the same family as Ebola). The ‘yellow’ part is because it attacks your liver which causes skin yellowing AKA jaundice. If you get bit by a mosquito carrying yellow fever, you could end up experiencing some of the minor symptoms before eventually recovering. From the CDC, these include:

    • Sudden onset of fever
    • Chills
    • Severe headache
    • Back pain
    • General body aches
    • Nausea
    • Vomiting
    • Fatigue (feeling tired)
    • Weakness

    Most people get better but 1 in 7 people progress to show the more serious symptoms where you’re looking at a 30-60% mortality rate:

    • High fever
    • Yellow skin (jaundice)
    • Bleeding
    • Shock
    • Organ failure

    While you can vaccinate against YF, there is no known cure. It kills about 30,000 people each year per the World Health Organization but there are multiple organizations that are trying to vaccinate the disease out of existence. There just needs to be enough of that vaccine to go around.

    Where is all the YF vaccine?

    There is only one FDA-approved YF vaccine in the United States. It’s manufactured by Sanofi Pasteur and is called YF-VAX (if you want to know more about it, the package insert is available through FDA). As of July 2019, there is no YF-VAX available. Zero. There’s a couple reasons for that according to the manufacturer:

    • YF outbreak in Angola that depleted supplies,
    • A planned movement by Sanofi Pasteur of YF-VAX production out of one facility into a new facility that temporarily caused new vaccines to stop being produced, and
    • Whatever ‘manufacturing complication’ means (your guess is as good as mine):

    Sanofi Pasteur was transitioning YF-VAX production from an older to a newer facility set to open in 2018, but a manufacturing complication resulted in the loss of a large number of doses. Source

    So there’s none left. But it’s not the only YF vaccine that exists. Enter Stamaril, which since 1986 has been licensed for use in 70 countries, just not the US. It’s also made by Sanofi Pasteur. FDA, CDC and Sanofi Pasteur worked together in light of the YF-VAX shortage to get authorization to use Stamaril in the United States, so while there’s not an abundance of it, you can still get it if you ask around. There’s a website where you can get a list of all the clinics in your state that have the Stamafil vaccine available but I would still call them to see if they’ve got it before you pay for a consulation. I went to my local Passport Health and they scheduled me for my Stamail vaccination at one of their other branches. $300 and a needle stick later I now have a stamped, completed yellow card.

    Officially vaccinated for YF with the yellow card to prove it!

    One comment

    1. I remember traveling to Vietnam for the first time in 2000… lots of shots months beforehand. The world is very big and we humans don’t come across all of these bugs so we never have a chance to either get a vaccine for it for become immune to it because we normally wouldn’t have risk of exposure. I’m glad you have planned and as of today… I believe you’re in Germany, starting the trip!

      Like

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