We are NOT authorized by Govt of India for Yellow Fever Vaccination

Tuesday, August 23, 2011

Can people with Egg Allergy take the Yellow Fever Vaccine ?

Yellow fever vaccines are required to visit some tropical countries. However, the vaccine is cultured in eggs.
Last week I had two people who claimed to be "allergic to eggs" and had been refused vaccination by the Government Vaccination Center/ other private centers.
They wanted to know if they could safely take the vaccine for personal protection as well as the embassy regulations of African / South American countries.
On careful history taking it became apparent that both did not suffer from true egg allergy. They complained of abdominal bloating/ gassiness/ mild stomach upset if they ate eggs.
This is not a contra-indication for the Yellow Fever Vaccine.

The latest clinical guidelines for food allergies caution against administering the yellow fever vaccines to patients with a history of severe allergic reactions to eggs or chicken. If you have a history of any of the following reactions to egg, you should avoid the yellow fever vaccine:
  • Hives (Chapake in Hindi)
  • Angioedema (Swelling over the face/ body)
  • Allergic asthma
  • Anaphylaxis (Severe reaction leading to injections/ hospitalization)
If you have had a less severe reaction to eggs, or chicken you can probably tolerate the yellow fever vaccine.
If you plan to travel to a region where yellow fever is a problem, it is possible to have allergy testing done with the vaccine itself to determine if it would be possible for you to tolerate it. Any attempt to try the vaccine should be done in a medical setting that can care for any potential reactions.
If testing determines that you have a potential for severe reaction to the vaccine, or if your doctor determines that it is not safe for you given your history of reactions, it is possible to get a medical waiver that will allow you to visit countries that require the yellow fever vaccination for entry.

In our case, since there was no contra-indication, we gave these people a test dose intradermally, and once there was no reaction to the test dose, after half hour we gave them the complete dose without any side-effects.

Finally, it is important to remember that getting a waiver is difficult since you would need to "prove" that you are allergic to egg with further blood / skin testing and then attach this report along with the waiver letter from your doctor. Otherwise your waiver certificate may not be accepted by the Embassy.

Hence I would recommend getting a proper history before labeling someone as "allergic to eggs" and denying them the Yellow Fever Vaccine.

Read more here
Here is the latest CDC recommendation regarding egg allergy with Yellow Fever Vaccination:
If international travel regulations are the only reason to vaccinate a patient hypersensitive to eggs, efforts should be made to obtain a waiver. A physician's letter stating the contraindication to vaccination has been acceptable to some governments. (Ideally, it should be written on letterhead stationary and bear the stamp used by health department and official immunization centers to validate the International Certificate of Vaccination.) Under these conditions, the traveler should also obtain specific and authoritative advice from the embassy or consulate of the country or countries s/he plans to visit. Waivers of requirements obtained from embassies or consulates should be documented by appropriate letters and retained for presentation with the International Health Certificate. If vaccination of an individual with a questionable history of egg hypersensitivity is considered essential because of a high risk of exposure, an intradermal test dose may be administered under close medical supervision. Specific directions for skin testing are found in the package insert.

2 comments:

  1. Hi i hope you can be of some help to me. I have a 22months old boy who is highly allergic to eggs confirmed by a rast test and it was on class 5, we are now relocating to west africa and i wanted him to get the vaccine as there isn't effecient medical care that side. He has never eaten eggs therefore i have no idea how he would even react if he ate them as he hates anything that egg is an ingridient of, even cakes or biscuits he wont even try yhem, what can i do?

    Your response will be highly appreciated.

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    Replies
    1. Here are a couple of things that need to be done.
      1. Get an allergist involved, and do a skin test. A RAST test alone is not confirmatory
      2. You may desensitize for yellow fever vaccination as per the following protocol.....
      A desensitization procedure may be used for individuals with a history of severe egg allergy and a postive skin test to the vaccine. Successive doses should be administered subcutaneously at 15- to 20-minute intervals as follows (Prod Info YF-VAX(R), 2002):
      0.05 milliliters of 1:10 dilution
      0.05 milliliters of full strength
      0.10 milliliters of full strength
      0.15 milliliters of full strength
      0.20 milliliters of full strength
      I t may be best to involve the allergist after details from the manufacturer and informed consent from the patient. And best to be done in the hospital.
      Source:
      Travmed list server
      https://listserv.yorku.ca/cgi-bin/wa?A2=ind0306&L=TRAVELMED&P=R2976&1=TRAVELMED&9=A&I=-3&K=1&X=725EA318E0FB42A48B&Y=docgaurav%40gmail.com&d=no+match%3Bmatch%3Bmatches&z=4

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