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INFORMATION STATEMENT

Many Vaccine Information Statements are available in Spanish and other languages. Yellow Vaccine See www.immunize.org/vis Hojas de información sobre vacunas están disponibles en español y en muchos otros What You Need to Know idiomas. Visite www.immunize.org/vis

1 What is ? 3 Yellow fever vaccine Yellow fever is a serious disease caused by the yellow Yellow fever vaccine is a live, weakened . It is fever virus. It is found in certain parts of Africa and given as a single shot. For people who remain at risk, a South America. booster dose is recommended every 10 years. Yellow fever is spread through the bite of an infected Yellow fever vaccine may be given at the same time as mosquito. It cannot be spread person to person by direct most other . contact. Who should get yellow fever vaccine? People with yellow fever disease usually have to be • Persons 9 months through 59 years of age traveling hospitalized. Yellow fever can cause: to or living in an area where risk of yellow fever is • fever and flu-like symptoms known to exist, or traveling to a country with an entry • jaundice (yellow skin or eyes) requirement for the . • bleeding from multiple body sites • Laboratory personnel who might be exposed to yellow • liver, kidney, respiratory and other organ failure fever virus or vaccine virus. • death (20% - 50% of serious cases) Information for travelers can be found online through CDC (www.cdc.gov/travel), the World Health 2 How can I prevent yellow fever? Organization (www.who.int), and the Pan American Health Organization (www.paho.org). Yellow fever vaccine Yellow fever vaccine can prevent yellow fever. You should not donate blood for 14 days following the vaccination, because there is a risk of transmitting the Yellow fever vaccine is given only at designated vaccine virus through blood products during that period. vaccination centers. After getting the vaccine, you should be given a stamped Who should not get yellow and signed “International Certificate of Vaccination or 4 fever vaccine? Prophylaxis” (yellow card). This certificate becomes valid 10 days after vaccination and is good for 10 years. • Anyone with a severe (life-threatening) allergy to any component of the vaccine, including eggs, chicken You will need this card as proof of vaccination to proteins, or gelatin, or who has had a severe allergic enter certain countries. Travelers without proof of reaction to a previous dose of yellow fever vaccine vaccination could be given the vaccine upon entry or should not get yellow fever vaccine. Tell your doctor if detained for up to 6 days to make sure they are not you have any severe allergies. infected. • Infants younger than 6 months of age should not get Discuss your itinerary with your doctor or nurse before the vaccine. you get your yellow fever vaccination. Consult your • Tell your doctor if: health department or visit CDC’s travel information - You have HIV/AIDS or another disease that affects website at www.cdc.gov/travel to learn yellow fever the . vaccine requirements and recommendations for different - Your immune system is weakened as a result of countries. cancer or other medical conditions, a transplant, or Other preventive measures radiation or drug treatment (such as steroids, cancer Another way to prevent yellow fever is to avoid chemotherapy, or other drugs that affect immune cell mosquito bites by: function). • staying in well-screened or air-conditioned areas, • wearing clothes that cover most of your body, • using an effective insect repellent, such as those containing DEET. - Your thymus has been removed or you have a thymus disorder, such as myasthenia gravis, DiGeorge 6 What if there is a serious syndrome, or thymoma. reaction? Your doctor will help you decide whether you can What should I look for? receive the vaccine. • Look for anything that concerns you, such as signs of • Adults 60 years of age and older who cannot avoid a severe allergic reaction, very high fever, behavior travel to a yellow fever area should discuss vaccination changes, or flu-like symptoms that occur 1-30 days after vaccination. with their doctor. They might be at increased risk for severe problems following vaccination. Signs of a severe allergic reaction can include hives, • Infants 6 through 8 months of age, pregnant women, swelling of the face and throat, difficulty breathing, and nursing mothers should avoid or postpone travel a fast heartbeat, dizziness, and weakness. These to an area where there is risk of yellow fever. If travel would start a few minutes to a few hours after the cannot be avoided, discuss vaccination with your vaccination. doctor. What should I do? If you cannot get the vaccine for medical reasons, but • If you think it is a severe allergic reaction or other require proof of yellow fever vaccination for travel, your emergency that can’t wait, call 9-1-1 or get the person doctor can give you a waiver letter if he considers the to the nearest hospital. Otherwise, call your doctor. risk acceptably low. If you plan to use a waiver, you • Afterward, the reaction should be reported to the should also contact the embassy of the countries you Reporting System (VAERS). plan to visit for more information. Your doctor might file this report, or you can do it yourself through the VAERS web site at 5 What are the risks from yellow www.vaers.hhs.gov, or by calling 1-800-822-7967. fever vaccine? VAERS is only for reporting reactions. They do not give A vaccine, like any medicine, could cause a serious medical advice. reaction. But the risk of a vaccine causing serious harm, or death, is extremely low. 7 How can I learn more? Mild problems • Ask your doctor. Yellow fever vaccine has been associated with fever, and • Call your local or state health department. with aches, soreness, redness or swelling where the shot was given. • Contact the Centers for Disease Control and Prevention (CDC): These problems occur in up to 1 person out of 4. They - Call 1-800-232-4636 (1-800-CDC-INFO) usually begin soon after the shot, and can last up to a - Visit CDC websites at www.cdc.gov/travel week. www.cdc.gov/yellowfever/ or Severe problems www.cdc.gov/vaccines/vpd-vac/yf • Severe allergic reaction to a vaccine component (about 1 person in 55,000). • Severe nervous system reaction (about 1 person in 125,000). • Life-threatening severe illness with organ failure (about 1 person in 250,000). More than half the people who suffer this side effect die. These last two problems have never been reported after a booster dose.

Vaccine Information Statement Yellow Fever Vaccine Office Use Only 3/30/2011 The Yellow Fever Vaccine

Like most health care decisions, one should be well informed when deciding whether or not to receive the Yellow Fever Vaccine. This decision is a personal one and should be based on your own personal risk benefit analysis. However, please understand that Deerfield Academy follows the CDC’s recommendations and requires all students going on this trip to receive Yellow Fever Vaccine. After reviewing this information, if you chose not to have your child receive the Yellow Fever vaccine you may withdraw your child from the trip and your money will be refunded.

The relative risks of disease exposure and potential complications

Yellow fever is a potentially fatal, mosquito borne illness that is found in the tropics, specifically areas of South/Central America and Africa. Although it is impossible to know the chances that any traveler will develop Yellow Fever on a given trip, the following is from the CDC Yellow Book, a trusted source for advice on travel related :

“From 1970 through 2011, a total of 9 cases of yellow fever were reported in unvaccinated travelers from the United States and Europe who traveled to West Africa (5 cases) or South America (4 cases). Eight (89%) of these 9 travelers died. There has been only 1 documented case of yellow fever in a vaccinated traveler. This nonfatal case occurred in a traveler from Spain who visited several West African countries in 1988.

The risk of acquiring yellow fever is difficult to predict because of variations in ecologic determinants of virus transmission. For a 2-week stay, the risks for illness and death due to yellow fever for an unvaccinated traveler visiting an endemic area in: • West Africa are 50 per 100,000 and 10 per 100,000, respectively • South America are 5 per 100,000 and 1 per 100,000, respectively”

In addition to looking at reported incidence of disease in travelers, experts believe the risk depends on how long the traveler will be in an area at risk and the degree to which they take measures to avoid mosquito bites.

Our Trip

The CDC recommends yellow fever vaccine for areas included on this trip’s itinerary. Please review the following website for details: https://wwwnc.cdc.gov/travel/diseases/yellow-fever

In addition, please consider that remembering to and being willing to apply insect repellent, wear long sleeves and pants or to carefully enclose the mosquito net at night is not necessarily a character trait of all adolescent travelers.

The Vaccine

The vaccine is a single dose that should be given at least 10 days before entering an area of Yellow Fever risk and provides lifetime immunity. In making this decision, you should consider the pros and the cons, and, as with any risk benefit analysis, your own tolerance for risk. We have listed some (but not all) of the important pros and cons of the vaccine below to help you in making your decision. Please also review this link from the CDC regarding the vaccine: https://www.cdc.gov/yellowfever/vaccine/index.html

PROS CONS Protects against Yellow Fever, a serious tropical mosquito- Cost = approximately $250 (less if reimbursed by borne disease with fatality rate of 20% insurance)

A vaccine before this trip will provide lifelong protection There is a low but measurable risk of life-threatening from yellow fever adverse reactions to this vaccine: Life threatening allergic reaction 1:55,000 () Documentation of this vaccine will allow you to travel into Severe nervous system reaction 1:125,000 countries that require this vaccine for entry Life-threatening severe illness with 1:250,000 organ failure (50% mortality) Unlike mosquito bite avoidance measures, the vaccine 25% of recipients of his vaccine may experience fever and offers protection against Yellow Fever if mosquito bites do body aches, as well as soreness, redness or swelling occur due to failure to apply insect repellent, wear where the shot was given that can last up to a week. appropriate clothing or a failure or absence of anticipated mosquito avoidance measures in the place of lodging

Yellow Fever Vaccine Shortage and the alternative Yellow Fever vaccine Stamaril.

Sanofi Pasteur, the maker of the Yellow Fever vaccine typically given to our students, YF-Vax, has had production issues causing a critical shortage of the only FDA-approved Yellow Fever vaccine available in the US. Therefore the FDA has allowed to provide an alternative Yellow Fever vaccine called Stamaril to a limited number of US clinics through a program called the Expanded Access Investigational New Drug Application (ING). Please understand that even though Stamaril is being provided through an "investigational new drug program," it is not a novel, investigational or experimental drug. Stamaril is produced by Sanofi in France, has been licensed for decades, is used in over 70 countries and has an efficacy and side effect profile similar to the typical vaccine, YF-Vax. Please see the following websites regarding the shortage in Yellow Fever vaccine and the alternative vaccine Stamaril: https://wwwnc.cdc.gov/travel/news-announcements/yellow-fever-vaccine-access http://www.sanofipasteur.us/vaccines/yellowfevervaccine

We are working with local travel medicine providers to obtain FDA-approved vaccine (YF-Vax) for our students. If we are not able to obtain enough vaccine we will transport our students to a FDA-designated clinic to obtain the alternative Yellow Fever vaccine, Stamaril.

Please consider the risk that Yellow Fever poses to your child on this trip, read the Vaccine Information Statement (VIS) that accompanies this document and consider the pros and cons. Then please CHECK ONE of the statements below, complete the form and sign it. Please call or email if you have any questions.

Please administer to my child, ______, the Yellow Fever Vaccine. If the FDA-approved vaccine, YF-Vax, is not available I will allow my child to receive the alternative Yellow Fever vaccine, Stamaril which I understand is not FDA-approved but made available through the FDA ING program. I have read the Yellow Fever Vaccine Information Statement and have had an opportunity to ask questions about the risks and benefits of vaccination.

Please DO NOT administer to my child,______, the Yellow Fever Vaccine.

______Date:______Parent/Guardian Signature