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Special Testing for Selected Patients with Severe Adverse Events Potentially Related to Yellow Fever Vaccination

Healthcare providers are encouraged to report cases of adverse events potentially caused by yellow fever vaccination to the CDC/FDA Vaccine Adverse Events Reporting System (VAERS) by one of the following methods:

  1. Submitting a report online at https://secure.vaers.org/VaersDataEntryintro.htm
  2. Printing a VAERS Form About PDF (58K) and faxing or mailing it using information at: http://vaers.hhs.gov/contact.htm.
  3. Calling 1-800-822-7967

To determine whether these illnesses are potentially related to recent yellow fever vaccination, CDC can perform special testing on specimens previously collected from the patient:

Please refer to the following for details on storage and shipment of specimens:

For further information on the enhanced surveillance and diagnostic system for adverse events potentially related to yellow fever vaccine, please see MMWR 2001;50:343-5.

Table 1. Storage and shipment of sera, cerebrospinal fluid, peritoneal fluid, pleural fluid
Type Test Preferred
Amount		 Storage Shipping Other
Serum or CSF Serology testing  1 ml 4°C Wet ice Multiple, serial samples may be tested.
Serum, CSF, peritoneal, or pleural fluid Viral isolation and PCR 1 ml -70°C Dry ice Promptly freeze at -70°C. Repeated freeze/thaw cycles are deleterious to virus. Multiple, serial samples may be tested.

 

Table 2. Storage and shipment of vaccine vials (from same lot as administered to patient)
Vaccine Preferred
Amount		 Storage Shipping Other
Lyophilized form (preferred) Vial  4°C Wet ice Lyophilized form preferred over rehydrated form.
Rehydrated form 1 ml -70°C Dry ice Promptly freeze at -70°C.

 

WARNING: Although not documented in recipients of yellow fever vaccine, persons with naturally-acquired yellow fever and associated bleeding diathesis have died of bleeding complications after liver biopsy. Liver biopsy should be performed only with extreme caution in recent recipients of yellow fever vaccine who develop hepatitis or serious systemic illness.
Table 3. Storage and shipment of biopsy, surgical, or autopsy specimens
Tissue Preferred
Amount		 Storage Shipping Other
Solid organ (brain, liver, spleen, pancreas, heart, kidney, etc.) – fresh frozen 1 g -70°C Dry ice Promptly freeze at -70°C. NO formalin or other preservatives.
Solid organ – fixed (formalin or similar preservatives) Representative samples Ambient Ambient Do NOT freeze.
Solid organ – in paraffin Representative tissue blocks Ambient Ambient Do NOT freeze.
Skin (rash) – fixed (formalin or similar preservatives) Representative samples Ambient Ambient Do NOT freeze.
Postmortem heart serum 1 ml -70°C Dry ice Promptly freeze at -70°C.

 

General sample shipping information

After the patient has been reported and specimen submission has been discussed with VAERS and CDC medical officers, samples may be shipped to the CDC Division of Vector-Borne Infectious Diseases under the conditions listed above.

A CDC Submission Form (CDC 50.34)About PDF (394 KB) must accompany each specimen. Please fill out the form as completely as possible and include the following:

Using precautions and packaging required for shipping of potentially infected materials, samples should be sent by overnight shipping to

Arbovirus Diseases Branch
Division of Vector-Borne Infectious Diseases
Immediate attention: Arboviral Diagnostic Reference Laboratory
3150 Rampart Road
Fort Collins, Colorado 80521
Phone number: 970.221.6400

To ensure that these samples arrive during the week, shipments should be scheduled to arrive on Monday through Thursday (unless previous arrangements have been made with the Lab).

 

Page last modified: June 11, 2007
Content Source:
 Division of Vector Borne Infectious Diseases
National Center for Zoonotic, Vector-Borne, and Enteric Diseases