Date: 26 Oct 2004

Archive Number 20041028.2913
Published Date 28-OCT-2004
Subject PRO/AH/EDR> Yellow fever vaccine-associated death - Spain

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 26 Oct 2004
From: Pablo Nart <>
Source: El Mundo, Spain, 26 Oct 2004 [in Spanish, translated by Jorge
Gonzales Mendoza <>, edited]

The Sanitation Ministry is retaining a batch of yellow fever vaccine
The Sanitation Ministry reported today [26 Oct 2004] that they are
retaining a batch of yellow fever vaccine as a "preventive measure,"
after a 26-year-old woman from Onuba died from yellow fever stemming
from a post-vaccination reaction. The woman was admitted last
Thursday [21 Oct 2004] to Juan Ramon Jimenez Hospital in Huelva
because of fever and multi-organ failure, having had, in addition to
fever, malaise, vomiting, and diarrhea during the previous days.

According to a press release from the hospital, since she was about
to travel abroad, the patient was also vaccinated for diphtheria and
tetanus on 14 Oct 2004 at the External Sanitation Services in Huelva,
an office of the Sanitary and Consumer Affairs Ministry.

The patient was directly admitted to intensive care, where she was
diagnosed with yellow fever associated with a post-vaccine reaction
that rapidly progressed and could not be successfully controlled by
the medical team, and she died last Friday [22 Oct 2004] at 5:30 AM.

Sources from the Sanitation Ministry reported that they are waiting
for new information from the Andalucia Council regarding this case.
They also emphasized that people "should still have their vaccines if
they have to travel abroad," since the benefits of immunization
outweigh the risks.

No past history of such an event in Spain
The same sources gave assurances that the performance of the Huelva
Vaccination Center was "perfect" with respect to the protocol, and
they have tried to avoid generating unnecessary alarm, insisting that
"the batch has been localized."

The Sanitation Ministry commented that "since 1985, there have been
only 25 communications reporting mild symptoms considered as vaccine
reactions, but not a single case similar to that reported in Huelva."
Accordingly, the Sanitation Ministry indicated that the frequency of
cases similar to the one reported today [26 Oct 2004] for the age
group between 25 and 44 years is less than zero percent per 100 000

The Ministry is waiting for information about the case from the
Andalucia Council; consequently, the vaccine batch retention "is only
a preventive measure issued by the Sanitation Ministry," they pointed

The Management at Juan Ramon Jimenez Hospital confirmed that samples
were sent to the Majahonda National Center for Microbiology and
Virology soon after the victim was admitted to the hospital for
biologic confirmation of the case.

Yellow fever vaccine, which is manufactured using attenuated viruses,
is not included in the vaccine calendar of the Andalucia Council,
since it is a disease absolutely absent in Andalucia and in Europe.

The batch immobilization is a measure recommended by the External
Sanitation Department, which belongs to the Ministry of Sanitation
and Consumer Affairs, to be complied with only in case of traveling
to countries where the disease is still present: i.e., the majority
of sub-Saharan countries and tropical countries in the Americas.

Pablo Nart

[Brazil, USA, and Australia have also reported such cases (see refs.
below). This case does not seem to correspond to problems with the
vaccine (contaminated batches), or with manufacturing problems, but
is a consequence of a special interaction between the virus in the
vaccine and the host; since, in rare cases, there might be an
inability by the host to generate an adequate immune response to the
virus. - Mod.LJS]

[see also:
Yellow fever vaccine-associated deaths - MMWR report 20021108.5756
Yellow fever vaccine-associated deaths reported 20010715.1367
Yellow fever vaccine-associated deaths (02) 20010727.1467
Yellow fever vaccine-associated deaths (05) 20011201.2925
Yellow fever - Brazil: vaccine deaths 20000326.0436
Yellow fever - Brazil: vaccine deaths (02) 20000328.0452]