Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Yellow fever and travel vaccination
Infectious diseases, microbiology and sexual health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending
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Suspected yellow fever with organ failure
Fever after exposure in sub-Saharan Africa or tropical South America followed by jaundice, bleeding, shock, renal injury, encephalopathy or recurrent fever after brief improvement may be severe yellow fever.
Action: Isolate from mosquitoes, use ABCDE and critical-care organ support, avoid medicines that worsen bleeding, contact infection specialists, UKHSA health protection and RIPL immediately, notify suspected disease, and arrange reference sampling without delaying care.
Synopsis
Recognise severe yellow fever, notify and test safely, and deliver an itinerary-led travel consultation that balances vaccine benefit, certificate requirements and serious adverse-event risk.
Yellow fever is a mosquito-borne flavivirus transmitted in parts of sub-Saharan Africa and tropical South America through sylvatic, intermediate and urban cycles.
Initial illness causes abrupt fever, severe headache, myalgia, nausea, relative bradycardia and conjunctival injection; most patients then improve.
A minority enter a toxic phase after brief remission with recurrent fever, jaundice, bleeding, shock, kidney injury, myocarditis and encephalopathy.
First-line assessment includes malaria testing, FBC, coagulation, renal and liver profiles, glucose, lactate, blood cultures and organ-directed imaging while RIPL testing is arranged.
Reference RT-PCR is most useful during early viraemia; serology later can cross-react with other flaviviruses and vaccines and needs expert interpretation.
There is no proven specific antiviral treatment: use meticulous supportive care, haemodynamic and renal support, glucose management and cautious blood products.
Stamaril is a live attenuated vaccine given as one 0.5 mL dose at an approved Yellow Fever Vaccination Centre, ideally at least 10 days before exposure.
The International Certificate of Vaccination becomes valid 10 days after primary vaccination and remains valid for life for most travellers under the International Health Regulations.
Vaccination is not automatic when a certificate is requested; assess actual itinerary risk, entry rules, age, pregnancy, immunity, thymus history and serious-adverse-event risk, using a waiver when appropriate.
Travel health also includes routine immunisations, destination vaccines, malaria prevention, food and water safety, mosquito avoidance, sexual health, accident reduction and insurance.
Key red flags
Jaundice, haematemesis, melaena, mucosal bleeding, oliguria, hypotension or confusion after a compatible journey indicates toxic-phase yellow fever.
A brief remission followed by recurrent fever and organ dysfunction is characteristic of progression rather than recovery.
Any febrile traveller from a malaria-risk area still needs urgent malaria microscopy or rapid testing irrespective of yellow-fever vaccination history.
Severe allergy, significant immunosuppression, thymus disease, age under six months or previous serious yellow-fever vaccine reaction is a contraindication to live vaccine.
Age 60 years or older, pregnancy, breastfeeding, age six to eight months and selected immune conditions require individual specialist benefit-risk assessment.
New fever with jaundice or neurological illness soon after vaccination may represent vaccine-associated viscerotropic or neurotropic disease and needs urgent expert review.
Acute febrile phase
Abrupt fever, chills, severe headache, backache, myalgia, nausea, vomiting and conjunctival injection begin after a short incubation.
Toxic phase
Recurrent fever with jaundice, epigastric pain, haematemesis, mucosal bleeding, oliguria, shock or encephalopathy marks severe visceral disease.
Investigation priorities
01
Immediate malaria testingFirst step
Exclude a common, rapidly fatal and treatable cause of fever after travel.
02
First-line severity panelFirst line
Quantify hepatic, renal, haematological and metabolic injury and guide organ support.
Management branches
ILL TRAVELLERStabilise and test in parallel
Fever, jaundice or haemorrhagic features follow travel in a yellow-fever risk area.
Use ABCDE, isolate from mosquitoes, obtain the severity panel and urgent malaria films, and manage hypoglycaemia, shock, bleeding and organ failure immediately.
Contact infection specialists, the local health-protection team and RIPL before reference sampling; provide precise countries, dates, mosquito exposure and vaccination history.
Send time-appropriate PCR and serology plus competing imported-fever tests, while avoiding aspirin, NSAIDs and unnecessary intramuscular injections when bleeding risk is present.
Notify suspected yellow fever without waiting for confirmation and involve critical care, renal, hepatology and haematology services according to organ injury.
COADMINISTERPlan other vaccines and timing
Yellow-fever vaccine is needed alongside routine or travel vaccines.
Give most inactivated vaccines at any interval and use separate sites; check each product and current Green Book advice rather than applying a single spacing rule.
Give yellow-fever and MMR vaccines four weeks apart where feasible because simultaneous administration may reduce immune responses to some antigens.
Key medicines
Yellow-fever 17D vaccine (Stamaril)Give one 0.5 mL dose by the licensed subcutaneous route, or intramuscular route where appropriate under official recommendations, at an approved Yellow Fever Vaccination Centre.Screen severe egg or component allergy, immune suppression, thymus disease, pregnancy, breastfeeding and age; use only trained authorised-centre processes and never vaccinate solely to satisfy paperwork when risk is disproportionate.
ParacetamolUse standard adult oral or intravenous dosing within the product maximum, reducing or avoiding it when severe hepatic dysfunction makes usual dosing unsafe.Do not exceed combined-product limits; severe yellow-fever hepatitis requires senior pharmacy or hepatology review, and symptom control must not delay reassessment of deterioration.
Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending+
Sources
Sources and review status
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Fever followed by meningitis, encephalitis, acute disseminated encephalomyelitis or Guillain–Barré-like weakness occurs rarely after vaccination.
Vaccine-associated viscerotropic disease
Post-vaccine fever progresses to hypotension, hepatitis, renal or respiratory failure and resembles wild-type severe yellow fever.
When urgent travel prevents spacing, vaccines may be given at any interval after informed specialist assessment, with additional doses considered according to current guidance.
Review oral live vaccines, immune globulins and immunosuppressive medicines individually, and record the rationale for any altered schedule.