Safety and immunogenicity of yellow fever 17D vaccine in adults receiving systemic corticosteroid therapy: an observational cohort study

Arthritis Care Res (Hoboken). 2013 Sep;65(9):1522-8. doi: 10.1002/acr.22021.


Objective: To assess the safety and immunogenicity of live attenuated yellow fever (YF) 17D vaccine in adults receiving systemic corticosteroid therapy.

Methods: All adult travelers on systemic corticosteroid therapy who had received the YF17D vaccine in 24 French vaccination centers were prospectively enrolled and matched with healthy controls (1:2) on age and history of YF17D immunization. Safety was assessed in a self-administered standardized questionnaire within 10 days after immunization. YF-specific neutralizing antibody titers were measured 6 months after vaccination in patients receiving corticosteroids.

Results: Between July 2008 and February 2011, 102 vaccine recipients completed the safety study (34 receiving corticosteroids and 68 controls). The median age was 54.9 years (interquartile range [IQR] 45.1-60.3 years) and 45 participants had a history of previous YF17D immunization. The median time receiving corticosteroid therapy was 10 months (IQR 1-67 months) and the prednisone or equivalent dosage was 7 mg/day (IQR 5-20). Main indications were autoimmune diseases (n = 14), rheumatoid arthritis (n = 9), and upper respiratory tract infections (n = 8). No serious adverse event was reported; however, patients receiving corticosteroids reported more frequent moderate/severe local reactions than controls (12% and 2%, respectively; relative risk 8.0, 95% confidence interval 1.4-45.9). All subjects receiving corticosteroids who were tested (n = 20) had neutralizing antibody titers >10 after vaccination.

Conclusion: After YF17D immunization, moderate/severe local reactions may be more frequent in patients receiving systemic corticosteroid therapy. Immunogenicity seems satisfactory. Large-scale studies are needed to confirm these results.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Adult
  • Arthralgia / chemically induced
  • Arthralgia / immunology
  • Cohort Studies
  • Fatigue / chemically induced
  • Fatigue / immunology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Surveys and Questionnaires
  • Yellow Fever / epidemiology
  • Yellow Fever / immunology*
  • Yellow Fever / prevention & control*
  • Yellow Fever Vaccine / adverse effects
  • Yellow Fever Vaccine / immunology*
  • Yellow Fever Vaccine / therapeutic use*
  • Yellow fever virus / immunology


  • Adrenal Cortex Hormones
  • Yellow Fever Vaccine