CONSENT FORM (Fill it on the day of your vaccination)

VACCINE INFORMATION STATEMENT

Yellow Fever Vaccine: What You Need to Know

  1. Why Get Vaccinated?

    Yellow fever vaccine can prevent yellow fever. Yellow fever is a serious disease caused by the yellow fever virus. There is no medicine to treat or cure yellow fever.

    Yellow fever virus is spread by the bite of an infected mosquito. It is found in parts of Africa and South America.

    The majority of people with yellow fever virus infections will either not have symptoms, or have mild disease and completely recover. But some people will develop severe diseases.

    • Sudden onset of fever and chills
    • Headache, back pain, or general body aches
    • Nausea or vomiting

    More severe symptoms of yellow fever can include:

    • Jaundice (yellow skin or eyes)
    • Bleeding from multiple body sites
    • Shock (life-threatening condition in which the body is not getting enough blood flow)
    • Liver, kidney, or other organ failure

    Severe yellow fever can cause death in 30% to 60% of affected people. In addition to getting vaccinated, you can also protect yourself from yellow fever by avoiding mosquito bites:

    • Use insect repellent
    • Wear long-sleeved shirts and long pants
    • Stay in well-screened or air-conditioned areas
  2. Yellow Fever Vaccine

    Yellow fever vaccine is a live vaccine containing weakened, live yellow fever virus. It is given as a single shot. One dose provides lifelong protection for most people.

    Yellow fever vaccine is recommended for:

    • People 9 months through 59 years of age who are traveling to or living in areas at risk for yellow fever virus activity, or traveling to a country with an entry requirement for vaccination. (People younger than 9 months or older than 59 years who are at increased risk might receive yellow fever vaccine in some situations. Ask your healthcare provider for more information.)
    • Laboratory personnel who might be exposed to yellow fever virus or vaccine virus.

    Yellow fever vaccine is given only at designated vaccination centers. After getting the vaccine, you will be given an “International Certificate of Vaccination or Prophylaxis” (ICVP, sometimes called the “yellow card”). You will need this card as proof of vaccination to enter certain countries. If you don’t have it, you might be required to get yellow fever vaccine upon entering the country or be forced to wait for up to 6 days to make sure you are not infected. Do not donate blood for 14 days after vaccination, because there is a risk of passing the vaccine virus to others during that period.

  3. Talk with Your Health Care Provider

    Discuss your itinerary with your health care provider before you get your yellow fever vaccination. You can visit CDC’s Travelers’ Health website at www.cdc.gov/travel to learn if yellow fever vaccination is recommended or required based on your travel location.

    Tell your vaccine provider if the person getting the vaccine:

    • Has had an allergic reaction after a previous dose of yellow fever vaccine, or has any severe, life-threatening allergies.
    • Has a weakened immune system.
    • Has had their thymus removed or been diagnosed with a thymus disorder?
    • Is pregnant or breastfeeding
    • Has gotten any other vaccines in the past 4 weeks

    People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting yellow fever vaccine. In some cases, your health care provider may decide to postpone yellow fever vaccination to a future visit.

    If you cannot get yellow fever vaccine for medical reasons and you are traveling to a country with a yellow fever vaccination entry requirement, your doctor will need to fill out the Medical Contraindications to Vaccination section of your yellow card. In addition, your doctor should give you a waiver letter. If you plan to use a waiver, you can contact the embassies of countries you plan to visit for more information.

  4. Risks of a Vaccine Reaction
    • Soreness, redness, or swelling where the shot was given are common after yellow fever vaccine.
    • Fever sometimes happens.
    • Headaches and muscle aches can occur.
    • More serious reactions happen rarely after yellow fever vaccine. These can include:
      • Nervous system reactions such as inflammation of the brain (encephalitis) and/or spinal cord covering (meningitis), or Guillain-Barré Syndrome (GBS), among others.
      • Life-threatening severe illness with organ dysfunction or failure.

    People 60 years and older and people with weakened immune systems might be more likely to experience serious reactions to yellow fever vaccine.

    People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

    As with any medicine, there is a remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death. What if there is a serious problem?

  5. What If There Is a Serious Problem?

    An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

    For other signs that concern you, call your health care provider.

    Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website at www.vaers.hhs.gov or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.

  6. How Can I Learn More?
    • Ask your health care provider.
    • Call your local or state health department.
    • Contact the Centers for Disease Control and Prevention (CDC):