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Table 5 List of recommendations for yellow fever vaccine (YFV) administration in patients with CIMID

From: Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

1. YFV should not be administered to patients with CIMID under high immunosuppression. For patients with a low degree or no immunosuppression, it is recommended to assess individually the risk of the vaccine. This evaluation should be performed by a physician, preferably the specialist assisting the patient
2. YFV should not be administered to patients with CIMID with high activity of the underlying disease. However, in clinically stable patients or those with no activity of the underlying disease there is no contraindication to vaccination. The risk to vaccinate in these situations should be assessed individually by a physician, preferably the specialist assisting the patient
3. YFV should not be administered to patients with CIMID using a high dose of corticosteroid. The risk of vaccinating patients receiving low doses should be assessed individually by a physician, preferably the specialist assisting the patient
4. Revaccination with YFV is not recommended for patients with CIMID under high immunosuppression. In specific situations in which a booster is necessary, the risk of vaccinating patients with a low or no immunosuppression degree should be assessed individually by a physician, preferably the specialist assisting the patient
5. In situations of risk, when YFV is indicated, a minimum interval of four weeks is recommended between application of the vaccine and the initiation or resumption of treatment with immunomodulatory and immunosuppressive drugs
6. In situations of risk, when YFV is indicated, a minimum period after the suspension of medications prior to the application of the vaccine is recommended, varying according to the immunosuppression degree. Advice on treatment discontinuation should be individualized and given by a specialist
7. When YFV is indicated in patients with CIMID, it is recommended that it not be applied concurrently with another live attenuated virus vaccine, primarily with the MMR (measles, mumps, and rubella). When indicated, a 28-day interval between the application of these vaccines is recommended
8. There is no contraindication of YFV in those in close contact with immunocompromised patients, since the transmission of the vaccine virus without vector participation is documented only through breast milk, blood donation, and, possibly, by accidental contact with biological materials