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Am J Trop Med Hyg. 2014 Feb;90(2):267-71. doi: 10.4269/ajtmh.13-0542. Epub 2014 Jan 6.

Defining risk groups to yellow fever vaccine-associated viscerotropic disease in the absence of denominator data.

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Department of Microbiology and Immunology, New York Medical College, Valhalla, New York; Laboratory of Populations, The Rockefeller University, New York, New York and Columbia University, New York, New York; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York; Department of Medicine, Georgetown University, Washington, DC.


Several risk groups are known for the rare but serious, frequently fatal, viscerotropic reactions following live yellow fever virus vaccine (YEL-AVD). Establishing additional risk groups is hampered by ignorance of the numbers of vaccinees in factor-specific risk groups thus preventing their use as denominators in odds ratios (ORs). Here, we use an equation to calculate ORs using the prevalence of the factor-specific risk group in the population who remain well. The 95% confidence limits and P values can also be calculated. Moreover, if the estimate of the prevalence is imprecise, discrimination analysis can indicate the prevalence at which the confidence interval results in an OR of ∼1 revealing if the prevalence might be higher without yielding a non-significant result. These methods confirm some potential risk groups for YEL-AVD and cast doubt on another. They should prove useful in situations in which factor-specific risk group denominator data are not available.

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