Most likely,

these unreported vaccinations also occurred in the 10- to 11-year vaccination subgroup ceasing antibody decay in some individuals and leading to overestimated seropositive rates attributable to a single dose. That observation disclosed a limitation of this study and illustrated the challenge of ascertaining the number of vaccine doses and time since immunisation in adults. Even more challenging was the characterisation of potential for exposure to natural infection, which led to exclusion of volunteers. In addition to selecting subjects not likely to be exposed to natural infections, to ensure that yellow fever Volasertib clinical trial seropositivity was explained by a single reported dose of the vaccine was a major challenge in this study. In a study used as reference for in the single vaccination recommendation by the WHO [21], 9 of 24 volunteers were revaccinated. However, other reference studies have not clarified whether revaccination was considered when assessing the duration of immunity [7]. Methodological differences across studies, such as, the vaccine

itself, different substrains of vaccine virus, vaccination procedures, volunteer profile, serological test methods and seropositity criteria, are important factors that may have contributed to the check details discrepancy of results previously reported. In general, these studies were cross-sectional and the comparison across subgroups with distinct elapsed times since vaccination disregarded variations in immunisation procedures and in the vaccine potency over time. In Brazil, vaccination against yellow fever in routine health care has used the same vaccine and similar procedures for several decades, thus favouring the comparability of results from the different cohorts represented in the present study. On the other hand, the representativeness of non-randomly selected volunteers may be limited. The selection of volunteers for this study

entailed the exclusion of those who resided or remained in geographical areas susceptible to yellow fever transmission so that natural booster infections would not confound the experimental results. Even in areas, medroxyprogesterone such as Alfenas, where vaccination is recommended for residents, yellow fever cases have not occurred in humans for many decades. In addition, epidemiological surveillance data have indicated the lack of circulation of sylvatic virus strains in non-human primates (unpublished data available in worksheets from Minas Gerais State Health Secretary). In this as in other studies [20] and [22], yellow fever seropositivity assessed by PRNT did not appear to have been inflated by prior exposure to dengue infection.