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Peer-reviewedCC BYnpj Vaccines

Proxy immunization enabling yellow fever vaccination after thymectomy

  • Emilie C. Rijnink1
  • Muriel Aguilar-Bretones2
  • Rory D. de Vries2
  • Sharon Veenbergen3
  • Daniël G. Aynekulu Mersha2
  • Corine H. Geurts van Kessel2
  • Marion P. G. Koopmans2
  • Pieter A. van Doorn4
  • Lennert Slobbe1
  • Rik A. Brooimans3
  • Gijsbert P. van Nierop2
  • Casper Rokx1
4 affiliations
  1. 1Department of Internal Medicine, Section Infectious Diseases, Erasmus University Medical Center
  2. 2Department of Viroscience, Erasmus University Medical Center
  3. 3Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center
  4. 4Department of Neurology, Erasmus University Medical Center
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Abstract

Yellow fever (YF) vaccination is generally contraindicated in individuals with thymic disorders because of the risk of YF vaccine–associated viscerotropic disease (YEL‑AVD). As YF transmission expands and global travel increases, protection may still be indicated for selected patients with prior thymectomy. We report a 25‑year‑old woman with childhood thymectomy for acetylcholine receptor antibody–positive generalized myasthenia gravis, now in long‑term remission without immunosuppression, who required YF prevention. Immune competence was evaluated using monitored orthoflaviviral proxy immunization with the live‑attenuated tetravalent dengue vaccine (TAK‑003). She experienced mild reactogenicity and developed dengue‑specific antibodies and T‑cell responses, with preserved B-cell maturation. After confirming orthoflaviviral immune competence, she received YF‑17D‑204 vaccination, which was well tolerated and induced transient viremia, seroconversion, and functional YF‑specific B‑ and T‑cell responses. This case demonstrates the feasibility of an individualized, immune‑guided approach to safely administering YF vaccination after thymectomy and highlights the need for broader clinical confirmation.

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Cite

BibTeXRIS
BibTeX
@article{rijnink2026proxy,
  title = {{Proxy immunization enabling yellow fever vaccination after thymectomy}},
  author = {Emilie C. Rijnink and Muriel Aguilar-Bretones and Rory D. de Vries and Sharon Veenbergen and Daniël G. Aynekulu Mersha and Corine H. Geurts van Kessel and Marion P. G. Koopmans and Pieter A. van Doorn and Lennert Slobbe and Rik A. Brooimans and Gijsbert P. van Nierop and Casper Rokx},
  journal = {npj Vaccines},
  year = {2026},
  month = jun,
  doi = {10.1038/s41541-026-01520-x},
  url = {https://doi.org/10.1038/s41541-026-01520-x},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Proxy immunization enabling yellow fever vaccination after thymectomy
AU  - Emilie C. Rijnink
AU  - Muriel Aguilar-Bretones
AU  - Rory D. de Vries
AU  - Sharon Veenbergen
AU  - Daniël G. Aynekulu Mersha
AU  - Corine H. Geurts van Kessel
AU  - Marion P. G. Koopmans
AU  - Pieter A. van Doorn
AU  - Lennert Slobbe
AU  - Rik A. Brooimans
AU  - Gijsbert P. van Nierop
AU  - Casper Rokx
PY  - 2026
DA  - 2026/06/01
JO  - npj Vaccines
DO  - 10.1038/s41541-026-01520-x
UR  - https://doi.org/10.1038/s41541-026-01520-x
AB  - Yellow fever (YF) vaccination is generally contraindicated in individuals with thymic disorders because of the risk of YF vaccine–associated viscerotropic disease (YEL‑AVD). As YF transmission expands and global travel increases, protection may still be indicated for selected patients with prior thymectomy. We report a 25‑year‑old woman with childhood thymectomy for acetylcholine receptor antibody–positive generalized myasthenia gravis, now in long‑term remission without immunosuppression, who required YF prevention. Immune competence was evaluated using monitored orthoflaviviral proxy immunization with the live‑attenuated tetravalent dengue vaccine (TAK‑003). She experienced mild reactogenicity and developed dengue‑specific antibodies and T‑cell responses, with preserved B-cell maturation. After confirming orthoflaviviral immune competence, she received YF‑17D‑204 vaccination, which was well tolerated and induced transient viremia, seroconversion, and functional YF‑specific B‑ and T‑cell responses. This case demonstrates the feasibility of an individualized, immune‑guided approach to safely administering YF vaccination after thymectomy and highlights the need for broader clinical confirmation.
SN  - 2059-0105
ER  -