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Stocks of yellow fever vaccine are insufficient to cover exceptional demands for outbreak response. Fractional dosing has shown efficacy, but evidence is limited to the 17DD substrain vaccine. We assessed the immunogenicity and safety of one-fifth fractional dose compared with standard dose of four WHO-prequalified yellow fever vaccines produced from three substrains.

BackgroundEvidence exists that even at high CD4 counts, mortality among HIV-infected antiretroviral therapy (ART) naïve individuals is higher than that in the general population. However, many developing countries still initiate ART at CD4 ≤350 cells/mm3.ObjectiveTo compare mortality among HIV-infected ART naïve individuals with CD4 counts ≥350 cells/mm3with mortality in the general Ugandan population and to investigate risk factors for death.DesignPopulation-based prospective HIV cohort.MethodsThe study population consisted of HIV-infected people in rural southwest Uganda. Patients were reviewed at the study clinic every 3 months. CD4 cell count was measured every 6 months. Rate ratios were estimated using Poisson regression. Indirect methods were used to calculate standardised mortality ratios (SMRs).ResultsA total of 374 participants with CD4 ≥350 cells/mm3were followed for 1,328 person-years (PY) over which 27 deaths occurred. Mortality rates (MRs) (per 1,000 PY) were 20.34 (95% CI: 13.95–29.66) among all participants and 16.43 (10.48–25.75) among participants aged 15–49 years. Mortality was higher in periods during which participants had CD4 350–499 cells/mm3than during periods of CD4 ≥500 cells/mm3although the difference was not statistically significant [adjusted rate ratio (aRR)=1.52; 95% CI: 0.71–3.25]. Compared to the general Ugandan population aged 15–49 years, MRs were 123% higher among participants with CD4 ≥500 cells/mm3(SMR: 223%, 95% CI: 127–393%) and 146% higher among participants with CD4 350–499 cells/mm3(246%, 117%–516). After adjusting for current age, mortality was associated with increasing WHO clinical stage (aRR comparing stage 3 or 4 and stage 1: 10.18, 95% CI: 3.82–27.15) and decreasing body mass index (BMI) (aRR comparing categories ≤17.4 Kg/m2and ≥18.5 Kg/m2: 6.11, 2.30–16.20).ConclusionHIV-infected ART naïve individuals with CD4 count ≥350 cells/mm3had a higher mortality than the general population. After adjusting for age, the main predictors of mortality were WHO clinical stage and BMI.