Journal of Mosquito Research, 2024, Vol.14, No.5, 264-275 http://emtoscipublisher.com/index.php/jmr 272 Fractional dosing strategies, where smaller doses of the vaccine are used to extend supply, have also been employed successfully in emergency settings, such as the 2016 outbreak in Angola and the Democratic Republic of Congo. Studies have shown that fractional doses can maintain high levels of seroconversion, making this a viable stop-gap solution during vaccine shortages (Nnaji et al., 2019). However, more research is needed to understand the long-term efficacy of fractional dosing and its applicability for routine immunization. 6.2 Enhancing vaccine safety through next-generation formulations While the 17D live-attenuated vaccine is effective, rare severe adverse reactions such as viscerotropic disease have prompted the need for safer alternatives. Next-generation formulations, including inactivated vaccines and recombinant subunit vaccines, are being developed to mitigate these risks. For example, inactivated vaccines grown in Vero cells have demonstrated safety and efficacy in animal models, providing a potential alternative for immunocompromised individuals (Pereira et al., 2015). Additionally, DNA and RNA vaccine platforms are being explored for yellow fever, capitalizing on their ability to generate immune responses without the risks associated with live virus replication. These platforms can also be adapted quickly to emerging strains or new variants, making them a flexible option for future vaccine development. As these technologies advance, they offer a pathway to safer vaccines that can be rapidly deployed during outbreaks. 6.3 Integrating vaccination with other control measures (e.g., vector control) Successful control of yellow fever requires a comprehensive approach that goes beyond vaccination alone. Integrating vaccination campaigns with vector control strategies is crucial, especially in areas where Aedes mosquitoes are abundant. Traditional methods such as insecticide spraying and the use of bed nets have been complemented by novel approaches, including the release of genetically modified mosquitoes designed to reduce mosquito populations and inhibit virus transmission (Silva et al., 2018). The EYE strategy has also emphasized the importance of enhanced surveillance systems that can detect and respond to outbreaks quickly. By combining vaccination efforts with early detection and rapid vector control measures, the spread of yellow fever can be curtailed more effectively. Such integrated approaches are essential for protecting populations in high-risk areas and preventing cross-border transmission during outbreaks. 6.4 Addressing vaccine hesitancy: public education and policy strategies Vaccine hesitancy remains a significant barrier to achieving high immunization coverage for yellow fever, particularly in communities that have low trust in health systems or where misinformation about vaccines is prevalent. Public education campaigns that address concerns and provide clear information about the safety and efficacy of the yellow fever vaccine are crucial for increasing uptake (Chen and Wilson, 2020). Policy strategies that support mandatory vaccination in high-risk areas, such as requiring proof of vaccination for travelers to endemic regions, have also been effective in increasing coverage. Moreover, community engagement initiatives that involve local leaders and healthcare workers can help build trust and acceptance of vaccination programs. Addressing these social and cultural factors is key to ensuring that yellow fever vaccination campaigns reach all vulnerable populations and achieve their intended impact. 7 Concluding Remarks Yellow Fever (YF) remains a critical global health challenge, particularly in endemic regions of Africa and South America. Despite the availability of a highly effective vaccine, the persistence of outbreaks and evolving epidemiological patterns necessitate ongoing innovation in vaccination strategies and public health approaches. This section summarizes key findings, explores their implications for policy and public health, and outlines recommendations for future research. The analysis of current yellow fever vaccination strategies highlights the effectiveness of the live-attenuated 17D vaccine, which continues to provide long-lasting immunity in most individuals. However, rare adverse events such as yellow fever vaccine-associated viscerotropic and neurotropic disease have driven the exploration of safer alternatives. Innovations such as fractional dosing, which has proven
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