|As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of anaphylaxis or other severe hypersensitivity reaction following administration of the vaccine.STAMARIL should be administered only to persons who are/will be at risk of infection with yellow fever virus or who must be vaccinated to comply with international health regulations. Before considering administration of yellow fever vaccine, care should be taken to identify those who might be at increased risk of adverse reactions following vaccination (see section 4.3 and below).Yellow fever vaccine associated neurotropic diseaseVery rarely, yellow fever vaccine-associated neurotropic disease (YEL-AND) has been reported following vaccination, with sequelae or with fatal outcome in some cases (see section 4.8). Clinical features have appeared within one month of vaccination and include high fever with headache that may progress to include one or more of the following: confusion, encephalitis/encephalopathy, meningitis, focal neurological deficits, or Guillain Barré syndrome. To date, those affected have been primary vaccinees. The risk appears to be higher in those aged over 60 years, although cases have been also reported in younger persons or following transmission from nursing mothers to the infants.Yellow fever vaccine-associated viscerotropic diseaseVery rarely, yellow fever vaccine-associated viscerotropic disease (YEL-AVD) resembling fulminant infection by wild-type virus has been reported following vaccination (see section 4.8). The clinical presentation may include fever, fatigue, myalgia, headache, hypotension, progressing to one or more of metabolic acidosis, muscle and liver cytolysis, lymphocytopenia and thrombocytopenia, renal failure and respiratory failure. The mortality rate has been around 60%. To date, all cases of YEL-AVD have been in primary vaccinees with onset within 10 days of vaccination. The risk appears to be higher in those aged over 60 years although cases have also been reported in younger persons. Disease of the thymus gland has also been recognised as a potential risk factor (see section 4.3 and section 4.8).Immunosuppressed persons STAMARIL must not be administered to immunosuppressed persons (see section 4.3). If the immunosuppression is temporary, vaccination should be delayed until the immune function has recovered. In patients who have received systemic corticosteroids for 14 days or more, it is advisable to delay vaccination until at least one month after completing the course. • HIV infectionSTAMARIL must not be administrated to persons with symptomatic HIV infection or with asymptomatic HIV infection when accompanied by evidence of impaired immune function (see section 4.3). However, there are insufficient data at present to determine the immunological parameters that might differentiate persons who could be safely vaccinated and who might mount a protective immune response from those in whom vaccination could be both hazardous and ineffective. Therefore, if an asymptomatic HIV-infected person cannot avoid travel to an endemic area available official guidance should be taken into account when considering the potential risks and benefits of vaccination.• Children born to HIV positive mothersChildren aged at least 6 months (see sections 4.2 and 4.3 and below) may be vaccinated if it is confirmed that they are not infected with HIV.HIV infected children aged at least 6 months who are potentially in need of protection against yellow fever should be referred to a specialist paediatric team for advice on whether or not to vaccinate. Age• Children aged 6 to 9 monthsSTAMARIL must not be administered to children before the age of 6 months (see section 4.3). Children aged from 6 months up to 9 months should only be vaccinated under special circumstances (e.g. during major outbreaks) and on the basis of current official advice. • Persons aged 60 years and olderSome serious and potentially fatal adverse reactions (including systemic and neurological reactions persisting more than 48 hours, YEL-AVD and YEL-AND) appear to occur at higher frequencies after the age of 60 years. Therefore, the vaccine should only be given to those who have a considerable risk of acquiring yellow fever (see above and section 4.8).Because intramuscular injection can cause injection site haematoma, STAMARIL should not be given by the intramuscular route to persons with any bleeding disorder, such as haemophilia or thrombocytopenia, or to persons on anticoagulant therapy. The subcutaneous route of administration should be used instead. Patients with rare hereditary problems of fructose intolerance should not take this vaccine.TransmissionThere are very few reports suggesting that transmission of Yellow Fever vaccine virus may occur from nursing mothers, who received Yellow Fever vaccine postpartum, to the infant. Following transmission the infants may develop yellow fever vaccine associated neurotropic disease (YEL-AND) from which the infants recover (see section 4.6).