We describe a man vaccinated with the 17D204 strain of yellow fever virus,
who subsequently died of yellow fever. Sequencing of the NS53' untranslated
region showed that the virus Isolated from the patient was identical to th
e vaccine strain of the same batch, and different from wild-type virus. Bot
h viruses contained a mutation, although the association of this mutation w
ith virulence is unknown. Severe, rapidly progressive, and ultimately fatal
disease can follow use of the 17D204 vaccine strain. There is need for ren
ewed discussion as to the safety of the vaccine and the indications for its
use.