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As YF transmission expands and global travel increases, protection may still be indicated for selected patients with prior thymectomy. We report a 25\u2011year\u2011old woman with childhood thymectomy for acetylcholine receptor antibody\u2013positive generalized myasthenia gravis, now in long\u2011term remission without immunosuppression, who required YF prevention. Immune competence was evaluated using monitored orthoflaviviral proxy immunization with the live\u2011attenuated tetravalent dengue vaccine (TAK\u2011003). She experienced mild reactogenicity and developed dengue\u2011specific antibodies and T\u2011cell responses, with preserved B-cell maturation. After confirming orthoflaviviral immune competence, she received YF\u201117D\u2011204 vaccination, which was well tolerated and induced transient viremia, seroconversion, and functional YF\u2011specific B\u2011 and T\u2011cell responses. This case demonstrates the feasibility of an individualized, immune\u2011guided approach to safely administering YF vaccination after thymectomy and highlights the need for broader clinical confirmation.<\/jats:p>","DOI":"10.1038\/s41541-026-01520-x","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:48:09Z","timestamp":1782748089000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proxy immunization enabling yellow fever vaccination after thymectomy"],"prefix":"10.1038","volume":"11","author":[{"given":"Emilie C.","family":"Rijnink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Aguilar-Bretones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory D.","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Veenbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani\u00ebl G.","family":"Aynekulu Mersha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine H. 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