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Influenza-like illness after yellow fever vaccination
Journal of Clinical Virology 60 (2014) 181
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Letter to the Editor Influenza-like illness after yellow fever vaccination
of case history and laboratory analyses in the evaluation of flu-like illness of unknown origin.
Keywords:
Funding
Vaccine Yellow fever Influenza-like illness
Dear Sir, We have read the paper of Lamson et al. with great interest. In their paper, Lamson et al. describe a case of influenza-like illness after yellow fever (YF) vaccination [1]. The paper is noteworthy, as it represents the first ever-published report in which yellow fever vaccine strain was isolated in a patient suffering of flu-like illness eight days after vaccination. In view of the importance of the results described for both health care providers and patients who are involved in immunisation programmes, we decided to investigate the issue further. A possibility of gaining additional information on adverse reactions to vaccination is to rely on data from pharmacovigilance databases, which contain reports on large populations and are thus particularly valuable in collecting information on rare occurrences. One of the biggest national and international databases is the Vaccine Adverse Event Reporting System (VAERS) that assembles approximately 28,000 adverse drug reactions following vaccination per year from the United States and worldwide [2]. The database allows extracting information on patients and adverse events, including laboratory analyses. We took advantage of this function to analyse further cases in which an YF vaccine strain was isolated in cell culture after immunisation in patients with flu-like symptoms. We retrieved four cases of flu-like illness associated with the identification of an YF vaccine strain. Three of these four cases (75%) occurred within five days after vaccination, while only one case was reported as having occurred after three weeks. Along with these four cases confirmed by laboratory analyses, we found 71 additional reports of flu-like illness associated with YF vaccination in the VAERS database. About 70% of these cases occurred within 5 days from immunisation, a period likely to be associated with previously described viraemia after inoculation of the YF vaccine [3]. Because of the known limitation of the VAERS database [2] it is possible that also some of these cases were associated with unreported laboratory tests identifying the presence of an YF vaccine strains. The results of our analysis indicate that few cases of vaccine associated flu-like illness are followed with proper analysis. Our analysis also documents, as Lamson et al. stated, the importance
http://dx.doi.org/10.1016/j.jcv.2014.03.015 1386-6532/© 2014 Elsevier B.V. All rights reserved.
The financial support by the Italian Medicines Agency, AIFA, and the Italian Ministry of Health (RC 2014 to EC) is gratefully acknowledged. Competing interests None declared. Ethical approval Not applicable. References [1] Lamson D, Ramani R, Kleabonas M, Metcalfe M, Humphrey C, St. George K. An unusual case of influenza-like illness after yellow fever vaccination. J Clin Virol 2014, pii:S1386-6532(14)00040-7. [2] http://vaers.hhs.gov/index [accessed 15.03.14]. [3] Reinhardt B1, Jaspert R, Niedrig M, Kostner C, L’age-Stehr J. Development of viremia and humoral and cellular parameters of immune activation after vaccination with yellow fever virus strain 17D: a model of human flavivirus infection. J Med Virol 1998;56:159–67.
Paolo Pellegrino Carla Carnovale Sonia Radice ∗ Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, 20157 Milan, Italy Emilio Clementi a,b Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, 20157 Milan, Italy b Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Lecco, Italy a
∗ Corresponding author at: Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, University of Milan, Via GB Grassi 74, 20157 Milano, Italy. Tel.: +39 0250319683; fax: +39 0250319682. E-mail address: [email protected] (S. Radice)
20 March 2014
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Letter to the Editor Influenza-like illness after yellow fever vaccination
of case history and laboratory analyses in the evaluation of flu-like illness of unknown origin.
Keywords:
Funding
Vaccine Yellow fever Influenza-like illness
Dear Sir, We have read the paper of Lamson et al. with great interest. In their paper, Lamson et al. describe a case of influenza-like illness after yellow fever (YF) vaccination [1]. The paper is noteworthy, as it represents the first ever-published report in which yellow fever vaccine strain was isolated in a patient suffering of flu-like illness eight days after vaccination. In view of the importance of the results described for both health care providers and patients who are involved in immunisation programmes, we decided to investigate the issue further. A possibility of gaining additional information on adverse reactions to vaccination is to rely on data from pharmacovigilance databases, which contain reports on large populations and are thus particularly valuable in collecting information on rare occurrences. One of the biggest national and international databases is the Vaccine Adverse Event Reporting System (VAERS) that assembles approximately 28,000 adverse drug reactions following vaccination per year from the United States and worldwide [2]. The database allows extracting information on patients and adverse events, including laboratory analyses. We took advantage of this function to analyse further cases in which an YF vaccine strain was isolated in cell culture after immunisation in patients with flu-like symptoms. We retrieved four cases of flu-like illness associated with the identification of an YF vaccine strain. Three of these four cases (75%) occurred within five days after vaccination, while only one case was reported as having occurred after three weeks. Along with these four cases confirmed by laboratory analyses, we found 71 additional reports of flu-like illness associated with YF vaccination in the VAERS database. About 70% of these cases occurred within 5 days from immunisation, a period likely to be associated with previously described viraemia after inoculation of the YF vaccine [3]. Because of the known limitation of the VAERS database [2] it is possible that also some of these cases were associated with unreported laboratory tests identifying the presence of an YF vaccine strains. The results of our analysis indicate that few cases of vaccine associated flu-like illness are followed with proper analysis. Our analysis also documents, as Lamson et al. stated, the importance
http://dx.doi.org/10.1016/j.jcv.2014.03.015 1386-6532/© 2014 Elsevier B.V. All rights reserved.
The financial support by the Italian Medicines Agency, AIFA, and the Italian Ministry of Health (RC 2014 to EC) is gratefully acknowledged. Competing interests None declared. Ethical approval Not applicable. References [1] Lamson D, Ramani R, Kleabonas M, Metcalfe M, Humphrey C, St. George K. An unusual case of influenza-like illness after yellow fever vaccination. J Clin Virol 2014, pii:S1386-6532(14)00040-7. [2] http://vaers.hhs.gov/index [accessed 15.03.14]. [3] Reinhardt B1, Jaspert R, Niedrig M, Kostner C, L’age-Stehr J. Development of viremia and humoral and cellular parameters of immune activation after vaccination with yellow fever virus strain 17D: a model of human flavivirus infection. J Med Virol 1998;56:159–67.
Paolo Pellegrino Carla Carnovale Sonia Radice ∗ Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, 20157 Milan, Italy Emilio Clementi a,b Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, 20157 Milan, Italy b Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Lecco, Italy a
∗ Corresponding author at: Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, University of Milan, Via GB Grassi 74, 20157 Milano, Italy. Tel.: +39 0250319683; fax: +39 0250319682. E-mail address: [email protected] (S. Radice)
20 March 2014