- Email: [email protected]
Possible association of encephalitis and 17D yellow fever vaccination in a 29-year-old traveller
2 Murphy, B.R., Sotnikov, A.V., Lawrence, L.A., Banks, S.M. and Prince, G.A. Enhanced pulmonary histopathology is observed in cotton rats immunized with formalin-inactivated respiratory syncytial virus (RSV) or purified F glycoprotein and challenged with RSV 3-6 months after immunization. Vaccine 1990, 8, 497- 502 3 Connors, M., Collins, P.L., Firestone, C.-Y., Sotnikov, A.V., Waitze, A., Davis, A.R. et al. Cotton rats previously immunized with a chimeric RSV FG glycoprotein develop enhanced pulmonary pathology when infected with RSV, a phenomenon not encountered following immunization with vaccinia-RSV recombinants or RSV. Vaccine 1992, 10(7), 475-484 4 Murphy, B.R., Prince, G.A., Walsh, E.E., Kim. H.W., Parrott, R.H., Hemming, V.G. et al.
Dissociation between serum neutralizing and glycoprotein antibody responses of infants and children who received inactivated respiratory syncytial virus vaccine. J. C/in. Microbiol. 1986, 24(2), 197-202 Chanock, R.M., Parrott, R.H., Connors, M., Collins, P.L. and Murphy. B.R. Serious respiratory tract disease caused by respiratory syncytial virus: Prospects for improved therapy and effective immunization. Pediatrics 1992, 90, 137-143 Connors, M., Kulkarni, A.B., Firestone, C.-Y., Holmes, K.L., Morse III, H.C. et al. Pulmonary histopathology induced by respiratory syncytial virus (RSV) challenge of formalin-inactivated RSV-immunized BALB/c mice is abrogated by depletion of CD4+ T cells. J. Viro/. 1992, 66, 7444-7451
Possible association of encephalitis and 17D yellow fever vaccination in a 29-year-old traveller Yellow fever vaccination is usually well tolerated by adults; only 0.2% of the vaccinees are unable to work due to systemic reactions ~ and encephalitis has never been reported in a vaccinee over the age of 132 . Thus, this case report is the first description of encephalitis temporally associated with 17D yellow fever vaccination in an adult. A 29-year-old previously healthy Swiss man was immunized on 21 August 1991 for the first time against yellow fever (Stamaril Pasteur, Lot E5309) for a 4-week journey to Columbia; on the same date he also received a diphtheriatetanus booster injection. His prior history was uneventful except for prolonged amnesia, transient aphasia and pareses of the right side after anaesthesia for herniotomy in 1983. Three days after immunization he had a fever of up to 38°C and headaches and he vomited repeatedly. These symptoms subsided after 3 days except for persistent posterior headaches, especially in the evening. On 8 September, two days after his arrival in
Columbia, fever and vomiting recurred with exacerbation of the headache, and the patient had diarrhoea, blurred vision and impaired visual focusing of moving objects. This was followed 1 day later by ataxia, dizziness and photophobia. The patient, who was becoming increasingly apathetic, was hospitalized in Columbia on 16 September in a somnolent state, with severe ataxia, proximal weakness of the lower extremities and bilateral 6th nerve palsy. Malaria, septicaemia, human immunodeficiency virus, cytomegalovirus and toxoplasmosis were excluded. Brain computed tomography and magnetic resonance imaging were normal but there was cerebrospinal fluid (CSF) mononuclear pleocytosis of 100 cells mm 3 and the diagnosis of encephalitis was made. The condition of the patient improved with symptomatic treatment but slight ataxia persisted. He was discharged on 30 September. When he returned to Switzerland, a repeat CSF measurement in January 1992 with
lymphocytic pleocytosis of 16 cells mm 3 and a pathological electroencephalogram were both consistent with a history of encephalitis. Serological assessment for neurotropic viruses (herpes simplex virus, varicella zoster virus, EpsteinBarr virus, human immunodeficiency virus, lymphocytic choriomeningitis virus, adenovirus, measles and mumps virus, poliovirus, coxsackie and echovirus, influenza and parainfluenzavirus, Central European tick-borne encephalitis virus, Venezuelan, Western and Eastern equine encephalitis viruses) were negative, as were assessments for toxoplasmosis, Lyme borreliosis and syphilis. Yellow fever neutralizing antibody at a titre of 1:80 was demonstrated in a serum collected 60 days after immunization. In April 1992 the patient still had slight ataxia, but experienced no other sequelae. No other cause of encephalitis was detected in this case despite thorough investigation, suggesting a possible association of the central nervous system infection with 17D yellow fever vaccine.
Christoph Merlo*, Robert Steffen*, Theodor Landis t, Theodore Tsai ~ and Nick Karabatsos ~ *Institute of Social and Preventive Medicine of the University, Division of Epidemiology and Prevention of Communicable Diseases, CH-8006 Zurich, Switzerland. t Department of Neurology, University Hospital, CH-8091 Zurich, Switzerland. *Division of Vector-Borne Infectious Diseases, Centers for Disease Control, Fort Collins, CO 80522, USA References 1 Br~s, P. Benefit versus risk factors in immunization against yellow fever. Dev. Biol. Stand. 1979, 43, 297 304 2 Schoub, B.D., Dommann, C.J., Johnson, S., Downie, C. and Patel, P.L. Encephalitis in a 13-year-old boy following 17D yellow fever vaccine. J. Infect. 1990, 21, 105-106
Vaccine, Vol. 11, Issue 6, 1993 691
Dissociation between serum neutralizing and glycoprotein antibody responses of infants and children who received inactivated respiratory syncytial virus vaccine. J. C/in. Microbiol. 1986, 24(2), 197-202 Chanock, R.M., Parrott, R.H., Connors, M., Collins, P.L. and Murphy. B.R. Serious respiratory tract disease caused by respiratory syncytial virus: Prospects for improved therapy and effective immunization. Pediatrics 1992, 90, 137-143 Connors, M., Kulkarni, A.B., Firestone, C.-Y., Holmes, K.L., Morse III, H.C. et al. Pulmonary histopathology induced by respiratory syncytial virus (RSV) challenge of formalin-inactivated RSV-immunized BALB/c mice is abrogated by depletion of CD4+ T cells. J. Viro/. 1992, 66, 7444-7451
Possible association of encephalitis and 17D yellow fever vaccination in a 29-year-old traveller Yellow fever vaccination is usually well tolerated by adults; only 0.2% of the vaccinees are unable to work due to systemic reactions ~ and encephalitis has never been reported in a vaccinee over the age of 132 . Thus, this case report is the first description of encephalitis temporally associated with 17D yellow fever vaccination in an adult. A 29-year-old previously healthy Swiss man was immunized on 21 August 1991 for the first time against yellow fever (Stamaril Pasteur, Lot E5309) for a 4-week journey to Columbia; on the same date he also received a diphtheriatetanus booster injection. His prior history was uneventful except for prolonged amnesia, transient aphasia and pareses of the right side after anaesthesia for herniotomy in 1983. Three days after immunization he had a fever of up to 38°C and headaches and he vomited repeatedly. These symptoms subsided after 3 days except for persistent posterior headaches, especially in the evening. On 8 September, two days after his arrival in
Columbia, fever and vomiting recurred with exacerbation of the headache, and the patient had diarrhoea, blurred vision and impaired visual focusing of moving objects. This was followed 1 day later by ataxia, dizziness and photophobia. The patient, who was becoming increasingly apathetic, was hospitalized in Columbia on 16 September in a somnolent state, with severe ataxia, proximal weakness of the lower extremities and bilateral 6th nerve palsy. Malaria, septicaemia, human immunodeficiency virus, cytomegalovirus and toxoplasmosis were excluded. Brain computed tomography and magnetic resonance imaging were normal but there was cerebrospinal fluid (CSF) mononuclear pleocytosis of 100 cells mm 3 and the diagnosis of encephalitis was made. The condition of the patient improved with symptomatic treatment but slight ataxia persisted. He was discharged on 30 September. When he returned to Switzerland, a repeat CSF measurement in January 1992 with
lymphocytic pleocytosis of 16 cells mm 3 and a pathological electroencephalogram were both consistent with a history of encephalitis. Serological assessment for neurotropic viruses (herpes simplex virus, varicella zoster virus, EpsteinBarr virus, human immunodeficiency virus, lymphocytic choriomeningitis virus, adenovirus, measles and mumps virus, poliovirus, coxsackie and echovirus, influenza and parainfluenzavirus, Central European tick-borne encephalitis virus, Venezuelan, Western and Eastern equine encephalitis viruses) were negative, as were assessments for toxoplasmosis, Lyme borreliosis and syphilis. Yellow fever neutralizing antibody at a titre of 1:80 was demonstrated in a serum collected 60 days after immunization. In April 1992 the patient still had slight ataxia, but experienced no other sequelae. No other cause of encephalitis was detected in this case despite thorough investigation, suggesting a possible association of the central nervous system infection with 17D yellow fever vaccine.
Christoph Merlo*, Robert Steffen*, Theodor Landis t, Theodore Tsai ~ and Nick Karabatsos ~ *Institute of Social and Preventive Medicine of the University, Division of Epidemiology and Prevention of Communicable Diseases, CH-8006 Zurich, Switzerland. t Department of Neurology, University Hospital, CH-8091 Zurich, Switzerland. *Division of Vector-Borne Infectious Diseases, Centers for Disease Control, Fort Collins, CO 80522, USA References 1 Br~s, P. Benefit versus risk factors in immunization against yellow fever. Dev. Biol. Stand. 1979, 43, 297 304 2 Schoub, B.D., Dommann, C.J., Johnson, S., Downie, C. and Patel, P.L. Encephalitis in a 13-year-old boy following 17D yellow fever vaccine. J. Infect. 1990, 21, 105-106
Vaccine, Vol. 11, Issue 6, 1993 691