Encephalitis temporally associated with live attenuated Japanese encephalitis vaccine: four case reports

Jia, Na; Zhao, Qin; Guo, Xin; Cheng, Jingxia; Wu, Chao; Zuo, Shimin; Dai, Pei-Fang; Jun-ying, Zhao; Zhang, Jiu-Song

doi:10.1186/1471-2334-11-344

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…In a prospective, randomized study where patients were actively monitored for 30 days, no cases of encephalitis or meningitis were observed, and no differences in hospitalization or prolonged fever were found ( 10 ). However, recent encephalitis cases have been reported in Chinese patients who received a first dose of LAJEV, although it is difficult to identify the causal link between the disease and JE vaccination ( 27 ). Therefore, concerns about safety still remain, and continued surveillance and careful investigation of any events that occur after LAJEV is required.…”

Section: Discussionmentioning

confidence: 99%

The Immunogenicity and Safety of the Live-attenuated SA 14-14-2 Japanese Encephalitis Vaccine Given with a Two-dose Primary Schedule in Children

et al. 2015

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Effective and tolerable vaccination is an essential strategy to prevent Japanese encephalitis (JE) in endemic areas. Although the live attenuated SA 14-14-2 JE vaccine (LAJEV) has been widely used since its introduction, the systemic data of LAJEV was very rarely available in Korea. We conducted the open-label, prospective cohort study to assess the immunogenicity and safety of this vaccine. Ninety subjects were enrolled, and LAJEV in a 2-dose primary series was given with a 12-month interval. Neutralizing antibody titers were measured before and after each vaccination, and active monitoring for adverse events was performed. After the first dose, 91.1% of subjects had seroprotection with a geometric mean titer (GMT) of 40.9. Seroprotection rate after the second dose was 97%, and GMT showed an increase of 6.5-fold. Most adverse events following immunization were self-limited, and no serious adverse events were reported until 42 days after each dose. The 2-dose administration of LAJEV in the primary immunization schedule appeared to be highly immunogenic and safe.Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

The Immunogenicity and Safety of the Live-attenuated SA 14-14-2 Japanese Encephalitis Vaccine Given with a Two-dose Primary Schedule in Children

et al. 2015

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“…These cases were apparently healthy and did not complain of any ailment at the time of enrolment in the study. Previous studies have reported two deaths and encephalitis case following the administration of LAJEV but were non-conclusive and judged as unrelated to the vaccine2627. Therefore, vigilant surveillance and complete investigations of any event following vaccination should be emphasized.…”

Section: Discussionmentioning

confidence: 98%

Immunogenicity & safety of a single dose of live-attenuated Japanese encephalitis vaccine SA 14-14-2 in adults

et al. 2016

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Background & objectives:Japanese encephalitis (JE) caused by mosquito-borne Flavivirus is one of the leading causes of viral encephalitis in Asia. Control strategies include vector control and human vaccination. Due to lack of immunization programmes in endemic regions, there are still high mortality and morbidity. A live-attenuated SA 14-14-2 JE vaccine (LAJEV) has been licensed and used in Asian countries, including India. We report the assessment of immunogenicity and safety of the vaccine in adults during the first mass adult vaccination campaign carried out in Assam, India.Methods:One thousand and seventy five adults (aged ≥15 yr) who received LAJEV were monitored for adverse events following immunization for one year. The safety assessment of vaccinated population was evaluated till 28 days and at 6 and 12 months. Blood samples collected from the enrolled participants were tested by plaque reduction neutralization test (PRNT50) to assess the neutralizing antibody titres (NATs) before vaccination and 28 days, six and 12 months post-vaccination (PV).Results:Among the 1075 vaccinated individuals, four reported minor adverse effects from 30 min to 28 days PV. Based on the pre-vaccination NAT, the study participants were categorized as seronegative, moderately seropositive and strongly seropositive. Nearly 85.5 per cent of JE seronegative participants seroconverted by 28 days PV. The geometric mean titre (GMT) in all the three groups increased by 28 days and decreased by six and 12 months PV. Nearly 60 per cent of the moderately positive individuals exhibited four-fold rise in GMT, 28 days PV. Almost 95.5 per cent of the participants in the study population remained seroprotected at the end of 12 months PV.Interpretation & conclusions:This study on immunogenicity and safety of LAJEV in adults showed that a single dose of the live-attenuated vaccine was safe and induced protective immunity to both JE seronegative and naturally seropositive adults. Further study is required to find out long term protective efficacy of this vaccine.

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“…The occurrence of seizures can be mediated by the immune system [13]. JEV is a vaccine that can cause a wide variety of complications, including encephalitis [11,14,15]. Seizures secondary to JEV have, however, not been reported to date.…”

Section: Discussionmentioning

confidence: 99%

A 44-year-old patient with a new-onset seizure disorder after vaccination against Japanese encephalitis: a case report

Schulze

2013

J Med Case Reports

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IntroductionSeizure disorders can have a wide variety of causes. In many cases, however, the underlying cause remains unknown. Vaccinations, for example, can trigger seizures, especially during childhood. In the literature, many cases have been reported in which febrile convulsions occurred after the administration of different types of vaccines, such as the measles, mumps and rubella vaccine or the tetanus and diphtheria vaccine. Only a few cases of epilepsy after vaccination have thus far been described in adults.Case presentationIn the case reported here, a 44-year-old German Caucasian man working as a soldier had a seizure the day after he received a third dose of Japanese encephalitis vaccine. Before this vaccination, he had received multiple vaccines that he had tolerated well. He underwent several drug therapies at various institutions but has continued to experience different forms of seizures for more than 18 months. The intervals between seizures were approximately six weeks in length. The present work discusses our patient’s history, including all diagnostic procedures and results, as well as treatment approaches. None of the examinations revealed a possible cause for the seizures. Since no structural or genetic causes were detected, the seizures were deemed most likely to have been caused by the vaccinations, especially vaccination against Japanese encephalitis. To date, no medication has prevented our patient from having repeated attacks.ConclusionsTo the best of our knowledge there have been no previous cases reported in the literature where seizures occurred after multiple vaccinations in general or after vaccinations against Japanese encephalitis in particular. Although vaccines are tested before release, the appearance of new adverse reactions cannot be prevented in all cases. Seizure after vaccination is difficult to treat. In our patient’s case, different approaches have not led to a satisfying result to date.

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Encephalitis temporally associated with live attenuated Japanese encephalitis vaccine: four case reports

Cited by 13 publications

References 8 publications

The Immunogenicity and Safety of the Live-attenuated SA 14-14-2 Japanese Encephalitis Vaccine Given with a Two-dose Primary Schedule in Children

The Immunogenicity and Safety of the Live-attenuated SA 14-14-2 Japanese Encephalitis Vaccine Given with a Two-dose Primary Schedule in Children

Immunogenicity & safety of a single dose of live-attenuated Japanese encephalitis vaccine SA 14-14-2 in adults

A 44-year-old patient with a new-onset seizure disorder after vaccination against Japanese encephalitis: a case report

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